Lower Urinary Tract Symptoms Research Articles

The Association Between Solid Fuel Use and Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia in Sichuan, China: Cross-Sectional Study.

Benign prostatic hyperplasia (BPH) is a global age-related disease. It has been reported that over half of the Chinese male population aged 70 years or older are experiencing BPH. Solid fuel, which is the major source of household air pollution, has been reportedly associated with several adverse events, including sex hormone disorders. Due to the certain relationship between sex hormone levels and prostate disease, the relationship between solid fuel use and lower urinary tract symptoms (LUTSs) suggestive of BPH (LUTS/BPH) deserves further exploration. This study mainly aimed to investigate the association between solid fuel use and LUTS/BPH. The data used in this study were obtained from the West China Natural Population Cohort Study. Household energy sources were assessed using questionnaires. LUTS/BPH was evaluated based on participant self-reports. We performed propensity score matching (PSM) to reduce the influence of bias and unmeasured confounders. The odds ratio (OR) and 95% CI of LUTS/BPH for the solid fuel group compared with the clean fuel group were calculated. We also conducted stratified analyses based on BMI, metabolic syndrome, waist to hip ratio, drinking status, smoking status, and age. A total of 5463 participants were included in this study, including 399 solid fuel users and 5064 clean fuel users. After PSM, the solid fuel group included 354 participants, while the clean fuel group included 701 participants. Solid fuel use was positively correlated with LUTS/BPH before and after PSM (OR 1.68, 95% CI 1.31-2.15 and OR 1.81, 95% CI 1.35-2.44, respectively). In stratified analyses, the OR of the nonsmoking group was higher than that of the smoking group (OR 2.56, 95% CI 1.56-4.20 and OR 1.47, 95% CI 0.99-2.18, respectively). Similarly, the OR of the nondrinking group was higher than that of the drinking group (OR 2.70, 95% CI 1.46-4.99 and OR 1.48, 95% CI 1.01-2.17, respectively). A positive correlation between solid fuel use and LUTS/BPH was observed. The results suggest that improving fuel structure for household cooking and other household needs can possibly help reduce the risk of LUTS/BPH.

Cowper’s Duct Syringocele Mimicking Prostatic Obstruction: A Case Report

Introduction: Cowper’s glands, also known as bulbourethral glands, were first described by French surgeon Jean Mery in 1684 and later detailed by William Cowper in 1699. Cowper’s duct syringocele, a rare condition involving cystic dilatation of Cowper’s gland, can mimic symptoms of prostatic obstruction, posing diagnostic challenges. Common presentations include lower urinary tract symptoms (LUTS) such as urgency, weak stream, and incomplete emptying, often leading to misdiagnosis as benign prostatic hyperplasia (BPH). Accurate diagnosis involves imaging studies like transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI), along with retrograde urethrography and cystourethroscopy. Management varies from conservative measures to surgical intervention, depending on symptom severity. Case Presentation: A 36-year-old male presented with urinary obstruction symptoms, reporting a poor stream and straining to urinate over three months, with exacerbation characterized by incomplete voiding. No hematuria, UTIs, or urolithiasis history was noted. Examination was largely unremarkable, except for a flat prostate on per rectal examination. Uroflowmetry indicated a maximum flow rate (Qmax) of 15 ml/sec with an interrupted pattern. MRI revealed a cystic lesion in the posterior urethra, raising suspicion for Cowper’s duct syringocele. Diagnostic cystoscopy confirmed the cystic dilatation, which was deroofed using monopolar energy. The patient’s recovery was uneventful, with follow-up uroflowmetry showing significant improvement, with a Qmax of 27 ml/sec. Discussion: This case underscores the importance of considering Cowper’s duct syringocele in the differential diagnosis of LUTS, especially in patients with atypical presentations. The diagnostic approach included uroflowmetry, MRI, and cystoscopy, which confirmed the cystic lesion. Management involved transurethral deroofing, leading to symptom resolution and improved urinary flow. Early recognition and intervention are crucial for favorable outcomes. Literature highlights the role of imaging and endoscopic techniques in diagnosing and managing this rare condition, emphasizing the need for interdisciplinary collaboration in complex urological cases. Conclusion: This case emphasizes the need for considering Cowper’s duct syringocele in patients with LUTS to avoid misdiagnosis and inappropriate management. Accurate diagnosis through a combination of uroflowmetry, imaging, and cystoscopy, followed by appropriate surgical intervention, can significantly improve patient outcomes. The case underscores the efficacy of endoscopic techniques and the importance of interdisciplinary collaboration in optimizing care for patients with rare urological conditions.

Clinical Recommendations for Managing Genitourinary Adverse Effects in Patients Treated with SGLT-2 Inhibitors: A Multidisciplinary Expert Consensus.

Background: SGLT-2 inhibitors (SGLT-2is) are considered to be a first-line treatment for common conditions like type 2 diabetes, chronic kidney disease, and heart failure due to their proven ability to reduce cardiovascular and renal morbidity and mortality. Despite these benefits, SGLT-2is are associated with certain adverse effects (AEs), particularly genitourinary (GU) events, which can lead to treatment discontinuation in some patients. Preventing these AEs is essential for maintaining the cardiorenal benefits of SGLT-2is. Methods: A multidisciplinary panel of experts from various medical specialties reviewed the best available evidence on GU AEs associated with SGLT-2i therapy. The panel focused on the prevention and management of genital mycotic infections, urinary tract infections, and lower urinary tract symptoms in both the general population and high-risk groups, such as renal and cardiac transplant recipients. Results: The panel found that permanent discontinuation of SGLT-2is results in a rapid loss of cardiorenal benefits. Preventive strategies, including identifying high-risk patients before initiating therapy, are critical for minimizing GU AEs. Clinical trials show that most GU infections linked to SGLT-2i therapy are mild to moderate in severity and typically respond to standard antimicrobial treatment, without the need for discontinuation. Conclusions: Routine discontinuation of SGLT-2is due to GU AEs is not recommended. Therapy should be resumed as soon as possible, unless severe or persistent conditions contraindicate their use, in order to preserve the significant benefits of SGLT-2is in reducing cardiovascular and renal events.

Investigation of lower urinary system symptoms in patients with isolated posterior compartment prolapsus: a cross-sectional study.

The effects of posterior vaginal wall prolapse on pelvic floor function have not been adequately investigated, particularly for lower urinary tract symptoms (LUTS). We aimed to investigate the effects of isolated posterior compartment prolapse on LUTS. The study was conducted as a PROSPECTIVE: cross-sectional study with female patients with isolated posterior prolapse who presented with any LUTS. All patients were evaluated according to the POP-Q system. A total of 41 patients with stage 2-3 isolated pelvic organ prolapse were included in the study group. The control group consisted of a total of 41 patients without significant pelvic organ prolapse. Study and control groups were compared in terms of demographic data and UDI-6, IIQ-7, ICIQ-FLUTS, LUTS QoL, FLUT Sex scales. The incidence of SUI, UI, frequency, nocturia, abnormal evacuation, difficulty in passage and vaginal farting in the study group was found to be statistically significantly higher than the control group. In the study group, the total scores on the UDI-6, IIQ-7, and LUTS QoL measures were significantly higher. While the total scores of the ICIQ-FLUTS Scale "Filling" and "Incontinence" subgroups were significantly higher in the study group, no significant difference was found in the "voiding" subgroup. There was no statistically significant difference between the two groups in terms of their total FLUT Sex scores. It has been shown that isolated posterior prolapse may be associated with an increase in lower urinary tract system symptoms and a decrease in quality of life.

Laser Application in Surgical Treatment of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a prevalent condition among middle-aged and elderly men, often causing lower urinary tract symptoms (LUTS). Current treatment options encompass watchful waiting, pharmacological therapy, and surgical intervention. Among these, surgical treatment rapidly alleviates LUTS and enhances quality of life, making it the most effective approach for moderate to severe BPH. In recent years, with the rapid development and clinical application of various laser technologies, transurethral resection of the prostate (TURP), once considered the "gold standard," has faced controversies due to its higher surgical morbidity and limitations in treating large prostate volumes. Laser technologies, with their remarkable surgical efficacy, safety, and reduced morbidity, have increasingly gained favor among clinicians. This article primarily delves into the clinical advancements of diode laser minimally invasive technology in BPH treatment, aiming to provide a theoretical basis for clinicians in addressing clinical challenges.

Altieri modified Nesbit corporoplasty for the treatment of penile curvature: Comparison of local anesthesia vs loco-regional anesthesia on the clinical outcomes

Objective: To compare the safety profile and clinical outcomes of Altieri-modified Nesbit corporoplasty using two different anesthesia methods including spinal anesthesia and local anesthesia. Materials and methods: A total of 40 patients with congenital penile curvature (CPC) and Peyronie’s disease (PD) underwent Altieri-modified Nesbit corporoplasty. Group 1 (n = 20) received spinal anesthesia, and Group 2 (n = 20) received local anesthesia. The patients were categorized into age groups (< 30 years, 31-45 years, 46-60 years, and 61-75 years) for analysis. Clinical outcomes, post-operative complications, hospital stay, pain levels, and other parameters were assessed. Results: The results showed that 2 patients (10%) reported postoperative complications, including headache, arterial hypotension, and penile foreskin necrosis from the spinal anesthesia group. Whereas, in the local anesthesia group, 1 patient (5%) reported scar phimosis. Further, post-operative pain was predominantly very mild, with 16 patients (80%) in the spinal anesthesia group and 14 patients (70%) in the local anesthesia group experiencing minimal discomfort. Age did not significantly impact hospital stay, post-operative intestinal disorders, constipation, lower urinary tract symptoms, voiding burning, or dysuria. Conclusions: Spinal anesthesia may lead to more post-operative complications and longer hospital stays compared to local anesthesia. Age does not significantly affect most clinical outcomes but can influence post-operative pain in patients receiving local anesthesia.

Safety and Efficacy of Trospium Chloride and Solifenacin in Stroke-Induced Neurogenic Lower Urinary Tract Dysfunction: A Randomized Controlled Trial.

Neurogenic dysfunction of the lower urinary tract is one of the challenging diseases with high burdens in urology. Our study aims to evaluate the efficacy of a 4-week treatment with Solifenacin and Trospium chloride and assess their safety and impact on quality of life. Following the selection of 206 stroke patients from two centers who met specific eligibility criteria, including a clinical diagnosis of stroke, normal cognitive function, and the presence of lower urinary tract symptoms (LUTS), participants were randomly assigned to receive oral Solifenacin, Trospium chloride, or a placebo. Under the supervision of the Ethics Committee, the baseline characteristics, compliance with medication, and outcomes were monitored, gathered, and analyzed. The majority of participants were male, with a mean age of 67.3, and most had ischemic stroke. The groups had no significant difference in urinary symptoms after stroke. All of the symptoms in the study groups, according to the NBSS questionnaire, were decreased following treatment compared to the baseline (p < 0.05). After treatment, ICIQ-OAB, and ICIQ-LUTS-QOL total scores and bothersome scores decreased significantly compared to baseline (p < 0.001). When compared to the placebo, both Trospium chloride and Solifenacin alleviated symptoms according to the NBSS questionnaire and ICIQ-LUTS-QOL, total ICIQ-OAB, and the total score of ICIQ-OAB-Bothersome. However, the total LUTS-QOL-Bothersome score did not change in the active treatment groups compared to the placebo. While comparing the two drugs, these values were similar except for the total score of LUTS-QOL-Bothersome, ICIQ-OAB, and ICIQ-OAB-Bothersome in favor of the Solifenacin group. Moreover, Solifenacin had fewer side effects compared to Trospium chloride or placebo. The study analyzed 206 stroke patients in two international centers and found both drug arms effective in treating overactive bladder. However, inconsistencies were found in efficacy and safety, necessitating further studies with larger populations. This triple-blind, multicenter, randomized controlled trial was done on 206 stroke patients after getting Ethical Committee approval and registering the project on IRCT (IRCT20160606028304N2).

A real-world evidence study of interhospital variability in the surgical treatment of patients with benign prostatic hyperplasia: the REVALURO study.

Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is a growing condition in males associated with a high clinical, economic and humanistic burden. Several surgical techniques are available for the treatment of LUTS/BPH; thus, the aim of this study was to describe and explore the variability in the use of surgical procedures among Spanish hospitals. The REVALURO was a retrospective, observational study conducted by collecting data from the clinical records of patients with LUTS/BPH aged ≥ 35years, from 5 national reference hospitals, who were surgically treated between 2018 and 2022. Among the 3038 patients who underwent 3084 surgeries, 66% were invasive (2018: 57.5%, 2022: 71.5%), 22% were minimally invasive (MISTs) (2018: 20.7%, 2022: 20.2%) and 12% were highly invasive (2018: 21.8%, 2022: 8.4%). A total of 22.4% of patients' complications, with a maximum incidence of 28.6% (open prostatectomy) and a minimum 0.8% (water vapor thermal therapy (WVTT)] (p < 0.001). The reintervention rate was 1.5% over the study period. The median length of hospital stay after surgery increased from 0days (interquartile range [IQR]: 0) with WVTT to 5days (IQR: 4-8) with open prostatectomy (p < 0.001). Trends in surgical treatment showed that the use of invasive techniques increased, while the use of highly invasive techniques decreased, and the use of MISTs remained constant. However, given the heterogeneity among hospitals, national clinical guidelines and recommendations are needed to guide the decision on which technique should be used and to homogenize the criteria.

Association of Workplace Toilet Access with Urinary Tract Symptoms and Productivity Loss among Female

Abstract Purpose Lower urinary tract symptoms (LUTS) are prevalent among women, affecting not only their physical well-being but also their quality of working life. We investigate workplace toilet access related to LUTS among women in the Korean workforce. Materials and methods An online survey was conducted to determine the demographic characteristics, occupational risk factors, and urinary tract symptoms among employed Korean women. Occupational risk factors included three survey questions on access to toilets at work: A) enduring urinary symptoms at work; B) capability to use the toilet at will during work, and C) needing to use the toilet during work but were unable to. The LUTS were assessed using the overactive bladder symptom score (OABSS) and international consultation on incontinence questionnaire-urinary incontinence short form (ICIQ-SF). Health-related productivity losses (HRPL) were estimated using the work productivity and activity impairment (WPAI) questionnaire for urinary symptoms. Multiple logistic regression was used to determined the association between workplace toilet access and LUTS. In addition, generalised linear regression analysis was performed to assess HRPL according to workplace toilet access. Results Of the 1057 participants, 260 (24.6%) and 294 (27.81%) had overactive bladder and urinary incontinence, respectively. More than 50% reported poor access to toilet. Multiple logistic regression analysis showed that the lower the access to toilets in the workplace, the higher the incidence of LUTS and the higher HRPL. Conclusions Restricted access to toilets at work are associated with poor urinary health and loss of productivity. The results highlight the need for interventions to improve the workplace environment. Key messages • Restricted access to toilets at work are associated with poor urinary health and loss of productivity. • The results highlight the need for interventions to improve the workplace environment.

Analysis of the efficacy of Prostatic Artery Embolization in the treatment of Benign Prostatic Hyperplasia.

To investigate the safety and efficacy of prostatic artery embolization (PAE) in the treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), and to investigate predictors of clinical success of PAE. A retrospective analysis was used to collect 107 patients [median age 81.0 (73.0,85.0)] with BPH-related LUTS treated with PAE from September 2014 to February 2022 in a hospital. Repeated measurement ANOVA was used to compare the efficacy evaluation indicators at different times before and after PAE. Univariate and multivariate analyses were used to identify potential predictors of PAE clinical success and establish the optimal joint prediction model. The Receiver Operating Characteristic curves of the quantitative predictors and multivariate model prediction probability values significantly correlated with clinical success were plotted. Of the 107 cases, 103 (96.3%) successfully underwent PAE. The International Prostate Symptom Score (IPSS) decreased from a baseline mean of 24.94 to 10.19 (P < 0.05) 3 months after PAE, and the mean IPSS at 6 months, 12 months and 24 months was 10.12, 11.30 and 11.86, respectively, which were statistically significant compared with baseline (P<0.05). Predictors of clinical success were greater prostate volume (> 65 ml, P = 0.018), adenomatous-dominant benign prostatic hyperplasia (AdBPH)(P = 0.030), indwelling catheterization due to urine retention (P = 0.028), and bilateral embolization (P = 0.018). PAE was able to significantly improve BPH-related LUTS and the outcome indicators remained stable at long-term follow-up. Preoperative urinary retention catheters, AdBPH, larger prostate volume (> 65ml) and bilateral embolization suggest better clinical efficacy.

Is seated voiding associated with lower urinary tract symptoms, health conditions, or marital status? Findings by age group from the 2023 Japan Community Health Survey.

Seated voiding may be an attempt to obviate voiding dysfunction, improve physical stability during voiding, and prevent messy bathroom contamination. Therefore, we hypothesized that seated voiders had a higher prevalence of lower urinary tract symptoms (LUTS), deteriorating health conditions, and a higher marriage rate than standing voiders. Of the participants from the 2023 Japan Community Health Survey conducted by the Japanese Continence Society, 2936 men (mean age: 53.6 years old) were divided into sitting and standing groups based on their posture when voiding at home. Characteristics of the two groups were compared, and factors associated with seated voiding stratified by age were investigated using multivariable logistic regression analysis. One-thousand six-hundred and sixty men (57%) voided in the sitting position at home, and the proportion of seated voiding decreased with age. On multivariable analysis, comorbidities other than benign prostatic hyperplasia were associated with the standing group aged 40-59, and storage symptoms were associated with the seated group aged 60 and older. Being married was significantly and consistently associated with seated voiding across all ages. Approximately 60% of Japanese men void in the sitting position at home. There are certain differences in the associations of LUTS and health conditions with voiding position by age, while seated voiding is consistently associated with marital status throughout all ages, which implies that sanitation matters.

Fabrication and Optimization of a Silodosin In Situ-Forming PLGA Implants for the Treatment of Benign Prostatic Hyperplasia: In Vitro and In Vivo Study

Objectives: Lower urinary tract symptoms (LUTSs) related to benign prostatic hyperplasia (BPH) are common in older men, and alpha-adrenoceptor blockers continue to be a key part of managing these symptoms. This study aimed to formulate injectable poly (lactic-co-glycolic acid) (PLGA) in situ-forming implants (ISFIs) loaded with silodosin (SLD) to address symptoms associated with BPH. This method, which ensures prolonged therapeutic effects of SLD, is intended to decrease dosing frequency and improve treatment outcomes, leading to better patient adherence. Methods: An appropriate solvent with favorable PLGA solubility, viscosity, and in vitro release profile was selected. Additionally, an I-optimal design was employed as an optimization technique. An in vivo study in albino male rats was conducted to investigate prostate-specific antigens (PSAs), prostate weight and prostatic index, histopathology, and SLD pharmacokinetics. Results: The optimized formulation showed experimental values of 29.25% for the initial burst after 2 h and 58.23% for the cumulative release of SLD after 10 days. Pharmacokinetic data revealed that the SLD–ISFI formulation had lower Cmax and higher AUC values than subcutaneous (SC) pure SLD and oral commercial SLD capsule, indicating the controlled-release impact and improved bioavailability of the ISFI systems. SLD–ISFI produced a marked drop in the prostatic index by 2.09-fold compared to the positive control. Serum PSA level decreased significantly from 0.345 ± 0.007 to 0.145 ± 0.015 ng/mL after SLD–ISFI injection compared to the positive control. Conclusions: This study indicated that the optimized SLD–ISFI formulation proved its efficacy in managing BPH.

Association Between Irritable Bowel Syndrome and Lower Urinary Tract Symptomatology: A Cross-sectional Study in Mexican Population.

This study aimed to investigate the clinical phenotype of urinary symptoms in patients diagnosed with irritable bowel syndrome, the factors associated with this overlap, and the impact of urinary symptoms on their quality of life. Irritable bowel syndrome is a common disorder, affecting up to 3.8% of the population. The overlap with other disorders of the gut-brain interaction, psychiatric disorders, and other somatic disorders is common. Moreover, the association between irritable bowel syndrome and urinary symptoms has been recognized, but the clinical phenotype remains unclear. This cross-sectional study involved patients with irritable bowel syndrome according to Rome IV. Lower urinary tract symptoms were classified using the International Continence Society's classification. Data on demographics, medical history, medication use, anxiety, depression, and quality of life were collected and analyzed using logistic regression analysis. The study included 428 subjects, 86 diagnosed with irritable bowel syndrome. Patients exhibited a higher prevalence of lower urinary tract symptoms (60.5%, 95% CI: 50.5-71.9). Multivariate analysis revealed associations between irritable bowel syndrome and lower urinary tract symptoms (OR: 2.49, 95% CI: 1.48-4.18, P=0.001), particularly storage urinary symptoms (OR: 1.94, 95% CI: 1.10-3.40, P=0.021). Patients with urinary symptoms reported significantly lower quality of life compared with those without these symptoms (50.8±17.2 vs. 76.7±21.8, P<0.001). Irritable bowel syndrome is associated with lower urinary tract symptoms, contributing to a significant reduction in quality of life. Clinicians should consider referring patients with irritable bowel syndrome and lower urinary tract symptoms to experts in urodynamics to provide targeted management.

Prevalence and predictors of detrusor underactivity and bladder outlet obstruction in women with lower urinary tract symptoms

This study aims to present age-stratified prevalence of women with lower urinary tract symptoms (LUTS) but without cystocele and predict detrusor underactivity (DU) or bladder outlet obstruction (BOO). Between 2005 and 2020, we reviewed women who visited the medical center with LUTS but without cystocele. Positive voiding dysfunction (VD) symptoms were defined as any one or more of the positive descriptions of weak urinary stream, intermittency, strain to urination, and sensation of not emptying. A total of 1,886 women were included in this study. 189 (10.0%) women were diagnosed with DU, and 77 (4.1%) women had BOO. Multivariate logistic regression analysis found that voided volume and VD symptoms were independent predictors for BOO. ROC curve analyses could predict BOO by voided volume ≤ 220 mL derived from uroflowmetry and the presence of VD symptoms with an area under a curve of 0.83. Age and voided volume could predict DU with an area under a curve of 0.82. We found a higher percentage of BOO in women with positive VD symptoms. A non-invasive uroflowmetry with voided volume (≤ 220 mL) and the presence of VD symptoms can predict BOO. DU could be predicted by age and voided volume.

Relationship between the risk of atherosclerotic cardiovascular disease and decreased functional bladder capacity.

Cardiovascular diseases (CVD) are among the leading causes of death worldwide. Recently, non-classical risk factors for cardiovascular disease, such as lower urinary tract symptoms (LUTS), have gained attention. Both CVD and LUTS are prevalent among aging populations and share common vascular risk factors. The purpose of this study was to investigate the potential relationship between Atherosclerotic Cardiovascular Disease risk and functional bladder capacity among men with LUTS. This study was conducted on 86 men aged 40-79 with complaints of LUTS who were asked for digital rectal examinations, blood tests on serum total cholesterol and high-density lipoprotein (HDL), and mid-stream urine tests for microscopy and culture. For evaluating patients' LUTS, a 24-h voiding diary was asked. The atherosclerotic cardiovascular diseases (ASCVD) score comprises the patient's current age, sex, race, diabetes mellitus status, smoking status, hypertension status, systolic and diastolic blood pressure, total cholesterol, and HDL levels. According to the ASCVD score, 46 and 40 patients were categorized as low and high risks for cardiovascular diseases, respectively. Based on the FBC, 47 patients had decreased FBC and the rest were normal. According to logistic regression, it was determined that age can be considered a predictive variable for decreased FBC and the lower FBC can be considered as a predictive factor in the high-risk group for cardiovascular diseases (p = 0.002). It seems that decreased FBC is related to a higher predicted cardiovascular event rate in men with LUTS and could be considered a predictor of ASCVD risk.

The Role of 5-Phosphodiesterase Inhibitors (PDE-5I) in Current Benign Prostatic Hyperplasia Treatment: A Narrative Review

Introduction: 5-phosphodiesterase inhibitors (PDE-5I) have been investigated as a treatment for urinary dysfunction for almost a decade. The general perception is that they play a significant role in managing lower urinary tract symptoms (LUTS), particularly those associated with benign prostatic hyperplasia (BPH). However, the specific biochemical processes by which PDE-5I repairs urinary function are still poorly understood and there is little instrumental evidence of significant improvement in urinary symptoms. Therefore, we explore the role of 5-phosphodiesterase inhibitors (PDE-5I) as complementary to the conventional treatment of symptomatic BPH; we provide the suggested biological procedures involved in the association between PDE-5 inhibitor use and improvement in LUTS; and we propose new approaches to this topic. Material and Methods: A systematic search for clinical trials, experimental studies, and systematic reviews was performed in electronic libraries (PubMed, EMBASE, Scopus) using the terms “benign prostate hypertrophy”, “benign prostate hyperplasia”, “lower urinary tract symptoms”, “storage symptoms”, “voiding symptoms”, “bladder outlet obstruction” and the keywords “mechanism of action”, “synergy”, “PDE-5 inhibitor”, “alpha1-adrenergic antagonist”, “5-alpha-reductase inhibitors” in various combinations. There was no restriction on publication date. Results: To date, only a few randomized studies have been published in which the effect of the combination of a conventional drug for the treatment of symptomatic BPH and a PDE-5I was investigated. Almost all showed significant improvement in IPSS and QoL. Some studies showed significant improvements in maximum urine flow (Qmax) and postvoiding residual volume (PVR) with combination therapy compared with a single agent alone. Conclusions: PDE-5I seems effective in relieving symptoms of some BPH patients when administered as complementary to agents currently used to treat BPH. However, the mechanism of action of PDE-5 inhibitors in LUTS remains poorly understood and it is difficult to determine the specific subset of BPH patients who will benefit from the combination of PDE-5 inhibitors with the current treatment. Well-designed, sufficiently informative comparative studies focusing on specific target group profiles (age, urogenital parameters) are needed to define new therapeutic options.

Experimental murine models of interstitial cystitis/bladder pain syndrome: A review.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic enigmatic disease of the urinary bladder characterized by persistent bladder/pelvic pain in conjunction with lower urinary tract symptoms. IC/BPS is categorized as either Hunner-type IC (HIC) or BPS based on the presence/absence of the Hunner lesion, a reddish mucosal lesion in the bladder. HIC and BPS present with similar symptoms, however, the etiologies are completely different. Recent evidence suggests that HIC is an immune-mediated inflammatory disease of the urinary bladder. In contrast, BPS, other forms of HIC lacking Hunner lesions, is a minimally inflamed condition comprising various clinical phenotypes. Based on this evidence, basic research into IC/BPS has shifted to target each subtype of IC/BPS. Today, experimental murine models of autoimmune cystitis are used for HIC research, whereas models related to neurophysiological and psychosocial dysfunctions have been developed for BPS research. This emerging concept of a subtype-tailored approach may contribute to a better understanding of the full picture of IC/BPS, thereby improving current clinical management strategies and the development of novel therapies.

Short-term postoperative recovery for patients after Thulium Laser Vapoenucleation of Prostate: evaluation of the impact of lower urinary tract symptoms on quality of life.

We evaluated short-term postoperative recovery in patients with benign prostatic hyperplasia (BPH), especially focusing on symptoms reduction and life quality enhancement. We prospectively enrolled 160 BPH patients who underwent surgery and were followed up regularly for 12 weeks, collecting the International Prostate Symptom Score (IPSS), Quality of Life (QoL), and Qmax. Regression analysis and mixed effect models were used to evaluate the tendency of symptoms on recovery from the perspective of quality of life. At 12 weeks, all patients recovered well with conspicuous change in IPSS, QoL and Qmax, that were 4.80 ± 4.59, 1.34 ± 1.14,20.02 ± 8.61 mL/s respectively. Voiding symptoms were significantly reduced by 79.4% at 2 weeks, whereas storage symptoms recovered slowly until 12 weeks with residual lower urinary tract symptoms (LUTS), predominantly urinary frequency and nocturia. Improvements in incomplete emptying urination and urinary frequency were significantly associated with QoL. With regards to the comprehensive full-cycle treatment of LUTS patients, in addition to the objective results, more attention should also be focused on the change in following symptoms, that is, incomplete emptying urination, urine frequency and urination difficulty, which play key roles in the enhancement of patients' quality of life.

Relationship Between Lifestyle, Health Factors, and Severity of Lower Urinary Tract Symptoms Amongst Men Living in Southeast Nigeria

Relationship Between Lifestyle, Health Factors, and Severity of Lower Urinary Tract Symptoms Amongst Men Living in Southeast Nigeria

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.