Lower Urinary Tract Symptoms Group Research Articles

Sleep and health-related quality of life in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the general population and patients with inguinal hernia

To determine whether there are differences in the quantity and quality of sleep, including sleep efficiency and insomnia, and health-related quality of life (HRQoL) between patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO), men from the general population and patients with inguinal hernia. The designs were descriptive and comparative. The groups consisted of 239 patients aged 45-80 years who were referred to urological departments with LUTS suggestive of benign prostatic obstruction. The comparison groups consisted of 213 randomly selected men from the general population, stratified according to age and geographical region, and 200 patients with inguinal hernia. The setting was one university and two general hospitals. The method was self-administered questionnaires about demography, comorbidity, sleep and health-related quality of life. Further, patients with LUTS answered questions about urinary symptoms and disease-specific quality of life. The prevalence of insomnia was 40%, 26% and 19% and the prevalence of sleep efficiency < 85% was 49%, 38.5% and 31% in the LUTS, general population and hernia groups, respectively. The median number of nocturnal micturitions was 2, 1 and 1. In the LUTS group (n = 216), 47% had IPSS 8-19 and 44% had ≥ 20 points. The HRQoL was significantly impaired in patients with LUTS compared with one or both of the comparison groups (p values < 0.05). Patients with LUTS suggestive of BPO had significantly impaired sleep, a higher prevalence of insomnia and significantly impaired HRQoL compared with one or both of the comparison groups.

Evaluation of an At-Home-Use Prostate Massage Device for Men with Lower Urinary Tract Symptoms

Introduction: Treatment of lower urinary tract symptoms (LUTS) in men due to benign prostatic hyperplasia (BPH) or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are difficult for both the patient and the clinician. In office prostatic massage has been documented to provide symptom relief but use of at-home massage has not been determined. We performed a retrospective analysis of data from men utilizing an at-home-use prostate device to examine disease, treatment characteristics, and symptom relief in order to ascertain whether evidence exists to perform a clinical trial. Methods: Data on 154 consecutive men was reviewed and subjects evaluated in two Groups, BPH w/ LUTS (Group 1) and CP/CPPS w/ LUTS (Group 2). All subjects completed the National Institutes of Health, Chronic Prostatitis Symptom Index (CPSI) at baseline and follow-up. Demographics, scores on the CPSI, duration of device use, self-reported symptom assessment, and comments were analyzed. Results: Of 154 men, 115 were analyzed. Of the 115, 90 (78.3%) were in Group 1 (BPH w/LUTS) and 25 (21.7%) were in Group 2 (CP/CPPS w/LUTS). The average age was 64.48 years ± 10.86 (average ± SD) vs 46.68 ± 12.5 (Group 1 - 2, respectively). In Group 1 total CPSI score from baseline to follow-up were (11.61 ± 7.07 (mean ± SD) - 6.63 ± 5.20, p = 0.0001). In Group 2 total scores from baseline to follow-up were (16.67 ± 7.0 vs 11.48 ± 5.84 (5.20, p = 0.0127). Other self-reported comments included 16/115 (13.9%) of subjects unsure about proper use/application and 10/115 (8.6%) reporting rectal soreness. Conclusions: The preliminary findings suggest that a clinical trial of a novel at-home-use prostatic massage device is warranted.

The Impact of Lower Urinary Tract Symptoms and Urinary Incontinence on Female Sexual Dysfunction Using a Validated Instrument

Lower urinary tract symptoms (LUTS) is a common problem in women and frequently coexists with female sexual dysfunction (FSD). However, the relationship of LUTS and FSD is poorly characterized. To evaluate the relationship of LUTS and urinary incontinence (UI) to FSD using a validated instrument, the female sexual function index (FSFI). We performed an institutional review board-approved retrospective evaluation of 236 female patients over a 3-year time-period who completed an FSFI-validated questionnaire and underwent urodynamics (UDS) evaluation for LUTS or UI. Patients were categorized based upon history and physical exam into different LUTS groups. Additionally, the presence or absence of UI, detrusor overactivity (DO), stress urinary incontinence, and maximal cystometric capacity (MCC) > or <200 mL on UDS were used to further evaluate these patients. FSFI domain and total scores were compared between the different LUTS groups. FSFI scores were evaluated for women with similar clinical LUTS diagnosis and UDS findings. The Kruskal-Wallis nonparametric test and the Dwass-Steel test determined statistical significance and performed multiple pairwise comparisons between the different voiding dysfunction groups and those with normal UDS (Leak-/DO-/urodynamic stress incontinence-). The mean age of the cohort was 49.5 (range 18-69), and there was no statistically significant difference in mean age within each LUTS subgroup. MCC < 200 mL did not significantly impair female sexual function. Patients with clinical diagnosis of overactive bladder (OAB)-Dry had the highest sexual function while those with mixed urinary incontinence had the worst. Additionally, women with UI and DO had the greatest degree of FSD, which was significantly worse than those with normal UDS. Additionally, for women with or without UI, the presence of DO on UDS resulted in a trend toward worse sexual function. The sexual function of women is negatively impacted by the presence of LUTS, with UI and DO causing the greatest degree of FSD. The sexual domains most affected are desire, lubrication, orgasm, and sexual satisfaction.

Examining lower urinary tract symptom constellations using cluster analysis

To gain a better understanding of how patients experience lower urinary tract symptoms (LUTS) and to determine whether particular symptoms cluster together, as LUTS seldom occur alone. A secondary analysis of a cross-sectional, population-based survey of adults in Sweden, Italy, Germany, UK and Canada was undertaken to examine the presence of LUTS groups. Of the 19,165 telephone surveys, 13,519 respondents reported at least one LUTS and were included in the analysis. All respondents were asked about the presence of 14 LUTS (International Prostate Symptom Score plus seven additional LUTS). K-means cluster analyses, a statistical method for sorting objects into groups so that similar objects are grouped together, was used to identify groups of people based on their symptoms. Men and women were analysed separately. A split-half random sample was selected from the dataset so that exploratory analyses could be conducted in one half and confirmed in the second. On model confirmation, the sample was analysed in its entirety. Included in this analysis were 5014 men (mean age 49.8 years; 95% white) and 8505 women (mean age 50.4 years; 96% white). Among both men and women, six distinct symptom cluster groups were identified and the symptom patterns of each cluster were examined. For both, the largest cluster consisted of respondents with minimal symptoms (i.e. reporting essentially one symptom), 56% of men and 57% of women. The remaining five clusters for men and women were labelled based on their predominant symptoms. For men, the clusters were nocturia of twice or more per night (12%); terminal dribble (11%); urgency (10%); multiple symptoms (9%); and postvoid incontinence (5%). For women, the clusters were nocturia of twice or more per night (12%); terminal dribble (10%); urgency (8%); stress incontinence (8%); and multiple symptoms (5%). The multiple-symptom groups had several and varied LUTS, were older, and had more comorbidities. Clusters of terminal dribble and male postvoid incontinence had a lower prevalence of all other LUTS, but were fairly common (11% and 5% of men). This analysis provides an empirical approach to examining the presentation of multiple LUTS and suggests it is possible to identify subgroups of patients with LUTS based on their symptom presentation. These analyses need to be replicated to evaluate the clinical relevance of these findings.

Relationship between Acute Urinary Retention and Intraprostatic Inflammation in Benign Prostatic Hyperplasia

Purpose: Acute or chronic prostatic inflammation exists to varying degrees in surgical specimens of prostates, extirpated for the treatment of benign prostatic hyperplasia (BPH). We investigated the relationship between acute urinary retention (AUR) and intraprostatic inflammation. Materials and Methods: Between January 1997 and December 2006, 221 patients underwent transurethral resection of the prostate (TURP) for the treatment of BPH. The patients were divided into 2 groups based on the indication for surgery; an AUR group and a lower urinary tract symptoms (LUTS) group. The area of acute inflammation, the extent, and the aggressiveness of chronic inflammation were classified into four grades. The grades of inflammation, prostate volume, age, serum prostate-specific antigen (PSA), and prior medical treatment were compared between the two groups. All specimens were reviewed by one pathologist. Results: The AUR group consisted of 106 (47.9%) patients, and the LUTS group consisted of 115 (52.1%) patients. There were no statistical differences between the two groups with respect to the mean values of the age, prostate size, and severity of chronic inflammation. There was a significant relationship between AUR and the areas of acute inflammation, and the extent of chronic inflammation (p=0.014 and p=0.003, respectively). The aggressiveness of chronic inflammation had no relationship with AUR (p=0.062). The serum PSA level was higher in the AUR group than the LUTS group (11.5 vs. 5.3ng/ml, respectively). Conclusions: The association for AUR with acute and chronic inflammation was stronger than that which existed with prostate size. Thus intraprostatic inflammation is an important risk factor in AUR. (Korean J Urol 2008;49:1081-1086) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

国際前立腺症状スコア (IPSS) に「排尿後尿滴下」を加えた独自の問診票による下部尿路症状の調査

At present, there are almost no report concerning post micturition dribble (PMD) in lower urinary tract symptoms (LUTS). PMD may have a negative effect on the quality of life (QOL) of afflicted patients. However, question concerning PMD are not included in the International Prostate Symptom Score (IPSS) questionnaire, and a number of questions about PMD remain to be addressed, such as the correlation between PMD and QOL. Therefore, we investigated PMD using an original question form (IPSS added PMD) we created. Between June 2006 and March 2007, the self-administered modified IPSS (IPSS with new questions included concerning PMD) was 5 obtained from 621 outpatients (394 men and 227 women) visiting our hospital. The PMD scores were 1.2 +/- 1.7 in men, and 0.6 +/- 1.2 in women, and thus we see that the men had a significantly higher than the women. Men's PMD scores rise from age 50 and reach a peak in the 70's. On the other hand, there is no significant change for women from the 20s and thereafter. Those with higher PMD scores were male patients with benign prostatic hyperplasia (BPH) and females with stress urinary incontinence. In BPH group, the average PMD score was higher than patients with another urological disease. The PMD scores were appreciably high at 1.59 +/- 1.90 for the LUTS group, and had the lower value of 0.36 +/- 0.90 for the non-LUTS group. Therefore, the LUTS group was found to have a significantly higher PMD score. Men in the LUTS group (especially those with BPH) had a positive correlation between their QOL scores and PMD scores. The following points may be revealed from the present study. In patients with LUTS (especially BPH), PMD score is higher and may impair their QOL. Even women and youth may experience PMD. A more detailed evidence concerning PMD will be needed.

The Urgency Perception Score: Validation and Test-Retest

We validate a grading system for urinary urgency. A total of 225 subjects participated in a validation study of a fixed format question that examined the reasons why an individual usually voids. The response comprised 5 graded categories. The written questionnaire was completed by the subject twice in 3 to 14 days, during which there was no change in symptoms. Subjects included asymptomatic normal volunteers and consecutive patients with lower urinary tract symptoms without urinary urgency and those with overactive bladder with or without other lower urinary tract symptoms. Content validity was established by an expert panel. Discriminant validity was assessed by examining the frequency of responses in the various categories across the 3 groups (chi-square test) and by comparing average scores in each of the 3 groups using 1-way ANOVA, followed by LSD post hoc tests. Test-retest reliability was assessed using the intraclass correlation coefficient and kappa coefficient. A total of 83 normal subjects, 62 patients with lower urinary tract symptoms and 80 patients with overactive bladder were included in the study. Median age was 71 years (range 21 to 97). For test-retest reliability the intraclass correlation coefficient (0.86) and kappa coefficient (0.68) indicated a good level of agreement (p <0.001). The overactive bladder group achieved a significantly higher score than the normal and lower urinary tract symptoms groups (mean +/- SD 2.5 +/- 0.99 vs 1.6 +/- 0.93 and 1.8 +/- 0.93, respectively, each p <0.001). The urgency perception score appears to be a valid and reliable means of grading urinary urgency. We believe that this method of grading urgency will prove to be more clinically useful than the simple yes/no characterization of urgency as a sudden compelling desire to void and it will be a useful item for questionnaires and diary keeping.

Sphincteric Urinary Incontinence: Relationship of Vesical Leak Point Pressure, Urethral Mobility and Severity of Incontinence

We examined the relationships among urethral hypermobility, intrinsic sphincter deficiency and incontinence in women. A total of 65 consecutive women with stress urinary incontinence and 28 with lower urinary tract symptoms not associated with stress urinary incontinence were evaluated with videourodynamics, 24-hour voiding diaries and pad tests, vesical leak point pressure measurement and the cotton swab test. A total of 93 patients with a mean age +/- SD of 63 +/- 13 years were studied, including 65 who presented with stress urinary incontinence and 28 who presented with lower urinary tract symptoms without stress urinary incontinence. The incidence of urethral hypermobility was 32% in the stress urinary incontinence group and 36% in the lower urinary tract symptoms group (p = 0.46). When stress urinary incontinence cases were stratified according to a vesical leak point pressure of 0 to 60, 60 to 90 and greater than 90 cm. H2O, urethral hypermobility was noted in 25%, 31% and 41%, respectively, a difference that was not statistically significant (p = 0.6). Overall incontinent patients with and without urethral hypermobility had the same median number of incontinence episodes (5, range 1 to 13 versus 7, range 1 to 15, p = 0.39) and median pad weight (39.5 range 1 to 693 gm. versus 33.5, range 1 to 751, p = 0.19). When patients with intrinsic sphincter deficiency, defined as vesical leak point pressure less than 60 cm. H2O, were divided into those with and without urethral hypermobility, there were no differences in the mean number of incontinence episodes (9.4 +/- 3 versus 6 +/- 3.6, p = 0.17) or median pad weight (90 gm., range 10 to 348 versus 86, range 30 to 81, p = 0.76). The degree of change in the urethral angle did not correlate with vesical leak point pressure (r = 0.16, p = 0.24) or with pad weight (r = -0.23, p = 0.1). Urethral hypermobility was equally common in this group of women with lower urinary tract symptoms and stress urinary incontinence. Intrinsic sphincteric deficiency and urethral hypermobility may coexist and they do not define discrete classes of patients with stress urinary incontinence. Urethral hypermobility did not appear to have an independent effect on the frequency or severity of incontinence. Patients with stress urinary incontinence can still be characterized by vesical leak point pressure and change in the urethral angle, although these variables do not always define discrete classes.