Lower Urinary Tract Symptom Score Research Articles

(A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS.

Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.

Correlation between fall experience and life functions among community-dwelling older adults in Japan

PurposeThis study investigated the correlation between the risk of falls and life functions, including motor function, cognitive function, and urinary disorders, among older adults residing in small cities in the metropolitan areas of Japan and evaluated the contents of fall prevention instructions. MethodsSixty-nine older adults residing at home participated in this case-control study conducted between September and October 2019. The survey items included questions pertaining to the history of falls; grip strength; the 30-s Chair Stand Test (CS-30), Functional Reach Test (FRT), and Timed Up and Go Test (TUG) scores; mental and cognitive functions [Test Your Memory-Japanese version test (TYM-J)]; living conditions; and urination status [Core Lower Urinary Tract Symptom Score (CLSS)]. ResultsParticipants with a history of falls had significantly lower CS-30 and FRT scores, and significantly higher TUG scores and CLSS than those with no history of falls. Grip strength bore significant correlations with the CS-30 and TUG scores. The CS-30 scores were correlated with the FRT and TUG scores. The FRT scores were correlated with the TUG and French State Activity Index (FAI) scores. The TUG scores were correlated with the TYM-J and FAI scores. The CLSS showed no significant correlations with the remaining items. The FRT scores and CLSS exerted a significant effect on the risk of experiencing falls. ConclusionBoth balancing ability and micturition status affect fall risk and should be considered in treatment strategies for urinary disorders in fall prevention programs for older adults.

Efficacy of high-dose vitamin D supplementation vs. solifenacin or standard urotherapy for overactive bladder dry in children: a secondary analysis of a randomized clinical trial.

To investigate the efficacy of high-dose vitamin D supplementation (VDS) plus standard urotherapy (SU) in managing pediatric overactive bladder dry (OAB-dry), specifically in children with (1) vitamin D levels between 20 and 35 ng/mL and (2) heightened baseline symptom severity. In this secondary analysis of a randomized controlled trial, eligible children (n = 303) were assigned to 8 weeks of VDS + SU group, solifenacin (SOL) + SU group, or SU alone group. The primary outcome was voiding frequency; secondary outcomes included urgency, nocturia, quality of life (QoL), pediatric lower urinary tract symptoms scores, and patient satisfaction. Among 303 participants, 197 (65%) had vitamin D levels between 20 and 35 ng/mL, and 119 (39%) exhibited heightened baseline symptom severity. In both subgroups, VDS + SU resulted in significantly greater improvements in voiding frequency compared to SOL + SU and SU alone. In the vitamin D subgroup (20-35 ng/mL), the median difference in voids/day between VDS + SU and SOL + SU was 2.0 (95% CI, 1.0 to 3.0; P = 0.003) and 3.2 compared to SU alone (P < 0.001). In the heightened symptom subgroup, the median difference was 3.0 (95% CI, 2.0 to 4.0; P < 0.001) vs. SOL + SU and 5.0 (95% CI, 4.0 to 6.0; P < 0.001) vs. SU alone. The VDS + SU group generally outperformed the other groups in various secondary outcome measures. High-dose VDS plus SU has significant therapeutic benefit in children with OAB-dry in those with vitamin D levels between 20 and 35 ng/mL and with more severe symptoms, compared to SOL + SU or SU alone.

Perineal Urethrostomy for Complex Urethral Strictures: Long-Term Patient-Reported Outcomes From a Reconstructive Referral Center and a Scoping Literature Review.

There is a paucity of long-term objective and patient-reported outcomes after definitive perineal urethrostomy for complex urethral strictures. Our objective is to determine comprehensive long-term success of perineal urethrostomy with our 15-year experience at a reconstructive referral center. Patients who underwent perineal urethrostomy between 2009 and 2023 were identified. A comprehensive long-term follow-up was conducted, evaluating both objective outcomes (retreatment-free survival) and subjective outcomes through the use of validated questionnaires. Additionally, to provide further context for our findings, we conducted a scoping review of all studies reporting outcomes following perineal urethrostomy. Among 76 patients, 55% had iatrogenic strictures, with 82% previously undergoing urethral interventions. At a median follow-up of 55 months, retreatment-free survival was 84%, with 16% of patients experiencing perineal urethrostomy recurrent stenosis. Patient-reported outcomes revealed a generally satisfactory voiding function (Urethral Stricture Surgery Patient-Reported Outcome Measure Lower Urinary Tract Symptoms score) and continence (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form), with median scores of 4 (range 0-24) and 0 (range 0-21), but with bimodal distributions of sexual function scores (median International Index of Erectile Function-Erectile Function domain: 3.5; median Male Sexual Health Questionnaire-Ejaculation Scale: 21). Treatment satisfaction was very high with a median International Consultation on Incontinence Questionnaire-Satisfaction outcome score of 21 (range 0-24). The scoping review revealed varying success rates ranging from 51% to 95%, highlighting difficulties in comparison due to variable success definitions and patient case mix. Perineal urethrostomy provides effective treatment for complex anterior urethral strictures, with high patient satisfaction, preserved continence function, and favorable voiding outcomes. It presents a viable option for older and comorbid patients, especially after thorough counseling on expected outcomes and potential risks.

Assessment of prevalence of sexual dysfunction in patients having lower urinary tract symptoms with benign prostatic hyperplasia and effect of various treatment modalities on sexual function.

Sexual dysfunction affects a couple's relationship and quality of life of the patient and the partner irrespective of age. In Lower urinary tract symptoms (LUTS) with benign prostatic hyperplasia (BPH), sexual dysfunction is highly prevalent. This study aims to evaluate prevalence of sexual dysfunction in patients having LUTS with BPH and effect of various treatment on it. The study is hospital based prospective cross-sectional study. Total 106 patients were included in this study. Fifty-six patients underwent medical treatment and 50 patients underwent transurethral resection of prostate (TURP) according to lower urinary tract symptom score along with grades of prostate. We measured prevalence of lower urinary tract symptoms, erectile dysfunction (ED), ejaculatory dysfunction (EJD).We compared the pre and post treatment ED, EJD scores in both medical and TURP group. In our study, 11 (10.4%) patients had very mild ED, 12 (11.3%) had mild ED, 54 (50.9%) had moderate ED and 23 (21.7%) had severe ED. In our study, 11 (10.4%) patients had very mild EJD, 7 (6.6%) had mild EJD, 28 (26.4%) had moderate EJD and 2 (1.9%) had severe EJD. In medical group, ED pre-treatment versus ED post treatment was statistically significant (p = 0.0046), treatment of LUTS improves ED. EJD pre-treatment versus EJD post treatment was not statistically significant (p = 0.8368), treatment of LUTS associated with deterioration of EJD. In TURP group association of ED pre-treatment versus ED post treatment was statistically significant (p = 0.0319). Post TURP patients shows improvement in ED Association of EJD pre-treatment versus EJD post-treatment was statistically significant (p = 0.03000). Post TURP EJD deteriorate. We concluded that the severity of sexual dysfunction correlates with severity of LUTS. Ejaculatory function deteriorates after treatment of TURP compared to medical.

Self-Assessment of Lower Urinary Tract Condition in Female Competitive Cyclists.

During cycling, prolonged compression by the bicycle saddle on the anatomical structures located in the perineum area occurs. An additional factor that may have a negative impact on organs located in the pelvic area may be a prolonged sitting position resulting in increased intraabdominal pressure. This situation has the potential to adversely affect pelvic floor function. Therefore, the aim of this study was to assess the incidence of lower urinary tract symptoms (LUTSs) in female competitive road cyclists and cross-country cyclists. The study included 76 female competitive road cyclists and cross-country cyclists and 76 women not practising competitive sport. The Core Lower Urinary Tract Symptom Score (CLSS) questionnaire was used to assess the lower urinary tract condition. Female competitive cyclists had a statistically significantly higher LUTSs score (95% CI: 3.12-4.2 vs. 2.31-3.16; p < 0.05) compared to women not practising competitive sports. Female cyclists had a statistically significantly higher overall CLSS score (95% CI: 3.99-5.61 vs. 2.79-3.97; p < 0.05). Female cyclists had a statistically significantly higher incidence and severity of urinary frequency (p < 0.05 and p < 0.02), urge (p < 0.001 and p < 0.02) and stress incontinence (p < 0.001 and p < 0.001), and pain in the bladder (p < 0.01 and p < 0.01), while physically inactive women recorded a statistically higher incidence of slow urinary stream (p < 0.01 and p < 0.04). A statistically significant association was recorded between the years of cycling and the number of hours per week spent on training and the number of symptoms and their severity. The number of natural births experienced by women involved in competitive cycling significantly affects the severity of LUT symptoms. Compared to women not practising competitive sports, competitive female cyclists are found to have a higher prevalence of LUTSs and a greater degree of severity. LUTSs in competitive female cyclists are negatively influenced by years of competitive career and weekly number of training hours and the number of natural births experienced.

Clinical effect of phytosterol-enriched saw palmetto extract on urinary function in healthy middle-aged and older males: a double-blind, placebo-controlled randomized comparative study

Background: Saw palmetto extract (SPE) is one of the most widely used supplements for benign prostatic hyperplasia (BPH) due to its pharmacological effects. β-sitosterol-enriched saw palmetto oil (VISPO™) contains more than 3% β-sitosterol and 85% total fatty acids and has been shown to improve symptoms in patients with BPH. Lower urinary tract symptoms (LUTS) require primary preventive measures in countries with accelerated population aging, including Japan. VISPO™ is expected to be effective against the early symptoms of LUTS. However, the effect of VISPO™ on urinary function in healthy individuals has not been elucidated. Objective: This clinical study evaluated the efficacy and tolerability of VISPO™ in the management of urinary complaints among healthy middle-aged and older men who did not require treatment. Methods: We conducted a randomized, double-blind, placebo-controlled trial that included 54 male participants who were assigned to consume VISPO™ or placebo (olive oil) capsules for 12 weeks. Biometric data, uroflowmetry results, and salivary hormone levels were assessed at weeks 1 and 12. Urinary function and quality of life were assessed at weeks 1, 4, 8, and 12 using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), Core Lower Urinary Tract Symptom Score (CLSS), and WHOQOL-26. Results: Two-way analysis of variance revealed that IPSS and OABSS were significantly lower in the VISPO™ group that in the placebo group. However, there were no significant differences in urine volume, urinary flow rate, or salivary hormone levels. In addition, no participants reported adverse effects (diarrhea, abdominal pain, etc.). Conclusion: The results of the present study, which is the first randomized controlled trial of VISPO™ conducted among healthy participants, demonstrate the effectiveness of VISPO™ in the management of lower urinary tract complaints that do not require treatment. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000046386). Keywords: saw palmetto, VISPO™, β-sitosterol, fatty acids, healthy subjects, primary preventive, IPSS, OABSS, lower urinary tract symptoms (LUTS)

Urinary tract symptoms that should be improved to enhance post-operative urinary quality of life in patients treated with low-dose-rate brachytherapy for prostate cancer: An importance-performance analysis.

To evaluate international prostate symptom score and urinary quality of life in patients with prostate cancer who underwent low-dose-rate brachytherapy, and to identify lower urinary tract symptoms that must be improved to enhance post-operative urinary quality of life and factors associated with lower urinary tract symptoms. This study included 193 patients who underwent low-dose-rate brachytherapy alone (145 Gy). Importance-performance analysis was conducted to identify lower urinary tract symptoms that should be prioritized to improve urinary quality of life. Association between lower urinary tract symptom scores and each factor was investigated. Receiver operating characteristic curve analysis was used to evaluate dosimetric parameters related to lower urinary tract symptom score to predict an average score of ≥ 3. Cut-off values were determined. One to nine months post-implantation was a period of significantly increased urinary quality of life scores compared with baseline (p < 0.05 each). The importance-performance analysis conducted for 1-9 months revealed that frequency, nocturia, and weak stream required improvement. Multivariate analysis showed that each lower urinary tract symptom score presented a significant association with its baseline value (p < 0.001 each, positive correlation). Frequency, incomplete emptying, urgency, and straining scores were significantly associated with prostate volume, whereas weak stream and intermittency scores were associated with dose covering 90% of the prostate and dose covering 90% of the urethra, respectively (p < 0.05 each, positive correlations). Cut-off values for these doses were 167.01 Gy and 136.84 Gy, respectively. This study highlights the importance of prioritizing specific lower urinary tract symptoms for improvement in post-operative urinary quality of life, and identifies the associated factors that can help in personalized treatment planning and goal-setting for better patient satisfaction.

Lower urinary tract symptoms among male patients on hemodialysis: Prospective and multi-central cross-sectional study.

Lower urinary tract symptoms are common and can significantly impact quality of life, especially in men with co-morbidities and end-stage renal disease. The presence of lower urinary tract symptoms affect the quality of life of patients on hemodialysis. The purpose of this study is assessing the presence and severity of lower urinary tract symptoms among male patients on hemodialysis. Factors that may exacerbate lower urinary tract symptoms were assessed and studied. The impact of lower urinary tract symptoms on quality of life was also identified. A prospective, multi-central, and cross-sectional study of male patients on hemodialysis was conducted. Demographics, clinical data, and core lower urinary tract symptoms score questionnaire were all collected. A correlation has been made between all variables. One hundred forty-five patients were enrolled. Eighty-seven percent of hemodialysis patients had at least one storage symptom, and 85% had at least one voiding symptom. The prevalence of storage symptoms (frequency, nocturia, urgency, and urgency incontinence) was found to be 3%, 70%, 44%, and 12%, respectively. The voiding symptoms were mainly weak stream, straining, and incomplete emptying, which were found in 60%, 43%, and 36%, respectively. Fifteen percent of the cohort had a negatively significant impact on their quality of life. The absence of voiding symptoms was statistically linked to a better quality of life (p < 0.05). Hemodialysis patients who are over 60 years old, smokers, or obese were found to be significantly more likely to report storage symptoms (18%, 9%, and 79%, respectively; p < 0.05). Bladder pain was significantly correlated to the dialysis duration of more than 24 months (p < 0.05). Storage and voiding lower urinary tract symptoms are common among hemodialysis male patients with a minor impact on their quality of life. Age, smoking, and obesity are major risks of exaggerating such symptoms.

Psychometric Properties and Cutoff Value of the Turkish Overactive Bladder Symptom Score.

The Overactive Bladder Symptom Score (OABSS) measures all overactive bladder (OAB) symptoms with graded answers, evaluates urgency symptoms, and reveals the subjective bladder control. However, the Turkish version and the cutoff value of the questionnaire have not yet been studied. The aims of this study were to determine the psychometric properties of the 7-item OABSS and to estimate the cutoff value of the scale. This was an observational study. The internal consistency (Cronbach α) and test-retest reliability were analyzed, and exploratory factor analysis was performed. For the criterion validity, the correlations between the OABSS, the Overactive Bladder Questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, and outcomes of a bladder diary were used. The cutoff value of the OABSS was analyzed by the receiver operating characteristics curve analysis. Participants with (n = 49) and without (n = 38) OAB were included. The internal consistency was very strong (Cronbach α = 0.95). The test-retest reliability was very strong (intraclass correlation coefficients = 0.93-0.95, P = 0.001). The percentage of explanation of the total variance was calculated as 78%. There was a strong to very strong correlation between the OABSS and the Overactive Bladder Questionnaire and Bristol Female Lower Urinary Tract Symptoms scores and outcomes of the bladder diary. The cutoff value for the OABSS was determined as 10.5. The Turkish OABSS was found to be a valid and reliable scale to determine OAB symptoms and severity. Those who score more than 10.5 on the questionnaire can be considered as at risk of OAB syndrome.

Rezūm water vapor thermal therapy in patients with benign prostatic hyperplasia: Initial real-world data from Japan.

Benign prostatic hyperplasia (BPH) is prevalent in older men. As surgery can be high risk in this group, minimally invasive procedures are preferrable. This study aimed to assess the initial results of minimally invasive Rezūm water vapor thermal therapy (WVTT) in patients with BPH. This single-center retrospective study included 25 consecutive patients with BPH who underwent WVTT between September 2022 and July 2023. Parameters including age, Charlson Comorbidity Index and Geriatric 8 (G8) scores, operative time, and number of vapor injections were evaluated. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, and Core Lower Urinary Tract Symptom Score (CLSS) were used to assess symptoms before the procedure, and at 1 and 3 months after it. Urinary function indicators such as single voiding volume, maximum flow rate (MFR), and post-void residual volume were assessed at the same time points. The mean patient age was 76.0 years and the mean prostate volume was 54.8 mL. The mean G8 score was 14.4 and the Charlson Comorbidity Index score averaged 1.2. The mean operative time was 6.84 min, and included a mean of 4.8 vapor injections. Three months after WVTT, significant improvements were observed in the maximum flow rate (P = .02), post-void residual volume (P = .001), and urine volume (P < .001), as well as in the IPSS incomplete emptying (P = .01) and weak stream (P = .01) domains. No significant changes were observed in the remaining IPSS domains or in the Overactive Bladder Symptom Score or CLSS. This study provides the first report on Rezūm WVTT outcomes in Japan using the CLSS assessment tool. The initial results indicate a promising experience with this new treatment method. With a rapidly aging population, the incidence of BPH is expected to increase, making the minimally invasive Rezūm system a valuable addition to BPH treatment options.

Brazilian Portuguese translation, cross-cultural adaptation, and content validation of the pediatric lower urinary tract symptom score

BackgroundEarly screening instruments for professionals are important to reduce the cost and time of diagnosing pediatric lower urinary tract dysfunction. This study aimed to translate, cross-culturally adapt, and validate pediatric lower urinary tract symptom scores. MethodsThis methodological study was conducted in 2019 in two phases: translation and cross-cultural adaptation, and content validation. In the first phase, we used translators, specialists, and 30 parents of children with voiding dysfunction. In the second phase, validation was performed by 11 pediatric urology specialists. FindingsThe instrument was translated and adapted to Brazilian Portuguese and presented an excellent level of verbal comprehension. Further, the instrument presented a good content validity index >0.8 for all items, except for the nomenclature and clarity of two items, as indicated by the Cronbach's alpha value of 0.75 for internal consistency. DiscussionThe final version showed semantic, idiomatic, experiential, and conceptual equivalence with the original instrument, indicating that it is adequate for other assessments of psychometric qualities. Practice implicationsThe translation and adaptation of an important instrument for diagnosing lower urinary tract dysfunction in children to other countries helps nurses identify the disease early and monitor the treatment.

Delineating the Diagnostic Concordance Between Pediatric Lower Urinary Symptoms Scoring and Voiding Diary in Pediatric Lower Urinary Tract Dysfunction.

This retrospective research endeavored to conduct a comparative evaluation of the Pediatric Lower Urinary Tract Symptoms Scoring (PLUTSS) system and the Voiding Diary (VD). The correlation between these diagnostic tools, their prognostic value for treatment outcomes in pediatric Lower Urinary Tract Dysfunction (LUTD), and their relationship with patients' sociodemographic characteristics were also explored. The study data for the cohort established between December 2005 and September 2006 were obtained from a specialized thesis, while the subsequent expansion from 2022 to 2023 involved a prospective approach, including an additional 73 patients, resulting in a total of 113 pediatric patients (79 females and 34 males). Comprehensive diagnostic evaluations, such as urinalysis, urine culture, renal function tests, urinary tract ultrasound, uroflowmetry-electromyography (EMG), and post-voiding residual urine measurement (PVR), were conducted. The patient's symptoms were assessed using the Pediatric Lower Urinary Tract Symptom Score (PLUTSS) and a two-day-three-night voiding diary. The correlation between the PLUTSS and VD was not absolute but substantial concerning daytime frequency and incontinence. Notably, PLUTSS emerged as the primary predictor of treatment outcomes. No significant association was discerned between sociodemographic characteristics, such as socioeconomic status, sibling count, toilet training, school performance, patientpersonality, and LUTD diagnosis or prognosis. The findings underscore the prognostic value of PLUTSS for treatment outcomes in pediatric LUTD. Although a significant correlation was observed between PLUTSS and VD, they are not interchangeable. As a result, concurrent utilization of both tools is endorsed for comprehensive diagnosis, follow-up, and treatment planning in pediatric LUTD.

Female sexual dysfunction and lower urinary tract symptoms associated with vulvovaginal atrophy symptoms: Results of the GENJA study.

To investigate the main symptoms of female sexual dysfunction (FSD) and lower urinary tract symptoms associated with vulvovaginal atrophy (VVA) symptoms as the core symptoms of genitourinary syndrome of menopause. We extracted the data of 4134 Japanese women aged 40-79 years who participated in the GENitourinary syndrome of menopause in JApanese women (GENJA) study. All participants responded to web-based questionnaires assessing their health situation, including the Vulvovaginal Symptoms Questionnaire, the Female Sexual Function Index (FSFI), and the Core Lower Urinary Tract Symptom Score. Multivariable regression and multivariable logistic regression analyses were applied to analyze the association between VVA symptoms and FSD, and between VVA symptoms and lower urinary tract symptoms. Multivariable regression analysis revealed that VVA symptoms were associated with lower scores for arousal, lubrication, orgasm, satisfaction, and pain domains in the FSFI in sexually active women (p < 0.01). Regression coefficients were higher for lubrication and pain domains than for the other domains. Multivariable logistic regression analysis revealed that women reporting VVA symptoms were more likely to have increased daytime urinary frequency, nocturia, urgency, slow stream, straining to void, feeling of incomplete emptying, bladder pain, and feeling a bulge/lump from or in the vagina (p < 0.05). Adjusted odds ratios were particularly high for straining to void, feeling of incomplete emptying, and bladder pain. Vulvovaginal atrophy symptoms were significantly associated with decreased lubrication and dyspareunia in FSD, and urinary symptoms of straining to void, feeling of incomplete emptying, and bladder pain.

Difference in symptom manifestation between postmenopausal and premenopausal women in acute uncomplicated cystitis: A multi-institutional pilot study.

We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy. This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020. After registration, we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score (CLSS) questionnaire. After treatment, pyuria disappeared in 60 of the 66 patients (14 premenopausal and 46 postmenopausal). The CLSS total score (range) changed from 13 (3-29) to 4 (0-18) with a significant improvement in all CLSS items. At baseline, nocturia, urgency, and urgency incontinence were more prominent in postmenopausal women than in premenopausal women. In contrast, baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women. After treatment, the CLSS total score was still higher in postmenopausal women, as reflected by the relatively higher scores for nocturia and urgency, irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups. Our results suggest that if storage symptoms persist, they should be carefully interpreted according to menopausal status.

MP71-10 LONGITUDINAL EVALUATION OF LOWER URINARY TRACT SYMPTOMS POST ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH THE CORE LOWER URINARY TRACT SYMPTOM SCORE

You have accessJournal of UrologyCME1 Apr 2023MP71-10 LONGITUDINAL EVALUATION OF LOWER URINARY TRACT SYMPTOMS POST ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH THE CORE LOWER URINARY TRACT SYMPTOM SCORE Yuma Waseda, Minato Yokoyama, Kasumi Yoshitomi, Masaki Kobayashi, Bo Fan, Yuki Nakamura, Motohiro Fujiwara, Yudai Ishikawa, Shohei Fukuda, Hajime Tanaka, Soichiro Yoshida, and Yasuhisa Fujii Yuma WasedaYuma Waseda More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Kasumi YoshitomiKasumi Yoshitomi More articles by this author , Masaki KobayashiMasaki Kobayashi More articles by this author , Bo FanBo Fan More articles by this author , Yuki NakamuraYuki Nakamura More articles by this author , Motohiro FujiwaraMotohiro Fujiwara More articles by this author , Yudai IshikawaYudai Ishikawa More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While the artificial urinary sphincter (AUS) can significantly improve continence status, improved continence has been shown to worsen slightly over time. However, few studies have evaluated the trend in lower urinary tract symptoms (LUTS) other than incontinence. The frequently used International Prostate Symptom Score questionnaires may not adequately assess LUTS due to a lack of queries regarding incontinence and pain. The Core LUTS Score (CLSS) allows for an overall assessment of LUTS, which addresses 10 important symptoms from the 25 defined by the International Continence Society standardization steering committee. The CLSS questionnaire was used to assess LUTS after AUS implantation, longitudinally. METHODS: The subjects were 19 male who underwent initial AUS implantation at Tokyo Medical and Dental University from 2018 to 2021. LUTS were assessed before AUS implantation as well as one month (early use) and 12 months (late use) after implantation. CLSS data was collected from 13 patients before implantation and 19 patients during early and late use. This study was approved by our ethics committee (approval number: #2018-157). RESULTS: The median age at surgery was 74 years. The causes of urinary incontinence were radical prostatectomy and benign prostatic hyperplasia surgery in 18 and one patient, respectively. All patients achieved social continence of ≤1 pad/day, and the quality of life index improved significantly from 5.6 to 1.8 (0: delighted to 6: terrible) in early use (p<0.001) in 13 patients with preoperative evaluations. The most bothersome symptom was urinary incontinence in 11 (85%) patients and frequent urination in 2 (15%) patients before use, while two in early use and four in late use listed incontinence-related symptoms. Longitudinal change between early and late use showed improvement in voiding and post-micturition symptoms. On the other hand, no apparent improvement in storage symptoms was observed (Figure 1). On late use, 3 (16%) were receiving medication for overactive bladder. CONCLUSIONS: Post AUS implantation, urinary incontinence distress decreased, and other LUTS became more prominent. There was no trend toward improvement of the storage symptoms over time, and pharmacotherapy should be adiministered as needed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1018 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuma Waseda More articles by this author Minato Yokoyama More articles by this author Kasumi Yoshitomi More articles by this author Masaki Kobayashi More articles by this author Bo Fan More articles by this author Yuki Nakamura More articles by this author Motohiro Fujiwara More articles by this author Yudai Ishikawa More articles by this author Shohei Fukuda More articles by this author Hajime Tanaka More articles by this author Soichiro Yoshida More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

The role of the bladder diary in phenotyping men with LUTS.

The aim of this study was to compare the clinical characteristics of men with lower urinary tract symptoms(LUTS) grouped by 24-hurine output determined from a bladder voiding diary. An online database was queried to identify men who completed a 24-hour bladder diary (24HBD), and the Lower Urinary Tract Symptom Score (LUTSS) questionnaire from 2015 to 2019 using a mobile app. Data from the bladder diary and questionnaire were contemporaneously matched within a 2-week period. Additional data, including maximum uroflow (Qmax ) and postvoid residual urine (PVR), were obtained from the electronic medical record (EMR). The cohort was divided into three groups: normal, oliguria, and polyuria based on their 24-hour voided volume (24HVV). The LUTSS, 24HVV, maximum voided volume (MVV), maximum flow rate (Qmax ), and PVRwere compared between those with oliguria and polyuria. A total of 327 men (mean age 62, SD: 19) completed the LUTSS questionnaire and contemporaneous 24HBD. Of these, 61% had a normal 24HVV, 13% had oliguria, and 26% had polyuria. A total of 147 patients from the study cohort had contemporaneous Qmax and PVR abstracted from the EMR. There was no difference in symptom severity, bother, or PVR among the three patient groups. However, several objective metrics were significantly correlated with urine output. Men with oliguria, as compared to men with polyuria were older (65 vs. 55years) and had lower MVV (260vs.470 mL), fewer voids/24 h (8 vs. 13),and lower Qmax (8.5vs. 18.3 mL/s). These observations suggest that men with oliguria or polyuria and LUTS constitute easily distinguished phenotypes that might require different diagnostic and therapeutic algorithms. Those with oliguria were older, and had lower MVVs and much lower uroflows, suggesting that they are more likely to have underlying disorders such as bladder outlet obstruction and detrusor underactivity or may be patients with overactive bladder who reduced fluid intake to improve symptoms.

Toileting Behaviors and Lower Urinary Tract Symptoms Among Female Physicians and Medical Students.

A greater understanding of the relationship between toileting behaviors and lower urinary tract symptoms (LUTS) has the potential to generate awareness and improvement of overall bladder health in specific populations. The aim of the study was to investigate the prevalence and correlation between maladaptive toileting behaviors and LUTS among female medical trainees and attending physicians. We surveyed female medical students, residents, fellows, and attending physicians at an academic hospital, capturing demographics, voiding behaviors, LUTS, and fluid intake using the Bristol Female Lower Urinary Tract Symptoms Short Form, the Toileting Behavior-Women's Elimination Behaviors, and the Beverage Intake Questionnaire. A total of 146 medical students and physicians participated in the study. Eighty-three percent reported at least 1 LUTS, most commonly storage symptoms, particularly incontinence (30%, stress urinary incontinence > urgency urinary incontinence). Altered toileting behaviors included "worrying about public toilet cleanliness" (82%), "emptying the bladder before leaving home" (81%), "delaying emptying their bladder when busy" (87%), and "waiting until they could not hold urine any longer" (57%). Total Toileting Behavior-Women's Elimination Behaviors scores were significantly associated with total Bristol Female Lower Urinary Tract Symptoms scores (β = 0.27; 95% CI, 0.12-0.42; P<0.01). This remained true after adjusting for total fluid intake in medical students (β = 0.41, P<0.01) and resident physicians (β = 0.28, P = 0.03) but was not correlated among attending physicians (β = -0.07, P = 0.77). Female physicians and medical students experience a high prevalence of LUTS. Many engage in maladaptive toileting behaviors, which highly correlate with LUTS (especially among medical students and residents) and may lead to impaired bladder health.

Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study.

To determine whether sacral transcutaneous electrical nerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs). A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3 months. Symptom progression was assessed using the voiding calendar and the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS), excluding questions 3 and 4 -referring to enuresis- so that progression of daytime symptoms only (LUTS variable) was analyzed. 66 patients -50% of whom were female- were included, with a mean age of 9.5years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1 baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions (8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume in the voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresis was the only variable refractory to S-TENS. Complication rate was 3% (2 patients with dermatitis in the S-TENS application area). S-TENS is effective and safe in the short-term in patients with OB refractory to Achs. Further studies assessing long-term efficacy and potential relapses are required.

Polyuria in patients with lower urinary tract symptoms: Prevalence and etiology.

Patients with lower urinary tract symptoms (LUTS) can be subcategorized into polyuria, normal or oliguria groups. Polyuria may be caused by pathologies including diabetes mellitus (DM), chronic kidney disease (CKD), diabetes insipidus (DI), or primary polydipsia (PPD). While fluid restriction is appropriate for some, doing so in all may result in serious complications. This study investigates the prevalence of these pathologies in LUTS patients with polyuria. Two databases were retrospectively queried for men and women who filled out a lower urinary tract symptom score (LUTSS) questionnaire, 24-hbladder diary (24HBD) and were polyuric (>2.5 L/day). Patients were divided into four groups: poorly controlled DM, DI, anCKD grade 3 and PPD. One-way analysis of variance compared 24HBD and LUTSS questionnaires. Pearson correlation examined LUTSS and bother with 24-h voided volume (24 HVV), maximum voided volume (MVV) and total voids. Among 814 patients who completed a 24HBD, 176 had polyuria (22%). Of the patients with complete data, 7.8% had poorly-controlled DM, 3.1% had DI, 4.7% had CKD grade 3% and 84.4% had PPD. Amongst the four different sub-groups, significant differences were seen in 24 HVV (p < 0.001), nocturnal urine volume (NUV) (p < 0.001), MVV (p = 0.003), daytime voids (p = 0.05), nocturnal polyuria index (NPi) (p < 0.001) and nocturia index (Ni) (p = 0.002). Significance was also seen between LUTSS and bother subscore (r = 0.68, p < 0.001), LUTSS and total voids (r = 0.29, p = 0.001) and bother sub-score and total voids (r = 0.21, p = 0.019). 22% of patients with LUTS were found to have polyuria based on a 24HBD. Within this cohort, four sub-populations were identified as being demonstrating statistically significant differences in 24 HVV, NUV, MVV, daytime voids, NPi and Ni. Identifying the underlying etiology of polyuria should be carried out to safely treat patients with LUTS.