Lower Urinary Tract Symptoms Dysfunction Research Articles

Reliability of Uroflowmetry Pattern Interpretation in Adult Women.

Uroflowmetry is often used to assess lower urinary tract symptoms (LUTS). Criteria for characterization of flow patterns are not well established, and subjective interpretation is the most common approach for flow curve classification. We assessed the reliability of uroflowmetry curve interpretation in adult women. Uroflowmetry studies were obtained in 296 women who participated in an observational cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for interrater reliability. A random subset of 50 tracings was re-reviewed by each investigator for intrarater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous fluctuating, interrupted, and prolonged. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters is summarized with kappa (k) statistics and percentage where at least three raters agreed. The mean age of participants was 44.8 ± 18.3 years. Participant age categories were 18-24 years: 20%; 25-34 years: 17%; 35-64 years: 42%; 65+ years: 18%. Nine percent described their race as Asian, 31% Black, 62% White, and 89% were of non-Hispanic ethnicity. The interrater reliability was highest for the continuous flow category (k = 0.65), 0.47 for prolonged, 0.41 for continuous fluctuating, and 0.39 for interrupted flow curves. Agreement among at least three raters occurred in 74.3% of uroflow curves (69% for continuous, 33% for continuous fluctuating, 23% for interrupted, and 25% for prolonged). For intrarater reliability, the mean k was 0.72 with a range of 0.57-0.85. Currently accepted uroflowmetry pattern categories have fair to moderate interrater reliability, which is lower for flow curves that do not meet "continuous" criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use in research and as a screening tool for LUTS and voiding dysfunction. Parent trial: Validation of Bladder Health Instrument for Evaluation in Women (VIEW); ClinicalTrials.gov ID: NCT04016298.

Evaluation of the results of urodynamic studies in patients with vesicoureteral reflux.

To investigate urodynamic abnormalities associated with vesicoureteral reflux (VUR) in toilet-trained children. The data of 157 children who were diagnosed with vesicoureteral reflux and referred to our hospital between 2013 and 2022 were retrospectively examined. The urodynamic parameters were analyzed and correlated with age, gender, lower urinary tract symptoms (LUTS), reflux severity, and laterality. Overall, 131 (83.4%) patients had abnormal urodynamic findings with a male-to-female ratio of 1:1.4. The most common pathological finding was detrusor overactivity (DO), identified in 101 (64.3%) patients, followed by dysfunctional voiding (DV) in 74 (50.3%) patients. Children with VUR grades II and III exhibited a greater percentage of abnormal urodynamic findings than children with grades IV and V. The prevalence of DO was higher in children younger than 10 years old with unilateral and lower-grade VURs. DV was more frequent in children older than 10 years, with bilateral VUR, and higher grade VUR. The prevalence of LUTS, bowel and bladder dysfunction (BBD), and urinary tract infection (UTI) was higher among children with abnormal urodynamic findings. Children with VUR have a high incidence of urodynamic disorders. Urodynamic dysfunction may contribute to the pathogenesis of VUR, especially in mild cases.

Role of Pelvic Ischemia in Human Lower Urinary Tract Symptoms and Sexual Function Among Patients With Common Iliac Artery Obstruction Undergoing Revascularization Surgery.

In this case-control study, we explored the relationships among pelvic ischemia, lower urinary tract symptoms (LUTS), and sexual function in patients with common iliac artery steno-occlusive disease, along with the potential therapeutic role of revascularization. We recruited 33 men diagnosed with radiologically documented common iliac artery stenosis (>80%) who underwent endovascular revascularization, and 33 healthy controls. Five patients had obstruction of the abdominal aorta (Leriche syndrome). The International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire, and International Index of Erectile Function were used to evaluate LUTS and erectile function. Medical history, anthropometrics, urinalysis, and blood tests, including levels of serum prostate-specific antigen, urea, creatinine, triglycerides, cholesterol, low-density lipoprotein, high-density lipoprotein, and hemoglobin A1c, were recorded. Uroflow (maximum flow, average flow, voided volume, and voiding time) and ultrasound parameters (prostate volume and postvoid residual [PVR]) were also measured. Patients with moderate-to-severe LUTS (IPSS>7) underwent complete urodynamic investigation. Patients were examined at baseline and 6 months postoperatively. Patients exhibited poorer total IPSS (P<0.001), storage (P=0.001) and voiding symptom (P<0.001) subscores, as well as worse OAB-bother (P=0.015), OAB-sleep (P<0.001), OAB-coping (P<0.001), and OAB-total (P<0.001) scores than control participants. Additionally, erectile function (P=0.002), sexual desire (P<0.001), and satisfaction from intercourse (P=0.016) deteriorated in the patient group. Six months postoperatively, significant improvements were observed in erectile function (P=0.008), orgasm (P=0.021), and desire (P=0.014). Similarly, PVR significantly improved (P=0.012), while fewer patients experienced increased bladder sensation (P=0.035) and detrusor overactivity (P=0.035) upon postoperative urodynamic study. No significant differences were found between patients with bilateral and unilateral obstruction or between either of those groups and Leriche syndrome patients. Patients with steno-occlusive disease of the common iliac artery experienced more severe LUTS and sexual dysfunction than healthy controls. Endovascular revascularization alleviated LUTS in patients with moderate-to-severe symptoms and improved bladder and erectile function.

Relationship between outpatient duration of young outpatient physicians and lower urinary tract symptoms and sexual dysfunction.

BackgroundIn China, physicians aged 30–45 years who work in tertiary hospitals perform most of the clinical duties, especially outpatient services, and the high-intensity, high-pressure workplace may through long-term sedentary affect their health, particularly urinary health.MethodsThe study, conducted from October 2020 to October 2021, included male physicians in Xiangya Hospital, the Second Xiangya Hospital, and the Third Xiangya Hospital of Central South University (Hunan, China). They were divided into surgeon and non-surgeon groups. We collect the data on age, body mass index (BMI), duration of outpatient duties and the International Prostate Symptom Score-voiding (IPSS-V) and IPSS-storage (IPSS-S), and the IPSS-Total, and the IPSS-Quality of Life Index (IPSS-QOL), and the Athens insomnia scale (AIS), and the International Prostate Symptom Score (IIEF-5).ResultsThe duration of outpatient duties positively correlated with IPSS-Total (P<0.001), IPSS-S (P<0.001), and IPSS-QOL (P<0.001) and negatively correlated with IIEF-5 (p=0.032). Compared to non-surgeons, surgeons performed fewer outpatient duties. The IPSS-Total (P=0.016), IPSS-Storage (P=0.005), and QOL scores (P=0.046) of the non-surgeon group were higher and the IIEF-5 scores were lower (P=0.039). There were no significant differences between the groups regarding age, body mass index, IPSS-Voiding, and Athens insomnia scale scores. A positive correlation between outpatient visit duration and lower urinary tract symptoms (LUTS) in the IPSS-Storage subscale was observed and there was a weak negative correlation between duration of outpatient duties and the IIEF-5 score.ConclusionsCompared to surgeons, non-surgeons had more outpatient duties, and they experienced more severe LUTS and sexual dysfunction, which suggests that outpatient duties maybe should not be more than 4 days/week in Chinese tertiary medical centers.

Prevalence of lower urinary tract symptoms in children with early-treated infantile-onset Pompe disease: A single-centre cross-sectional study.

To evaluate lower urinary tract symptoms (LUTS) in children with infantile-onset Pompe disease (IOPD) who received early treatment. Pompe disease (PD), or glycogen storage disease II is a rare autosomal recessive lysosomal storage disease that affects multiple organ systems. To our knowledge, only one study has focused on the relationship between LUTS and incontinence in children with PD. This cross-sectional study was conducted from August 2019 through March 2021 and children with IOPD, who had received early and regular enzyme replacement therapy, were enrolled. Participants or their parents completed the Dysfunctional Voiding Scoring System (DVSS) questionnaire. All children underwent uroflowmetry and postvoid residual urine measurements. Fourteen children (age, 4-9 years) with IOPD were enrolled. Ten patients (71.4%) had abnormal uroflow curves. In addition, results of the DVSS revealed that approximately half (42.9%) of our IOPD patients had voiding dysfunction, with urinary incontinence as the most common symptom (64.3%, 9/14). No significant correlations were found between LUTS and uroflow curves in children with IOPD. The frequency of LUTS and lower urinary tract dysfunction noted on uroflowmetry should encourage pediatricians to actively identify IOPD patients with LUTS, regardless of the timing and frequency of their treatments, and refer them to a urologist for further evaluation and appropriate treatment.

Impact of coronavirus disease on the management of lower urinary tract symptoms and voiding dysfunction.

Purpose of reviewCoronavirus disease (COVID-19) has caused a crisis in the entire healthcare system since its emergence. The urgency and priority of various diseases have impacted the medical and surgical treatment in this period. We aim to review the impact of COVID-19 on lower urinary tract symptoms (LUTS) and management.Recent findingsThere may be a relationship between COVID-19 and de novo or increased LUTS. Patients with LUTS should also be evaluated for COVID-19. Management of diseases has varied during the COVID-19 due to the density of the pandemic. Virtual consultations can mitigate patients who are postponed or cancelled, such as patients with LUTS. Patients suffering voiding dysfunction may manage with oral medications such as alpha blocker and 5-alpha reductase inhibitor via telemedicine. Minimally invasive procedures with a low risk of complications and a short hospitalization time should be considered in complicated cases such as the inability to catheterize.SummaryTelemedicine should be implemented on managements of noncomplicated LUTS and voiding dysfunction. Each centre can schedule its LUTS management approach according to the density of pandemic. Virtual consultations need to be developed to compete with face-to-face consultations.

Does deep brain stimulation improve Parkinson's disease-related lower urinary tract symptoms and voiding dysfunction?

Parkinson’s disease (PD), caused by degeneration of dopaminergic neurons, leads to motor and autonomic symptoms. A large proportion of PD patients experience lower urinary tract symptoms (LUTS) and voiding dysfunction, associated with poor quality of life. Deep brain stimulation (DBS) is an adjunctive therapy used in combination with medication for Parkinsonian motor symptoms and is currently being explored to treat PD-related LUTS. This review discusses the current literature on the effects of DBS on lower urinary tract function and whether this modality can be used to modulate PD-related LUTS and voiding dysfunction.

Lower urinary tract symptoms in pre-menopausal women and its association with sexual dysfunction

Background: Sexual dysfunction (SD) is one of the common problems observed by premenopausal women and it frequently exists along with other associated lower urinary tract symptoms (LUTS).&#x0D; Aims and Objective: The present study was planned to evaluate the correlation between SD in pre-menopausal women with LUTS.&#x0D; Materials and Methods: This was a prospective observational study conducted between March 2018 to February 2019. All sexually active premenopausal women, who presented with complains of LUTS were enrolled in this study. All included patients were given two types of questionnaires (Bristol female lower urinary tract symptom [BFLUTS] and pelvic organ prolapse-urinary incontinence sexual function [PISQ-12]). These were for the assessment of LUTS and sexual function. Assessment of association between presence of LUTS and sexual dysfunction was done.&#x0D; Results: A total of 105 women were enrolled in the study. Their mean age was 43.70 years and BMI was 29.49. The total mean BFLUTS score recorded was 28.12. Their sub-dimension scores recorded for the filling, voiding, incontinence symptoms, sexual function and quality of life were 8.21, 34.32, 12.21, 4.49, and 10.65, respectively. Total mean score of PISQ-12 was 23.72 in all women and the mean values for the sub-dimension scores were 5.21 for the behavioural-emotive state, 11.78 for the physical state, and 6.2 for the partner-related state. There was Negative association observed between the total of PISQ-12 scores and total and sub-dimension of the BFLUTS scores (p&lt;0.01).&#x0D; Conclusion: This study observes the presence of LUTS in women with sexual dysfunction. LUTS directly or indirectly increase the sexual problems in premenopausal women. These results highlight the clinical importance of evaluating LUTS in premenopausal women with sexual dysfunction.

Post-void residual urine ratio: A novel clinical approach to the post-void residual urine in the assessment of males with lower urinary tract symptoms.

PurposeTo assess the correlation between post-void residual urine ratio (PVR-R) and pathological bladder emptying diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS).Materials and MethodsPVR-R and PVR urine were evaluated in 410 males underwent PFS for LUTS. PVR-R was the percentage of PVR to bladder volume (voided volume+PVR). Schafer and International Continence Society (ICS) nomograms, Bladder Contractility Index (BCI) were used to diagnose bladder outlet obstruction (BOO) and detrusor underactivity (DUA). We subdivided the cohort in 4 groups: Group I, BOO+/DUA+; Group II, BOO-/DUA+; Group III, BOO+/DUA−; Group IV, BOO−/DUA− (control group). We subdivided the 4 groups according to PVR-R strata: (1) 0%–20%; (2) 21%–40%; (3) 41%–60%; (4) 61%–80%; (5) 81%–100%.ResultsGroup I had a greater median PVR-R (50%) with a >40% in 61.4% of the cohort. Median PVR-R was 16.6% in Group II, 24% in Group III, and 0% in the control Group. According to ICS nomograms and BCI, median PVR-R and PVR were significantly higher (p<0.001) in obstructed and underactive males. PVR-R threshold of 20% allowed to recognize males with voiding disorders with high sensibility, specificity, PPV, and NPV. A PVR-R cut-off of 40% identified males with associated BOO and DUA and more severe voiding dysfunction.ConclusionsA higher PVR-R is related to a more severe pathological bladder emptying, and to the association of BOO and DUA. PVR-R may have a clinical role in first assessment of males with LUTS and severe voiding dysfunction.

Improvement of the symptoms of lower urinary tract and sexual dysfunction with tadalafil and solifenacin after the treatment of benign prostatic hyperplasia with dutasteride.

BackgroundThe aim of this research is to study the influence of simultaneous taking of tadalafil and solifenacin in standard and double dosage on the lower urinary tract symptoms (LUTS) and sexual dysfunction in men with benign prostatic hyperplasia after the course of dutasteride.Materials and methodsThe research included 326 patients older than 50 years with benign prostatic hyperplasia coupled with LUTS and sexual dysfunction having undergone the course of treatment with dutasteride. After random division into three groups, patients from the Group A (n = 107) got tadalafil 5 mg/d as monotherapy, from the Group В (n = 107) got tadalafil 5 mg/d and solifenacin 10 mg/d, and from the Group С (n = 112) got tadalafil 5 mg/d and solifenacin 20 mg/d. The duration of treatment was 12 weeks. The rating of sexual function was made with the questionnaires International Index of Erectile Function and other.ResultsThe results of rating of sexual function with the questionnaires MSHQ-EjD and International Index of Erectile Function correlated among themselves. According to MSHQ-EjD, overall rating of the sexual function increased in each of the three groups (A: 67.9 (12.4)/91.5 (10.4), P ≤ 0.05; B: 72.4 (14.5)/102.6 (16.9), P ≤ 0.05; C: 76.6 (16.3)/109.6 (15.6), P ≤ 0.05). The level of hyperactivity symptoms decreased in Groups В and С (В: urgency −2.9 (0.7)/1.1 (0.6), P ≤ 0.05; nocturia 2.7 (1.0)/0.7 (0.5), P ≤ 0.05; C: urgency −2.5 (0.5)/0.8 (0.6), P ≤ 0.05; nocturia −2.8 (0.6)/1.0 (0.5), P ≤ 0.05), and it did not change in the Group A.ConclusionsThe use of tadalafil as monotherapy significantly improves the sexual function but does not affect overactive bladder symptoms. The combination therapy of tadalafil and solifenacin leads to dramatic improvement of sexual function and reversibility of detrusor hyperactivity symptoms.

Assessment of Intrapelvic Blood Flow with the Penile Brachial Index Using a Toe Blood Pressure Cuff in Japanese Patients with Lower Urinary Tract Symptoms

Purpose: We aim at investigating the relationship between lower urinary tract symptoms (LUTSs) and intrapelvic blood flow. Conventionally, intrapelvic blood flow is assessed using a Doppler blood flowmeter. In this study, the penile brachial pressure index (PBI), which is a simpler tool, was used. Materials and Methods: The participants of this study were 103 male outpatients with LUTS whose PBI was measured using the form pulse wave velocity/ankle-brachial index with a toe blood pressure cuff. Data including age, body mass index (BMI), penile blood pressure, PBI, complications (hypertension, dyslipidemia, and diabetes mellitus), International Prostate Symptom Score (IPSS), and Erection Hardness Score (EHS) were retrospectively examined. LUTS positivity was defined as an IPSS score ≥8 and LUTS negativity as an IPSS score &lt;8. Results: The PBI and EHS scores were significantly higher in the LUTS-negative participants than in the LUTS-positive participants. Furthermore, a multivariate analysis showed a significant difference only in PBI. However, age, BMI, EHS, or previous history of complications did not significantly differ. Conclusion: PBI was found to be an independent factor of LUTS. Recent studies have shown that LUTS and erectile dysfunction are associated with lifestyle-related diseases, and that these conditions are caused due to impaired blood flow in the intrapelvic arteries due to arteriosclerosis. Therefore, LUTS should be treated as a vascular disease.

Urogenital symptoms in mitochondrial disease: overlooked and undertreated.

Background and purposeBowel symptoms are well documented in mitochondrial disease. However, data concerning other pelvic organs is limited. A large case–control study has therefore been undertaken to determine the presence of lower urinary tract symptoms (LUTS) and sexual dysfunction in adults with genetically confirmed mitochondrial disease.MethodsAdults with genetically confirmed mitochondrial disease and control subjects were recruited from a specialist mitochondrial clinic. The presence and severity of LUTS and their impact on quality of life, in addition to sexual dysfunction and bowel symptoms, were captured using four validated questionnaires. Subgroup analysis was undertaken in patients harbouring the m.3243A>G MT‐TL1 mitochondrial DNA mutation. A subset of patients underwent urodynamic studies to further characterize their LUTS.ResultsData from 58 patients and 19 controls (gender and age matched) were collected. Adults with mitochondrial disease had significantly more overactive bladder (81.5% vs. 56.3%, P = 0.039) and low stream (34.5% vs. 5.3%, P = 0.013) urinary symptoms than controls. Urodynamic studies in 10 patients confirmed that bladder storage symptoms predominate. Despite high rates of LUTS, none of the patient group was receiving treatment. Female patients and those harbouring the m.3243A>G MT‐TL1 mutation experienced significantly more sexual dysfunction than controls (53.1% vs. 11.1%, P = 0.026, and 66.7% vs. 26.3%, P = 0.011, respectively).ConclusionsLower urinary tract symptoms are common but undertreated in adult mitochondrial disease, and female patients and those harbouring the m.3243A>G MT‐TL1 mutation experience sexual dysfunction. Given their impact on quality of life, screening for and treating LUTS and sexual dysfunction in adults with mitochondrial disease are strongly recommended.

Prostatic Calculi: Do They Matter?

Prostatic calculi (PC) are frequently detected at computed tomography or ultrasound in men attending the health center or the urology outpatient department. PC have attracted more attention from urologists, but the clinical significance of PC is unknown. To review the available literature on the effects of PC on prostatic diseases and sexual function in men. Relevant clinical trials were identified by searching the PubMed, Embase, and Cochrane Library databases. Results were classified, summarized, and analyzed. Transabdominal and rectal ultrasonography; urodynamics analysis; International Prostate Symptom Score; pathologic examination of prostatic tissue; prostate-specific antigen; and expressed prostatic secretion. PC can not only prolong the duration of bothersome symptoms but also decrease the cure rate of antibacterial therapy in patients with chronic prostatitis. Patients with PC usually have more severe lower urinary tract symptoms (LUTS), and some studies reported that moderate to marked PC are a predisposing factor for moderate to severe LUTS. Studies also reported that the serum level prostate-specific antigen is not influenced by PC. In addition, the presence of PC is not associated with an increased risk of prostate cancer. However, the correlation between PC in the peripheral zone and prostate cancer is statistically significant. In addition, the association between PC and Gleason scores is controversial. Some novel studies suggested that PC might play an important role in sexual impairment in middle-age men or men with chronic pelvic pain syndrome or chronic prostatitis. Recently, PC were found to increase the incidence of severe LUTS, urinary retention, and hematospermia after transrectal ultrasound-guided prostate biopsy. PC can aggravate LUTS, chronic prostatitis, and sexual dysfunction in men, but the association between PC and prostate cancer is still controversial. Cao J-J, Huang W, Wu H-S, etal. Prostatic Calculi: DoThey Matter? Sex Med Rev 2018;6:482-491.

Urinary, bowel and sexual symptoms in a cohort of patients with Friedreich\u2019s ataxia

BackgroundPelvic symptoms are distressing symptoms experienced by patients with Friedreich’s Ataxia (FRDA). The aim of this study was to describe the prevalence of lower urinary tract symptoms (LUTS), bowel and sexual symptoms in FRDA.MethodsQuestionnaire scores measuring LUTS, bowel and sexual symptoms were analysed with descriptive statistics as a cohort and as subgroups (Early/Late-onset and Early/Late-stage FRDA) They were also correlated with validated measures of disease severity including those of ataxia severity, non-ataxic symptoms and activities of daily living.Results80% (n = 46/56) of patients reported LUTS, 64% (n = 38/59) reported bowel symptoms and 83% (n = 30/36) reported sexual symptoms. Urinary and bowel or sexual symptoms were significantly likely to co-exist among patients. Late-onset FRDA patients were also more likely to report LUTS than early-onset ones. Patients with a longer disease duration reported higher LUTS scores and poorer quality of life scores related to urinary symptoms.ConclusionsA high proportion of FRDA have symptoms suggestive of LUTS, bowel and sexual dysfunction. This is more marked with greater disease duration and later disease onset. These symptoms need to be addressed by clinicians as they can have a detrimental effect on patients.

Effect of cerebrospinal fluid shunt surgery on lower urinary tract dysfunction in idiopathic normal pressure hydrocephalus.

To examine the outcomes of lower urinary tract symptoms (LUTS) and urodynamic test results after cerebrospinal fluid (CSF) shunt surgery in idiopathic normal pressure hydrocephalus (iNPH). Records of 48 patients (33 men; 15 women), who met the definite iNPH criteria and underwent CSF shunt surgery, were retrospectively analyzed. LUTS and their impact on quality of life (QOL) were evaluated using an all-or-none questionnaire targeting four symptoms, the Overactive Bladder Symptoms Score (OABSS), and the QOL index. Urodynamic investigations included filling cystometry and pressure-flow studies performed before and after surgery. Forty-seven (98%) patients complained of LUTS, 41 (87%) patients of whom experienced LUTS improvement after surgery. The OABSS and QOL index, which before surgery were 6.8 ± 0.7 and 4.1 ± 0.4, respectively, significantly decreased to 4.6 ± 0.6 and 3.2 ± 0.3, respectively, after surgery. The maximum cystometric capacity (174.9 ± 13.3 mL to 222.4 ± 14.7 mL) and bladder compliance (35.8 ± 4.4 ml/cmH2 O to 52.1 ± 5.4 ml/cmH2 O) significantly increased after surgery. Detrusor overactivity, which was observed in 37 (77%) patients preoperatively, became undetectable in 7 patients postoperatively. Voiding dysfunction (defined as maximum flow rate <10 mL/s or post-void residual >100 mL) was observed in 29 (60%) patients, 22 (75%) of whom had detrusor underactivity before surgery. None of the voiding urodynamic parameters significantly improved postoperatively. iNPH is often associated with LUTS and both storage and voiding dysfunctions. CSF shunt surgery improved LUTS and storage dysfunction, with limited effects on voiding dysfunction.

The impact of nerve-sparing robot-assisted radical prostatectomy on lower urinary tract function: Prospective assessment of patient-reported outcomes and frequency volume charts.

To elucidate the effects of a nerve-sparing (NS) procedure on lower urinary tract symptoms (LUTS) and urinary function after robot-assisted radical prostatectomy (RARP), the associations between the NS procedure and LUTS and urinary function were investigated. The participants in this study were 200 consecutive patients who underwent RARP. These patients were categorized into unilateral and bilateral NS groups and the non-NS group. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, frequency-volume chart, uroflowmetry, 1-h pad test, and the 5-item International Index of Erectile Function (IIEF-5) questionnaire were evaluated before and after RARP. The total IPSS score was significantly lower in the unilateral (P = 0.03) and bilateral NS groups (P = 0.03) than in the non-NS group after RARP. Diurnal maximum voided volume (MVV) values were significantly greater in the bilateral NS group than in the non-NS group after RARP (P = 0.002). Nocturnal frequency was significantly decreased in the unilateral NS group than in the non-NS group after RARP (3 months P = 0.01, 12 months P = 0.01). Erectile function was significantly better in both the unilateral NS group (P < 0.0001) and the bilateral NS group (P = 0.02) than in the non-NS group 12 months after RARP. The NS procedure in RARP has the possibility to improve not only erectile function, but also LUTS, owing to both the increase of MVV and the decrease of nocturia. Therefore, the NS procedure is also recommended from the viewpoint of early improvement of LUTS and lower urinary tract dysfunction after RARP.

Efficacy of a formulation containing Serenoa repens, Crocus sativus and Pinus massoniana extracts in men with concomitant LUTS and erectile dysfunction.

The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) has received increased attention recently. This study aims to evaluate the efficacy of IDIProst® Gold, a product containing Serenoa repens, Crocus sativus and Pinus massoniana bark extract (PMBE), in improving sexual function, urinary symptoms and quality of life in patients with concomitant LUTS and ED. A total 140 men (mean age 48 years) were enrolled and treated in this study. All patients were administered IDIProst® Gold (Crocus sativus, PMBE, Serenoa repens) once daily for three months. At visit (T0) and after ninety days of treatment (T90), the patients were evaluated and asked to complete two self-administered questionnaires: International Prostate Symptoms Score (IPSS), International Index of Erectile Function (IIEF-5). The main outcomes were the improved IIEF-5 and IPSS scores in the 40-60 age group. The secondary outcome was the improved quality of life score among treated patients. The baseline mean scores at T0 were 17.29 and 15.12 for the IPSS and IIEF-5 respectively. After three months of treatment (T90), the questionnaire results were as follows: 10.21 and 20.53 for IPSS and IIEF-5 respectively. Statistically significant differences (P<0.001) were reported between the two visits in terms of IPSS and IIEF-5 for all the groups treated, but particularly the 40-60 age group. There was also a statistically significant improvement (P<0.001) in quality of life between T0 and T90 (3.82 vs. 1.45). Compliance with the study protocol was 100%. 140 patients were enrolled out of a population of 164. No adverse events were reported. Treatment once daily with IDIProst® Gold (Serenoa repens, Crocus sativus and PMBE) for three months significantly improved sexual function, urinary symptoms and quality of life in patients with concomitant LUTS and ED, especially in the 40-60 age group.

Correlation between Fasting Glucose, Erectile Dysfunction, and Lower Urinary Tract Symptoms in Benign Prostate Hyperplasia Patients

This study is aimed to determine the correlation between fasting glucose level, erectile dysfunction,and lower urinary tract symptoms (LUTS) in patients diagnosed with benign prostatic hyperplasia (BPH). Weenrolled patients with BPH-related LUTS aged over 50 years old. LUTS and erectile dysfunction (ED) wereevaluated using International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5(IIEF-5). Diabetes mellitus was established if fasting glucose level was above 126mg/dL. Forty-two patientswere enrolled in this study from outpatient clinic in Kardinah Hospital, Tegal during January–March 2015.Patients’ mean age was 68.8±8.6 years old with most of them suffered from ED (83.3%) and also suffered fromsevere LUTS (80.96%). Mean fasting glucose level was 108.3 + 21.1 mg/dl. However, diabetes mellitus wasobserved in 26.2% subjects with mean fasting glucose level was 136.8+7.8mg/dl. IPSS score was correlatedwith fasting glucose level (r=0.879, p<0.001) and IIEF-5 score (r= -0.346, p=0.025). IIEF-5 score showednegative correlation with age (r=-0.31, p=0.046) and fasting glucose level (r=-0.305, p=0.049). Higher fastingglucose level in a man older than 50 years with BPH would increase severity of LUTS and ED. Normal 0 false false false IN X-NONE X-NONE

Relationship among diet habit and lower urinary tract symptoms and sexual function in outpatient-based males with LUTS/BPH: a multiregional and cross-sectional study in China

ObjectivesThis study assessed the effect of diet habits on lower urinary tract symptoms (LUTS) and sexual function in Chinese men with LUTS/benign prostatic hypertrophy (LUTS/BPH).SettingMulticentre study conducted between July 2013 and December 2013 in 11 hospitals in 3 geographic regions in China.ParticipantsOverall, participants with LUTS/BPH accounted for 61.4% (2584/4208) of the respondents, whose data were processed in the following statistical analysis.Primary and secondary outcome measuresLUTS and sexual function were assessed based on the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function 5 (IIEF-5) score. Prostate volume (PV) was determined by ultrasound.ResultsA total of 4208 participants met the inclusion criteria. The average age of the whole participants was 65.8±7.7 years. Overall, participants with LUTS/BPH accounted for 61.4% (2584/4208) of the respondents, whose data were processed in the following statistical analysis. Generally, prostate enlargement was greatest in south China. LUTS and male sexual dysfunction (MSD) were most severe in northwest China. Based on multivariable analysis, PV enlarged as the age (p<0.001), body mass index (BMI; p<0.001) and vegetable intake (p<0.001) increased. Age (p<0.001) and BMI (p<0.05) independently increased the IPSS. A higher level of education (p<0.001) and more frequent meat, fish and egg intake (p<0.05) decreased the IPSS. Age (p<0.001), BMI (p<0.001), low education level (p<0.05), vegetable intake (p=0.001), and milk and dairy product intake (p=0.001) decreased the IIEF-5 score.ConclusionsIn addition to factors including age, obesity and level of education, dietary habits and geographic difference might also play an important role in the variation of PV, LUTS and MSD for Chinese men with LUTS/BPH.

A Meta-Analysis of Long- Versus Short-Acting Phosphodiesterase 5 Inhibitors: Comparing Combination Use With α-Blockers and α-Blocker Monotherapy for Lower Urinary Tract Symptoms and Erectile Dysfunction.

Purpose:Combination therapy with an α-1-adrenergic blocker and phosphodiesterase type 5 inhibitors (PDE5Is) has shown improvements in lower urinary tract symptoms (LUTS) with negligible side effects. Nonetheless, decisive advantages in symptom improvement were insufficient, and there were no clinical differences between long- or short-acting PDE5Is in combination with combination medication.Methods:To review the studies on α-1-adrenergic blocker monotherapy and combination therapy with long vs. short-acting PDE5Is in their use in LUTS and erectile dysfunction (ED). A search of the MEDLINE, Embase, Cochrane Library, and KoreaMed databases was conducted from 2000 to 2014 using combinations of the relevant terms. Among the 323 relevant references discovered, 10 were selected for meta-analysis. The data showed that 616 men received combination therapy (PDE5Is with α-1-adrenergic blockers) or α-1-adrenergic blocker monotherapy.Results:Meta-analysis of the combination therapy showed it was more effective than α-blockers in improving symptoms, with a mean International Prostrate Symptom Score change difference of –1.93 while those of the long- vs. short-acting PDE5I were –2.12 vs. –1.70. Compared to maximum flow rate (Qmax) value with monotherapy, the Qmax increased more with the combination therapy (mean difference of 0.71) while change values were 0.14 and 1.13 for the long- and short-acting PDE5Is, respectively. Residual urine decreased more with the combination therapy than it did with α-1-adrenergic blocker monotherapy with a mean difference of –7.09 while the mean residual urine change values for long- vs. short-acting PDE5Is were –18.83 vs. –5.93. The International Index of Erectile Function value increased by 3.99, 2.85, and 4.85 following combination therapy, and therapy with long- and short-acting PDE5Is.Conclusions:Our meta-analysis suggests that PDE5Is can significantly improve LUTS in men with benign prostatic hyperplasia/ED. Furthermore, combination PDE5I and α-1-adrenergic blocker could be a more effective treatment than α-1-adrenergic blocker monotherapy, and the differences between long and short-acting agents were minimal.