Mild Lower Urinary Tract Symptoms Research Articles

Prevalence of metabolic syndrome and its association with lower urinary tract symptoms and sexual function

ObjectivesTo estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Material and methodsA retrospective study was conducted. Data from all male patients aged ≥40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors. ResultsA total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6–48.3). The bivariate model showed an association between MetS and LUTS (p<0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14–2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24–7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12–5.8). ConclusionThis study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it.

Prevalencia del síndrome metabólico y su asociación con síntomas del tracto urinario inferior y función sexual

ObjectivesTo estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Material and methodsA retrospective study was conducted. Data from all male patients aged ≥40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors. ResultsA total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6-48.3). The bivariate model showed an association between MetS and LUTS (p<0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14-2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24-7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12-5.8). ConclusionThis study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it.

Impact of Androgen Deprivation Therapy on Volume Reduction and Lower Urinary Tract Symptoms in Patients with Prostate Cancer.

To evaluate the impact of androgen deprivation therapy (ADT) on prostate volume, lower urinary tract symptoms (LUTS), and LUTS-related quality of life (QOL) in patients with prostate cancer. Patients with prostate cancer (PCa) were treated with goserelin and bicalutamide for 24 weeks. Changes in the total prostate volume (TPV), International Prostate Symptom Score (IPSS), and QOL score for urinary symptoms were assessed every 12 weeks. Of the 42 patients enrolled, 8 patients withdrew and 2 were excluded, so 32 patients were analyzed. The median age, PSA levels, and TPV were 77.5 years, 22.0 ng/mL, and 29.5 cm3 , respectively. TPV showed a significant decrease from baseline in weeks 12 and 24, with the mean percent decreases being -37.5 ± 4.25 and -7.5 ± 3.84%, respectively. The IPSS decreased from baseline to weeks 12 and 24 (from 11.7 ± 1.6 to 9.3 ± 1.0 and 9.3 ± 1.0; P = 0.15 and 0.2, respectively). The IPSS voiding score showed a significant decrease from baseline to weeks 12 and 24 whereas the IPSS storage score did not. In patients with moderate to severe LUTS, the IPSS and the QOL score showed a significant decrease in weeks 12 and 24. In patients with mild LUTS, nocturia increased significantly from baseline and there was approximately one additional episode of nocturia at 24 weeks. In this study, we observed that ADT significantly reduced TPV and improved LUTS in patients with PCa and moderate to severe LUTS, but increased nocturia in patients with mild LUTS.

PD30-07 QUANTITATION OF LONG TERM STABILITY AND SPECIFIC RELIEF OF LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2016PD30-07 QUANTITATION OF LONG TERM STABILITY AND SPECIFIC RELIEF OF LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Adam Gordon, Douglas Skarecky, Kathyrn Osann, Harleen Dhaliwal, Blanca Morales, and Thomas Ahlering Adam GordonAdam Gordon More articles by this author , Douglas SkareckyDouglas Skarecky More articles by this author , Kathyrn OsannKathyrn Osann More articles by this author , Harleen DhaliwalHarleen Dhaliwal More articles by this author , Blanca MoralesBlanca Morales More articles by this author , and Thomas AhleringThomas Ahlering More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.538AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The primary goal of radical prostatectomy (RP) is cancer control, but intuitively it is also an incidental treatment for LUTS relief by removing obstructive prostatic symptoms, but at what cost is it to men with mild LUTS? This study assesses long-term changes in AUA symptom scores (AUAss) in patients after robot-assisted RP (RARP). METHODS RARP was performed on 666 men, by one surgeon from 2002-2007 at a single institution. I-PSS were queried preoperatively and at 3, 9, 15, 24-48, 60-84, and 96+ months postoperatively. 174 men reported preoperative and long-term responses, average FU of 5.8 years (Range 4.0- 10.3 Yrs). RESULTS The average follow up for all men was 3.0 years and pad free continence at 12 months was 89%. Table 1 shows the baseline demographics of respondents is not significantly different from non-respondents. AUAss for all men declined from baseline to 5 Years by 3.7 (8.6 to 4.8), while QOL/Bother scores decreased by 0.5 (1.7 to 1.2), all p < .05. Men with mild LUTS remained statistically and clinically unchanged at 5 years in respect to preoperative AUA scores. In contrast, individuals with moderate/severe preoperative LUTS markedly declined in AUA and QOL scores, all p ≤ 0.05, Figure 1. Long-term improvements in each individual AUA category are shown for the long-term men (5+years) across the 3 LUTS groups, Figure 2. CONCLUSIONS Men with mild LUTS have short term increases in AUA but return to baseline IPSS and are stable at 5 years. Benefits were found for men with preoperative moderate/severe LUTS in that 63% had significant QOL improvements, and 68% reduced their AUA scores to mild LUTS, persisting years after RARP. Men should be counseled that RARP confers a significant long-term benefit in men with moderate/severe AUAss, improving LUTS and QOL. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e714 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Adam Gordon More articles by this author Douglas Skarecky More articles by this author Kathyrn Osann More articles by this author Harleen Dhaliwal More articles by this author Blanca Morales More articles by this author Thomas Ahlering More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lower Urinary Tract Symptoms and Risk of Nonspine Fractures among Older Community Dwelling U.S. Men

Among older men, moderate and severe lower urinary tract symptoms are associated with increased fall risk compared to mild lower urinary tract symptoms. Falls are a major risk factor for fractures. Therefore, we assessed associations of lower urinary tract symptoms with fracture risk in community dwelling U.S. men age 65 years or older. We conducted a prospective study in the MrOS (Osteoporotic Fractures in Men Study) cohort. Men were enrolled at 6 U.S. sites. The AUA-SI, lower urinary tract symptoms medication use, fracture risk factors and potential confounders were recorded at baseline and every 2 years thereafter for 4 assessments. Lower urinary tract symptom severity was categorized from the AUA-SI as mild (0 to 7 points), moderate (8 to 19 points) or severe (20 or more points). Associations of lower urinary tract symptom severity with fracture rate were estimated with HRs and 95% CIs from extended proportional hazards regression. Among 5,989 men with baseline AUA-SI score and hip bone mineral density measures, 745 incident nonspine fractures occurred during 43,807 person-years of followup. In a multivariable model adjusted for age, enrollment site, baseline hip bone mineral density, falls in the last year and prevalent fracture before baseline, there were no significant associations of moderate (HR0.9, 95% CI 0.8-1.1) or severe (HR 1.0, 95% CI 0.8-1.3) lower urinary tract symptoms with fracture risk. None of the individual lower urinary tract symptoms assessed on the AUA-SI, including nocturia and urgency, was associated with increased fracture risk. In this cohort of older U.S. men, lower urinary tract symptoms were not independently associated with fracture risk.

The Relationship Between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review

To systematically review prospective trials evaluating the clinical effects of testosterone-replacement therapy on lower urinary tract symptoms and prostate volume. We performed a literature review through PubMed, Embase, and Cochrane Library from 1994 to 2015 for prospective trials of hypogonadal men with benign prostatic hyperplasia or lower urinary tract symptoms treated with testosterone-replacement therapy. We evaluated the abstracts for outcomes related to International Prostate Symptom Score, prostate volume, and urodynamic parameters. An original cohort of 3079 abstracts was reviewed. Thirty-five trials were selected for inclusion. The majority of trials reviewed found no significant prostate growth due to testosterone-replacement therapy. Studies of men with baseline mild lower urinary tract symptoms demonstrated either no change or an improvement in symptoms after treatment. There was a lack of relevant urodynamic studies. Trials of men with the metabolic syndrome demonstrated uniform improvement in lower urinary tract symptoms. Forty-six percent of all the trials identified included exclusion criteria for baseline severe-range lower urinary tract symptoms or other signs of obstructive lower urinary tract symptoms. The current literature demonstrates scant support for a causative relationship between testosterone-replacement therapy, de novo or worsening lower urinary tract symptoms, and prostate volume. Furthermore, our review found an absence of high quality evidence that would support guideline recommendations that testosterone-replacement therapy is relatively contraindicated in men with severe-range lower urinary tract symptoms. Future clinical trials with more inclusive voiding criteria are needed.

Giant Prostatic Hyperplasia: Case Report of 3987 mL

We present herein a 72-year-old male with a long history of mild lower urinary tract symptoms, with a serum prostate-specific antigen level value of 87.9 ng/mL and an estimated prostate size of 3987 mL, according to magnetic resonance imaging. Prostatic biopsies showed benign prostatic hyperplasia. Prostatic surgery has not been required. To the best of our knowledge, this is the highest prostate volume reported in the medical literature.

Urinary tract symptoms and erectile function in patients at risk of prostate cancer

Introduction and objectiveWe estimate that more tan 63,000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. Material and method1128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. ResultsThe mean age of the sample was 65. Prostate cancer detection rate was 32.71%, 52.2% of the sample had mild lower urinary tract symptoms (LUTS) and 13.4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12.6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. ConclusionsPatients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage.

MP71-16 GENERATION DIFFERENCE ON THE ASSOCIATION BETWEEN LOWER URINARY TRACT SYMPTOMS AND LATE-ONSET HYPOGONADISM SYMPTOMS: ANALYSIS OF 1398 HEALTHY YOUNG AND ELDERLY ADULTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Evaluation and Symptoms1 Apr 2015MP71-16 GENERATION DIFFERENCE ON THE ASSOCIATION BETWEEN LOWER URINARY TRACT SYMPTOMS AND LATE-ONSET HYPOGONADISM SYMPTOMS: ANALYSIS OF 1398 HEALTHY YOUNG AND ELDERLY ADULTS Hiroshi Kiuchi, Tetsuji Soda, Kentaro Takezawa, Shinichiro Fukuhara, Yasushi Miyagawa, Akira Tsujimura, Tetsuya Takao, and Norio Nonomura Hiroshi KiuchiHiroshi Kiuchi More articles by this author , Tetsuji SodaTetsuji Soda More articles by this author , Kentaro TakezawaKentaro Takezawa More articles by this author , Shinichiro FukuharaShinichiro Fukuhara More articles by this author , Yasushi MiyagawaYasushi Miyagawa More articles by this author , Akira TsujimuraAkira Tsujimura More articles by this author , Tetsuya TakaoTetsuya Takao More articles by this author , and Norio NonomuraNorio Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2629AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aging is known to affect sexual, psychological and physiological functions including lower urinary tract symptoms (LUTS). Recent data suggested that severity of LUTS was associated with that of late-onset hypogonadism (LOH) in elderly men. However, information on the association in young adults is limited. In this study, we evaluated the relationship between LUTS and LOH symptoms in young and elderly adults. METHODS This study included 1398 healthy men ≥20 years; 130 in 20□fs, 519 in 30□fs, 399 in 40□fs, 268 in 50□fs and 82 in 60□fs. LUTS was assessed using I-PSS questionnaire and LOH symptoms was evaluated using Aging Male's Symptoms (AMS) questionnaire with higher score indicating more severe symptoms. LUTS was diagnosed as I-PSSS ≥8. Severity of LUTS was defined by I-PSS-QOL as follows; 0-1 as mild, 2-3 as moderate, and 4-6 as severe. Generalized additive models were used for statistical analysis. RESULTS Total I-PSS score increased with age: LUTS was observed in 3.1% in 20's, 2.7% in 30's, 7.8% in 40's, 15.3% in 50's and 22.0% in 60's (p for trend <0.01) (Fig.1). Mild LUTS was found in 751(54%), and moderate LUTS in 556(40%), severe LUTS in 91(7%). Severity of LOH symptoms increased with increasing LUT severity in any years of age. Moreover, young adults with severe LUTS had more severe LOH symptoms than elderly adults (36.3 vs. 28.5, p<0.05) (Fig. 2); they reported higher psychological and physiological sub-score than elderly men, whereas they reported lower sexual score. CONCLUSIONS Both young and elderly adults with severe LUTS have severe LOH symptoms, but young adults with severe LUTS were more likely to have severe LOH symptoms than elderly adults. Therefore, urologist should take care of hypogonadism symptoms other than LUTS when young adults are presented with LUTS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e918 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroshi Kiuchi More articles by this author Tetsuji Soda More articles by this author Kentaro Takezawa More articles by this author Shinichiro Fukuhara More articles by this author Yasushi Miyagawa More articles by this author Akira Tsujimura More articles by this author Tetsuya Takao More articles by this author Norio Nonomura More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Síntomas del tracto urinario inferior y función eréctil en pacientes con sospecha de cáncer de próstata

Introduction and objectiveWe estimate that more tan 63000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. Material and method1,128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. ResultsThe mean age of the sample was 65. Prostate cancer detection rate was 32,71%, 52,2% of the sample had mild lower urinary tract symptoms (LUTS) and 13,4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12,6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. ConclusionsPatients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage.

MP32-05 ASSOCIATIONS BETWEEN PREMATURE EJACULATION, LOWER URINARY TRACT SYMPTOMS AND ERECTILE DYSFUNCTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation1 Apr 2014MP32-05 ASSOCIATIONS BETWEEN PREMATURE EJACULATION, LOWER URINARY TRACT SYMPTOMS AND ERECTILE DYSFUNCTION Jun Ho Lee and Dong-Gi Lee Jun Ho LeeJun Ho Lee More articles by this author and Dong-Gi LeeDong-Gi Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.935AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is controversy concerning the relationship between premature ejaculation (PE) and erectile dysfunction (ED), as well as the scan data regarding the association between PE and lower urinary tract symptoms (LUTS). We performed this study to evaluate the association between PE and ED or LUTS. METHODS A total of 2591 policemen aged 40-59 years who had participated in a health examination were included in this study. PE, LUTS and ED were evaluated using the premature ejaculatory diagnostic tool (PEDT), the international prostate symptoms score (IPSS) and the international index of erectile function questionnaire-5 (IIEF), respectively. Males with PEDT scores>10 were classified as having PE. Spearman¡¯s correlation test, the multiple linear regression test and logistic regression analyses were used to evaluate the relationship between PE and ED or LUTS. RESULTS The median age of the study group was 49.0 years and the median PEDT, IIEF and IPSS was 4, 18 and 9, respectively. In total, 1279 men had moderate LUTS (49.4%) and 319 (12.3%) men had severe LUTS. The number of men with mild ED, mild to moderate ED, moderate ED, and and severe ED was 785 (30.3%), 530 (20.5%), 242 (9.3%), and and 260 (10.0%), respectively. Additionally, 660 (25.5%) men had PE. By univariate analysis, PEDT showed a significant correlation with IPSS (r=.310, P=<.001) and IIEF (r=-.413, P<.001). After adjusting for age, components of metabolic syndrome, testosterone and IIEF, PEDT was significantly correlated with IPSS (Beta=.166, P<.001). PEDT was also significantly correlated with IIEF after adjusting for age, components of metabolic syndrome, testosterone and IPSS (Beta=-.274, P<.001). Additionally, the severity of LUTS or ED was associated with the PE positive ratio (P trend=.001) (PE; positive ratio (%) according to LUTS severity: mild, 15.6; moderate, 27.5; severe 48.9) (PE; positive ratio (%) according to ED severity: normal, 11.1; mild, 23.1; mild to moderate: 28.5; moderate, 45.6; severe, 51.5). The odds ratio (OR) for PE also significantly increased with the severity of LUTS or ED after adjusting for potential confounding factors(PE; OR, 95% CI vs. severity of LUTS: mild LUTS, 1.000, reference; moderate LUTS, 1.681, 1.335-2.115; severe LUTS, 3.736, 2.754-5.070; P=.001) (PE; OR, 95% CI vs. severity of LUTS: normal, 1.000, reference; mild ED, 2.242, 1.678-2.997; mild to moderate ED, 2.806, 2.049-3.844; moderate ED, 5.821, 4.036-8.395; severe ED, 7.782, 5.422-11.171; P=.001). CONCLUSIONS In our study, ED and LUTS were significantly and independently correlated with PE. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e332 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jun Ho Lee More articles by this author Dong-Gi Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Severity of lower urinary tract symptoms reflects different composition of bladder storage dysfunction and bladder outlet obstruction in men with symptomatic benign prostatic hyperplasia

Differentiation of different lower urinary tract dysfunctions (LUTD) is essential for selecting the optimal first-line medical treatment of lower urinary tract symptoms (LUTS). This study analysed the association of the severity of LUTS with LUTD and therapeutic results based on the International Prostate Symptom Score (IPSS) voiding to storage (V/S) ratio. Lower urinary tract symptoms were evaluated in 849 men using the IPSS questionnaire and the IPSS-V/S ratio. The prostate measures, urinary flow measures, and C-reactive protein (CRP) were investigated at baseline and 1 month after treatment. Therapeutic results were assessed by changes in the quality of life index (QoL-I). The associations of the severity of LUTS with LUTD and therapeutic results were analysed. Mild (IPSS ≤ 7), moderate (8 ≤ IPSS ≤ 19) and severe LUTS (IPSS ≥ 20) were noted in 215, 461 and 173 men. IPSS-V/S ≤ 1 was noted in 81.4% of patients with mild LUTS, while IPSS-V/S > 1 was noted in 71.1% of patients with severe LUTS. After treatment with alpha-blockers in patients with IPSS-V/S > 1 and antimuscarinic agents in patients with IPSS-V/S ≤ 1 for 1 month, 84.0% and 88.8% of patients with mild LUTS had effective therapeutic results, respectively. In contrast, the therapeutic results were less effective in patients with moderate (64.9% and 63.8%, respectively) or severe LUTS (50% and 33.3%, respectively). Patients with benign prostatic hyperplasia (BPH) and mild LUTS have more bladder storage dysfunction, whereas patients with BPH and severe LUTS had higher grade of bladder outlet disorders in associated with storage symptoms. Treatment based on the IPSS-V/S ratio results in good therapeutic results in men with mild and moderate LUTS, but not in men with severe LUTS.

Incidence of Lower Urinary Tract Symptoms in a Population-based Study of Men and Women

To report the incidence of lower urinary tract symptoms (LUTS) in a racially and ethnically and age-diverse U.S. population-based sample of men and women. We conducted a prospective cohort study with 5 years of follow-up. A stratified 2-stage cluster random sampling method was used to recruit 5502 Boston residents aged 30-79 years of black, Hispanic, or white race or ethnicity. Of these, 4144 (1610 men and 2534 women) completed the follow-up protocol. The American Urological Association Symptom Index was used to define moderate-to-severe LUTS. Of the 3301 men and women with no or mild LUTS at baseline, the 5-year incidence of moderate-to-severe LUTS (American Urological Association Symptom Index ≥8) was 11.4% overall and was higher for women than for men (13.9% vs 8.5%, P = .02). Although the incidence increased with age (P <.001), it had a plateau among women aged 50-70 years and then doubled to 35.0% among women aged ≥70 years. White men had a distinctly lower incidence (7%) than all other sex and race subgroups (13%). Approximately 1 in 10 adults had newly developed LUTS at 5 years follow-up of in our study, with differences by sex and race or ethnicity, indicating a greater occurrence of urologic problems among black and Hispanic participants and women.

Erectile function and late-onset hypogonadism symptoms related to lower urinary tract symptom severity in elderly men

The aim of this study was to evaluate the relationship between lower urinary tract symptoms (LUTSs), erectile dysfunction (ED) and symptomatic late-onset hypogonadism (SLOH) in ageing men in the Aegean region of Turkey. Five hundred consecutive patients >40 years old who had been in a steady sexual relationship for the past 6 months and were admitted to one of six urology clinics were included in the study. Serum prostate-specific antigen and testosterone levels and urinary flow rates were measured. All patients filled out the International Prostate Symptom Score and Quality of Life (IPSS-QoL), International Index of Erectile Function (IIEF) and Aging Males' Symptoms (AMS) scale forms. Of the patients, 23.9% had mild LUTSs, 53.3% had moderate LUTSs and 22.8% had severe LUTSs. The total testosterone level did not differ between groups. Additionally, 69.6% had ED. The presence of impotence increased with increasing LUTS severity. Symptomatic late-onset hypogonadism (AMS >27) was observed in 71.2% of the patients. The prevalence of severe hypogonadism symptoms increased with the IPSS scores. A correlation analysis revealed that all three questionnaire scores were significantly correlated. In conclusion, LUTS severity is an age-independent risk factor for ED and SLOH. LUTS severity and SLOH symptoms appear to have a strong link that requires etiological and biological clarification in future studies.

Current pharmacological treatment options for male lower urinary tract symptoms

Introduction: Benign prostatic hyperplasia (BPH) is a highly prevalent disease in the aging male and significantly impairs quality of life. Men with BPH present with lower urinary tract symptoms (LUTS), which include storage and voiding disorders. Medical therapy is the first option in patients with mild to moderate symptoms.Areas covered: α1-adrenoceptor antagonists, 5α-reductase inhibitors or the combination of both have been considered gold standard for pharmacological treatment over the last decade in this patient cohort. Recently, a variety of novel substances have been tested which include Phosphodiesterase Typ 5 inhibitors (PDE5i), anti-cholinergic agents and β-3-agonists. This article highlights the key studies with regard to each drug class and discusses current pharmacotherapy and possible future treatment options.Expert opinion: In patients with small prostates, α1-adrenoceptor antagonists represent the gold standard in the medical treatment of mild LUTS. For men with large prostate glands and mild to moderate LUTS, recent data support the combination of α1-adrenoceptor antagonists and 5α-reductase inhibitors. PDE5i may be useful in men with LUTS and concomitant erectile dysfunction, while anti-cholinergics have been shown to be beneficial in patients with predominant storage disorders. Future studies have to elucidate the role of β-3-agonists in men with BPH and LUTS.

Impact of lower urinary tract symptoms on prostate cancer risk among Japanese men with prostate‐specific antigen &lt;10 ng/mL and non‐suspicious digital rectal examination

To investigate the association between lower urinary tract symptoms status and prostate cancer risk at initial extended biopsy. Between 2005 and 2011, the International Prostate Symptom Score was completed on 1467 consecutive men with prostate-specific antigen <10 ng/mL and non-suspicious digital rectal examination. After excluding 308 men treated with alpha-blockers, the remaining 1159 men were enrolled in the present study. Lower urinary tract symptoms status was divided into absent or mild (International Prostate Symptom Score scores of 0-7) and moderate or severe lower urinary tract symptoms (International Prostate Symptom Score scores of 8-35). The risks of prostate cancer diagnosis and high-grade (Gleason score ≥4 + 3) prostate cancer diagnosis in relation to lower urinary tract symptoms status was evaluated using logistic regression. A stratified analysis based on prostate volume (<30 cc, 30-50 cc and >50 cc) was also carried out. Of 1159 patients, 421 (36.3%) had a positive biopsy and 590 (51.0%) had moderate or severe lower urinary tract symptoms. On multivariate analysis, absent or mild lower urinary tract symptoms had a significant and positive impact on the risk of prostate cancer and high-grade disease (odds ratio 1.64 and 1.70, P = 0.0007 and 0.0121, respectively). Furthermore, the aforementioned findings for prostate cancer detection did not change throughout every prostate volume subgroup. In contrast, in men with prostate volume ≤50 cc, but not in those with prostate volume >50 cc, prostate-specific antigen or %free prostate-specific antigen remained as a significant predictor of prostate cancer. In men with elevated prostate-specific antigen, absent or mild lower urinary tract symptoms are positively associated with prostate cancer and high-grade disease regardless of the prostate volume. This finding is especially useful in men with enlarged prostates.

Impact of Robot-assisted Radical Prostatectomy on Lower Urinary Tract Symptoms and Predictive Factors for Symptom Changes: A Longitudinal Study

To investigate the longitudinal changes in lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP). Data on 127 patients who underwent RARP and completed the American Urological Association Symptom Score (AUASS) preoperatively and at 3, 6, and 12 months after surgery were collected prospectively and reviewed retrospectively. Based on the preoperative AUASS, the patients were divided into 2 groups: mild vs moderate to severe. In patients with moderate to severe LUTS, the AUASS gradually decreased after RARP. However, in patients with mild LUTS, the AUASS increased significantly at 3 months postoperatively; although LUTS began to improve at 6 months postoperatively. In multivariate logistic regression analysis, higher body mass index (BMI) was associated with an exacerbation of LUTS at 3 months postoperatively (odds ratio [OR]= 1.148, P<.05). Within the moderate to severe LUTS group, urinary continence at 3 months after RARP was independently associated with the symptom improvement of LUTS at 1 year after surgery (OR= 4.772, P<.05). In a subgroup analysis, lower BMI and urinary continence at 3 months after RARP predicted a significant improvement in storage symptoms at 12 months postoperatively (OR= 0.856, P<.05, and OR= 3.828, P<.05, respectively). After RARP, LUTS significantly improved over a 1-year period in patients with moderate to severe LUTS. However, in the immediate postoperative setting, LUTS was exacerbated in patients with mild LUTS. Increased BMI was associated with a lack of improvement in LUTS, whereas early recovery of urinary continence after surgery predicted better symptomatic improvement in LUTS, especially storage symptoms.

Effect of Depression on the Risk and Severity of Lower Urinary Tract Symptoms in Community-Dwelling Elderly Korean Men.

To evaluate the association of the risk and severity of lower urinary tract symptoms (LUTS) and depression diagnosed by neuropsychiatrists according to the DSM-IV diagnostic criteria using an objective questionnaire within community-dwelling elderly Korean men. A total of 392 men who completed urological and psychiatric evaluations as a participant in the Korean Longitudinal Study on Health and Aging were included in this analysis. From each subject, an interview elicited demographic characteristics and medical history, International Prostate Symptom Score was ascertained, and a psychiatric questionnaire was completed. Subjects were analyzed with regard to depression and LUTS severity. The mean age of the subjects was 75 years, 22% were current smokers and 45% were heavy drinkers. Two hundred and twenty-nine subjects (59%) had moderate to severe LUTS and 6.4% of the subjects were diagnosed with major depressive disorders. Those with depression showed higher International Prostate Symptom Score and lower quality of life than the euthymic group (P = 0.03 and P = 0.02, respectively). Severe LUTS was more prevalent in the depression group compared with the euthymic group (P = 0.01). Moderate to severe LUTS was associated with higher age, lower prevalence of hypertension, and higher prevalence of depression than mild LUTS. Univariate and multivariate analyses identified age, hypertension, and depression as significant prognostic factors for moderate to severe LUTS. Depression was the most significant prognostic factor. Depression was associated with 5.81-fold increased odds of having moderate to severe LUTS. In older Korean men, depressive symptoms are associated with moderate to severe LUTS.

The etiology and management of acute prostatitis

Acute bacterial prostatitis is a common and clinically important genitourinary disorder. Patient populations who are at especially high risk of acute prostatitis include those with diabetes, cirrhosis, and suppressed immune systems. The cause is usually an ascending infection, but bacteria can also be introduced during transrectal prostate biopsy. Clinical presentation ranges from mild lower urinary tract symptoms to full sepsis. The causative organisms are usually similar to those that cause other common genitourinary infections, and include Escherichia coli and Enterococcus spp. Oral or intravenous antibiotics are usually effective for curing the infection and progression to chronic bacterial prostatitis is, therefore, uncommon. Immunosuppressed patients require special consideration, as bacterial prostatitis in these patients can be caused by atypical infecting organisms and might, therefore, require additional therapies. A lack of response to standard therapy can lead to complications such as a prostatic abscess or fistula.

Diagnostic values of detrusor wall thickness, postvoid residual urine and prostate volume to evaluate lower urinary tract symptoms in men

This prospective, controlled clinical study aimed to assess the diagnostic values of detrusor wall thickness (DWT), postvoid residual urine volume (PVR), and prostate volume in men with lower urinary tract symptoms (LUTS). During an 18-month period, a total of 243 males were included in the study. Three groups were assessed due to their International Prostate Symptom Score (IPSS): men with normal lower urinary tracts (n = 51; control group), men with mild LUTS (n = 60; Group 1), and men with moderate to severe LUTS (n = 132; Group 2). DWT, bladder, and prostate volumes and PVR were measured by suprapubic ultrasonography. DWT was measured when the bladder was full (DWT-1) and when it was empty (DWT-2). The mean age for the study population was 60.0 ± 0.6 years, while the mean IPSS for the whole group was 8.0 ± 0.4. Both the bladder and prostate volumes in Group 2 were statistically significantly higher than the control group and Group 1. The mean DWT-1 values were significantly lower in the control group when compared to Groups 1 and 2. However, when study groups were compared with each other, no statistical significance was noticed (1.12 vs. 1.17 mm). In contrast, the mean PVR and DWT-2 values were significantly different in each group. There was a significant correlation between IPSS questionnaire results and all individual parameters. Suprapubic transabdominal ultrasonographic assessment of the lower urinary tract in a noninvasive manner allows the clinician to assess LUTS severity in men without morbidity. Additional studies are necessary to provide further conclusions regarding this clinical procedure.