Lower Urinary Tract Symptoms Research Articles

Assessment of lower urinary tract symptoms 6 weeks after delivery and the relationship of pelvic floor muscle function

BackgroundStudies on lower urinary tract symptoms (LUTS) in women, especially in relation to different modes of delivery, are limited. The relationship between the emergence of LUTS and the decline of pelvic muscle function after childbirth remains uncertain.Study designThis observational study was carried out at the Peking University First Hospital over a time span of 2019–2022. A total of 2,462 women were recruited and surveyed 6 weeks after delivery, utilizing questionnaires for data collection. Additionally, gynecological physical examinations and pelvic floor muscle screenings were conducted as part of the study. To assess individual LUTS and the level of discomfort caused by these symptoms, a modified Chinese version of the Bristol Female Lower Urinary Tract Symptoms questionnaire was employed. Data analysis methods such as descriptive statistics, χ2 tests, one-way ANOVAs, and multivariate logistic regressions were used to thoroughly examine the collected data.ResultsA high prevalence of LUTS was observed in the study participants, with 70.6% experiencing any symptoms. Storage symptoms were reported by 65.4%, while voiding symptoms were reported by 23.0%. Nocturia was the most commonly reported symptom (35.4%), followed by frequency (25.6%) and urgency (25.3%). Stress urinary incontinence (SUI) was reported by 20.8% of women. Interestingly, nocturia and frequency were generally perceived as less troublesome, with only a minority rating them as problematic. In contrast, urinary incontinence (UI) was frequently reported as highly bothersome, with SUI and urge urinary incontinence (UUI) accounting for significant proportions. Vaginal delivery (VD) and forceps delivery (FD) were identified as significant predictors of LUTS, with statistical significance observed (P < 0.05). Specifically, women who underwent VD, particularly FD, exhibited lower surface electromyography (sEMG) activity compared to those who had cesarean section (CS), both in terms of resting baseline and contraction amplitude (P < 0.001).ConclusionsOver half of the examined women exhibited LUTS 6 weeks postpartum, with the most common symptoms being nocturia, frequency, urgency, and SUI. Straining and urinary incontinence were commonly reported as significantly uncomfortable, particularly severe in cases of UI. Additionally, vaginal delivery methods, especially those involving the use of forceps (FD), seemed to be more likely to cause pelvic floor muscle or nerve damage, making it the key predictor of storage-related LUTS.

Validated questionnaires for the assessment of Italian patients with pelvic floor dysfunctions: a systematic review.

Pelvic floor dysfunctions (PFDs) have a complex, multifactorial pathophysiology that impacts women's health and must be identified to provide the most appropriate care and treatment. Therefore, symptom and quality of life (QoL) questionnaires, briefly identified as patient-reported outcomes (PROs), have been developed. Despite the large number of questionnaires available for the assessment of PFDs and QoL-related issues in English, few of them have been validated for the Italian language. The aim of this article is to systematically review the literature on Italian-language validated PROs for PFDs assessment, along with practical information on literature references and suggestions on how to obtain each individual questionnaire. A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was performed up to 1 March 2024. PubMed/MEDLINE databases and websites were used to identify validated questionnaires in Italian language for PFDs. Once identified, the possibility of obtaining a copy of the questionnaire was checked, and the steps to obtain one are given in the text. Thirty-five Italian-validated questionnaires were included: 17 out of 35 (48.6%) questionnaires focused on Lower urinary tract symptoms, 1 (2.8%) on genital prolapse symptoms, 8 (22.8%) on sexuality, 3 (8.6%) on bowel symptoms and 6 (17.2%) on pelvic dysfunctions. The literature search turned up seven more Italian PRO validation papers than the previous review. Specifically, the newly validated PROs include: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), Sexual Desire and Erotic Fantasies (SDEF) Questionnaire, Sexual Inhibition/Sexual Excitation Scales (SIS/SES), 12-Item Sexual Distress Scale (SDS) and 5-Item Sexual Distress Scale-Short Form (SDS-SF), Vaizey and Wexner and fecal incontinence severity index (FISI) questionnaires, Pelvic Floor Distress Inventory (PFDI-20) questionnaire, Intermittent Catheterization Acceptance Test (I-CAT). This systematic review is intended to be a tool to promote the adoption of appropriate PROs when studying PFDs in Italian patients.

Artesunate remarkably alleviates interstitial cystitis/bladder pain syndrome in a murine model: Novel molecular signature deciphered by bulk tissue and single-cell transcriptomic analysis.

Interstitial cystitis/bladder pain syndrome is a chronic pain syndrome of elusive etiology, accompanied by lower urinary tract symptoms. Over the past decades, many studies have been carried out for exploration of more effective therapies against IC/BPS. However, the results have been inconsistent, probably due to the multifactorial nature of IC/BPS. We establish a model of IC/BPS in mice by combining protamine sulfate /lipopolysaccharide and phenylephrine. Typical histological changes and symptoms were observed. We then explored the effectiveness of artesunate (ART), which has been reported to alleviate autoimmune diseases. Phenotypic tests demonstrated a significant reduction in symptoms. Histological staining showed pathological improvement. WGCNA identified three gene modules specifically related to IC/BPS, and six genes were identified as hub genes. CIBERSORT analysis showed that the activated NK cells seem to be decreased in IC modeling group and partially restored in IC + ART group, whereas the resting NK cells showed the opposite trend. Single-cell transcriptomic analysis elaborated on the changing trends of subgroups of infiltrated immune cells, including T cells, NK cells, and dendritic cells. Our study represents our effort in establishing a reliable and reproducible IC/BPS murine model, and the first study using scRNA-seq in exploring the immune microenvironment of the IC/BPS murine model, and the possible molecular mechanisms of ART treatment in IC/BPS. Further studies are needed to confirm the effect of ART in IC/BPS patients.

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.

Assessment of novel biomarkers of renal dysfunction associated with lower urinary tract symptoms in men with benign prostatic hyperplasia

Introduction. The problem of diagnostics and treatment of patients with complex lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) remains highly relevant. Clinical diagnostic methods do not always allow timely prediction of changes in renal, upper and lower urinary tract function with different types of treatment intervention. The search for potential biomarkers allowing minimally invasive assessment of the bladder and renal function condition seems to be a promising direction of scientific research.Objective. To identify potential urine and serum biomarkers allowing to assess renal function in patients with LUTS/BPH.Materials & methods. The study included 69 patients with LUTS/BPH and subsequently divided them into two groups. Group 1 included 48 patients with moderate LUTS who received combination therapy with alpha-1 adrenergic blockers (AABs) and 5-alpha reductase inhibitors (5ARIs). Group 2 included 21 patients with severe LUTS/BPH. Patients of group 2 underwent surgical treatment: transurethral resection of the prostate. In addition to standard research methods (IPSS, voiding diaries, laboratory, urodynamic and radiation techniques), to search for potential biomarkers in serum and urine, concentrations of: insulin-like growth factor binding protein-7 (IGFBP7), B-Cross Laps, Cystatin C, OPN, trefoil factor (TFF3), uromodulin, Clusterin, lactate dehydrogenase (LDH). The follow-up period for patients was 12 months.Results. The study noted that IGFBP7, Cystatin C, TFF3 in the blood serum, as well as LDH, Clusterin in the urine are associated with the severity of LUTS/BPH. Serum biomarker levels were initially higher in patients with severe LUTS compared to patients with moderate LUTS (group 1). The levels of these substrates decreased in patients of all groups during treatment (conservative therapy, surgical interventions for BPH). When assessing urinary biomarkers, the greatest decrease in Clusterin level by the end of follow-up was registered in group 1 patients, the least pronounced in group 2 patients. The initial value of LDH was twice higher in group 2 vs group 1 and progressively decreased after surgical treatment of bladder outlet obstruction.Conclusion. Biomarkers used to assess renal dysfunction in the development of LUTS/BPH are a promising area of scientific research. Panels of new markers will enable to predict renal dysfunction in patients with moderate-to-severe LUTS, which will improve the quality of medical care for this category of patients.

Peripheral Mechanisms Underlying Bacillus Calmette–Guerin-Induced Lower Urinary Tract Symptoms (LUTS)

Peripheral Mechanisms Underlying Bacillus Calmette–Guerin-Induced Lower Urinary Tract Symptoms (LUTS)

Association between physical activity levels and lower urinary tract symptoms: a cohort study in 20,732 Brazilian men

Association between physical activity levels and lower urinary tract symptoms: a cohort study in 20,732 Brazilian men

Comparing Patient-Reported Outcomes Following the Minimally Invasive Treatment of Benign Prostatic Hyperplasia (BPH)-Related Lower Urinary Tract Symptoms: Rezum Versus UroLift

Comparing Patient-Reported Outcomes Following the Minimally Invasive Treatment of Benign Prostatic Hyperplasia (BPH)-Related Lower Urinary Tract Symptoms: Rezum Versus UroLift

Assessing the Knowledge of ChatGPT in Answering Questions Regarding Female Urology.

With the recent increase in the use of artificial intelligence in the medical field, this study aimed to evaluate the accuracy and adequacy of ChatGPT's responses to questions related to female urology. Intensive internet research was performed to prepare a frequently asked question (FAQs) list. Scientific questions were created in accordance with the European Urology Association (EAU) Non-neurogenic Female Lower Urinary Tract Symptoms Guidelines, EAU Chronic Pelvis Pain Guidelines, and EAU Neuro-Urology Guidelines. All answers by ChatGPT were analysed by two experienced urologists and each answer was scored between 1 and 4 by the physicians. A score of 1 was the highest and showed that the answer was completely true and sufficient. The reproducibility of ChatGPT answers was evaluated by asking each question twice using two different computers. A total of 96 (97.0%) ChatGPT answers about female urology were accurate and sufficient, and categorized as grade 1. Additionally, two (2.0%) answers were scored as grade 2, and one answer (1.0%) was scored as grade 3. None of ChatGPT's responses about female urology were classified as grade 4. In total, 83 questions were prepared according to EAU guidelines recommendations, and ChatGPT gave complete accurate and satisfactory answers for 68 (82.9%) questions. The reproducibility rate was highest for ChatGPT answers for questions related to urinary incontinence, pelvic organ prolapses, and pelvic pain syndromes, and reproducibility rate was 100% for each subgroup. The reproducibility rate for ChatGPT answers was lowest for CPG questions (84.1%). For the first time our study revealed that ChatGPT had an excellent accuracy rate in answering questions related to female urology with 97% success rate. In addition, the outcomes of this study showed that ChatGPT accurately and satisfactorily answered 82.9% of questions about female urology based on EAU guidelines.

Robot-assisted simple prostatectomy for men with benign prostatic hyperplasia and bothersome LUTS-a retrospective cohort study.

BPH is a common urological pathology that affects 2480 per 100,000 men worldwide. With a rising population and increased age expectancy, the prevalence of benign prostatic hyperplasia (BPH) is increasing (Awedew et al. in Lancet Healthy Longev 3(11), 2022). There are many surgical management options for BPH with LUTS, including open simple prostatectomy (OSP), holmium laser enucleation of the prostate (HoLEP), transurethral resection of prostate (TURP), and transurethral electro vaporization of the prostate (TUVP) (Cho et al. in Int Neurourol J 24(1), 2020). However, these options often have a steep learning curve and increasing complexity with larger prostates. Robot-assisted simple prostatectomy (RASP) offers an alternative approach for large and very large glands for those already trained in robotic-assisted radical prostatectomy (RARP), particularly as robotic surgery continues to increase in popularity and is steadily becoming the standard of care in the management of prostate disease (Madersbacher et al. in Gerontology 65(5), 2019). The aim of this study was to demonstrate the surgical outcomes for men undergoing RASP for bothersome LUTs and/or acute urinary retention (AUR) secondary to BPH. A retrospective study was performed which included 105 patients who underwent RASP for the treatment of BPH causing lower urinary tract symptoms or acute urinary retention. This study reviews the pre-operative, (age, PSA, weight, prostate size) operative (duration, histology, estimated blood loss and hospital length of stay) and post-operative (duration of indwelling catheter, trial of void outcome, complications and post-operative PSA) outcomes, to evaluate the effectiveness of RASP for the management of BPH with LUTS. Data were analyzed using standard descriptive measures and multivariate logistic regression for comparison of continuous variables, significance was set to a CI of 95%. The median age of patients was 75years (IQR 70-78) with a median prostate size of 135.5cc (IQR 112.25-162.25). Patient demographic and pre-operative LUTS assessments are summarized in Table1. Median operative time was 60min (IQR 50-80), estimated blood loss was 350ml (IQR 200-563), specimen weight was 98.5g (IQR 69.5-120). Prostate size on imaging directly impacted operative duration (CI 0.07-0.2, p = < 0.001). Eleven (10.5%) of the patients involved in the review had a post-operative complication, two (1.9%) considered major complications Clavien-Dindo grade ≥ 3. There was a statistically increased risk of complications associated with advanced age and prostate size (p = 0.043 and p = 0.001). This study, although limited by its retrospective nature, demonstrates the safety and utility of robotic simple prostatectomy in the context of large and very large prostate volumes. In particular, it offers a safe alternative for men with large prostates who otherwise may not be suitable for endoscopic management. Further prospective and randomized control trials are needed to reinforce the efficacy of RASP to assess its functional and cost effectiveness long term.

Long-term quality of life and surgical outcome of female congenital adrenal hyperplasia patients.

To investigate the long-term quality of life and surgical outcome of female patients with congenital adrenal hyperplasia (CAH). Questionnaires for health-related quality of life (HRQoL) outcome (WHO-5, SF-36), lower urinary tract symptoms (ICIQ-FLUTS) and sexual outcome (ICIQ-FLUTSsex) were administered to adult CAH patients. Paediatric CAH patients and their parents were invited to complete WHO-5, PedsQL-4.0-SF15-Generic Core Scales and ICIQ-CLUTS. Six (46%) adults and 7 (54%) children with 21-hydroxylase-deficiency (age ranged from 8 years to 53 years) were recruited. Eleven (85%) had undergone a feminising genitoplasty. In the adult group, no statistically significant difference was identified in the HRQoL and ICIQ-FLUTS scores. Mean overall score of ICIQ-FLUTSsex was lower but not significantly in adult patients compared to controls (7.3 ± 2.9 vs. 2.9 ± 3.4, P = 0.06). A statistically significant negative correlation (r = -0.98, P = 0.02) was found between age at first operation and role limitations due to emotional problems in SF-36. No statistically significant difference was identified in the self-reported HRQoL and ICIQ-CLUTS scores in the paediatric group compared to controls. However, parent's report showed a statistically significant difference in school functioning (73.8 ± 18.9 vs. 91.2 ± 18.7, P = 0.02) and emotional functioning (80.3 ± 15.9 vs. 94.7 ± 12.7, P = 0.007). Our data did not show an impaired HRQoL nor long-term lower urinary tract symptoms in CAH patients' self-reports. Healthcare team should pay more attention to adult patient's sexual function.

Recent advances in the diagnosis of bladder outlet obstruction in men

Background: Bladder outlet obstruction (BOO) represents a common cause of lower urinary tract symptoms in men, frequently resulting from benign prostatic hyperplasia. Key symptoms include both obstructive and irritative urinary tract symptoms, such as dysuria, increased frequency and urgency of urination, and recurrent urinary tract infections. BOO can also cause upper urinary tract dilation (hydronephrosis), damage structure, and impair function of the bladder. Objective: Early diagnosis of BOO is essential to the protection of kidney and bladder functions. The gold standard for diagnosing BOO is urodynamic studies (UDS), which measure detrusor pressure and urinary flow. However, UDS is an invasive test and is associated with risks for urinary tract infections, bothersome urinary symptoms, and hematuria. Given the invasiveness and discomfort associated with UDS, non-invasive diagnostic methods have been developed. Nevertheless, the main limitation of these techniques is the variability in threshold values, highlighting the need for further standardization of measurement protocols. This article reviews the current diagnostic approaches for BOO in men and explores their clinical utility. Conclusion: Various non-invasive diagnostic methods are promising; yet, UDS remains the primary diagnostic approach.

The relationship between neuropathic pain and lower urinary tract symptom scores in patients with primary Sjögren's syndrome.

To evaluate the effect of neuropathic pain on lower urinary tract symptoms (LUTS) scores in patients with primary Sjögren's syndrome (pSS). Seventy-two patients diagnosed with pSS were included in the study. The patients with pSS were divided into two groups according to the presence/absence of neuropathic pain. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire was recorded assess neuropathic pain. LUTS was evaluated using the International Prostate Symptom Score (IPSS), International Incontinence Consultation Questionnaire Short Form (ICIQ-SF) and Overactive Bladder Questionnaire (OAB-V8). The mean age of the patients was 52.4 ± 11.2 years. Neuropathic pain was recorded in 21 (29.2%) patients. Among the patients, the number of patients with mild symptoms was recorded as 41 (56.9%), moderate symptoms in 25 (34.7%), and severe symptoms in 6 (8.3%) according to IPSS. IPSS and IPSS voiding subscores were statistically significantly higher in patients with neuropathic pain than non-neuropathic pain group (p = 0.035; p = 0.001, respectively). Although ICIQ-SF, OAB-V8 and IPSS storage subscores were found to be higher in patients with neuropathic pain group, there was no statistically significant difference between the groups (p = 0.299; p = 0.283; p = 0.237, respectively). Neuropathic pain concomitant with PSS patients may negatively affect bladder voiding functions.

Trend in incidence and clinicopathological characteristics of prostate cancer in Northern Tanzania: analysis from a population based cancer registry data 2015-2021.

Globally, prostate cancer is a common disease among men. However, limited epidemiological data exists regarding prostate cancer in Tanzania. Consequently, there is insufficient evidence to convince policymakers of the need to combat this health issue. The study aimed to assess the prevalence, trends and clinicopathological characteristics of prostate cancer in northern Tanzania. This cross-sectional study with chart review utilised data from the Kilimanjaro cancer registry, identifying all adult men diagnosed with cancer from January 2015- December 2021. The study recorded variables such as subject age, symptoms, Gleason score, prostate specific antigen (PSA) and metastatic statuses at presentation. Risk stratification followed American Society of Medical Oncology criteria, including low, intermediate and high-risk categories. The analysis was conducted using STATA version 17. Over the study period, 5164 adult men were registered, with prostate cancer accounting for 1619(31.4%) and showing an increase trend in incidence. The mean age at presentation was 73.9(± 10.1) years, and the majority of study subjects were from Kilimanjaro region 1200(74.1%). After applying exclusion criteria, 714 subjects with histologically confirmed diagnoses of prostate cancer remained. Of these, 710(99.4%) were symptomatic at presentation, with lower urinary tract symptoms being the most common symptoms in 548(76.8%). The median PSA at presentation was 109(36.2-263) ng/mL with 349(51.1%) having a PSA of > 100ng/mL. Gleason group grades 4 and 5 accounted for 207(29.5%) and 219(31.2%), respectively. A total of 178(43.6%) subjects had metastatic disease at presentation. The treatment of choice for a large proportion of subject 440(94.6%) was androgen deprivation therapy. The burden of prostate cancer in northern Tanzania is high and the majority of subjects present with symptoms. A large proportion of subjects have metastatic disease at initial presentation, emphasizing the need for prostate cancer screening.

Occupational Factors Influencing Turnover Intention in Working Women with Lower Urinary Tract Symptoms

Occupational Factors Influencing Turnover Intention in Working Women with Lower Urinary Tract Symptoms

Lower urinary tract symptoms in men after surgery for benign prostatic hyperplasia

BACKGROUND: The development of medical technologies has resulted into a significant increase in the number of patients undergoing minimally invasive surgeries for benign prostatic hyperplasia. However, 29.9–41% of patients after surgical treatment are not satisfied with the surgical treatment results. AIM: To assess the rate and nature of lower urinary tract symptoms in men after surgical treatment of benign prostatic hyperplasia with various surgical techniques. MATERIALS AND METHODS: A telephone survey was carried out among 6117 men aged 59.57 ± 11.11 years (48–83 years), who underwent surgical treatment for benign prostatic hyperplasia with various surgical techniques and 5960 of these patients were surveyed using the IPSS questionnaire in the period 2012–2022. Moreover, to assess urination, patients kept their voiding diaries for 72 hours, a questionnaire to evaluate the symptoms of overactive bladder; ultrasound of the bladder, prostate and upper urinary tract, uroflowmetry, and, if indicated, a urodynamic study were performed. RESULTS: The study showed that 2413 (40.5%) patients were “absolutely satisfied” with the surgical treatment results, 829 (13.9%) patients were “partially satisfied” and noted improved urination, although its quality was assessed as unsatisfactory, and 2718 (45.6%) operated men were “absolutely dissatisfied”. Lower urinary tract symptoms persisted in 2655 (47.9%) men which underwent surgery, and in 3.3% of cases (87 patients) their severity increased in the postoperative period. CONCLUSIONS: The high rate of dissatisfaction with the surgical treatment results of patients with benign prostatic hyperplasia is caused by the persistence of irritative symptoms in the postoperative period and does not depend on the surgery performed. The origin of symptoms in most patients is not associated with benign prostatic hyperplasia, and the surgery indications are overestimated.

Surgical treatment of hypospadias with lichen sclerosus: Long‐term outcomes from a single center

AbstractBackgroundHypospadias with lichen sclerosus (LS) poses surgical challenges due to lack of materials for urethral reconstruction and coverage and the limited number of reports on this clinical condition.ObjectivesTo report surgical strategies and outcomes for primary and redo hypospadias patients with LS.Materials and methodsWe conducted a retrospective observational descriptive study with 31 patients with primary/redo hypospadias and LS between 2013 and 2023. Of these patients, 9 had primary hypospadias with 7 distal types and 2 proximal types, and 22 were redo patients. Nineteen of the 31 patients underwent various surgical techniques, and 12 underwent the oral mucosa onlay procedure (OMOP). Postoperative uroflowmetry, hypospadias objective scoring evaluation (HOSE), and complications were evaluated.ResultsFor primary distal hypospadias with LS‐affected skin, five patients underwent circumcision; these patients had normal postoperative urinary flow, and only one patient had an inconspicuous penis after surgery. For the patients with primary proximal hypospadias with an LS‐affected urethra, one patient required perineal urethrostomy following a modified Koyanagi procedure for recurrent stricture; the other patient underwent two‐stage transverse preputial island flap urethroplasty with no postoperative lower urinary tract symptoms (LUTS) and satisfactory aesthetic scores. In two remaining cases of primary distal hypospadias with meatus/urethral LS, no LUTS or postoperative complications occurred following meatoplasty/circumcision and penile basal fixation. During reoperations, compared with those of patients who underwent other redo procedures, twelve patients who underwent OMOP had better Qmax and uroflowmetry (p = 0.002) and higher HOSE scores (p = 0.01).ConclusionsFor primary hypospadias patients with LS, enhanced exposure of the penile shaft and glans may benefit distal hypospadias, whereas staged surgery may be suitable for proximal hypospadias. The oral mucosa is favored for urethral augmentation in patients with redo hypospadias complicated with LS, and the OMOP can address neourethra coverage effectively.

Population-Based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Developing Countries: Results of the BEBIC Study.

This study aimed to assess the prevalence of urinary incontinence (UI) and lower urinary tract symptoms (LUTS) in five selected low and middle-income countries to provide appropriate evidence for other related studies. In this multinational population-based cross-sectional survey between August 2019 and April 2021, validated questionnaires were used to assess LUTS in adults over 18 years from Iran, Egypt, Bangladesh, Brazil, and Cameroon. A total of 1477 participants from five countries completed the questionnaires. The mean age of participants was 43.5 ± 15.7 years. 37.1% reported at least one episode of UI per week. UUI prevalence in different countries analysis showed that the commonest prevalence was reported in Cameron (40.0%; n = 30), while the lowest was 15.0% (n = 31) in Brazil. Stress UI was common in Iran (38.7%; n = 338), and Bangladesh had the lowest rate (7.8%; n = 16). Urinary urgency was the common LUTS among participants (59.9%, n = 818 out of 1477 participants). Nocturia was the other prevalent symptom among cases (50.6%; 748 out of 1477 cases), and this symptom had a higher rate in elderly populations. Men reported voiding and postmicturition symptoms more frequently than women. Storage symptoms except for nocturia, including frequency, urgency, and UI were common in women while voiding symptoms, including straining, and intermittency were reported more frequently in men than women. A high prevalence of urinary symptoms was reported in low to middle-income countries.

Urinary Retention After GreenLight Laser Photoselective Vaporization of the Prostate (GLL.PVP) Surgery for Benign Prostatic Hyperplasia (BPH): A 3-6 Month Retrospective Follow-Up Study.

Objective Our study was designed to evaluate the postoperative urinary retention (UR) and success rate of the GreenLight Laser (Boston Scientific, Marlborough, MA, USA) photoselective vaporization of the prostate (GLL.PVP) procedure for Benign Prostatic Hyperplasia (BPH) patients, both with and without high-risk factors. Methodology We conducted a retrospective follow-up study of postoperative patients who underwent GLL.PVP for BPH. We collected data from clinical health records, including notes from the lower urinary tract symptoms (LUTS) clinic, trial without catheter (TWOC) clinic, and emergency department presentations with UR. The analysis examined several parameters, including the patient's age, high-risk factors, prostate volume, and both preoperative and postoperative objective voiding parameters. These voiding parameters included post-void residual (PVR) and maximum flow rate (Qmax). Additionally, the analysis looked into whether the patient had a catheter or experienced urinary retention prior to the surgery. Results A total of 50 GreenLight Laser PVP surgeries were performed over a 14-month period from May 2023 to July 2024 at West Middlesex University Hospital in London. Most of the patients were between the ages of 60 and 80. Prior to the surgery, data indicated that 17 patients (34%) were using long-term catheters, whereas 33 patients (66%) were not. Additionally, 25 patients (50%) were identified as having high-risk factors, which included being on anticoagulation therapy, a history of urinary retention, and a prostate volume exceeding 100 cc.Notably, the patient without h/o urinary retention had an average preoperative PVR of 150 mL and an averageQmaxof 7 mL/second In our 3-6 month retrospective postoperative follow-up study, we found that eight cases (16%) developed urinary retention, while 42 cases (84%) did not, with an average PVR volume of 105 mL and an average Qmax of 13.5 mL/second. In patients with preoperative urinary retention, 13 cases (76%) did not develop UR postoperatively whereas four cases (24%) developed. Conclusion Our study conclusively found that 42 cases (84%) of patients did not experience urinary retention (UR) in the follow-up after undergoing the GLL PVP operation, irrespective of any history of urinary retention or other high-risk factors. This unequivocally demonstrates the operation's efficacy. Furthermore, our findings revealed that three-quarters of patients with a preoperative history of urinary retention also did not develop UR post-surgery. The GLL.PVP procedure is safe and effective, leading to rapid improvements in voiding parameters.

Characteristics and outcomes in bladder Leiomyoma management: a systematic review of case reports and case series from the past 20 years

IntroductionBladder leiomyomas (LM) are uncommon, non-cancerous growths that originate from the smooth muscle cells of the bladder and constitute 0.5% of bladder tumor cases. This review aims to compile existing data and present a summary of bladder leiomyomas’ characteristics, management, and related outcomes.MethodWe conducted systematic review of studies that investigated bladder leiomyoma. Case studies or series describing individuals with bladder leiomyoma who underwent surgery and the outcomes were included. Four databases were used in our literature search, which was carried out until January 2024: PubMed, Proquest, EBSCOHost, and Google Scholar. We utilized MeSH terms such as “leiomyoma,” “urinary bladder,” and looked for synonyms of “bladder leiomyoma” in free text.ResultsA total of 99 studies with 119 patients were included. Most reported bladder leiomyoma cases were female, accounting for 79.0% of all cases. While symptomatic patients primarily presented with lower urinary tract symptoms (LUTS) (59.7%), hematuria (24.4%), acute urine retention (11.8%), and about 16.8% of cases were incidentally detected. Storage-related symptoms were the most common LUTS (37.0%). Different diagnostic techniques were used, frequently combining CT (Computed Tomography), MRI (Magnetic Resonance Imaging), USG (Ultrasonography), and/or cystoscopy. Bladder leiomyomas were commonly found on the left lateral wall (26.9%) and the bladder neck (17.6%). In more than half of the cases (52.1%) the treatment techniques used were transurethral resection (TURBt/TUR). Fifteen out of 119 cases (12.6%) had recurrence or remain symptomatic. Symptomatic symptoms at first presentation and extended location are frequently found among recurrent or symptomatic cases after first management.ConclusionManagement of bladder leiomyoma should focus on the relief of symptoms and recurrence and be personalized based on the tumor characteristics, patient symptoms, and surgeon’s expertise. Further investigation is necessary to fully understand the best course of treatment and long-term results for bladder leiomyomas. In particular, prospective trials with bigger participant pools and meticulously controlled factors should be the main emphasis of this research.