Mild Lower Urinary Tract Symptoms Research Articles

Impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms in older males.

To assess the impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms (LUTS). A total of 193 male patients, aged 60 years and above, who visited the geriatric outpatient clinic at Ibn-i Sina Hospital in Ankara, Turkey, between December 2019 and March 2021, were enrolled. Sarcopenia was diagnosed according to the criteria set by the European Working Group on Sarcopenia in Older People. The presence and severity of lower urinary tract symptoms were assessed using the International Prostate Symptom Score questionnaire, categorizing symptom severity as mild or moderate-to-severe. The median patient age was 71 years (range: 66-77). Sarcopenia affected 24.9% of the population studied. Mild LUTS was observed in 43.5% and moderate-to-severe LUTS was observed in 56.5% of patients. Sarcopenia prevalence was significantly higher in the individuals with moderate-to-severe LUTS compared to those with mild-LUTS (p=0.021). After adjusting for Charlson comorbidity index and age, only vitamin D levels were significantly associated with increased odds of moderate-to-severe LUTS (odds ratio [OR]=0.95, 95% confidence interval [CI]: [0.92-0.98], p=0.002). Sarcopenia was not significantly associated with the severity of LUTS (OR=2.04, 95% CI: [0.94-4.45], p=0.070). An inverse linear trend was observed between quartiles of 25 (OH) vitamin D and LUTS severity. As 25 (OH)vitamin D levels increased, the proportion of patients with moderate-to-severe LUTS decreased (p=0.023). Sarcopenia did not significantly impact LUTS severity, but low vitamin D levels were associated with moderate-to-severe LUTS.

Evaluating Transperineal Prostate Biopsies Performed by a New Operator: A Prospective Clinical Audit at Dorset County Hospital.

Introduction The transperineal (TP) approach for prostate biopsy offers advantages such as a low risk of infection, the ability to target lesions in difficult locations, and a rapid acquisition of proficiency. This prospective clinical audit aims to evaluate the outcomes and patient experiences of TP prostate biopsies performed by a new operator to determine the feasibility of adopting the TP biopsy as the primary method for prostate evaluations. Methods The study included all patients who underwent a TP prostate biopsy from August 1 to September 30, 2022, at Dorset County Hospital National Health Service Foundation Trust. The operator, a member of the urology team, had recently begun performing these biopsies independently after completing a four-month supervised training program and receiving approval from two consulting trainers. The biopsy technique was evaluated based on diagnostic yield and patient experience, comparing pre-procedure imaging results with histology reports and analyzing patient-completed questionnaires. Results Among the 42 patients, the cancer detection rate was 79%. The highest core positivity rate was 100% in two patients (5%), with 90% in 11 patients (26%). Of the patients, 57% showed complete agreement between magnetic resonance imaging findings and histology. A questionnaire assessing patient experience received a 64% response rate. The most common pain score reported was 2 (on a scale of 0-10), noted in 25% of patients. Most reported mild lower urinary tract symptoms (88%) and mild hematuria (85%). Of the patients, 44% rated their overall satisfaction as 10 (on a scale of 0-10), and no urinary tract infections were reported. Conclusion The findings support the adoption of TP biopsy as the primary method for prostate biopsies due to its short learning curve, high diagnostic yield, and favorable patient satisfaction. Training for new operators should be encouraged to achieve this goal.

Lower urinary tract symptoms as an independent predictor of aortic regurgitation in women with cardiac symptoms.

Very few studies have focused on the correlation between structural heart disease and lower urinary tract symptoms. In this study, we applied echocardiography to explore the correlation between lower urinary tract symptoms and structural heart disease. In this single-center, prospective, cross-sectional study, we enrolled adult women undergoing echocardiography for suspected cardiac abnormalities causing cardiac symptoms between February 1, 2021, and March 31, 2021. All participants completed a questionnaire regarding demographic information and lower urinary tract symptoms, which were assessed according to the International Prostate Symptom Score. A total of 165 women aged 69.96 ± 10.20 years were enrolled. The prevalence of moderate-to-severe aortic regurgitation in patients with moderate-to-severe lower urinary tract symptoms was significantly higher than that in patients with mild lower urinary tract symptoms (33.3% vs 13.6%, p = 0.008). The prevalence of other echocardiographic abnormalities was not associated with severity of lower urinary tract symptoms. Multivariable logistic regression analyses revealed that moderate-to-severe lower urinary tract symptoms predicted moderate-to-severe aortic regurgitation ( p = 0.007; odds ratio: 3.560; 95% confidence interval: 1.409-8.993). Furthermore, the International Prostate Symptom Score storage subscore ( p = 0.001; odds ratio: 1.285; 95% confidence interval: 1.111-1.486), except the voiding subscore, was an independent predictor of moderate-to-severe aortic regurgitation. Moderate-to-severe lower urinary tract symptoms, especially storage symptoms, are an independent predictor of the co-existence of moderate-to-severe aortic regurgitation in women with cardiac symptoms. Early cardiological referral of patients with moderate-to-severe lower urinary tract symptoms and cardiac symptoms may improve their general health.

Relationship between lower urinary tract symptoms (LUTS) and prostate cancer: A persistent myth

Background:The presence of lower urinary tract symptoms (LUTS) is described as an early symptom of prostate cancer in some patient guidelines; however, a statistical association has never been established.Methods:This study was conducted using a prospective electronic database at a single tertiary institution between January 2015 and November 2017. LUTS were assessed using the International Prostate Symptom Score (IPSS), and prostate cancer was graded according to the International Society of UroPathologists (ISUP) grading system. The association between IPSS and Grade Group was tested using parametric one-way analysis of variance (ANOVA) with post hoc analysis using Tukey’s honestly significant difference (Tukey’s HSD).Results:A total of 611 men attended the One-Stop Prostate Clinic (OSPC) and IPSSs were available for 557 men. Overall, 46% had mild LUTS (IPSS: 1–7), 38% had moderate LUTS (IPSS: 8–19) and 16% had severe LUTS (IPSS: 20–35). Almost 85% proceeded to have transrectal ultrasound (TRUS) prostate biopsies, and clinically significant prostate cancer (CSPC) was detected in 37% with mild LUTS, 35% with moderate LUTS and 42% with severe LUTS. Correlation between histopathology and IPSSs was assessed in all 78.8% of men who had IPSS data available and underwent prostate biopsies.Conclusion:This large series did not establish any correlation between LUTS and prostate cancer in men undergoing investigation for the suspicion of prostate cancer.Level of evidence:Not applicable

Association of symptomatic late-onset hypogonadism and lower urinary tract symptoms in aging males: a community-based study

Objective: Testosterone deficiency may be a risk factor for lower urinary tract symptoms (LUTS), and there may be a causal link between the emergence of LUTS and the incidence of late-onset hypogonadism (LOH). We performed an epidemiologic study to investigate the association between symptomatic late-onset hypogonadism (SLOH) and LUTS in middle-aged and elderly rural Chinese males. Methods: A total of 965 men completed a questionnaire and underwent a detailed physical examination. The Aging Males’ Symptoms (AMS) scale was used to assess SLOH, and the International Prostate Symptom Score (IPSS) questionnaire was used to assess LUTS. Serum reproductive hormone levels of testosterone, sex hormone-binding globulin (SHBG) and luteinizing hormone (LH) were measured. Results: A total of 965 males (mean age: 56.34 ± 8.85, range: 40–80 years) were recruited for the present study. A total of 20.93% (202/965) were diagnosed with SLOH. A total of 93.16% (899/965) had mild LUTS, 5.18% (50/965) had moderate LUTS, and 1.66% (16/965) had severe LUTS. Among SLOH patients, 13.40% (27/202) and 3.90% (8/202) had moderate and severe LUTS, respectively. Patients with severe LUTS had increased SHBG and LH compared with those with mild and moderate LUTS (P <0.01). Correlation analysis revealed that the AMS total score was positively correlated with the IPSS score (P <0.05). The prevalence of SLOH was significantly increased with LUTS severity. In addition to the known effect of age, the results of multiple regression analysis also showed that serum LH or SHBG appeared to have a weak link with SLOH and LUTS that requires etiological and biological clarification in our future study. Conclusion: In this cross-sectional analysis of SLOH and LUTS, LUTS severity was significantly associated with hypogonadism symptoms. Additionally, the prevalence of SLOH advanced with increasing LUTS severity. Serum SHBG or LH showed a positive correlation with SLOH and LUTS.

Trosier's sign: A Rare Presentation of Metastatic Prostate Cancer

Prostate cancer is the second most common cause of cancer death in men globally. The most common sites of metastasis include the bone, lymph nodes, lungs, liver, pleura, and adrenal glands. A 65-year-old Zambian man presented with neck swelling for 3 months with mild lower urinary tract symptoms. He reported that the swelling was fast growing, painless and with no history of trauma. On examination, Trosier’s sign was present. Histology report following a lymph node incision biopsy demonstrated Adenocarcinoma. Prostate specific antigen (PSA) was also positive. A follow up prostate biopsy found adenocarcinoma Gleason 8. This case highlights the need for a high index of suspicion in older, male patients presenting with unexplained neck swelling and no known history of prostatic adenocarcinoma.

Trosier's sign: A Rare Presentation of Metastatic Prostate Cancer

Prostate cancer is the second most common cause of cancer death in men globally. The most common sites of metastasis include the bone, lymph nodes, lungs, liver, pleura, and adrenal glands. A 65-year-old Zambian man presented with neck swelling for 3 months with mild lower urinary tract symptoms. He reported that the swelling was fast growing, painless and with no history of trauma. On examination, Trosier’s sign was present. Histology report following a lymph node incision biopsy demonstrated Adenocarcinoma. Prostate specific antigen (PSA) was also positive. A follow up prostate biopsy found adenocarcinoma Gleason 8. This case highlights the need for a high index of suspicion in older, male patients presenting with unexplained neck swelling and no known history of prostatic adenocarcinoma.

Correlation of Detrusor Wall Thickness with International Prostate Symptom Score: A Cross-sectional Study of Nigerian Men with Prostate-Related Diseases

Introduction: Bladder Outlet Obstruction (BOO) due to prostate- related diseases can lead to changes in bladder wall resulting in detrusor wall thickening. These changes are time-dependent and may reflect the severity of underlying BOO. Although urodynamic tests are considered to be the gold standard for the assessment of the severity of Lower Urinary Tract Symptoms (LUTS), these are time-consuming, invasive and expensive. The Detrusor Wall Thickness (DWT) measurement has emerged as a cheap, non invasive and reproducible alternative means of assessing the severity of LUTS in men with BOO. Aim: To determine the correlation between the DWT and International Prostate Symptom Score (IPSS) in men being evaluated for prostate-related BOO/LUTS. Materials and Methods: A cross-sectional hospital based study was conducted over a period of 12 months (May 2014 to April 2015), at Urology Clinics of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All 100 new consecutive male patients aged ≥40 years with prostate-related LUTS and who can achieve bladder volume of >250 mL were included in the study. The DWT was measured at three different sites (anterior, lateral and dome) at bladder volume >250 mL. Ethical approval was attained from the institutional ethical review board. Severity of LUTS was assessed using a validated IPSS questionnaire. Data was analysed using SPSS version 20. Spearman’s correlation was used to assess the correlation. The p-value <0.05 was considered significant. Results: A total of 100 men with the mean age of 71.02±9.10 years were studied. The mean duration of symptoms was 30.63±26.60 months with the average IPSS being 20.94±6.13. A total of 43 patients and 57 patients had moderate and severe LUTS, respectively. None of the patients had mild LUTS. The mean anterior, lateral, dome and average DWT measurements were 4.95±2.36 mm, 4.96±2.37 mm, 5.02±2.34 mm and 4.97±2.35 mm, respectively. A total of 97 patients had DWT ≥2 mm. There was a significant positive correlation between the DWT and IPSS (r2=0.635 and p<0.001). Conclusion: The positive correlation between the DWT and IPSS has demonstrated that the DWT measurement can be used in assessing the severity of LUTS in men with prostate-related diseases.

Baseline patient reported outcomes data shows high prevalence of overactive bladder, sexual dysfunction, depression and anxiety in Canadian men with newly diagnosed localized prostate cancer.

BackgroundResearch on prostate cancer survivorship patients has largely been on oncological outcome, incontinence and erectile dysfunction, with less data on the relationship between prostate cancer, bladder function and mental health. This study aims to elucidate the prevalence of lower urinary tract symptoms (LUTS), overactive bladder (OAB), sexual dysfunction, depression and anxiety in Canadian men with newly diagnosed localised prostate cancer.MethodsThis is a single-centre prospective cross-sectional study of men with newly diagnosed localized prostate cancer recruited from June 2017 to July 2018. The patient-reported outcomes (PRO) instruments used in this study included the international prostate symptoms score (IPSS), OAB-V8, EQ-5D™, and the Expanded Prostate Cancer Index Composite short form (EPIC-26). Clinico-pathological data were extracted from medical records. The prevalence of LUTS, OAB, sexual dysfunction, depression and anxiety were determined from the PROs.ResultsA total of 83 patients were included in this study. The median age was 63. Based on IPSS scores, 55.3% of men had mild LUTS, 36.8% had moderate LUTS and 7.9% had severe LUTS. Based on OAB-V8 scores, 55.8% of men had a score of 8 or higher, suggestive of OAB. Only 55.8% of men reported erections adequate for intercourse. 23.1% of men reported to have a moderate to big problem with depression, and 28.8% of men reported to have a degree of anxiety or depression.ConclusionsOAB is a significant problem in men with newly diagnosed localized prostate cancer, with a prevalence of 55.8% based on this study. Baseline sexual dysfunction, anxiety and depression are also prevalent in this population.

Self-Assessed Benefits of a Prostate Health Formulation on Nocturia in Healthy Males With Mild Lower Urinary Tract Symptoms: An Open Label Study.

BackgroundNocturia is the most bothersome lower urinary tract symptoms (LUTS) and can significantly reduce men's quality of life. It is often poorly managed with conventional treatments.ObjectiveThe purpose of this study was to evaluate the self-assessed benefits of a prostate health dietary combination formulation on mild LUTS, especially nocturia in healthy males.MethodsIn an open label clinical study, thirty healthy male subjects with mild LUTS took one daily capsule of the product for 60 days. The primary outcome was self-assessed severity of LUTS using the International Prostate Symptoms Score (IPSS) questionnaire at Day 1 (baseline), Day 30 and Day 60. Safety and compliance were also evaluated.ResultsAt Day 60, IPSS significantly decreased from baseline by 16.3% (3.6 ± 2.1 vs. 4.3 ± 1.5, p < 0.05). Although the reduction in IPSS did not reach statistical significance at Day 30, it was mostly driven by a 30.7% decrease (p < 0.05) in the nocturia sub-score compared with baseline. While 37% of subjects reported at baseline waking up 2‒3 times/night to void, none did so after taking the study product for 60 days. Compliance was very high throughout the study. No adverse events related to the study product were reported.ConclusionsThe study product might be a safe alternative for individuals willing to explore a non-conventional approach to manage their nocturia. A larger randomized placebo-controlled clinical trial is warranted to confirm these results. Clinical trial registry: Clinical Trials.gov. Registration number (September 1st, 2016): NCT02886832.

Lower urinary tract symptoms in patients with advanced prostate cancer: What are the outcomes of androgen deprivation therapy?

Androgen deprivation therapy (ADT) is accepted as the first-line treatment of advanced prostate cancer. This study sets out to determine the outcomes of ADT in reducing lower urinary tract symptoms (LUTS) in patients with advanced prostate cancer and also to determine the quality of life (QoL) of the patients. This was a prospective study carried out at Jos University Teaching Hospital. All consecutive patients who had LUTS due to advanced prostate cancer were recruited into the study. All patients completed the international prostate symptom score (IPSS) questionnaire, including QoL assessment. Post-void residual (PVR) urine, maximum flow rate (Qmax), prostate specific antigen and total prostate volume (TPV) were assessed. The parameters before and at 12 months were compared. Data from 65 patients were analysed. The mean age of the patients was 68.5 ± 8.67 years with an age range of 46-85 years. Four (6.2%) had mild LUTS before AD, and their symptoms remained mild at 12 months of ADT. Twenty-two (33.9%) patients had moderate urinary symptoms. Of this, 10 (18.5%) patients had symptomatic improvement at 12 months of ADT. Of 39 (60%) patients who presented with severe LUTS, 21 (32.3%) had improvement at 12 months of ADT. Before ADT and at 12 months of ADT, the mean IPSS score, mean TPV, Qmax, PVR and mean QoL score were 23 ± 8.8 and 15 ± 8.8 (P < 0.0001); 79.7 ± 51.4 and 73.4 ± 34.3 (P = 0.212); 8.0 ± 4.7 and 11.2 ± 4.4 (<0.001); 209.8 ± 127.8 and 163 ± 111.4 (<0.001); 4.23 ± 1.2 and 3.24 ± 1.2 (P < 0.001), respectively. Of the 39 patients (60%) with severe urinary symptoms, 18 (27.7%) of patients had urethral catheterization for either acute or chronic urinary retention before ADT. At 12 months on ADT, eight patients (12.3.7%) were still on catheter due to failed attempts at trial without catheter. ADT significantly improves urodynamic parameters, IPSS score and IPSS-related QoL. There remains a subset of patients, in whom LUTS persist with negative effects on QoL.

Lower urinary tract symptoms (LUTS) are not associated with an increased risk of prostate cancer in men 50–69 years with PSA ≥3 ng/ml

Background: There is conflicting evidence about the association between prostate cancer and Lower Urinary Tract Symptoms (LUTS). We aimed to describe the prevalence of LUTS and its association with prostate cancer risk.Methods: We studied the association between International Prostate Symptom Score (IPSS) and prostate cancer in a population-based sample of men (n = 45,595) aged 50–69 years from the Stockholm3 study. Men with PSA ≥3 ng/ml (n = 4579) underwent systematic prostate biopsies. We used the International Society of Urological Pathology Gleason Grading (ISUP grade) and performed regression analysis for risk of any cancer (n = 1797), ISUP grade ≥2 (n = 840) and advanced cancer, defined as ISUP grade ≥3 or cT ≥3 (n = 353).Results: 74.6% of all men had no or mild LUTS (IPSS ≤7) and 3.2% had severe LUTS (IPSS >19). Men with any, ISUP grade ≥2 or advanced cancer had lower median IPSS compared to men with benign biopsy (any cancer: 4 (IQR 2–9); ISUP grade ≥2: 4 (2–8); advanced cancer: 4 (2–8); benign biopsy: 6 (3–11); p < 0.05). IPSS was not associated with increased risk of cancer in multivariate analyses (OR (any cancer) 0.97; 95% CI 0.96–0.98; OR (ISUP grade ≥2) 0.97; 95% CI 0.96–0.99; OR (advanced cancer) 0.99; 95% CI 0.99–1.01).Conclusions: Three-quarters of men aged 50–69 years report no or mild LUTS. Our data do not support any clinically meaningful association between LUTS and prostate cancer. Specifically, men with advanced prostate cancer did not exhibit more urinary symptoms than men without cancer.

PO-01-007 Effects of nutraceuticals on sexual satisfaction and lower urinary tract symptoms in a cohort of young/old men

The aim of this study was to evaluate the effects of nutraceuticals containing multiple supplemental facts (Virherbe®/Rekupros®) on sexual satisfaction and lower urinary tract symptoms (LUTS) in young–old men. In an open-label trial, 40 males (mean age 66 ± 13) with sexual disturbances and mild LUTS but without cognitive/motor impairment and clinical hypogonadism were enrolled. Sexual desire (SD; IIEF-SD domain) and satisfaction (Global Assessment Question; GAQ), the capacity to perform daily activities (evaluated by 6-min walking test [6MWT]), and International Prostate Symptoms Scores (IPSS) were evaluated before and after oral administration of 2 capsules/day of each supplement for 8 weeks. Subjects were admitted to assume PDE5i as complimentary therapy if ED was present. The difference from baseline for SD was +2.6 (p < .05) and −4.2 points for IPSS (p < .05), with significance in subscales of urinary streaming/nocturia (p < .01), respectively; 6MWT increased from 507 ± 44 versus 527 ± 58 meters (p < .001). GAQ scale-responses showed overall improvement in overall 75% population, with a significant improvement in QoL (p < .01). These changes returned to baseline at 1-month withdrawal follow-up. No adverse events were reported.

Tadalafil vs. tamsulosin in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a prospective, randomized study.

IntroductionTo compare the efiicacy of tadalafil 5 mg with tamsulosin 0.4 mg in the treatment of Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).Material and methodsA randomized prospective study on patients diagnosed with LUTS secondary to BPH with 50 patients in each group. Duration of the study is 12 weeks. Drug was given 30 min after dinner. Patients were assessed at baseline 1, 4 and 12 weeks with efficacy measures being Maximum flow rate (Qmax), Postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), International Prostate Symptom Score Quality of life (IPSS QoL) and Sexual Health Inventory for Men (SHIM) scoring. Statistical analysis was done using paired sample t test and independent sample t test.ResultsIn tadalafil group, 12 (24%) patients were having mild LUTS and 38 (76%) were having moderate LUTS. In tamsulosin group, 9 (18%) patients were having mild LUTS and 41 (82%) patients were having moderate LUTS. Seventeen patients in tadalafil group had associated ED (erectile dysfunction) and 13 patients had associated ED in tamsulosin group.ConclusionsWhen both groups were compared, tamsulosin showed better efficacy than tadalafil in treating LUTS secondary to BPH.

Prevalence and predictors of lower urinary tract symptoms in Pakistani men: A cross-sectional study

Objective: The purpose of this study was to investigate the prevalence and severity of the condition of lower urinary tract symptoms in Pakistani men, determine its predictors and assess its impact on the quality of life. Methods: A cross-sectional, population-based study was conducted among men aged 30 years and over in three districts of Punjab province, Pakistan. The modified Urdu version of the International Prostate Symptom Score was used to assess the prevalence and severity of lower urinary tract symptoms. Individuals with total symptom score ⩾8 were considered as having lower urinary tract symptoms. The data were analysed using SPSS version 22. The chi-square test and Mann-Whitney U test were used to assess the difference among categorical and continuous variables, respectively. Moreover, binary logistic regressions were performed to determine the predictors of lower urinary tract symptoms. Results: The overall prevalence of lower urinary tract symptoms in our sample was 33.7%. The frequency of individuals having mild, moderate and severe lower urinary tract symptoms was 66.3, 30.3 and 3.4%, respectively. Storage symptoms were more common than voiding symptoms (35.6% vs 28.2%, respectively). Increasing age (one-decade interval age stratum), higher education levels, working status (currently not working), smoking, hypertension, diabetes and renal impairment were positive predictors of lower urinary tract symptoms. Moreover, the condition of lower urinary tract symptoms was associated with a significant reduction in an individual’s quality of life. Conclusion: Around one-third of adult Pakistani men suffer from clinically relevant urinary symptoms, with lower urinary tract symptoms sufferers having poor quality of life as compared to non-sufferers. We recommend that the aging population should be made aware of conventional measures to mitigate mild urinary symptoms affecting their routine activities. Level of evidence: 2c

Male Bladder Microbiome Relates to Lower Urinary Tract Symptoms

BackgroundIn women, compelling evidence associates lower urinary tract microbiota (LUTM) with lower urinary tract symptoms (LUTS); a similar association in men with benign prostate enlargement (BPE) is not established. ObjectiveTo determine whether associations exist between LUTM and LUTS. Design, setting, and participantsForty-nine male volunteers, aged 40–85 yr, were recruited from one academic tertiary care center. Twenty-eight patients undergoing BPE/LUTS surgery and 21 undergoing non-BPE/LUTS surgery were stratified by International Prostate Symptom Score (IPSS), and paired voided/catheterized urine specimens were collected for expanded quantitative urine culture (EQUC) and 16S ribosomal RNA gene sequencing. Outcome measurements and statistical analysisPrimary and secondary outcomes were presence of detectable LUTM and specific bacterial members of the LUTM, respectively. Baseline data were compared. Univariable logistic regression models were used to calculate odds ratios (ORs) for IPSS category associated with the presence of bladder microbiota. Relative LUTM proportions were compared with IPSS using chi-square tests. Results and limitationsThirty-nine percent of catheterized and 98% of voided specimens contained LUTM. Catheterized and voided LUTM differed significantly. LUTM was detected in catheterized urine of 22.2% of men with mild LUTS, 30.0% with moderate LUTS, and 57.1% with severe LUTS (p=0.024). Increased IPSS category was associated with significantly higher odds of detectable bacteria (OR: 2.21, 95% confidence interval: 1.09–4.49). Small sample size limited this study, making it unable to identify significant differences in specific bacterial taxa based on IPSS. ConclusionsVoided urine does not adequately characterize the male bladder microbiome. In males with and without BPE, IPSS severity was associated with detectable bacteria in catheterized urine, which samples the bladder. Additional studies are needed to identify specific bladder bacteria associated with LUTS. Patient summaryTo study bladder bacteria, urine should be collected with a catheter. Men with severe urinary symptoms are more likely to have detectable bladder bacteria than those with less severe symptoms.

Étude algérienne des effets bénéfiques de la triptoréline sur les symptômes du bas appareil urinaire chez les patients atteints d’un cancer de la prostate non localisé

This study aims to assess the effectiveness of triptorelin on lower urinary tract symptoms (LUTS) in Algerian patients with non-localized prostate cancer in routine practice. This prospective, observational, non-interventional, multicentre study was conducted in Algeria. Included patients who had locally advanced or metastatic prostate cancer and were treated with triptorelin 11.25mg given every 12 weeks. LUTS were evaluated with the International Prostate Symptom Score (IPSS) until week 48 after treatment initiation. An IPSS>7 indicated moderate to severe LUTS. The primary objective of the study was to determine the distribution of IPSS at week 48. This study enrolled 193patients at 21centres. A total of 144participants had IPSS available at baseline and after baseline (136patients had moderate to severe LUTS and eight had mild LUTS at baseline). At week 48, amongst the 116patients with IPSS available and moderate to severe LUTS at baseline, 94 (81.0%) had moderate to severe LUTS and 22 (19.0%) had mild LUTS. At week 48, the eight patients with mild symptoms at baseline remained in this category. The proportion of patient with severe LUTS decreased from 53.7% at baseline to 12.1% at week 48. Adverse events were reported in 22.9% of participants. A reduction of LUTS is observed in patients with locally advanced or metastatic prostate cancer treated with triptorelin in routine practice. This is in agreement with similar observational studies of triptorelin conducted in other countries. 4.

MP23-10 INCREASING INTERNATIONAL PROSTATE SYMPTOM SCORE PREDICTS PRESENCE OF BACTERIA WITHIN THE BLADDER IN THE ABSENCE OF URINARY TRACT INFECTION

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-10 INCREASING INTERNATIONAL PROSTATE SYMPTOM SCORE PREDICTS PRESENCE OF BACTERIA WITHIN THE BLADDER IN THE ABSENCE OF URINARY TRACT INFECTION Petar Bajic, Michelle Van Kuiken, Bethany Burge, Eric Kirshenbaum, Alan Wolfe, Cara Joyce, Kristin Baldea, Larissa Bresler, and Ahmer Farooq Petar BajicPetar Bajic More articles by this author , Michelle Van KuikenMichelle Van Kuiken More articles by this author , Bethany BurgeBethany Burge More articles by this author , Eric KirshenbaumEric Kirshenbaum More articles by this author , Alan WolfeAlan Wolfe More articles by this author , Cara JoyceCara Joyce More articles by this author , Kristin BaldeaKristin Baldea More articles by this author , Larissa BreslerLarissa Bresler More articles by this author , and Ahmer FarooqAhmer Farooq More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.742AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bacteria have been identified in urine deemed sterile by standard culture and have been shown to influence lower urinary tract symptoms (LUTS). We define the relationship between International Prostate Symptom Score (IPSS) and the bladder microbiome. METHODS Catheterized urine specimens (CUS) were collected from 49 adult men: 29 with benign prostatic hyperplasia (BPH)/LUTS based on IPSS who were undergoing BPH surgery, and 20 asymptomatic males (ASM) undergoing non-BPH surgery. Men with preoperative urinary tract infection, history of urinary retention or instrumentation were excluded. CUS were obtained prior to administration of perioperative antibiotics and expanded quantitative urine culture (EQUC) and 16S rRNA sequencing were performed. EQUC utilizes 100x more urine, additional media and environmental conditions, with double the incubation period of standard culture. Colonies grown were identified using mass spectrometry. Relative proportions of bacterial species/genera identified by either method were compared to patient IPSS scores using chi-square tests. The odds ratios for IPSS category and BPH associated with presence of bacteria were reported from univariable logistic regression models. RESULTS We detected bacteria in 20/49 (40.8%) of patients: 3/18 (16.7%) men with mild LUTS, 4/10 (40.0%) men with moderate LUTS and 13/21 (61.9%) men with severe LUTS (p = 0.017). There was no difference between patients with and without bacteria with respect to age, race, ethnicity, BMI, tobacco use, hypertension diabetes and circumcised status. An increase in IPSS category was associated with significantly higher odds of detectable bacteria (OR: 2.81, 95% CI: 1.34-5.92). Compared to ASM, men with BPH were over eight times more likely to have bacteria detected (OR: 8.03, 95% CI: 1.92-33.62). Men with severe LUTS were found to have more Streptococcus species (p = 0.025). CONCLUSIONS Increasing IPSS predicts the presence of bacteria in the bladders of non-instrumented, non-infected men. Those with severe LUTS are likely to harbor Streptococcus species compared to mildly and moderately symptomatic men. Further characterization of the male urinary microbiome may elucidate a pathophysiological relationship to LUTS. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e284-e285 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Petar Bajic More articles by this author Michelle Van Kuiken More articles by this author Bethany Burge More articles by this author Eric Kirshenbaum More articles by this author Alan Wolfe More articles by this author Cara Joyce More articles by this author Kristin Baldea More articles by this author Larissa Bresler More articles by this author Ahmer Farooq More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Hypogonadal men with moderate-to-severe lower urinary tract symptoms have a more severe cardiometabolic risk profile and benefit more from testosterone therapy than men with mild lower urinary tract symptoms.

PurposeTo analyze data from an observational, prospective, cumulative registry study in 805 hypogonadal men stratified by mild or moderate-to-severe lower urinary tract symptoms (LUTS) according to International Prostate Symptom Score.Materials and MethodsA total of 412 men underwent testosterone therapy (TTh) with injectable testosterone undecanoate, 393 men served as untreated controls. Measures of urinary function, anthropometric and metabolic parameters were performed at least twice per year.ResultsData from 615 men with mild LUTS (253 treated, 362 untreated) and 190 with moderate-to-severe LUTS (159 treated, 31 untreated) were available. During a follow-up period of 8 years a significant improvement of LUTS was noted for all TTh-patients whereas the control-groups showed deterioration or fluctuation around initial values. Despite advancing age, TTh fully prevented worsening of symptoms. In parallel, a considerable improvement of anthropometric parameters, lipids and glycemic control, blood pressure, C-reactive protein, and quality of life was found. Moderate-to-severe LUTS was associated with worse cardiometabolic risk profile at baseline as well as worse cardiovascular outcomes during follow-up in comparison to mild LUTS. Effect size of TTh was more pronounced in men with moderate-to-severe than with mild LUTS.ConclusionsCorrecting hypogonadism by TTh is highly effective and safe for improving LUTS in hypogonadal men. TTh may also improve cardiometabolic risk and major adverse cardiovascular events.

Effects of nutraceuticals on sexual satisfaction and lower urinary tract symptoms in a cohort of young-old men.

The aim of this study was to evaluate the effects of nutraceuticals containing multiple supplemental facts (Virherbe®/Rekupros®) on sexual satisfaction and lower urinary tract symptoms (LUTS) in young-old men. In an open-label trial, 40 males (mean age 66±13) with sexual disturbances and mild LUTS but without cognitive/motor impairment and clinical hypogonadism were enrolled. Sexual desire (SD; IIEF-SD domain) and satisfaction (Global Assessment Question; GAQ), the capacity to perform daily activities (evaluated by 6-min walking test [6MWT]), and International Prostate Symptoms Scores (IPSS) were evaluated before and after oral administration of 2 capsules/day of each supplement for 8weeks. The difference from baseline for SD was +2.6 (p<.05) and -4.2 points for IPSS (p<.05), with significance in subscales of urinary streaming/nocturia (p<.01), respectively; 6MWT increased from 507±44 versus 527±58meters (p<.001). GAQ scale-responses showed overall improvement in overall 75% population, with a significant improvement in QoL (p<.01). These changes returned to baseline at 1-month withdrawal follow-up. No adverse events were reported. These supplemental facts improved sexual desire, satisfaction with sex life, physical performance, and LUTS in young-old men, suggesting that they may be effective in patients in whom standard treatments are not suitable.