Lower Urinary Tract Symptoms/benign Prostatic Hyperplasia Research Articles

Lowering the percent body fat in the obese population might reduce male lower urinary tract symptoms.

This study aimed to investigate the practicality of percent body fat (PBF), calculated using bioelectrical impedance analysis (BIA), in predicting benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS). This study included 844 men who underwent medical checkups at our institution between 2014 and 2022. Demographic characteristics, serum PSA levels, and prostate volume were collected using TRUS. BPH was defined as a prostate volume ≥ 30cc. Subjects were divided into two groups according to their quartiles of PBF: the normal PBF group (first to third quartile; PBF < 27.9%) and the high PBF group (fourth quartile; PBF ≥ 27.9%). Characteristics between the groups were compared using the chi-square test and Student's t-test. Multivariate logistic regression analysis was performed to evaluate risk factors for BPH and severe LUTS. The prostate volume (25.21 ± 8.4 vs 27.30 ± 9.0, p = 0.005) and percentage of BPH (22.9% vs. 32.1%, p = 0.007) were greater in the high PBF group. After multivariate analysis, old age (OR = 1.066, p < 0.001), higher appendicular skeletal muscle mass index (ASMI) (OR = 1.544, p = 0.001), and PBF ≥ 27.9% (OR = 1.455, p = 0.037) were risk factors for BPH. Larger prostate volume (OR = 1.035, p = 0.002) and PBF ≥ 27.9% (OR = 1.715, p = 0.025) were risk factors for severe LUTS. However, a greater ASMI had a protective effect against severe LUTS (OR = 0.654, p = 0.011). This study shows that PBF and ASMI are useful for predicting BPH/LUTS. We suggest that lowering PBF to the normal range in a population with high PBF might prevent BPH, while lowering PBF and maintaining adequate ASMI could lower LUTS.

Prostatic arterial embolization versus holmium laser enucleation of the prostate: 1-year outcomes.

Holmium Laser Enucleation of the Prostate (HoLEP) and Prostatic Artery Embolization (PAE) are novel techniques for the treatment of benign prostatic hyperplasia lower urinary tract symptoms (BPH-LUTS). The objective of this study was to describe and compare the functional results and complications of these two techniques at one year follow-up. We performed a retrospective, monocentric study of all patients consecutively treated in our center with HoLEP or PAE for symptomatic or complicated BPH between January 2016 and December 2019. Data regarding patient and perioperative characteristics, follow-up biological results, functional questionnaires and uroflowmetry were collected from medical records. A total of 490 and 57 patients were treated with HoLEP and PAE, respectively. The demographic and clinical characteristics of the two groups were similar. The operative time was significantly higher for PAE (p < 0.001) and hospitalization time longer after HoLEP (p = 0.0006). The urinary catheterization time was longer after PAE (p < 0.001). The prostatic volume treated was higher with HoLEP than with PAE (56% versus 26%, p < 0.001). The mean difference in IPSS from baseline to 12months was significantly higher after HoLEP than after PAE: - 17.58 versus - 8 (p < 0.001). The mean difference in QoL-IPSS from baseline to 12months was significantly higher after HoLEP: - 4.09 versus - 2.27 (p < 0.001). The rate of postoperative adverse events in the first three months was similar between the two groups:35% after HoLEP and 33% after PAE (p = 0.88). HoLEP and PAE both significantly improved BPH-LUTS, with HoLEP having an advantage over PAE.

Homoeopathic treatment for lower urinary tract symptoms in men with benign prostatic hyperplasia: an open randomized multicentric placebo controlled clinical trial

Homoeopathic treatment for lower urinary tract symptoms in men with benign prostatic hyperplasia: an open randomized multicentric placebo controlled clinical trial

Effect of systemic atherosclerosis on overactive bladder symptoms in men with benign prostatic hyperplasia.

Symptoms of male overactive bladder (OAB) may be caused by several systemic pathophysiological factors rather than a single-source etiology. We investigated the clinical factors associated with the severity of OAB symptoms in treatment-naïve men with coexisting benign prostatic hyperplasia. We obtained records from a health promotion center database of male patients who visited between March 2019 and February 2020. Men without a history of treatment for lower urinary tract symptoms were evaluated using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, transrectal ultrasonography, medical history, and carotid duplex ultrasound for the evaluation of atherosclerosis. Benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) was defined as an IPSS of eight points or higher. Patients with comorbidities that may affect their voiding function were excluded. A total of 764 patients were divided into two groups based on their diagnosis: an OAB group and a non-OAB group. The non-OAB group consisted of 627 patients (82.1%) and the OAB group consisted of 137 patients (17.9%). Using multivariable analysis BPH/LUTS was identified as an independent risk factor for OAB. In the OAB group without BPH/LUTS, carotid atherosclerosis was significantly associated with the severity of OAB symptoms. A history of diabetes mellitus was the only variable that was associated with the severity of urinary urgency. Systolic blood pressure was associated with severity of urinary urgency in the OAB group with BPH/LUTS. Factors associated with male OAB exhibit different pathophysiology in the severity of symptoms depending on the presence of BPH/LUTS. Treatment for atherosclerosis and associated systemic pathophysiological factors could lower OAB symptom severity in male patients without BPH/LUTS.

Prospective Comparative Study between Silodosin 8 mg Versus Combination of Tadalafil 5mg and Silodosin 4mgfor treatment of Lower Urinary Tract Symptoms related to Benign Prostatic Hyperplasia

Background:In men, lower urinary tract symptoms (LUTS) are associated with benign prostatichyperplasia (BPH). Therapeutic options aim to relax prostate smooth muscle and/or reduce prostate enlargement. Objectives:To evaluate the efficacy of Silodosin 8 mgalone versus the combinationof Tadalafil 5mg and Silodosin 4 mgfor treatment of LUTS related to BPH. Patients and methods: About 203 patients with LUTS of BPH who completed the study up protocolpresented to our department classified into two groups group A (101 patients) received Silodosin 8 mg, group B (102 patients) received the combination of Tadalafil 5mg and Silodosin 4 mg. All results recorded and analyzed with Statistical Package for Social Science® (SPSS) and Microsoft Excel 2010. Results: The IPSS, QOL, IIEF score, Q-max and PVR showed significantly greater improvement in the combination of Tadalafil 5mg with Silodosin 4mg than monotherapy of Silodosin 8mg. Conclusions:Despite Silodosin 8mg is well-tolerated and effective treatment option in men with LUTS of BPH, butthe combination of tadalafil 5m and Silodosin 4mg is more effective and feasible for these patients.

The safety and feasibility of the simultaneous use of 180-W GreenLight laser for prostate vaporization during concomitant surgery.

To explore the safety and feasibility of photo-selective vaporization of the prostate (PVP) with GreenLight XPS 180 Watt laser (GL-180- W XPS) combined with other surgical procedures. Data on patients in whom GL-180-W XPS was performed to relieve lower urinary tract symptoms/ benign prostatic hyperplasia (LUTS/BPH) symptoms were extracted from a multi-institutional database (2011-2016). Patients were stratified into two groups. In the first all patients who had GL-180-W XPS with a concomitant procedure during the same surgical session were included as cases while those who underwent GL-180-W XPS PVP only were included as control. A total of 487 patients were included. Fifty-eight (11.9%) patients underwent concomitant procedures. Multivariable linear regression models failed to find an association between concomitant procedures and longer laser time (p = 0.4). Similarly, multivariable linear regression models failed to find an association between concomitant procedures and laser time even when the analyses were repeated and stratified into endoscopic (p = 0.6) and open/laparoscopic (p = 0.4) procedures. Multivariable logistic regression models failed to demonstrate any association between concomitant procedures and early complications (OR:1.39, CI: 0.379-2.44, p = 0.2), late complications (OR:1.84, CI:0.78-3.98; p = 0.1) and acute urinary retention (OR:1.84, CI:0.78-3.98; p = 0.1). When the analyses were repeated and the concomitant procedures stratified into endoscopic and open/laparoscopic ones, they yielded virtually the same results. GL-180-W XPS PVP could be safely performed in concomitant endoscopic or open/laparoscopic surgery. These results should be taken into consideration in the counseling of the patient who might choose to undergo simultaneous procedures.

PMD27 Cost Comparison of Surgical Interventions to TREAT Lower Urinary TRACT Symptoms (LUTS) Secondary to Benign Prostatic Hyperplasia (BPH) in the UK, Sweden, and South Africa

BPH is a common condition in ageing men that can negatively impact quality of life. Surgical management is indicated when medical management is no longer effective. We compared the overall cost and capacity benefit of available surgical interventions for the relief of LUTS in BPH in three countries considering the post-COVID19 “new normal”. A recently published Markov model developed from a UK NHS perspective and used in NICE MTG49 was adapted to the Swedish and South African healthcare perspectives. Patients entered the model having a surgical procedure before transitioning to one of four health states, defined by whether patients suffer from one, both or none of the long-term complications captured in the model, namely urinary incontinence or erectile dysfunction. Surgical retreatment, complications and procedure-related resource use was also considered. Surgical interventions included Water Vapor Thermal Therapy (WVTT), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Holmium Laser Enucleation of the Prostate (HoLEP) and current standard of care, Transurethral Resection of the Prostate (TURP). Due to local practice differences, not all technologies were modelled in all geographies. In the UK, using a 4-year timeline, PVP and WVTT were associated with lowest costs (£2,421 and £2,466 respectively), followed by PUL (£2,994), TURP (£3,098) and HoLEP (£3,120). In Sweden, PVP was associated with lower costs (38,638kr) than TURP (39,801kr). In South Africa, WVTT was associated with lower costs (R58,882) than TURP (R82,939). WVTT, PUL and PVP had shorter procedure times (17.5-30, 30, 49.6 minutes, respectively) compared to TURP (66-90 minutes) and did not require hospitalization. Cost reductions were driven by shorter procedure durations and length of stay. WVTT and PVP were the joint lowest cost interventions over 4-years. Day-case procedures are of particular relevance in a post-COVID19 landscape.

Lower urinary tract symptoms-Benign prostatic hyperplasia may increase the risk of subsequent inguinal hernia in a Taiwanese population: A nationwide population-Based cohort study.

It has been suggested that lower urinary tract symptoms-benign prostatic hyperplasia (LUTS-BPH) may be a risk factor for inguinal hernia (IH). The aim of this study was to examine the emergence of a subsequent IH diagnosis in men with and without LUTS-BPH. From a database derived from the National Health Insurance Program covering 99% of the population in Taiwan, 22,310 men with LUTS-BPH and 22,310 matched men without LUTS-BPH were identified and followed for IH from 1997 to 2013. Both IH and LUTS-BPH were defined by the ninth revision of the International Classification of Diseases code (ICD9). Subjects younger than 20 years of age and with IH diagnosed before the index date were excluded. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) for subsequent IH, controlling for potential confounders. Men with and without LUTS-BPH had similar age and comorbidity distributions. During the 10 years of follow-up, 1,303 (5.84%) men with LUTS-BPH and 735 (2.53%) men without LUTS-BPH developed IH. The mean time to IH was 4.02 years and 4.44 years, respectively. After adjusting for age and comorbidities, LUTS-BPH was associated with a two-fold increased risk of IH (HR:2.25, 95% CI = 2.04-2.49). This nation-wide population-based cohort study showed that LUTS-BPH increased the risk of subsequent IH in a Taiwanese Population.

The effects of statins on benign prostatic hyperplasia and the lower urinary tract symptoms: A Meta-analysis.

The aim of this meta-analysis was to understand the relationship between statin with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). A systematic literature search was conducted using PubMed, Embase, Cochrane Library, Chinese Medical and Biological Literature Database, China HowNet, Vip, and Wanfang. We calculated pooled odds ratios (OR) and 95% CI and standardized mean difference (SMD). Using Stata 12.0 and Review 5.3 for meta-analysis. This meta-analysis included 11 articles and 49,128 participants. Results show statins could not reduce the incidence of BPH [OR = 0.77 (0.57, 1.03, P = .08]. For patients over 60 years old, statins could reduce the incidence of BPH [OR = 0.35 (0.22, 0.55), P < .0001]. Statins can slow down the progression of LUTS in BPH [SMD = -0.32 (-0.54, -0.10), P = .004], but there is no significant correlation between them in patients taking drugs for less than 1 year. Statins have no significant effect on the incidence of BPH, but statins can reduce the risk of BPH for patients over 60 years old. For patients with hyperlipidemia, the duration of medication is more than 1 year, which can slow down the progression of LUTS. However, more high-quality and large sample size studies are needed to further improve and verify.

PO-01-077 The effects of testosterone treatment on fat tissue dysfunction and nonalcoholic fatty liver disease in obese men undergoing bariatric surgery

Substitution treatment of hypogonadism in clinical and experimental models has shown beneficial effects on insulin sensitivity and accumulation of visceral and liver fat. Aim of the study was to analyze the effects of testosterone replacement therapy on benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) clinical parameters, adipose tissue dysfunction and nonalcoholic fatty liver disease (NAFLD) in obese patients candidates for bariatric surgery. Patients were divided into three groups: eugonadal, untreated hypogonadal and symptomatic hypogonadal treated for 6-8 months with testosterone. BPH/LUTS parameters were assessed by IPSS (International Prostate Symptom Score) and prostate ultrasound. Preadipocyte cells (hPADs) isolated from adipose tissue biopsies were used to evaluate insulin sensitivity, adipogenic potential and mitochondrial function. NAFLD was evaluated by triglycerides (TG) assay and histological examination of liver biopsies. Clinically, notwithstanding a prostate volume increase, testosterone treatment improved the IPSS score and hyperemia. Liver TG levels correlated positively with both steatosis and NAS scores, and resulted significantly higher in hypogonadal patients when compared to eugonadal patients, with testosterone treatment significantly reducing TG levels. In the liver, testosterone treatment induced an increased mRNA expression of lipid metabolism markers, whereas in visceral adipose tissue it induced an increased mRNA expression of lipid catabolism and mitochondrial biofunctionality markers. In hPADs testosterone treatment induced an increased mRNA expression of brown adipogenesis and mitochondrial biofunctionality markers. Testosterone treatment normalized hPADs ability to respond to increasing concentrations of insulin. Accordingly, glucose uptake AUCs showed a positive correlation with testosterone levels. Hypogonadal hPADs mitochondria displayed a lower average length and a superoxide generation increase, compared to eugonadal, with testosterone treatment normalizing both parameters.

EFFECTIVENESS AND SAFETY OF TADALAFIL IN VERY ELDERLY PATIENTS WITH LOWER URINARY TRACT SYMPTOMS

(Aim) The α-1 blockers have been used as first-line therapy for benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS). A new phosphodiesterase type 5 inhibitor, tadalafil, was approved in 2014 and received a Grade A recommendation in the 2017 clinical practice guidelines for LUTS. In this study, we examined the effectiveness and safety of tadalafil in very elderly patients with LUTS. (Subjects and methods) The subjects were 84 very elderly patients, at least 75 years of age, with BPH/LUTS for which they had been administered tadalafil.Data of the 71 patients were retrospectively reviewed in terms of the International Prostate Symptom Score (IPSS), quality of life (QOL) index, overactive bladder symptom score (OABSS), maximum flow rate and postvoid residual urine volume at baseline and at weeks 4, 8, 12, and 24. We also examined the safety of tadalafil therapy. (Results) Patient characteristics were: median age 80.1±4.38 years, prostate volume 41.2±24.3 cc and IPSS 15.7±5.68. Patients who had undergone treatment for BPH/LUTS prior to tadalafil therapy accounted for 67.9% of the study population.Significant improvements occurred in IPSS, QOL and OABSS at week 4, and the improvements were maintained until week 24. As for postvoid residual urine test results, a significant improvement was seen at week 8 only.Adverse events were noted in 9 patients (10.7%), but only 5 (6.0%) needed to discontinue tadalafil therapy. (Conclusion) Tadalafil is considered to be a highly effective and safe drug in very elderly patients with LUTS.

Aquablation among novice users in Canada: A WATER II subpopulation analysis.

Surgical management options for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) associated with prostates of small to moderate volume (<80 cc) are numerous; however, for men with enlarged prostates (>80 cc), many of these options are neither safe nor effective. Recently, Aquablation (PROCEPT BioRobotics, Inc., U.S.), a precise ultrasound-guided, robotically executed prostatic ablative procedure, has become available with U.S. Food and Drug Administration approval. Herein, we present three-month safety and efficacy data from the cohort of Canadian men included in the WATER II trial. WATER II is a prospective clinical trial of the Aquablation system for the treatment of BPH in men with prostate volumes between 80 and 150 cc. Only patients from Canada were included for this analysis. At baseline, subjects completed International Prostate Symptom Score (IPSS), as well as several validated questionnaires, uroflowmetry and post-void residual volume measurements, and underwent standard laboratory blood assessment. These were repeated at one and three months post-Aquablation. A total of 19 subjects who met inclusion and exclusion criteria were enrolled at three Canadian academic sites. Mean pre-, one-month, and three-month post-treatment IPSS scores were 21.2±5.5, 9.9±6.9 (p<0.0001), and 5.0±4.5 (p<0.0001), respectively. Mean pre-, one-month, and three-month post-treatment maximum urinary flow rates (Qmax) were 6.6±3.1 ml/s, 19.5±6.1 ml/s (p<0.0001), and 23.1±9.2 ml/s (p<0.0001), respectively. The Clavien-Dindo grade 2 or higher event rate at three months was 31.6% (six events). In this short-term, three-month analysis of Canadian men, Aquablation appears to provide a strong surgical alternative in patients with LUTS/BPH due to larger prostate volumes, with impressive functional outcomes, relatively short operative time and length of hospital stay, and acceptable complication and low transfusion rates.

Effects of a single dose 20 mg tadalafil on resistive index value of prostate zones

Objectives: Although there are several studies addressing the efficacy of phosphodiesterase type 5 inhibitors for the management of benign prostatic hyperplasia-lower urinary tract symptoms (BPH-LUTS), unfortunately, there is a lack of high evidence data to support their effect at the prostate level. The existing studies suggested that resistive index (RI) could be used as a hemodynamic parameter to measure the severity of benign prostatic hyperplasia and intraprostatic pressure or bladder outlet obstruction. The aim of this study was to evaluate the effect of a single dose 20 mg tadalafil on resistive index value in prostate zones to evaluate the mechanism of action of phosphodiesterase type 5-inhibitors at the prostate level. Methods: Twenty consecutive patients aged between 54-67 years with BPH-LUTS [International Prostate Symptom Score ≥ 12] and erectile dysfunction [five-item International Index of Erectile Function (IIEF) questionnaire &amp;lt; 22] underwent RI measurement in prostate transitional zone (TZ) and peripheral zone (PZ) using transrectal power Doppler ultrasonography baseline and within 16 hours after the administration of 20 mg tadalafil. The primary study end point is the change in prostate TZ RI values. Results: The mean baseline total prostate scores and peak urinary flow were 16.2 ± 4.34 (range: 12-26) and 10.45 ml/s (range: 7-13 ml/s), respectively. The mean baseline total IIEF was 12.8 ± 4.22 (range: 6-20). The mean TZ RI at baseline and after tadalafil administration were 0.4985 and 0.5497, respectively (p = 0.232). No statistically significant differences for RI changes between baseline and after the administration of a single dose 20 mg tadalafil were observed in the prostatic zones. Conclusion: A single dose 20 mg tadalafil showed no impact on prostate TZ RI.

Factors affecting the efficacy and safety of phosphodiesterase 5 inhibitor and placebo in treatment for lower urinary tract symptoms: meta-analysis and meta-regression.

We aimed to investigate the real benefit and safety of phosphodiesterase 5 inhibitor (PDE 5I) for benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) by determining the affecting factors and to overcome the previous meta-analysis studies. We conducted a systematic review of improvements in LUTS using International Prostate Symptom Score (IPSS), voiding subscore of IPSS (voiding IPSS), storage subscore of IPSS (storage IPSS), quality of life (QoL), maximal urinary flow rate (Qmax), and post-voided residual volume (PVR), and also investigated adverse events and relevant withdrawal rate. Final included studies were 28 studies with 19,820 subjects (9800 treatment group and 10,020 control group). The overall weighted mean differences of total IPSS, voiding IPSS, storage IPSS, and QoL showed significant improvement. Single placebo group showed significant improvement in all outcomes except PVR. The weighted prevalence of overall withdrawal rate and adverse event-specific withdrawal rate was 10 and 3%, respectively. Meta-regression showed that baseline IPSS, dosage of PDE 5I, and country affect clinical improvement compared with placebo. This study clarifies the efficacy of PDE 5I on treatment of BPH/LUTS as an initial treatment strategy. However, baseline IPSS, dosage of PDE 5I and country affected the clinical improvement. Moreover, adverse event-specific withdrawal rate was not as high as suspected based on the overall withdrawal rate.

Safety and efficacy of tamsulosin, alfuzosin or silodosin as monotherapy for LUTS in BPH - a double-blind randomized trial.

IntroductionCurrently alpha1-adrenoceptor blockers (AB) are widely used as first-line therapy to improve lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). We compared the efficacy and safety profile of tamsulosin, alfuzosin and silodosin in LUTS due to BPH.Material and methodsConsecutive consenting male patients (N = 269) undergoing medical management of BPH with AB from February 2012 to October 2015 were enrolled. Patients were randomized to a 0.4 mg tamsulosin (group T), 10 mg alfuzosin (group A) or a 8 mg silodosin (group S) by double-blind randomization. All patients were assessed for improvements and post-void residual urine (PVR) and for adverse drug events (ADE).ResultsIPSS showed significant improvement in Group S at the first week (11.7 ±4.18, p = 0.027) and at 3 months (7.97 ±3.84, p = 0.020). QOL showed significant improvement at 1 (2.2 ±0.76, p = 0.020), 4 (1.47 ±0.63, p <0.001) and 12 (1.2 ±0.66, p <0.001) weeks in Group S. The mean Qmax improvement was the maximum (13.76 ±2.44, p = 0.028) in Group S at 1 week. Reduction in PVR was the maximum in Group S, but it was not statistically significant. Adverse drug events (ADE) were observed in 20.07% (54/269) patients and distribution was similar in the three groups with decreasing incidence with progression of time.ConclusionsSilodosin is the most efficacious AB with rapid onset of action. Silodosin also improves the quality of life in patients with LUTS due to BPH and objectively improves maximum flow rate. However, silodosin has more adverse events when compared to tamsulosin and alfuzosin.

MP13-18 IMPACTS OF APOLIPOPROTEIN A-1 AND ALPHA-FETOPROTEIN ON THE DEVELOPMENT OF BENIGN PROSTATIC HYPERPLASIA AND LOWER URINARY TRACT SYMPTOMS: RESULTS FROM A HIGH-VOLUME HEALTH CHECK-UP DATABASE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation1 Apr 2017MP13-18 IMPACTS OF APOLIPOPROTEIN A-1 AND ALPHA-FETOPROTEIN ON THE DEVELOPMENT OF BENIGN PROSTATIC HYPERPLASIA AND LOWER URINARY TRACT SYMPTOMS: RESULTS FROM A HIGH-VOLUME HEALTH CHECK-UP DATABASE Kwang Suk Lee, Kyo Chul Koo, Do Kyung Kim, Jongsoo Lee, Jong Won Kim, Jae Yong Jeong, Sung Ku Kang, and Byung Ha Chung Kwang Suk LeeKwang Suk Lee More articles by this author , Kyo Chul KooKyo Chul Koo More articles by this author , Do Kyung KimDo Kyung Kim More articles by this author , Jongsoo LeeJongsoo Lee More articles by this author , Jong Won KimJong Won Kim More articles by this author , Jae Yong JeongJae Yong Jeong More articles by this author , Sung Ku KangSung Ku Kang More articles by this author , and Byung Ha ChungByung Ha Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.461AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate the reference ranges for prostate volume (PV) and annual PV change rate, and to clarify the risk factors for the development of benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) in healthy Korean men. METHODS A total of 11,222 healthy men who received transrectal ultrasonography at our hospital for a routine health check-up were included. Those with prior biopsies or surgery for prostate disease, or with BPH medication were excluded. BPH/LUTS was defined as International Prostate Symptom Score (IPSS)≥8 points and PV ≥30 mL. RESULTS The prostate-specific antigen (PSA) level, PSA density, PV, transitional zone volume (TV), and transitional zone index (TZI) increased significantly with age. The annual PV growth rate was 0.48 cm3/year. Body mass index, PSA, basal metabolism, fat mass, apolipoprotein A-1, high-density lipoprotein, aspartate aminotransferase, creatine, and urine pH were statistically associated with PV. PSA, fat mass, apolipoprotein A-1, creatine, and urine pH were significant predictive factors for both PV and TV. For men aged >40 years without prostate cancer history and treatment for BPH/LUTS, TZI (Hazzad ration (HR) =1.02, p = 0.001), total IPSS (HR = 1.04, p = 0.004) and alpha-fetoprotein (AFP) (HR = 0.86, p=0.040) were significant risk factors for the development of BPH/LUTS within 5 years. CONCLUSIONS This study showed that the TZI, total IPPS, and AFP were the major factors for the development of BPH/LUTS within 5 years in healthy Korean men. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e160-e161 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kwang Suk Lee More articles by this author Kyo Chul Koo More articles by this author Do Kyung Kim More articles by this author Jongsoo Lee More articles by this author Jong Won Kim More articles by this author Jae Yong Jeong More articles by this author Sung Ku Kang More articles by this author Byung Ha Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

CORRELATION BETWEEN PCAR WITH IPSS SCORE, QMAX, AND POST VOIDING RESIDUAL URINE AND ITS CUT-OFF VALUE IN DETERMINING BOO IN PATIENTS WITH BPH LUTS

Objective: This study was conducted to determine the correlation between Presume Circle Area Ratio (PCAR) and IPSS score, Qmax, and post voiding residual urine (PVR) and to find PCAR cut-off value in determining the presence Bladder Outlet Obstruction (BOO) in Benign prostatic hyperplasia (BPH) Lower Urinary Tract Symptoms (LUTS). Materials &amp; Methods: This study was observational analytic study with 30 BPH LUTS patients as subjects during the period September 2015 to January 2016. The determined variables were PCAR, IPSS score, Qmax, post voiding residual urine (PVR) and analyzed using the SPSS program v21. Results: There were 30 patients who met the inclusion and exclusion criteria with the mean age of 67.47 years. In the correlation test, there was insignificant correlation between PCAR with IPSS (r=0.138, p=0.467), a significant correlation between PCAR with Qmax (r=0.468, p=0.009), PCAR with PVR (r=0.399, p=0.029), PCAR with BOO (r=0.491, p=0.006) PCAR cutoff value is 0.65 with sensitivity of 69% and specificity of 71%. Conclusion: PCAR has a significant correlation with PVR, Qmax and BOO but no significant with IPSS score. PCAR value &gt;0.65 indicating BOO in BPH LUTS. PCAR can be used as an alternative non-invasive examination in determining the existence of BOO.

Assessment of noninvasive predictors of bladder detrusor underactivity in BPH/LUTs patients.

To retrospectively assess the diagnostic predictive value of clinical characteristics to improve the diagnostic accuracy of bladder detrusor underactivity (DU) among benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) patients who cannot undergo urodynamic examinations. A total of 704 BPH/LUTS patients at Tianjin Medical Union Center from January 2013 through June 2016 were enrolled in the study. All cases were stratified by maximum detrusor pressure (Pdet.max) into two groups (DU and control). Patient and clinical variables were analyzed in both groups. One hundred twelve and 592 cases were classified into the DU and control group, respectively. PV (OR 0.976, 95% CI 0.961-0.991, P=0.002) and PVR (OR 1.004, 95% CI 1.001-1.007, P=0.004) were independent predictors of DU. In addition, Pdet.max was positively correlated with HTN (≥10years) (r=0.373, P=0.001), smoking (r=0.108, P=0.039), IPSS (20-23) (r=0.257, P=0.013), PV (r=0.305, P<0.001), PSA (1-2.2ng/mL) (r=0.428, P=0.002), PSAD (0-0.02) (r=0.430, P=0.02), and Q max (≤4mL/s) (r=0.372, P<0.001), and inversely correlated with age (>76years) (r=-0.265, P=0.015), BMI (21-23) (r=-0.382, P=0.001), DM (0-20years) (r=0.365, P=0.009) and PVR (50-400mL) (r=0.423, P=0.001). The AUCs for BMI, PV, tPSA, PSAD, Q max, and PVR were 0.762, 0.739, 0.727, 0.681, 0.749, and 0.716, respectively. Combined ROC analysis showed the AUC for PV+PVR was 0.774 with sensitivity of 77.78% and specificity of 73.68%. Clinical factors were effective for predicting DU and could help improve the diagnostic accuracy for BPH/LUTS patients who cannot undergo urodynamic examinations.

Correlation between international prostate symptom score and uroflowmetry in patients with benign prostatic hyperplasia.

To determine the correlation between severity of symptoms using the International Prostate Symptom Score (IPSS) and uroflowmetry in patients with lower urinary tract symptoms-benign prostatic hyperplasia (LUTS-BPH). We prospectively collected data from 51 consecutive men, who presented with LUTS-BPH at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, from January 2012 through December, 2014. Symptom severity was assessed using the self-administered IPSS questionnaire. We also performed uroflowmetry using the Urodyn 1000 (Dantec, serial no. 5534). The mean age of the patients was 67.2 ± 9.7 years (range 40-89 years). The most common presenting IPSS-LUTS was nocturia (100%) followed by urinary frequency (98%), straining (92.0%), weak stream (84.3%), urgency (41.2%), incomplete voiding (39.2%), and intermittency (35.3%) Most of the patients had moderate symptoms (58.8%) on IPSS with a mean value of 13.5 ± 3.0. The mean Qmax was 15.6 ± 18.7 mL/s and the mean voided volume was 193.0 ± 79.2 mL. About one-third of the patients (39.2%) had an unobstructed flow pattern based on Qmax. Correlation analysis showed a weak correlation between IPSS and voiding time (r = 0.220, P > 0.05), flow time (r = 0.128, P > 0.05), and time to maximum flow (r = 0.246, P > 0.05). These correlations were not significant (P > 0.05). IPSS showed a negative correlation with maximum flow rate (r = 0.368; P < 0.0075), average flow rate (-0.203, P > 0.05), and voided volume (r = -0.164, P > 0.05). This negative correlation was significant for maximum flow rate. Correlation between IPSS and Qmax was negative but statistically significant. This implies that an inverse relationship exists between IPSS and Qmax, and remains the only important parameter in uroflowmetry. There was no statistically significant correlation between IPSS and the other variables of uroflowmetry.

Short-term effect of tamsulosin and finasteride monotherapy and their combination on Nigerian men with benign prostatic hyperplasia

Objective:The objective of this study was to assess the efficacy of tamsulosin and finasteride monotherapies, and their combination in men with benign prostatic hyperplasia (BPH).Materials and Methods:This is a prospective single-blind randomized study of ninety men with BPH who were managed using drugs. The International Prostate Symptom Score (IPSS), peak urinary flow rate, and prostate volume were measured as parameters for assessment at the beginning, 3 months, and 6 months of the study.Results:The mean age of patients was 61.65 with a range of 44–81 years. There was a progressive and sustained improvement in the IPSS score in all patient groups with mean decrease at 3 months of 7.24 (42.59%), 7.60 (41.85%), and 7.24 (40.61%) and at 6 months of 8.14 (47.88%), 10.33 (56.88%), and 11.1 (62.25%) in the tamsulosin, finasteride, and combination groups, respectively. There was an increase in peak urinary flow rate in all groups with mean increase at 3 months of 0.98, 0.05, and 3.55 (ml/s) and at 6 months of 4.11, 0.87, and 3.74 (ml/s) in the tamsulosin, finasteride, and combination groups, respectively. There was a reduction in the prostate volume in the finasteride and combination groups at 6 months of 6.8 and 6.32 cm3, respectively, while the tamsulosin group recorded an increase.Conclusion:At the end of 6 months, tamsulosin monotherapy and combination therapy appear to be equally effective in the treatment of lower urinary tract symptoms BPH while finasteride monotherapy appears to be the least effective. Bothersome, side effects were more in patients taking finasteride alone or as combination therapy.