Diagnosis Of Lower Urinary Tract Symptoms Research Articles

A multi-omic investigation of male lower urinary tract symptoms: Potential role for JC virus.

Male lower urinary tract symptoms (LUTS) comprise a common syndrome of aging that negatively impacts quality of life. The etiology of LUTS is multifactorial, involving benign prostatic hyperplasia, smooth muscle and neurologic dysfunction, inflammation, sexually transmitted infections, fibrosis, and potentially dysbiosis, but this aspect remains poorly explored. We investigated whether the presence of infectious agents in urine might be associated with LUTS by combining next-generation DNA sequencing for virus discovery, microbiome analysis for characterization of bacterial communities, and mass spectrometry-based metabolomics. In urine from 29 LUTS cases and 9 controls from Wisconsin, we found a statistically significant association between a diagnosis of LUTS and the presence of JC virus (JCV), a common neurotropic human polyomavirus (Polyomaviridae, Betapolyomavirus) linked to severe neurologic disease in rare cases. This association (based on metagenomics) was not borne out when specific polymerase chain reaction (PCR) testing was applied to this set of samples, likely due to the greater sensitivity of PCR. Interestingly, urine metabolomics analysis identified dysregulation of metabolites associated with key LUTS processes. Microbiome analysis found no evidence of microbial community dysbiosis in LUTS cases, but JCV-positive samples contained more Anaerococcus species, which are involved in polymicrobial infections of the urinary tract. Neither age nor body mass index were significantly associated with the presence of urinary JCV—in the initial group or in an additional, regionally distinct group. These data provide preliminary support the hypothesis that viruses such as JCV may play a role in the development or progression of LUTS, together with other infectious agents and host metabolic responses.

Association Between Lower Urinary Tract Symptoms and Frailty in Older Men Presenting for Urologic Care

To evaluate the association between non-neurogenic lower urinary tract symptoms (LUTS) and frailty among treatment-seeking older men. This is a cross-sectional study of male patients age 65 years and older presenting to an academic urology practice between December 2015 and March 2019. Men with cancer, neurologic disease, indwelling catheter, or continuous leakage were excluded. Participants completed a Timed-Up-and-Go-Test (TUGT) which was used to categorize men as fast (≤10 seconds), intermediate (11-14 seconds), or slow (≥15 seconds). Participants with the following diagnoses were identified using billing codes extracted from the electronic medical record: overactive bladder (OAB), benign prostatic hyperplasia (BPH), mixed OAB/BPH, or non-LUTS urologic condition. Multivariable associations were evaluated using multinomial logistic regression models adjusted for age, race, and body mass index. Among 2206 men included in our sample, 64% were fast (mean TUGT time: 8.3 ± 1.2 seconds), 25% were intermediate (mean TUGT time: 12.0 ± 1.0 seconds), and 11% were slow (mean TUGT time: 18.5 ± 4.7 seconds). Subjects with slow TUGT times were more likely to be older, non-White, and have LUTS. Compared to non-LUTS conditions, OAB (odds ratio [OR]=2.62, 95% CI 1.74, 3.93), BPH (OR=1.70, 95% 1.14, 2.55), and mixed OAB/BPH (OR=1.82, 95% 1.14, 2.92) were all associated with increased odds of slow TUGT time. LUTS diagnosis was not significantly associated with intermediate TUGT time. LUTS diagnosis, particularly OAB, is associated with increased odds of slow TUGT time, a surrogate of frailty, compared to non-LUTS conditions. Frailty is common among older men with LUTS and should be considered during the initial urological evaluation.

Systemic Alpha1-Adrenoceptor Antagonists and Increased Risk of Open-Angle Glaucoma: A Nationwide Population-Based Cohort Study.

PurposeTo examine the risk of open-angle glaucoma (OAG) among patients receiving alpha1-adrenoceptor (α1-AR) antagonists for lower urinary tract symptoms (LUTS).MethodsThis was a nationwide, population-based, retrospective cohort study from Asia/Taiwan. One million beneficiaries were randomly sampled from among 27.38 million individuals enrolled in the National Health Insurance program, and subjects with a diagnosis of LUTS from 2001 to 2012 were identified (N = 105,341). After 1:1 propensity score matching by gender, age, comorbid medical diseases, number of all medical visits during the observational period, and index date, 4081 patients were enrolled in the study group, comprised of patients who had taken α1-AR antagonists, and 4081 patients were enrolled in the control group, comprised of patients who had never taken α1-AR antagonists. The incidence and risk of OAG (defined as two ambulatory visits with a ICD-9 diagnosis code 365, excluding ICD-9 diagnosis codes 365.2–365.6, 365.02, 365.03, 365.13, 365.14, and 365.8) were calculated.ResultsPatients taking α1-AR antagonists had a higher incidence ratio of 1.86 (95% confidence interval [CI], 1.30–2.65) for developing OAG. After adjusting for age, gender, and comorbidities, the hazard ratio (HR) for OAG for patients taking α1-AR antagonists was 1.66 (95% CI, 1.16–2.39; P = 0.006). Among patients with hypertension, the hazard ratio for OAG associated with taking α1-AR antagonists increased to 1.79 (95% CI, 1.07–2.99; P = 0.003). On the other hand, the association of α1-AR antagonists with OAG was not significant among patients with diabetes mellitus, hyperlipidemia, or older age.ConclusionsThe findings of our study suggest an increased risk for OAG among patients taking α1-AR antagonists for LUTS, especially in patients with hypertension.

PD33-01 QUALITY OF LIFE WITH PHARMACOLOGICAL TREATMENT IN PATIENTS WITH BENIGN PROSTATIC ENLARGEMENT

INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) can lead to significant disturbances to health-related quality of life (HRQoL) and psychological well-being. There is variability in the relationship between individual symptom severity and the bother reported by patients as symptom scores alone, may not capture their actual impact on men. The aim of this study was to evaluate the effect of pharmacological treatment of LUTS/BPE on disease-specific and generic QoL measures. METHODS: Evolution was a European prospective, multicenter multi-national, observational registry collecting real life clinical data over two years on the management of LUTS/BPE in primary and secondary care. This study investigated disease specific QOL using questionnaires like IPSS Q8, BPH Impact Index (BII) and generic QOL using questionnaires like EuroQOL Five Dimension (EQ5D) which encompassed EQ5D VAS and EQ5D health index. RESULTS: The registry enrolled 1838 BPE patients and 1246 patients were evaluable at the end of the study period (24 months). Nearly 70% of patients in the study were previously treated with medical therapy and 17% of these had already discontinued medical treatment previously for various reasons, lack of efficacy of medication being the most common. The mean time since diagnosis of LUTS in the previously treated group was 4.7 years (0-26 years). Medical management produced statistically successful improvement in QOL (disease specific and generic), albeit significantly better in previously untreated patients. CONCLUSIONS: At an average of five years from the onset of symptoms, LUTS/BPE patients previously treated with medication had significantly impaired QOL in patients in a manner comparable to other chronic diseases. Medical management was successful in producing improvement in QOL when first started in previously untreated patients, but was much less significant in the previously treated patients. We need to rethink how we treat LUTS/BPE in clinical practice in line with emerging evidence, it is imperative to offer other options like Minimally Invasive Therapy (MIT) early, especially in patients previously treated with medical therapy.Source of Funding: Financial disclosure: The Evolution registry was supported by a restricted Grantfrom GlaxoSmithKline© (GSK).

Evaluation of Lower Urinary Tract Symptoms (LUTS): Severity Score and Symptom Association

Introduction: Lower urinary tract symptoms (LUTS) is a group of symptoms relating to stages of micturation such as storage symptoms, voiding dysfunction and post micturation dysfunction. Overactive bladder symptom score (OABSS) is a questionnaires with scores which helps in evaluating the severity of symptoms.
 Objectives To find the incidence of women visiting with LUTS and to evaluate storage symptoms in LUTS (urgency, urge incontinence, frequency) using OABSS (overactive bladder symptom score) questionnaires.
 Methodology This is a prospective study done from February 2016 to February 2017. Patients visiting Department of Obstetrics and Gynaecology with lower urinary tract symptoms (LUTS) were enrolled in the study after informed consent. Patients were assessed for types of LUTS and data were filled in the performa. If patients had urgency, urge incontinence, increased day time frequency, then the patients were explained and asked overactive bladder symptom score questionnaire (OABSS) and noted. Patients were then examined for pelvic floor dysfunction and neurological abnormalities for identifying association with the symptoms. Statistical analysis was done using SPSS 11.5.
 Results Fifty-seven patients were enrolled with lower urinary tract symptoms (LUTS) during study period. Forty-six patients had overactive bladder symptoms (OABS). LUTS were found in age ranging from 21 to 80 years. Majority of patients visiting out-patient department with LUTS were found to have urgency, urge incontinence, increased day time frequency, nocturia. Patients with urgency and urge incontinence showed significant correlation with increasing likert score of OABSS (p<0.05). But the increased day time frequency did not show any correlation with increasing score. The score showed significant correlation with combination of symptoms (urgency, urge incontinence and increased frequency) than patients presenting with single symptom.
 Conclusion Diagnosis of LUTS with valid assessment tools and treatment benefits patients with chronic urinary symptoms and also helps clinicians to further re-assess the treatment.

Management of Postoperative Lower Urinary Tract Symptoms (LUTS) After Pelvic Organ Prolapse (POP) Repair

Pelvic organ prolapse (POP) is a common condition for which approximately 200,000 US women annually undergo surgical repair [Am J Obstet Gynecol 188:108-115, 2003]. After surgical correction, persistent or new lower urinary tract symptoms (LUTS) can be present. We provide guidance on the current tools to predict, counsel, and subsequently handle postoperative LUTS. The current literature is reviewed regarding LUTS diagnosis and management in the setting of prolapse surgery with an emphasis on newer developments in this area. 1. More severe stages of prolapse are positively correlated with obstructive symptoms [Am J Obstet Gynecol 185:1332-1337, 2001], but not with other LUTS [Adv Urol 2013:5673753, 2013, Eur J Obstet Gynecol Reprod Biol 177:141-145, 2014, Am J Obstet Gynecol 199:683, 2008, Int Urogynecol J 21:1143-1149, 2010]. 2. One-week ambulatory pessary trial is an effective way to approximate postoperative results-one study correctly predicted persistent urgency and frequency in addition to occult stress urinary incontinence in 20% of study population [Obstet Gynecol Int 2012:392027, 2012]. 3. No preoperative overactive bladder (OAB) symptom was the best predictor for the absence of de novo OAB symptoms postoperatively [Int Urogynecol J 21:1143-1149, 2010]. 4. Urge incontinence patients respond favorably to sacral neuromodulation [Neurourol Urodyn 26: 29-35, 2007], botulinum toxin, and anticholinergic therapy [Res Rep Urol 8:113-122, 2016 , N Engl J Med, 367:1803-1813, 2012]. 5. Primary bladder outlet obstruction (BOO) can be treated effectively with alpha antagonists or anticholinergics, timed voiding, and pelvic physiotherapy as first-line therapy. Counseling regarding postoperative LUTS is key when planning POP surgery. A thorough understanding of patient history is crucial to successful repair. Patients with significant preoperative symptoms, history of neurologic disease, pelvic floor dysfunction, bladder neck obstruction, or higher stages of anterior wall prolapse may be higher risk for postoperative LUTS. UDS with or without reduction and an ambulatory pessary trial can help prognosticate. Patients will likely maintain a positive therapeutic relationship postoperatively for LUTS if counseled preoperatively.

Nocturia is more bothersome than daytime LUTS: Results from an Observational, Real-life Practice Database including 8659 European and American LUTS patients.

Lower urinary tract symptoms (LUTS) encompass several diagnoses, including overactive bladder (OAB) and benign prostatic hyperplasia (BPH). Nocturia is a standalone symptom, but also included in OAB and BPH. Current discussion addresses whether the overlap of the diagnoses is too broad, leading to misdiagnosis. This study explored the differences in level, causes and consequences for patients with a diagnosis of daytime LUTS compared with a diagnosis of nocturia, and discussed whether people are being treated for the symptoms that truly bother them the most. Data were drawn from a survey of physicians and patients in France, Germany, Spain, UK and USA. Physicians filled out patient record forms (PRFs) for patients with LUTS diagnosis. The patients completed the patient self-completion form (PSC). Three PRO questionnaires were included; the OAB-q SF, NI-Diary and WPAI. Patients were grouped based on the diagnoses assigned to them by their physicians in a real-life setting. Eight thousand seven hundred and thirty eight patients had a LUTS diagnosis and 5335 completed a PSC. Patients diagnosed with night-time symptoms were significantly more bothered by their LUTS than only daytime LUTS patients (all questionnaires P<.0001). Patients with nocturia reported being tired "always" or "usually" more often than patients with daytime problems only (P<.0001). Only 13% of patients with nocturia had an initial sleep period of more than 2-3hours. In this population of real-life patients, those with a diagnosis of nocturia reported significantly higher impact on their quality of life than patients with a diagnosis of daytime LUTS only. The underlying causes of bother were related to sleep problems. It is essential that nocturia is understood, treated and monitored as a distinct problem from OAB and BPH, to ensure that patients are treated for their main symptom.

New opportunities to treat combined luts in patients with benign prostatic hyperplasia premises and advantages

This paper provides an overview of studies on the prevalence, pathogenesis and management of combined lower urinary tract symptoms (LUTs) in men. The authors emphasize the role of urodynamic studies in the diagnosis of LUTs in the pre- and postoperative period aimed at the early detection of functional lower urinary tract disorders and selection of the appropriate medical treatment.

Non-invasive ultrasound measurements in male patients with LUTS and benign prostatic obstruction: implication for diagnosis and treatment

To evaluate the role of the ultrasound assessments of the bladder/detrusor wall thickness (BWT/DWT) and the ultrasound estimated bladder weight (UEBW) in lower urinary tract symptoms diagnosis and treatment. A systematic literature search from January 1995 until February 2016 was performed on PubMed using the following terms: "bladder weight", "bladder wall thickness", "detrusor wall thickness", "LUTS", "bladder outlet obstruction" (BOO), "benign prostatic obstruction". Additional references were obtained from the reference list of full-text manuscripts. Abstracts presented at the annual congresses of the European Association of Urology, American Urology Association and the International Continence Society were also included. BWT and DWT are accurate predictors of BOO. Despite several differences in the technique assessment, population characteristics and study design, the BWT/DWT accuracy for BOO was close to 90%. Furthermore, the ultrasound evaluation of bladder/detrusor thickness correlates positively with symptoms score and the main clinical parameters in BPH patients. Lastly, BWT and DWT have proved to be optimal predictor of response to medical/surgical treatment of lower urinary tract symptoms/benign prostatic obstruction (LUTS/BPO). However, the lack of standardization among the available studies marks these methods promising but still experimental and further studies are needed to clarify the standard methodology. The ultrasound evaluation of bladder/detrusor thickness appears to be simple, highly accurate and non-invasive technique to predict BOO and to evaluate the clinical outcomes after medical/surgical treatments for LUTS/BPH. The implementation of these techniques and their standardization will probably better define their role in the diagnostic algorithms of patients with LUTS and possibly reduce the number of unnecessary pressure flow-studies.

MP35-09 PHYSICAL ACTIVITY AS A RISK FACTOR FOR LOWER URINARY TRACT SYMPTOMS DIAGNOSIS IN PATIENTS WITH BENIGN PROSTATIC ENLARGEMENT: A PROSPECTIVE MULTICENTER COHORT ANALYSIS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation1 Apr 2016MP35-09 PHYSICAL ACTIVITY AS A RISK FACTOR FOR LOWER URINARY TRACT SYMPTOMS DIAGNOSIS IN PATIENTS WITH BENIGN PROSTATIC ENLARGEMENT: A PROSPECTIVE MULTICENTER COHORT ANALYSIS Cosimo De Nunzio, L. Cindolo, F. Cancrini, M. Gacci, F. Pellegrini, P. Castellan, R. Lombardo, F. Presicce, A. Brassetti, M. Bellangino, G. Tema, L. Schips, A. Sica, and A. Tubaro Cosimo De NunzioCosimo De Nunzio More articles by this author , L. CindoloL. Cindolo More articles by this author , F. CancriniF. Cancrini More articles by this author , M. GacciM. Gacci More articles by this author , F. PellegriniF. Pellegrini More articles by this author , P. CastellanP. Castellan More articles by this author , R. LombardoR. Lombardo More articles by this author , F. PresicceF. Presicce More articles by this author , A. BrassettiA. Brassetti More articles by this author , M. BellanginoM. Bellangino More articles by this author , G. TemaG. Tema More articles by this author , L. SchipsL. Schips More articles by this author , A. SicaA. Sica More articles by this author , and A. TubaroA. Tubaro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1601AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aim of our study was to assess the association between physical activity, evaluated by the Physical activity scale for elderly (PASE) questionnaire and lower urinary tract symptoms (LUTS) in patients with benign prostatic enlargement. METHODS From 2009 onward, a consecutive series of patients with LUTS-BPE were enrolled. Patients were evaluated using the International Prostate Symptom Score (IPSS) and ultrasonographic prostate volume. Body mass index, waist circumference and blood pressure were measured. Blood samples were collected for prostate-specific antigen levels. Physical activity was evaluated with the PASE questionnaire, consisting of 12 questions regarding frequency and duration of leisure activity and recently used to evaluate physical activity in patients with prostatic disorders. The risk of detecting LUTS (IPSS >7) was evaluated using the logistic regression analysis. RESULTS 617 patients were enrolled in two centers (Rome, Vasto, Italy) with a median age of 67 years (IQR 61/73) and PSA of 6 ng/ml (IQR 4/8). Median BMI was 26.4 kg/m2 (IQR: 24.5/28.7); 72/617 (12%) patients were obese. Median waist circumference was 101 cm (IQR: 96/108), median PASE score was 118 (IQR73/169), and median IPSS was 9 (IQR 5/15). Overall 189/617 (30%) patients presented with moderate/severe LUTS. Patients with moderate/severe LUTS presented a higher PASE score (111 IQR 69/160 vs 125 IQR 83/180; p= 0.016). On multivariate analysis, PASE score (OR: 1.003 per unit, 95%CI: 1.001 – 1.006; p= 0.037) and TRUS volume (OR=1.009 per ml, 1.001-1.017; p=0.025) were independent risk factors for LUTS severity. CONCLUSIONS In our multicentre study a reduced physical activity, assessed using the PASE questionnaire, is associated with an increased risk of moderate severe LUTS. Although these results should be confirmed, and the pathophysiology is yet to be completely understood, assessment of patients physical activity is suggested in the evaluation of patients with LUTS. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e483 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Cosimo De Nunzio More articles by this author L. Cindolo More articles by this author F. Cancrini More articles by this author M. Gacci More articles by this author F. Pellegrini More articles by this author P. Castellan More articles by this author R. Lombardo More articles by this author F. Presicce More articles by this author A. Brassetti More articles by this author M. Bellangino More articles by this author G. Tema More articles by this author L. Schips More articles by this author A. Sica More articles by this author A. Tubaro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The role of ambulatory urodynamics in investigation of female urinary incontinence.

Lower urinary tract symptoms (LUTS) impact upon quality of life and occur in women of all ages. The National Institute for Clinical Excellence states that ambulatory urodynamic monitoring (AUM) should be used as a second-line investigational modality; however, its use is becoming more frequent. AUM provides a valid second line to conventional urodynamic methods that may be more widely used. A literature review was undertaken to assess evidence for the use of AUM alongside a retrospective review of patients undergoing AUM at a tertiary care centre and symptom reporting at a follow-up visit. Both these methods included evidence for pathology detection, technical ease of use, recreation of symptoms and patient experience, allowing comparison of literature results to those experienced in day-to-day use. The literature shows AUM to have sensitivity superior to that of other urodynamic investigations. However, evidence suggests this correlates less well with clinical effectiveness. Patients felt AUM was superior in recreating their symptoms, and they tolerated the procedure well. The increased technical demands of AUMs, however, meant that traces were more commonly harder to interpret than with conventional urodynamics. Our experience correlates well with the existing literature, suggesting increased symptom diagnosis; 63.2% of diagnoses correlated well with symptoms. AUM remains an important urodynamic method to supplement conventional urodynamics. Evidence suggests it is superior in LUTS diagnosis, but its technical difficulty can affect results.

The association of healthcare seeking behavior for anxiety and depression among patients with lower urinary tract symptoms: A nationwide population-based study

Lower urinary tract symptoms (LUTS) have a negative impact on the quality of life, and may relate to anxiety and depression. The objective of this study was to test the hypothesis that LUTS are associated with anxiety and depression using a nationwide population-based database in Taiwan. Data were obtained from a random population sample of about one million enrollees in the National Health Insurance program from 2001 to 2009, and consisted of 22,980 LUTS patients and 45,960 matched controls. The records of healthcare seeking for anxiety and depression were collected 2 years before and after the diagnosis of LUTS. The results showed that patients with LUTS had a significantly higher prevalence of anxiety or depression than the matched controls (11.45% vs. 5.72%). After controlling for sociodemographic variables and other major systemic diseases, the odds ratios for anxiety, depression, either anxiety or depression, and both anxiety and depression, were 2.05, 2.19, 2.14, and 2.56, respectively. There was an association between LUTS and the stress-related common mental disorders, and there seemed to be an additive effect of anxiety and depression on the association with LUTS. These findings imply a psychological role in the pathogenesis or sequelae of LUTS.

Evaluation and management of male lower urinary tract symptoms: treatment patterns and guidelines in a correlation study among Polish urology consultants.

IntroductionIn March 2013, the European Association of Urology (EAU) released a new edition of the guidelines on management of male lower urinary tract symptoms (LUTS), including benign prostatic obstruction. The objective of this study was to evaluate how well the EAU guidelines have been implemented in day-to-day practice by Polish urologists.Material and methodsA structured questionnaire, which explored how urologists diagnose and manage male lower urinary tract symptoms, was emailed to all certified, actively practicing urologists from a list provided by the Polish Urological Association.ResultsThe questionnaire return rate was 33.7% (135/400). Overall, the median (quartile 1; quartile 3) frequency of correct answers was 65.0% (58.0%; 69.0%). Analysis of the association of availability and acceptance of the EAU guidelines with question answers showed no pattern. A multivariate regression model showed a positive correlation with regards to correct answers given in the survey and doctors’ participation in international congresses (p = 0.018, r = 0.181). Basket analysis showed the strongest association for those who failed to correctly answer the questions regarding diagnosis of LUTS and overactive bladder (OAB) (support = 27.41%, confidence = 86.05%).ConclusionsAlthough there is a significant degree of adherence to the 2013 EAU guidelines, some discrepancies between urologists’ practice and the recommendations regarding diagnosis and treatment of male LUTS do exist. The data obtained provide valuable benchmarks and also identify possible interventions that may improve the standard of care in this population of patients.

Lower Urinary Tract Dysfunction in Male Iraq and Afghanistan War Veterans: Association With Mental Health Disorders: A Population-based Cohort Study

To determine the prevalence and correlates of lower urinary tract symptoms (LUTS) among returned Iraq and Afghanistan veterans; in particular its association with mental health diagnoses and medication use. We performed a retrospective cohort study of Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs health care. Mental health diagnoses were defined by International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes from medical records. LUTS was defined by ICD-9-CM code, use of prescription medication for LUTS, or procedure for LUTS. We determined the independent association of mental health diagnoses and LUTS after adjusting for sociodemographic and military service characteristics, comorbidities, and medications. Of 519,189 veterans, 88% were men and the mean age was 31.8 years (standard deviation ± 9.3). The overall prevalence of LUTS was 2.2% (11,237/519,189). Veterans with post-traumatic stress disorder (PTSD) were significantly more likely to have a LUTS diagnosis, prescription, or related procedure (3.5%) compared with veterans with no mental health diagnoses (1.3%) or a mental health diagnosis other than PTSD (3.1%, P <.001). In adjusted models, LUTS was significantly more common in veterans with PTSD with and without other mental health disorders vs those without mental health disorders (adjusted relative risk [ARR] = 2.04, 95% confidence interval [CI] = 1.94-2.15) and in veterans prescribed opioids (ARR = 2.46, 95% CI = 2.36-2.56). In this study of young returned veterans, mental health diagnoses and prescription for opioids were independently associated with increased risk of receiving a diagnosis, treatment, or procedure for LUTS. Provider awareness may improve the detection and treatment of LUTS, and improve patient care and quality of life.

Lower Urinary Tract Symptoms Associated with Male Urologic Pelvic Pain Syndrome

A common urologic diagnosis in men, urologic chronic pelvic pain (UCPP) is often associated with bothersome lower urinary tract symptoms (LUTS), which contribute to the diminished quality of life observed in these patients. The differential diagnosis of LUTS as a separate entity should be considered during evaluation of UCPP patients to exclude other urologic or neurological conditions. However, most patients can be afforded improvement of LUTS as they receive appropriate therapy for UCPP.

Prostatic growth rate determined from MRI data: age-related longitudinal changes.

Men with prostatic enlargement are at highest risk of developing symptomatic lower urinary tract symptoms (LUTS) and related outcomes, such as acute urinary retention. The study of prostatic growth rate can identify the age range at which prostate growth peaks. Evaluation of the natural course of prostate growth requires repeated intraindividual volume measurements at time intervals sufficient to document growth. Our objective was to examine age-stratified prostate growth rates from men taking part in a longitudinal study of aging using magnetic resonance imaging (MRI) of the prostate. Sixty-four men (ages 30-71 years) enrolled in the Baltimore Longitudinal Study of Aging (BLSA) who had T2 pelvic MRIs taken approximately every 2 years were studied. Men were age stratified into four groups: <45, 45-55, 56-65, and >65 years old. Whole prostate and central gland (anatomically referred to as the transition zone) volumes were determined from the MRI images by a semi-automated image analysis program. Peripheral gland volumes were calculated as the difference between whole prostate and central gland volumes. Growth rates (cc per year) were calculated as change in volume divided by the time interval. On the basis of measurements from the T2 images (n = 128), we observed a linear trend between prostate volume and age. The overall prostate growth rate was 2.36 +/- 3.52 cc per year. Age-stratified growth rates revealed that prostate growth increased with age, peaked at 4.15 +/- 4.98 cc/year for the 56-65-year-old age group and then declined rapidly for the older-aged men. The central gland growth rates followed a trend similar to total prostate volume. These data suggest that there is an age-related increase in prostate growth rate that peaks in men ages 56-65 and then declines. Identification of this trend in prostate growth may aid physicians in targeting men for early diagnosis of LUTS and for possible early intervention. Future studies with a larger sample size are necessary to substantiate these findings.