Lower Urinary Tract Symptoms Status Research Articles

Comparing the efficacy of tadalafil and tamsulosin for managing erectile dysfunction and lower urinary tract symptoms in prostate brachytherapy patients: a prospective study

IntroductionAdverse events, such as erectile dysfunction (ED) and lower urinary tract symptoms (LUTS), are significant concerns in prostate cancer (PCa) patients treated with Iodine 125 (I-125) low-dose rate (LDR) prostate brachytherapy (PB). Alpha antagonists and phosphodiesterase-5 inhibitors are used to manage these events. The present study compared the efficacy of low-dose tadalafil with that of tamsulosin for concomitant ED and LUTS in PCa patients treated with I-125 LDR PB. Materials and methodsOne hundred and seventeen patients who received PB for low- or intermediate-risk localized PCa were analyzed. They were randomized into two groups, one receiving tamsulosin (N = 58) and the other receiving low-dose tadalafil (N = 59) immediately after PB. Sexual and urinary functions were assessed at various time points post-PB using questionnaires and objective measurements. The primary endpoint was sexual function measured by the International Index of Erectile Function-15 (IIEF-15) EF domain scores 6 months after PB. Secondary endpoints were sexual function measured by total IIEF-15 scores and Erection Hardness Scores 6 months after PB. The exploratory endpoint was the LUTS status 6 months after PB. ResultsNo significant differences were observed in baseline characteristics between the two groups. Tadalafil exerted stronger effects on sexual function, particularly erection hardness, than tamsulosin. No significant differences were observed in the management of LUTS between both treatments. ConclusionLow-dose tadalafil and tamsulosin may manage LUTS equally after PB. Low-dose tadalafil may contribute to the maintenance of erectile function, particularly erection hardness, after PB; therefore, it is a viable option for patients with baseline erectile function.

The Urobiomes of Adult Women With Various Lower Urinary Tract Symptoms Status Differ: A Re-Analysis.

The discovery of the urinary microbiome (urobiome) has created opportunities for urinary health researchers who study a wide variety of human health conditions. This manuscript describes an analysis of catheterized urine samples obtained from 1,004 urobiome study participants with the goal of identifying the most abundant and/or prevalent (common) taxa in five clinically relevant cohorts: unaffected adult women (n=346, 34.6%), urgency urinary incontinence (UUI) (n=255, 25.5%), stress urinary incontinence (SUI) (n=50, 5.0%), urinary tract infection (UTI) (n=304, 30.4%), and interstitial cystitis/painful bladder syndrome (IC/PBS) (n=49, 4.9%). Urine was collected via transurethral catheter and assessed for microbes with the Expanded Quantitative Urine Culture (EQUC) technique. For this combined analytic cohort, the mean age was 59 ± 16; most were Caucasian (n=704, 70.2%), Black (n=137, 13.7%), or Hispanic (n=130, 13.0%), and the mean BMI was 30.4 ± 7.7. Whereas many control or IC/PBS cohort members were EQUC-negative (42.4% and 39.8%, respectively), members of the other 3 cohorts were extremely likely to have detectable microbes. The detected urobiomes of the controls and IC/PBS did not differ by alpha diversity or genus level composition and differed by only a few species. The other 3 cohorts differed significantly from the controls. As expected, Escherichia was both prevalent and highly abundant in the UTI cohort, but other taxa also were prevalent at more moderate abundances, including members of the genera Lactobacillus, Streptococcus, Staphylococcus, Corynebacterium, Actinomyces, and Aerococcus. Members of these genera were also prevalent and highly abundant in members of the UUI cohort, especially Streptococcus anginosus. Intriguingly, these taxa were also detected in controls but at vastly lower levels of both prevalence and abundance, suggesting the possibility that UUI-associated symptoms could be the result of an overabundance of typical urobiome constituents. Finally, prevalence and abundance of microbes in the SUI cohort were intermediate to those of the UUI and control cohorts.These observations can inform the next decade of urobiome research, with the goal of clarifying the mechanisms of urobiome community composition and function. There is tremendous potential to improve diagnosis, evaluation and treatment for individuals affected with a wide variety of urinary tract disorders.

The bidirectional association between depression and lower urinary tract symptoms (LUTS) in men: A systematic review and meta-analysis of observational studies.

Recent evidence from observational studies suggests a bidirectional association between lower urinary tract symptoms (LUTS) and depression in men. We sought to systematically quantify the effect of the presence of LUTS on depression symptoms, compared to those without LUTS, in adult males, and vice versa. Electronic databases (MEDLINE, PsycINFO, SCOPUS, Embase) were examined for articles in English before March 2021. Observational studies of men aged over 18 years; reporting an association between LUTS and depression; including a validated scale for LUTS and depression symptoms were eligible for study inclusion. Seventeen studies out of 1787 records identified 163 466 men with reported depression symptoms by LUTS status, while 10 studies reported 72 363 men with LUTS by depression symptoms. Pooled estimates showed a strong effect of LUTS presence on depression risk (OR: 2.89, 95% CI: 2.50-3.33), with a high degree of heterogeneity among the examined studies (I2 = 83%; τ2 = 0,06; p < 0.001). Subgroup analyses demonstrated differences by study region (Q value:13.7, df:4, p = 0.003), setting (7.8(2), p = 0.020), design (7.2(1), p = 0.003), quality (6.2(1), p = 0.013), and LUTS measure (40.9(3), p < 0.001). Pooled estimates also showed a strong effect of depression presence on LUTS risk in men (OR: 3.13, 95% CI: 2.72-3.60), with only moderate heterogeneity between studies (I2 = 58%; τ2 = 0,02; p = 0.001). The strong relationship observed between LUTS and depression implies shared risk factors that cannot be solely attributed to the prostate. This has immediate implications for future studies and the assessment and management of patients with either condition.

Impact of lower urinary tract symptoms on prostate cancer risk among Japanese men with prostate‐specific antigen &lt;10 ng/mL and non‐suspicious digital rectal examination

To investigate the association between lower urinary tract symptoms status and prostate cancer risk at initial extended biopsy. Between 2005 and 2011, the International Prostate Symptom Score was completed on 1467 consecutive men with prostate-specific antigen <10 ng/mL and non-suspicious digital rectal examination. After excluding 308 men treated with alpha-blockers, the remaining 1159 men were enrolled in the present study. Lower urinary tract symptoms status was divided into absent or mild (International Prostate Symptom Score scores of 0-7) and moderate or severe lower urinary tract symptoms (International Prostate Symptom Score scores of 8-35). The risks of prostate cancer diagnosis and high-grade (Gleason score ≥4 + 3) prostate cancer diagnosis in relation to lower urinary tract symptoms status was evaluated using logistic regression. A stratified analysis based on prostate volume (<30 cc, 30-50 cc and >50 cc) was also carried out. Of 1159 patients, 421 (36.3%) had a positive biopsy and 590 (51.0%) had moderate or severe lower urinary tract symptoms. On multivariate analysis, absent or mild lower urinary tract symptoms had a significant and positive impact on the risk of prostate cancer and high-grade disease (odds ratio 1.64 and 1.70, P = 0.0007 and 0.0121, respectively). Furthermore, the aforementioned findings for prostate cancer detection did not change throughout every prostate volume subgroup. In contrast, in men with prostate volume ≤50 cc, but not in those with prostate volume >50 cc, prostate-specific antigen or %free prostate-specific antigen remained as a significant predictor of prostate cancer. In men with elevated prostate-specific antigen, absent or mild lower urinary tract symptoms are positively associated with prostate cancer and high-grade disease regardless of the prostate volume. This finding is especially useful in men with enlarged prostates.

V1544 ROBOT-ASSISTED BLADDER DIVERTICULECTOMY

You have accessJournal of UrologyReconstruction1 Apr 2010V1544 ROBOT-ASSISTED BLADDER DIVERTICULECTOMY Marcelo Orvieto, Rafael Coelho, Sanket Chauhan, Bobby Ardila, Kenneth Palmer, and Vipul Patel Marcelo OrvietoMarcelo Orvieto More articles by this author , Rafael CoelhoRafael Coelho More articles by this author , Sanket ChauhanSanket Chauhan More articles by this author , Bobby ArdilaBobby Ardila More articles by this author , Kenneth PalmerKenneth Palmer More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1296AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The open approach has traditionally been utilized for the surgical management of bladder diverticuli. With increasing popularity and experience, laparoscopic and most recently, robot-assisted bladder diverticulectomy have been described. However, intracorporeal identification of the divierticulum can be challenging. The following video exemplifies the use of robot-assistance with combined endoscopic assistance during bladder diverticulectomy. METHODS A 63-year-old patient with long-term history of lower urinary tract symptoms status post TURP, presented to our office with recurrent urinary tract infections and elevated post-void residuals. Cystoscopic examination revealed a large bladder diverticulum in the retro-trigonal area. The patient elected to undergo robot-assisted bladder diverticulectomy. Prior to docking the robot, bilateral ureteral catheters were placed and the rigid cystoscope was kept in the bladder during the entire case to assist with intracorporeal diverticular identification and dissection. Using this method, the diverticulum was easily recognized and dissected from the surrounding tissue with violating it. After, the diverticulum was fully excised, the bladder was closed in two layers. RESULTS Total operative time was 90 minute and blood loss was 50cc. The patient was discharged on postoperative day (POD) number 1. A cystogram on POD #6 before the Foley catheter was removed confirmed indemnity of the bladder. CONCLUSIONS Robot-assisted bladder diverticulectomy is feasible and provides the benefits of the minimally invasive approach to patients. Combined endoscopic visualization facilitates intracorporeal recognition and dissection of the diverticulum. Celebration, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e595 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcelo Orvieto More articles by this author Rafael Coelho More articles by this author Sanket Chauhan More articles by this author Bobby Ardila More articles by this author Kenneth Palmer More articles by this author Vipul Patel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Open-label, Intermittent Dose, Prospective Study Evaluating the Effects of Tadalafil on Lower Urinary Tract Symptoms and Erectile Function in Patients with Benign Prostatic Hyperplasia: Continuation and Durability of Effects

Benign prostatic hyperplasia is often accompanied by age-related comorbidity, such as erectile dysfunction (ED). Recent data suggest an association between ED and lower urinary tract symptoms (LUTS), and increasing evidence indicates that the clinical use of phosphodiesterase type 5 (PDE5) inhibitors provides relief from LUTS. The aim of the present study was to investigate the effects of tadalafil (20 mg once every 3 days for 12 weeks, p.o.) in men with moderate-to-severe ED and LUTS and to investigate the duration of the effects of tadalafil beyond treatment cessation. Men with an International Index of Erectile Function-5 (IIEF-5) score of less than 11 (representing "moderate-to-severe" ED status) and with an International Prostate Symptom Score (IPSS) of more than 8 (representing "moderate-to-severe" LUTS status) were enrolled. IPSS (total score, storage subscore, and voiding subscore) and IIEF-5 scores before treatment (baseline), during treatment (weeks 4 and 12 after treatment commencement), and after treatment (weeks 16 and 20after treatment commencement) were compared. IPSS and IIEF-5 scores were significantly different between baseline and week 12 after treatment commencement. Furthermore, these scores were significantly different between baseline and week 20 after treatment commencement. However, except for IIEF-5 scores, no significant differences were observed between week 12 and week 20. Treatment with 20 mg tadalafil (once every 3 days) had beneficial effects on LUTS and ED beyond treatment cessation in patients with moderate-to-severe ED and LUTS.