Mean Bother Score Research Articles

Novel Treatment for Interstitial Cystitis Pilot Study

Background and aims: Use of platelet-rich plasma (PRP) is well established in treatment of orthopedic patients. This pilot study aims to determine the efficacy of using instillation of PRP paired with hydrodistention of the bladder to treat patients with interstitial cystitis (IC). Methods: Patients with a diagnosis of interstitial cystitis were recruited to this study. Patients completed Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale, which quantified a symptom and bother score. Patients were treated with hydrodistention with instillation of PRP. Patients completed the PUF questionnaire weekly for six weeks following treatment. Results: 12 patients underwent hydrodistention with instillation of PRP. The patients were all women, ranging in age from 23 to 71. The mean symptom score went from 13.167 to 7.417 and the mean bother score decreased from 6.833 to 4.41, showing a statistically significant reduction in symptom and bother scores. Conclusions: Hydrodistention with instillation of PRP is an effective treatment of interstitial cystitis.

COMPARISON OF EFFICACY OF TAMSULOSIN, ALFUZOSIN, AND SILODOSIN IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA

Objectives: This study was done to determine the efficacy of alpha-1 adrenoceptor blockers such as tamsulosin, alfuzosin, and silodosin in patients with the lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) over 6 months by assessing change in international prostate symptom score (IPSS), quality of life scale for urinary symptoms (Bother score), and improvement in peak urine flow rate (Qmax) from baseline. We also tried to identify any adverse drug reactions (ADRs) caused by these drugs. Methods: A prospective observational study was conducted in 291 patients with LUTS secondary to BPH attending urology outpatient department of a tertiary care center for 1 year. Ninety-seven patients in each group received tamsulosin, alfuzosin, or silodosin once daily. IPSS, Qmax, and the quality of life scale for urinary symptoms by Bother score were assessed at 1st, 3rd, and 6th month of treatment period. ADR was noted and recorded in ADR reporting form. Results: IPSS, mean bother score, and mean Qmax showed significant improvement from the baseline in each follow-up visit at 1, 3, and 6 months for all the three groups, but maximum was for alfuzosin and was found to be statistically significant (p<0.001). Two patients developed adverse drug reaction during the study; asthenia in tamsulosin group and hypotension in Silodosin group. Conclusion: Patients on alfuzosin showed maximum improvement in the values of IPSS, Bother score, and Qmax in BPH patients as compared to tamsulosin and silodosin. Alfuzosin would be a better choice in the treatment of LUTS due to BPH.

Obstetric risk factors for anal sphincter trauma in a urogynecological population.

Obstetric anal sphincter tears are the single major modifiable risk factor for anal incontinence (AI) in women. We undertook a retrospective observational study in a tertiary urogynecology unit to describe the prevalence of sonographic anal sphincter defects in a urogynecological population and investigate obstetric risk factors. Files of women seen for investigation of pelvic floor disorders between January 2014 and May 2021 were reviewed. Sonographic defects of the external anal sphincter were analyzed using stored 4D ultrasound imaging data. Explanatory parameters were number of vaginal births, delivery mode, age at first vaginal birth, and birthweight of the first vaginally born baby. Of 3,037 women seen during the inclusion period, data were missing in 219, leaving 2,818. AI was reported by 508 (18%), with a mean St Marks score of 11 (1-23) and a mean bother score of 5.9 (0-10). External sphincter defects were detected in 945 women (34%), with a "residual defect" in 343 (12%). The strongest risk factors for a residual defect were first vaginal birth and forceps, with higher-order multiparity adding risk. On multivariate analysis, forceps and vaginal parity >5 remained significant predictors, as opposed to age at first birth and birthweight of the firstborn. In this observational study in urogynecological patients, 12% showed a residual EAS defect on imaging. The most obvious risk factors for the diagnosis of a residual defect on exo-anal imaging were the first vaginal birth and forceps, with higher-order vaginal parity conveying additional risk.

Prevalence of nocturia among community-dwelling adults: a population-based study in Malaysia

BackgroundNocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults.MethodsA cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night.ResultsThere were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31–40 (1.91 [1.52–2.40]) or > 60 years old (2.03 [1.48–2.71]), and those who presented with hypertension (2.84 [2.28–3.53]), diabetes mellitus (1.78 [1.42–2.25]), renal disease (3.58 [1.93–6.63]) or overactive bladder (1.61 [1.10–2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41–50 (0.73 [0.59–0.91]), male (0.78 [0.69–0.88]) and Chinese (0.47 [0.30–0.74]) or Indian (0.34 [0.21–0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia.ConclusionsThe prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.

Consequential Late Effects up to 10 years Following Primary and Postoperative Radiotherapy for Prostate Cancer

To evaluate the impact of acute toxicity on chronic problems following primary (pRT) and postoperative radiotherapy (opRT) for prostate cancer. Patients treated in the years 2003-2008 were surveyed prospectively using a validated questionnaire (EPIC, Expanded Prostate Cancer Index Composite) before the beginning of RT, at the last day, two months, 1-3 years, 5-8 years and 9-13 years after the end of RT. A score difference of 5 points is regarded as clinically significant, >20 points as a clinically large quality of life (QoL) change. Only patients treated up to 70.2-72Gy (pRT) and 66.0-66.6Gy (opRT) in 1.8-2.0Gy fractions were included. Patients were required to respond to the questionnaire before and at the end of RT, additionally at least one questionnaire >1 year after RT, resulting in 287 patients (n = 185 pRT and n = 102 opRT). The response rate to the questionnaire after 1-3 years was 85% (n = 245), after 5-8 70% (n = 201) and after 9-13 years 55% (n = 157). Significant differences before the start of RT between pRT and opRT were lower urinary (mean bother score of 87 vs. 82; p = 0.02) and sexual (mean bother score of 61 vs. 39; p<0.01) scores for opRT. However, larger changes at the end of RT were found for pRT (urinary score: 21 vs. 13 points; p<0.01; sexual score: 11 vs. -2 Punkte; p<0.01; negative change = QoL improvement). After 10 years, urinary scores declined less (5 vs. 14 points; p = 0.04), sexual scores declined more (18 vs. -2 points; p = 0.01) following pRT vs. opRT. For patients with a bother score decline >20 points in the bowel domain (Bdiff>20) and urinary domain (Udiff>20) at the last day of RT, the respective bowel baseline scores were similar both for pRT and opRT, urinary baseline scores only for opRT. However, patients with pRT and Udiff>20 had significantly higher baseline scores (85 vs. 79; p<0.01). For patients with Bdiff >20, both the difference in relation to baseline levels and the absolute bother scores 10 years after RT remained significantly worse in comparison to patients with smaller acute changes (71 vs. 93 10 years after pRT; p<0.01; 82 vs. 91 after opRT; p = 0.07). The same effect was found for patients with Udiff>20 in the urinary domain, statistically significant up to 5 years after pRT, but only up to 2 months after opRT. In comparison to opRT, significantly larger acute, but smaller chronic urinary changes resulted. Acute toxicity during radiotherapy has a significant impact on chronic problems as consequential late effects, especially in the bowel domain. These acute bowel score changes cannot be predicted by baseline problems before the beginning of treatment.

Is vaginal flatus related to pelvic floor functional anatomy?

Vaginal flatus is an embarrassing condition that can impair women's quality of life. The underlying pathophysiology is unclear. We aimed to evaluate the association between vaginal flatus and pelvic floor anatomy. Retrospective observational study on women seen in a tertiary urogynaecological service. All had undergone a standardised interview, clinical examination and four-dimensional transperineal ultrasound. Offline analysis of volume data was performed blinded against clinical data. Datasets of 570 women were analysed. Five hundred twelve (90%) were vaginally parous. Vaginal flatus was reported by 190 (33%). Mean bother score was 4.2 (SD 3.4, range 0-10). One hundred eighty-five reported frequency of vaginal flatus: it occurred < once a month in 25 (14%), once a month in 70 (38%), once a week in 47 (25%), once daily in 28 (15%) and > once daily in 15 (8%). One hundred two women identified the following precipitating factors: intercourse in 72 (71%), postural change in 22 (22%) and physical activities in 9 (9%). Vaginal birth, central and posterior compartment prolapse, anal incontinence, higher levator resting tone and younger age were associated with vaginal flatus. The latter was moderately correlated with symptom bother (correlation coefficient - 0.21). Vaginal flatus is a prevalent and bothersome condition affecting one-third of our study population. The condition is associated with pelvic floor functional anatomy. A higher resting tone may confer a higher resistance against which trapped air is expelled during physical activities. Younger age was moderately correlated with symptom bother.

Pelvic Organ Prolapse and Urinary Incontinence in Women After Bariatric Surgery: 5-Year Follow-up.

The objective of this study was to determine if weight loss surgery is associated with decreased prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP) symptoms. A survey was conducted among previously morbidly obese women who underwent bariatric surgery at Brigham and Women's Hospital, Boston from 2007 to 2015. In addition to the Pelvic Floor Distress Inventory 20, we collected demographic and clinical data including symptoms of and treatment for UI and POP before surgery. Participants were divided into 4 quartiles based on self-reported postsurgical weight loss: less than 26.1 kg, 26.1 to 36.2 kg, 36.3 to 46.2 kg, and greater than 46.2 kg. Cox proportional hazard ratios were used to estimate risk of UI and POP by quartile. Kruskal-Wallis test was used to compare bother scores between the groups. A total of 447 women responded to the survey. Mean follow-up from surgery was 5 years. Women with Roux-en-Y gastric bypass had significantly greater weight loss than gastric banding or sleeve gastrectomy. The adjusted hazard ratios of current UI, stress UI, urgency UI, and prolapse decreased with increasing weight loss quartile (P trend <0.005). Based on the Pelvic Floor Distress Inventory 20, prevalence of POP symptoms was 26% with a mean bother score of 50. Although symptom bother by quartile of weight loss was not statistically significant, the trend (from the first to fourth quartile) for the mean values of Urogenital Distress Inventory 6 (from 13 to 9) and Pelvic Organ Prolapse Distress Inventory 6 (from 26 to 20) showed an improvement in bother symptoms. There exists an inverse relationship between amount of weight loss and subsequent POP and UI symptoms 5 years after bariatric surgery.

Quality of Life after Radiation Therapy for Prostate Cancer With a Hydrogel Spacer: Five Year Results

Long-term clinical results are needed to better define a possible benefit of spacers for prostate cancer radiotherapy (RT). The aim of this analysis was to evaluate quality of life changes up to five years after radiotherapy for prostate cancer with a hydrogel spacer. In the years 2010-2011, 114 patients received external beam radiotherapy to the prostate. Fifty-four patients were selected for a hydrogel injection before the beginning of RT. Treatment was performed with a five-field IMRT technique with daily ultrasound based image guidance, applying fractions of 2 Gy up to a total dose of 76 Gy (n = 96) or 78 Gy (n = 18, all with hydrogel). Patients were surveyed prospectively before RT, at the last day of RT, a median time of 2 months, 17 months and 63 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite; comprising 50 items concerning urinary, bowel, sexual and hormonal domains). The multi-item scale scores were transformed linearly to a 0-100 scale, with higher scores representing better QOL. A mean score change of >5 points is defines as clinically relevant. Mean bowel function and bother score changes of >5 points in comparison to baseline levels before treatment were found only at the end of RT (10-15 points; P < 0.01) for patients treated with a hydrogel spacer. Mean long-term urinary and bowel domain scores did hardy differ from baseline levels (<2 points). Not a single patient reported about a moderate or big problem with his bowel problems overall (see Table 1).Abstract 1083; Table 1With spacer(n = 54)Without spacer(n = 60)P-valueMean (quartiles) urinary bother score change1 year after RT-2 (-7;0;4)-3 (-11;-4;4)0.49Mean (quartiles) bowel bother score change-1 (0; 0; 0)7 (-4;0;14)0.13Moderate/big problem with bowel urgency0%13%<0.01Moderate/big problem with bowel habits overall0%17%<0.01Mean (quartiles) urinary bother score change5 years after RT0 (-5;0;7)-3 (-9;-4;4)0.22Mean (quartiles) bowel bother score change1 (0;0;4)6 (-4;0;11)0.99Moderate/big problem with bowel urgency0%14%0.01Moderate/big problem with bowel habits overall0%7%0.08 Open table in a new tab Baseline patient characteristics were similar to patients who were treated without a spacer in the same time period (median age of 73 years in both groups, median prostate volume of 56cc with vs. 62cc without a spacer). Bowel domain score changes were higher (statistically not significant) in comparison to the patient group with a spacer, with mean bother score changes of 21 points at the end of RT, 8 points at two months, 7 points at 17 months and 6 points at 63 months after RT. A bowel bother score change >10 points was found in 6% vs. 32% (P<0.01) at 17 months and in 5% vs. 14% (P = 0.2) at 63 months with vs. without a spacer. The first five-year quality of life results in a group of prostate cancer patients treated with a hydrogel spacer demonstrate excellent treatment tolerability, in particular regarding bowel problems. Further studies with dose-escalated or re-irradiation concepts can be encouraged.

Quality of Life After Radiation Therapy for Prostate Cancer With a Hydrogel Spacer: 5-Year Results

To evaluate quality of life changes up to 5years after prostate cancer radiation therapy (RT) with a hydrogel spacer. In the years 2010 to 2011, 114 patients received external beam radiation therapy to the prostate; 54 patients were selected for a hydrogel injection before the beginning of RT. Treatment was performed applying fractions of 2Gy up to a total dose of 76Gy (n=96) or 78Gy (n=18, all with hydrogel). Patients were surveyed before RT; at the last day of RT; and a median time of 2months, 17months, and 63months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite). A mean score change of >5 points was defined as clinically relevant. For patients treated with a hydrogel spacer, mean bowel function and bother score changes of >5 points in comparison with baseline levels were found only at the end of RT (10-15 points; P<.01). No spacer patient reported moderate or big problems with his bowel habits overall. Mean bother score changes of 21 points at the end of RT, 8 points at 2months, 7 points at 17months, and 6 points at 63months after RT were found for patients treated without a spacer. A bowel bother score change >10 points was found in 6% versus 32% (P<.01) at 17months and in 5% versus 14% (P=.2) at 63months with versus without a spacer. The first 5-year quality of life results in a group of prostate cancer patients treated with a hydrogel spacer demonstrate excellent treatment tolerability, in particular regarding bowel problems. Further studies with dose-escalated or re-irradiation concepts can be encouraged.

The association between different measures of pelvic floor muscle function and female pelvic organ prolapse.

We aimed to compare palpatory and translabial ultrasound (TLUS) measurements of pelvic floor muscle (PFM) function with symptoms and signs of female pelvic organ prolapse (FPOP) to determine a possible association. We analysed data from 726 women with a mean age of 56 (SD 13.7, range 18-88) years, seen for symptoms of pelvic floor dysfunction between August 2011 and April 2013. The examination included a standardised interview and clinical assessment of FPOP with Pelvic Organ Prolapse Quantification (POP-Q) measurements, Modified Oxford Scale (MOS) grading and 4D TLUS. Symptoms of prolapse were reported in 51.4% (373 out of 726) with a mean bother score of 5.8 (SD 2.91, range 0-10). A clinically significant POP (Incontinence Society [ICS]-POP-Q stage ≥2) in any compartment was diagnosed in 77.1%. Mean MOS was 2.4 (SD 1.1, range 0-5). Significant POP on TLUS was seen in 54.6% (389 out of 712). TLUS volumes at rest and on maximal PFM contraction were analysed on a desktop PC, to assess the degree of bladder neck (BN) cranioventral shift and levator antero-posterior (AP) diameter reduction, blinded against other data. Mean cranioventral BN shift was 7.11 (SD 4.36, range 0.32-25.32) mm and mean levator AP diameter reduction was 8.6 (SD 4.8, range 0.3-31.3) mm. MOS was strongly associated with subjective and objective POP (P ≤ 0.001), whereas this was not true for TLUS measurements of tissue displacement. The MOS seems to be a more valid measure of PFM function than sonographically determined BN displacement or reduction of hiatal AP diameter observed on PFM contraction.

Use of a visual analog scale for evaluation of bother from pelvic organ prolapse

A specified anatomical degree of prolapse may cause no bother in one individual and a severe form of bother in another. The aim of this study was to determine the factors contributing to the degree of bother due to a given degree of prolapse, to help with the clinical evaluation of patients and planning of preventive intervention trials and surgical treatment. Consecutive patient records of 654 women who had attended a urogynecology unit between August 2011 and December 2012 were reviewed. All patients underwent a standardized interview, clinical examination and four-dimensional translabial ultrasound scan. The degree of bother was evaluated using a visual analog scale. Six hundred and thirty-six women were included in the analysis, with ultrasound data available for cystocele, rectocele and enterocele descent and rectocele depth measurements and 442 for uterine descent. 313 women (49.2%) had subjective symptoms of female pelvic organ prolapse at a mean bother score of 6.0 ± 2.6. Average bother score for the complete dataset was 3.0 ± 3.5. Parity, vaginal delivery, levator avulsion, any significant clinical prolapse or prolapse seen on ultrasound were associated with prolapse bother and all clinical and ultrasound measures of pelvic organ descent remained significant or near significant on multivariate analysis. Quantification of prolapse bother using a visual analog scale is valid and repeatable and may represent a simple tool for use in clinical practice.

MP15-16 THE PREVALENCE OF AN UNDIAGNOSED SLEEP DISORDER IN VA PATIENTS PRESENTING WITH VOIDING COMPLAINTS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2014MP15-16 THE PREVALENCE OF AN UNDIAGNOSED SLEEP DISORDER IN VA PATIENTS PRESENTING WITH VOIDING COMPLAINTS Arun Rai, Nannan Thirumavalavan, and Lori Lerner Arun RaiArun Rai More articles by this author , Nannan ThirumavalavanNannan Thirumavalavan More articles by this author , and Lori LernerLori Lerner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.569AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been shown that obstructive sleep apnea (OSA) not only disrupts sleep patterns, it can cause nocturnal polyuria and nocturia. Nocturia has a prevalence of 63% in men over the age of 65, and the prevalence of OSA is near 70%. Despite these high percentages, at the VA Boston Healthcare System, only 4% of patients carry a concomitant ICD-9 code for both nocturia and OSA, suggesting an under diagnosis of sleep disorders within the urologic patient population. Given this, we sought to determine if men presenting to a urology clinic with nocturia and/or voiding complaints were also more likely to be at risk for an unrecognized sleep disorder. METHODS A case-control study was conducted on all patients who presented to the VA Boston Healthcare System urology clinic between August 2012 and January 2013. As part of routine evaluation, all patients over age 50 were administered the International Prostate Symptom Score (IPSS) and Berlin sleep questionnaires at the time of clinic check in.Patients completed the questionnaires voluntarily while in the waiting room and the responses were addressed during the clinical visit. RESULTS A total of 633 male patients completed the questionnaires. Of those, 65% (n=410) were found to have nocturia (> 2 voids/night). Of the patients with nocturia, 55% had a positive response on the Berlin questionnaire, suggesting an underlying presence of a sleep disorder. Having nocturia increased the probability of a positive Berlin score (OR 2.09, p<0.01). However, we did not find a significant association between amount of nocturia and Berlin score. Additionally, patients with a positive Berlin response had a higher mean bother score than those with a negative Berlin response (p<0.0001) Not surprisingly, patients with a positive Berlin score had a higher BMI when compared to those with a negative Berlin score (31.7 vs 26.6, p<0.001). CONCLUSIONS Published studies postulate that higher circulating levels of ANP are observed in patients with OSA, leading to polyuria and nocturia. The findings of our study suggest that indeed, nocturia is found in patients at high risk for sleep disorders, an association that has not been significantly explored. OSA is associated with an overall increase in morbidity and poorer patient outcomes and life expectancy, of which nocturia may be the first/most bothersome, indicator. For patients refractory to standard urologic approaches to lower urinary tract symptoms, further investigation into other etiologies of nocturia, such as undiagnosed sleep disorders, is important and referral for evaluation may be prudent. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e151 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Arun Rai More articles by this author Nannan Thirumavalavan More articles by this author Lori Lerner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial

To compare the de novo prolapse rate in the untreated vaginal compartments following conventional vaginal prolapse repair and tension-free vaginal mesh repair. Secondary analysis of a randomised controlled trial. Thirteen centres in the Netherlands. Women with recurrent pelvic organ prolapse stage II or higher. Random assignment to either conventional vaginal native tissue repair or vaginal mesh insertion. de novo pelvic organ prolapse stage II or higher in the untreated vaginal compartments at 12 months after surgery. de novo pelvic organ prolapse at and beyond the hymen, de novo prolapse beyond the hymen and prolapse domain scores of the Urogenital Distress Inventory. At 12 months ten of 59 women (17%) in the conventional group versus 29 of 62 women (47%) in the mesh group were diagnosed with a de novo pelvic organ prolapse stage II or higher in the untreated compartment (P < 0.001, odds ratio 4.3, 95% confidence interval 1.9-10.0). Additional apical support to a mesh-augmented anterior repair significantly reduced the de novo prolapse rate. Women with a de novo prolapse in the mesh-treated group demonstrated significantly higher mean bother scores on the domain genital prolapse of the Urogenital Distress Inventory score (13.1 ± 24.2) compared with those without de novo prolapse (2.9 ± 13.9) (P = 0.03). Mesh-augmented prolapse repair in only one vaginal compartment is associated with a higher de novo prolapse rate in the untreated compartments compared with conventional vaginal native tissue repair in women with recurrent pelvic organ prolapse.

The Personal Burden of Decreased Vision-Targeted Health-Related Quality of Life in Nursing Home Residents

To present the bother subscales of the Nursing Home Vision-Targeted Health-Related Quality of Life Questionnaire (NHVQoL) and to examine their relationship to the original NHVQoL subscales and objective measures of visual function. 395 nursing home residents completed the bother subscales. Associations between bother subscales and original subscales and objectively measured vision were evaluated. Mean bother scores ranged from 1.97 to 2.30, reflecting an average rating of "a little" bother. For 20 NHVQoL items, more than 50% of participants reported "a lot" of bother. All NHVQoL original subscale scores were moderately correlated with bother subscales (p < .0001). Bother subscales and visual acuity were not highly correlated. Nursing home residents are bothered by reductions in vision-targeted health-related quality of life. The NHVQoL bother subscales may probe the personal burden of visual problems in this population that is not captured by the original subscales or objectively measuring visual function.

Health Related Quality of Life Significance of Single Pad Urinary Incontinence Following Radical Prostatectomy

Continence outcomes after radical prostatectomy are frequently reported as the proportion of men using 1 urinary pad or less daily. We postulated that under appreciated health related quality of life (HRQOL) differences may exist between patients requiring 1 pad daily and those who do not require pads. A total of 168 patients who underwent radical prostatectomy performed by a single surgeon in a 2-year period were surveyed at a mean of 75 +/- 30 weeks postoperatively using the urinary function and bother scales of the University of California-Los Angeles Prostate Cancer Index (PCI), the American Urological Association symptom index and a question assessing satisfaction. To establish patient groups the levels of the PCI question assessing pad use were redefined to 0, 1, or 2 or greater pads daily. The remaining 4 urinary function questions were used to calculate the summary function score. Of the patients 146 (86.9%) reported no pad use and 20 (11.9%) used 1 pad daily. The mean function score +/-SD was 81.7 +/- 19.5 and 51.5 +/- 26.5 for the no and 1 pad groups, respectively (p <0.0001). The mean bother score was 86.8 +/- 18.8 and 54.2 +/- 30.0 (p <0.0001). There were sharp differences between the 2 groups for each of the individual PCI questions and for the satisfaction question but no differences in American Urological Association symptom index scores. We noted significant differences in urinary HRQOL between patients who do not require urinary pads after surgery and those who use a single pad daily across several domains of urinary function and bother. We believe that these findings underscore the need for more comprehensive HRQOL assessment in urinary outcome assessment after prostatectomy.

How potent is potent? Evaluation of sexual function and bother in men who report potency after treatment for prostate cancer:data from CaPSURE

Objectives To characterize the association between potency and comprehensive sexual function. The accurate assessment of sexual function is critical for the evaluation of outcomes after treatment of prostate cancer. The assessments of potency typically used in this context, however, may be oversimplified. Methods CaPSURE is a large, observational database of men with prostate cancer. Participants complete health-related quality-of-life questionnaires, including the University of California, Los Angeles Prostate Cancer Index, every 6 months after treatment. A total of 5135 men completed at least one questionnaire and did not use medications for erectile function. The men were categorized as potent or impotent based on their ability to have erections and/or intercourse in the prior 4 weeks. Using the remaining questions on the Prostate Cancer Index, sexual function and bother scores were calculated for each group. Results Of the 5135 men, 27.4% were potent. The mean sexual function scores were 56 and 13 for potent and impotent men, respectively ( P <0.0001). The corresponding mean bother scores were 62 and 36 ( P <0.0001). The function scores ranged from 0 to 100 and 0 to 92 among potent and impotent men, respectively, and bother scores from 0 to 100 in both groups. Function was inversely associated with age in both groups, but bother did not change among potent men and ameliorated among impotent men. Individual Prostate Cancer Index questions correlated with potency to a variable extent. Conclusions Although potent and impotent men have divergent sexual function and bother scores after treatment, the wide range of these scores in both groups denotes a complex picture of sexual function. The simple documentation of potency after treatment provides an insufficient measure of sexual health-related quality of life and should be supplemented with more comprehensive measures.

Is previous transurethral resection of the prostate a contraindication to brachytherapy

Purpose/Objective: To evaluate the incidence of urinary incontinence and urinary bother after prostate brachytherapy (PB) in patients who have had prior transurethral resection of the prostate (TURP). Materials/Methods: Between October 1997 and August 2001, 171 patients (1997 AJCC) Stage T1a-T2b, Gleason Grade ≤7 who underwent prior TURP received PB as monotherapy at a single institution. All patients were mailed the University of California-Los Angeles Prostate Cancer Index (UCLA PCI) to assess their urinary function. 102 surveys were returned for an overall response rate of 60%. 2 respondents did not complete at least 80% of the survey and were therefore excluded. Time of TURP ranged from 2 to 300 months (median 6.5 yrs, mean 7.7 yrs) before implant. 8 patients had more than one TURP prior to implant. Mean patient age was 74±5.2 yrs. Follow-up ranged from 6.1 to 50.9 months (median 25 months). 59% received Amersham 6711 125I implant (144 Gy TG-43) while 41% received Theragenics 200 103Pd (132 Gy NIST 99). 31% had neoadjuvant Total Androgen Blockade (TAB) for downsizing. Brachytherapy was performed using a 3-D volume reconstructed preplanned/preloaded needle technique. Special care was taken in all cases to identify the urethral defect and avoid 150% of the prescribed matched peripheral dose to this site. Results: UCLA PCI urinary function and bother scores for all 100 patients were analyzed (Table 1). The mean urinary function score and bother score for the entire study group was 83.5±19.5 and 82.5±23.7, respectively. The mean urinary function scores for patients treated with Iodine vs. Palladium were 88.3±16.3 vs. 76.6±21.8, p = .003 and the mean bother scores for patients treated with Iodine vs. Palladium were 87.7±19.3 vs. 75.0±27.4, p = .008. T-tests were performed using the following grouping variables: age≥74 yrs, use of TAB, 125I vs. 103Pd and time to follow-up ≥25 months. The isotope used was the only variable that showed a significant difference in urinary function and bother scores. Conclusions: The majority of patients experienced little or no problem with urination. Specifically, only 3% of patients reported a moderate or big problem with dripping urine and 7% reported a moderate or big problem in urinary function bother (Table 1). Tabled 1Total No. Pts (%)How often leaked urine:Not at all51 (51)Less than once a week17 (17)About once a week10 (10)Every day22 (22)Best description of urinary control:Total control54 (54)Occasional dribbling45 (45)Frequent dribbling1 (1)No control whatsoever0 (0)Pads or adult diapers used daily to control leakage:Not Needed77 (77)No Pads14 (14)1–2 pads per day9 (9)3 or more pads per day0 (0)How big a problem is dripping urine or wetting pants:No problem57 (58)Very small problem23 (23)Small problem16 (16)Moderate problem2 (2)Big problem1 (1)Missing response1How big a problem is urine leakage interfering with sexual activity:No problem78 (91)Very small problem5 (6)Small problem1 (1)Moderate problem0 (0)Big problem2 (2)Missing response14Overall urinary function bother:No problem55 (55)Very small problem28 (28)Small problem10 (10)Moderate problem6 (6)Big problem1 (1)Quality of life scale ranges from 0–100 with higher scores representing better outcomes. Percentage of each item may not equal 100% due to rounding. For items with missing responses, valid percentage is reported. Open table in a new tab Quality of life scale ranges from 0–100 with higher scores representing better outcomes. Percentage of each item may not equal 100% due to rounding. For items with missing responses, valid percentage is reported.