Moderate Lower Urinary Tract Symptoms Research Articles

Lower Urinary Tract Symptoms (LUTS) as a New Clinical Presentation of Histamine Intolerance: A Prevalence Study of Genetic Diamine Oxidase Deficiency.

Lower urinary tract symptoms (LUTS) are highly prevalent, and their treatment is mainly focused on the control of symptoms. Histamine intolerance (HIT) has been related to a variety of systemic symptoms. DAO deficiency has been identified as a significant factor contributing to histamine intolerance (HIT). Preclinical evidence indicates the involvement of histamine in the lower urinary tract. This study aimed to assess the prevalence of diamine oxidase deficiency (DAO) in a prospective cohort of 100 patients with at least moderate LUTS. A genetic study of four single nucleotide polymorphisms (SNPs) (c.-691G>T, c.47C>T, c.995C>T, and c.1990C>G) was performed. HIT was found in 85.9% of patients. The prevalence of at least one minor allele in the SNPs analyzed was 88%, without gender differences. Storage symptoms were more intense in the presence of HIT as well as asthenia and neurological and musculoskeletal symptoms. The presence of minor alleles of the AOC1 gene was associated with a higher intensity of symptoms. Minor alleles from c.-691G>T and c.47C>T SNPs were also associated with a greater severity of obstructive symptoms. Thirty-one percent of patients presented the four SNPS with at least one associated minor allele. The relationship between HIT and LUTS in a mixed population of men and women found in this study supports further investigations to define the pathophysiology of histamine in LUTS.

Cervi Parvum Cornu complex for men with lower urinary tract symptoms: a multicenter, randomized, double-blind, placebo-controlled trial

BackgroundTo evaluate the efficacy and safety of Cervi Parvum Cornu, Angelicae Gigantis Radix and Glycyrrhizae Radix complex (CAG) in men with moderate lower urinary tract symptoms (LUTS). Materials and methodsFrom November 2020 to January 2022, participants with International Prostate Symptom Score (IPSS) of 12–19 in two centers were recruited and randomize into three groups: a CAG 500 mg/day group (CAG 500), a CAG 1000 mg/day group (CAG 1000), and a placebo group (PG). They were treated for 12 weeks. The primary endpoint was change of IPSS at the end of study from baseline. Secondary end points included change of prostate specific antigen (PSA), testosterone, dihydrotestosterone (DHT), maximum urinary flow rate (Q max), post-void residual volume (PVR), International Index of Erectile Function (IIEF), and drug safety. ResultsA total of 103 patients were able to finish the study according to the study protocol. Total IPSS and sub-scores (residual urine sensation, frequency, weak stream, hesistancy, nocturia, and quality of life) in CAG 500 and CAG 1000 were significantly improved at the 12th week compared to those of the PG. Changes of serum PSA, DHT, and testosterone levels at the 12th week from baseline did not show significant differences among the three groups. Q max and PVR changes did not show significant differences among the three groups either. Total IIEF and sub-scores (erectile function, orgasmic function, sexual desire, intercourse satisfaction) in CAG 1000 were significantly improved at 12th week compared to those in PG. No significant adverse events were found. ConclusionsCAG is well tolerated in patients with moderate LUTS. Treatment with CAG for 12 weeks has a therapeutic effect on moderate LUTS.

Spectrum of lower urinary tract symptoms in the women attending gynecological OPD in a tertiary care hospital in Northeast India

<b>Aim:</b> Lower Urinary Tract Symptoms (LUTS) are common conditions seen in women of all ages and by clinicians of nearly all specialties. The prevalence of LUTS has been measured by numerous epidemiological studies around the globe. However, there are insufficient data from India, particularly among women consulting gynecology clinics. This observational study was conducted to determine the proportion of LUTS among women attending the Gynecology OPD.<br /> <b>Material and methods:</b> For the evaluation, a standardized, pretested, structured, and scored Bristol LUTS questionnaire containing sociodemographic information and a clinical history of LUTS symptoms has been utilized. The symptoms of LUTS were classified as storage, voiding, and stress symptoms. Each response received a score between 0 and 4. Patients were categorized into no/minimal LUTS (score1–7), moderate LUTS (score8–19), and severe LUTS (score>20). In our study, 48% of women attending the Gynecological OPD had LUTS. Age and vaginal delivery had a significant influence on the incidence of LUTS.<br /> <b>Results:</b> Despite the high prevalence of LUTS, few patients in our study spontaneously reported symptoms of LUTS. This underreporting may be due to a lack of awareness as well as social stigma. Many consider these symptoms to be a normal part of the ageing process, especially in postmenopausal women.<br /> <b>Conclusion:</b> Although all of the patients we have identified are based on the evaluation of a symptomatic questionnaire, a urodynamic study should be conducted to determine whether or not these women have different types of LUTS.

Impact of Falls and Sleep Quality on Quality of Life among Older Men with Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia

Suffering from lower urinary tract symptoms in male older adults with benign prostatic hyperplasia affects quality of life profoundly. Lower urinary tract symptoms may precipitate to fall and poor quality of sleep. Less is known of the impact of falls and sleep quality on quality of life. This cross-sectional study aimed to determine the impact of falls and sleep quality on quality of life in this population. The participant was 140 older males, diagnosed with benign prostatic hyperplasia, presented with lower urinary tract symptoms, and no history of prostatic surgery. Structured interview with questionnaires—Demographic and Health Record Form, International Prostate Symptom Score, Pittsburgh Sleep Quality Index, and European Quality of Life—Five Dimension—was conducted at outpatient urological surgery unit at a tertiary care hospital in Bangkok, Thailand. Descriptive statistics and multiple-logistic regression with bootstrapping analysis were used for data analysis.                    Results revealed that majority of the participants reported falls and poor sleep quality, while nearly half had poor quality of life. Moderate lower urinary tract symptoms severity including nocturia, frequency, and urgency were predominantly identified. The predictive model explained 36.7% and correctly classified 74.3% of the cases. Significantly, those who experienced falls last year, and poor sleep quality increased the risk of developing the poor quality of life by 2.43 to 20.68-fold and 4.90-fold, respectively. Findings suggest that nurses should focus on preventing falls and poor sleep quality to improve quality of life. Proactive identification or specific symptom assessment, particularly falls history, sleep quality, and urinary symptoms severity during the treatment, is of concern in older men with lower urinary tract symptoms.

Associations of Clinical and Dosimetric Parameters with Urinary Toxicities after Prostate Brachytherapy: A Long-Term Single-Institution Experience.

To examine the association of clinical, treatment, and dose parameters with late urinary toxicity after low-dose-rate brachytherapy (LDR-BT) for prostate cancer, we retrospectively studied patients with prostate cancer who underwent LDR-BT from January 2007 through December 2016. Urinary toxicity was assessed using the International Prostate Symptom Score (IPSS) and Overactive Bladder (OAB) Symptom Score (OABSS). Severe and moderate lower urinary tract symptoms (LUTS) were defined as IPSS ≥ 20 and ≥ 8, respectively; OAB was defined as a nocturnal frequency of ≥ 2 and a total OABSS of ≥ 3. In total, 203 patients (median age: 66 years) were included, with a mean follow-up of 8.4 years after treatment. The IPSS and OABSS worsened after 3 months of treatment; these scores improved to pretreatment levels after 18-36 months in most patients. Patients with a higher baseline IPSS and OABSS had a higher frequency of moderate and severe LUTS and OAB at 24 and 60 months, respectively. LUTS and OAB at 24 and 60 months were not correlated with the dosimetric factors of LDR-BT. Although the rate of long-term urinary toxicities assessed using IPSS and OABSS was low, the baseline scores were related to long-term function. Refining patient selection may further reduce long-term urinary toxicity.

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

(146) Rezum Water Vapor Therapy for Patients with Mild, Moderate, or Severe Lower Urinary Tract Symptoms: A Retrospective Study in a Multiethnic Population

Abstract Introduction Benign prostatic hyperplasia (BPH) is a common chronic condition that is associated with the development of lower urinary tract symptoms (LUTS). Symptom severity of LUTS secondary to BPH can range from mild, moderate, to severe and can be assessed utilizing the International Prostate Symptom Score (IPSS). The Rezum System (Rezum; Boston Scientific, Marlborough, MA, USA) is a minimally invasive surgical therapy that utilizes convective radiofrequency water vapor thermal energy to ablate obstructive lobes of the prostate, resulting in cell necrosis and improvement in LUTS. Objective To evaluate the safety and efficacy of Rezum in patients with mild, moderate, or severe LUTS secondary to BPH. Methods A single office, retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were categorized into three cohorts based on baseline IPSS LUTS severity: mild LUTS (IPSS ≤ 7), moderate LUTS (IPSS 8-19), or severe LUTS (IPSS ≥ 20) cohorts. Outcome measures, including IPSS, quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), alpha blockers and 5-alpha reductase inhibitors usage, and adverse events (AEs) were collected and analyzed at baseline, 1-, 3-, 6-, and/or 12-months postoperatively. Results A total of 238 patients were included: 33 with mild LUTS, 109 with moderate LUTS, and 96 with severe LUTS. At 1-month follow-up, the moderate and severe LUTS cohorts saw significant improvements in IPSS (moderate LUTS: -3.0 [-6.0, 1.5], p<0.001; severe LUTS: -10.0 [-16.0, -5.0], p<0.001) and QoL (moderate LUTS: -1.0 [-3.0, 0.0], p<0.001; severe LUTS: -1.0 [-3.0, 0.0], p<0.001) and improvements remained durable up to 12-months (p<0.001). The mild LUTS cohort saw significant worsening in IPSS by 2.0 (0.0, 12.0) at 1-month (p=0.002) but returned to baseline at 3-months (p=0.114). However, the mild LUTS cohort experienced significant improvements in QoL by -0.5 (-3.0, 0.0) at 3-months (p=0.035) and nocturia by 0.0 (-1.0, 0.0) at 6-months (p=0.002), both of which remained durable to 12-months (p<0.05). Most AEs were transient and non-serious, with gross hematuria (66.5%) being most common. There were no significant differences in QoL point reduction, Qmax improvement, PVR reduction, and AE occurrence between the cohorts at 12-months (p>0.05). At 12-months, 80.0%, 87.5%, and 66.0% of the patients in the mild, moderate, and severe LUTS cohorts discontinued their BPH medications, respectively. Conclusions Rezum provides rapid and durable relief in LUTS in patients with moderate or severe LUTS and can be offered to patients with mild LUTS who have bothersome nocturia and wish to discontinue their BPH medications. Disclosure No

The Role of Oxybutynin Chloride in the Management of Patientswith Benign Prostatic Hyperplasia

Objectives: To determine the efficacy and tolerability of Oxybutynin chloride in men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in which previous a-blocker therapy had failed. :
 Materials and Methods: A total of 38 consecutive men with BPH complaining of LUTS in whom a mean of 6.3 months of a-blocker therapy had failed received Oxybutynin (5 mg twice daily orally) for 3 months in addition to the usual a-blocker medication. Primary efficacy end points were American Urological Association symptom score, and mean daytime and nighttime micturition frequency. Secondary end points were the peak urinary flow rate, post-void residual volume, the incidence of urinary retention, and adverse events. Statistical analysis was used when needed.
 Results: A total of 33 men (87%) with a mean age of 59 years completed the 3-month trial. Mean 24- hour micturition frequency decreased from 11.2 to 6.5 voids and nocturia decreased from 5.1 to 2.4 episodes nightly. Significant changes in mean American Urological Association symptom scores (- 5.31), the peak urinary flow rate (1.8 ml per second) and post-void residual volume (=21 ml) were also observed. Five men (13%) discontinued therapy because of intolerable dry mouth. There were no reports of urinary retention.
 Conclusions: Treatment with Oxybutynin in carefully selected men with BPH and moderate LUTS may be a reasonable therapeutic option after failed treatment with a-blockers.

MP76-09 SCHELIN CATHETER TM FOR TRANS URETHRAL INTRAPROSTATIC ANESTHESIA BEFORE REZŪM WATER VAPOR TREATMENT: A NEW TOOL TO ENHANCE THE MINIMAL INVASIVENESS

You have accessJournal of UrologyCME1 Apr 2023MP76-09 SCHELIN CATHETERTM FOR TRANS URETHRAL INTRAPROSTATIC ANESTHESIA BEFORE REZŪM WATER VAPOR TREATMENT: A NEW TOOL TO ENHANCE THE MINIMAL INVASIVENESS Giampaolo Siena, Francesco Sessa, Paolo Polverino, Lorenzo Viola, Anna Rivetti, Pietro Spatafora, Riccardo Campi, and Luca Cindolo Giampaolo SienaGiampaolo Siena More articles by this author , Francesco SessaFrancesco Sessa More articles by this author , Paolo PolverinoPaolo Polverino More articles by this author , Lorenzo ViolaLorenzo Viola More articles by this author , Anna RivettiAnna Rivetti More articles by this author , Pietro SpataforaPietro Spatafora More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , and Luca CindoloLuca Cindolo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Among minimally invasive surgical techniques (MISTs) for moderate lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), RezūmTM water vapor treatment (Boston Scientific Corporation, Marlborough, USA) (RT) has been accepted as one of the most effective and versatile, with a very good sexual safety profile. To further enhance the minimal invasiveness of RT, we sought to evaluate potential advantages and feasibility of pure local transurethral intraprostatic anesthesia (TUIA) via the Schelin CatheterTM (ProstaLund AB, Lund, Sweden) (SC), a 3 ways device designed with an operational channel equipped with a retractile needle and the standard drainage and ballon ports (Figure 1). METHODS: After Ethical Commitee approval, included and collected data from 20 patients with moderate LUTS due to BPO, undergone RT procedure using TUIA by SC, from 2 centers. To rate their pain, patients were asked to use a numeric rating scale (NSR; numbered 0–10; 0 “No pain”/10 “Worst pain”) at 9-time points: 1-Preoperatively; 2-Schelin catheter insertion; 3-anestethic infiltration; 4-Rezum probe insertion; 5-Water Vapor Treatment (WVT); 6-Catheter insertion; 7-Day 1; 8-Day 7 catheter removal; 9-Day 30 follow-up visit. RESULTS: All 20 patients safely received TUIA prior RT. None required further anesthesiologic treatment. Median prostate size, Qmax, IPSS and QoL were 7 5ml, 9 mL/sec, 23 and 4, respectively. Median TUIA time was 3 minutes. Median catheterization time was 7 days. No need of re-catheterization or urinary tract infections at 30 days post-operatively were reported. Median NRS reported was 1.5 at each time point except at point 1, 2, 3 and 5. At preoperative stage NRS of pain was 0 in all cases. During catheter insertion (point 2) median NRS of pain was 2; during LA infiltration (point 3) was 2.5, and during WVT was 2 (point 5). One out of 10 patients reported a NRS of 6 during WVT (point 5). No perioperative anesthesiologic and procedure-related complications were recorded. CONCLUSIONS: Our data report for the first time in literature the feasibility and safeness of TUIA during RT using SC that showed full operative and post-operative pain control and reduced operative time and patient discomfort. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1094 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giampaolo Siena More articles by this author Francesco Sessa More articles by this author Paolo Polverino More articles by this author Lorenzo Viola More articles by this author Anna Rivetti More articles by this author Pietro Spatafora More articles by this author Riccardo Campi More articles by this author Luca Cindolo More articles by this author Expand All Advertisement PDF downloadLoading ...

Rezum water vapor therapy for patients with mild, moderate, or severe lower urinary tract symptoms: A retrospective study in a multiethnic population.

The Rezum System (Rezum) represents a novel, minimally invasive surgical therapy used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We evaluated the safety and efficacy of Rezum in patients with mild, moderate, or severe LUTS. A single office, retrospective study was conducted on patients from a multiethnic population treated with Rezum between 2017 and 2019. Patients were categorized into three cohorts based on baseline International Prostate Symptom Score (IPSS) LUTS severity: mild LUTS (IPSS ≤ 7), moderate LUTS (IPSS 8-19), or severe LUTS (IPSS ≥ 20) cohorts. Outcome measures, including IPSS, quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), BPH medication usage, and adverse events (AEs) were collected and analyzed at baseline, 1-, 3-, 6-, and/or 12-months postoperatively. A total of 238 patients were included: 33 with mild LUTS, 109 with moderate LUTS, and 96 with severe LUTS. At 1-month follow-up, the moderate and severe LUTS cohorts saw significant improvements in IPSS (moderate LUTS: -3.0 [-6.0, 1.5], p < 0.001; severe LUTS: -10.0 [-16.0, -5.0], p < 0.001) and QoL (moderate LUTS: -1.0 [-3.0, 0.0], p < 0.001; severe LUTS: -1.0 [-3.0, 0.0], p < 0.001) and improvements remained durable up to 12-months (p < 0.001). The mild LUTS cohort saw significant worsening in IPSS by 2.0 (0.0, 12.0) at 1-month (p = 0.002) but returned to baseline at 3-months (p = 0.114). However, the mild LUTS cohort experienced significant improvements in QoL by -0.5 (-3.0, 0.0) at 3-months (p = 0.035) and nocturia by 0.0 (-1.0, 0.0) at 6-months (p = 0.002), both of which remained durable to 12-months (p < 0.05). Most AEs were transient and nonserious, with gross hematuria (66.5%) being most common. There were no significant differences in QoL point reduction, Qmax improvement, PVR reduction, and AE occurrence between the cohorts at 12-months (p > 0.05). At 12-months, 80.0%, 87.5%, and 66.0% of the patients in the mild, moderate, and severe LUTS cohorts discontinued their BPH medications, respectively. Rezum provides rapid and durable relief in LUTS in patients with moderate or severe LUTS and can be offered to patients with mild LUTS who have bothersome nocturia and wish to discontinue their BPH medications.

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 &lt;0.01). Correlation analysis revealed that the AMS total score was positively correlated with the IPSS score (P &lt;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.

How does symptom severity impact clinical outcomes of men with lower urinary tract symptoms after holmium laser enucleation or transurethral resection of the prostate?

International Prostate Symptom Score (IPSS) is a validated outcome measure for the evaluation of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). When treating patients with transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP), patient selection is key to achieve the best clinical outcome. Therefore, we analyzed how the severity of LUTS as determined by IPSS influenced postoperative functional outcomes. We conducted a retrospective, matched-pair analysis of 2,011 men who underwent HoLEP or TURP for LUTS/BPO between 2013-2017. We included 195 patients in the final analysis (HoLEP n = 97; TURP n = 98), who were matched for prostate size (50 cc), age, and body mass index. Patients were then stratified by IPSS. Groups were compared for perioperative parameters, safety and short-term functional outcomes. While preoperative symptom severity was a significant predictor of postoperative clinical improvement, patients who received HoLEP showed superior postoperative functional results with higher peak flow rates and 2-fold greater improvement in IPSS. In patients presenting with severe symptoms, we observed 3- to 4-fold less Clavien-Dindo grade ≥II and overall complications after receiving HoLEP compared to TURP. Patients with severe LUTS were more likely to experience clinically significant improvement after surgery than patients with moderate LUTS, and HoLEP showed superior functional outcomes than TURP. However, patients with moderate LUTS should not be denied surgery, but may warrant a more comprehensive clinical work-up.

Association of Lower Urinary Tract Symptoms Based on the International Prostate Symptom Score and Cardiovascular Disease.

Because it is unclear whether lower urinary tract symptoms (LUTS) are associated with cardiovascular disease (CVD) in the Japanese population, we explored the association in general Japanese men aged 55-75 years.Methods and Results:The cross-sectional study included male participants who had both national health checkup data and the International Prostate Symptom Score (IPSS) in the same calendar year between 2009 and 2017. LUTS severity was evaluated by IPSS. A robust Poisson regression model was used to assess the association between LUTS severity and the composite CVD outcome [coronary artery disease (CAD), stroke, or atrial fibrillation (AF)] and each component of the composite outcome. Prevalence ratio (PR) was adjusted for conventional cardiovascular risk factors. Of 16,781 male participants (mean age, 67±5 years), mild LUTS were observed in 9,243 (55.1%); moderate, 6,445 (38.4%); and severe, 1,093 (6.5%). Compared with the mild LUTS group, moderate LUTS [PR 1.18, 95% confidence interval (CI) 1.10-1.25, P<0.001] and severe LUTS (PR 1.38, 95% CI 1.24-1.53, P<0.001) were significantly associated with a higher prevalence of CVD. LUTS severity was associated with higher prevalence of CAD and stroke, but not AF. The severity of LUTS was associated with a higher prevalence of CVD, especially CAD and stroke, independent of conventional CVD risk factors.

Transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia.

Transurethral resection of the prostate (TURP) has been the gold-standard treatment for alleviating urinary symptoms and improving urinary flow in men with symptomatic benign prostatic hyperplasia (BPH). However, the morbidity of TURP approaches 20%, and less invasive techniques have been developed for treating BPH. Transurethral microwave thermotherapy (TUMT) is an alternative, minimally-invasive treatment that delivers microwave energy to produce coagulation necrosis in prostatic tissue. This is an update of a review last published in 2012. To assess the effects of transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Web of Science, and LILACS), trials registries, other sources of grey literature, and conference proceedings published up to 31 May 2021, with no restrictions by language or publication status. We included parallel-group randomized controlled trials (RCTs) and cluster-RCTs of participants with BPH who underwent TUMT. Two review authors independently assessed studies for inclusion at each stage and undertook data extraction and risk of bias and GRADE assessments of the certainty of the evidence (CoE). We considered review outcomes measured up to 12 months after randomization as short-term and beyond 12 months as long-term. Our main outcomes included: urologic symptoms scores, quality of life, major adverse events, retreatment, and ejaculatory and erectile function. In this update, we identified no new RCTs, but we included data from studies excluded in the previous version of this review. We included 16 trials with 1919 participants, with a median age of 69 and moderate lower urinary tract symptoms. The certainty of the evidence for most comparisons was moderate-to-low, due to an overall high risk of bias across studies and imprecision (few participants and events). TUMT versus TURP Based on data from four studies with 306 participants, when compared to TURP, TUMT probably results in little to no difference in urologic symptom scores measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms at short-term follow-up (mean difference (MD) 1.00, 95% confidence interval (CI) -0.03 to 2.03; moderate certainty). There is likely to be little to no difference in the quality of life (MD -0.10, 95% CI -0.67 to 0.47; 1 study, 136 participants, moderate certainty). TUMT likely results in fewer major adverse events (RR 0.20, 95% CI 0.09 to 0.43; 6 studies, 525 participants, moderate certainty); based on 168 cases per 1000 men in the TURP group, this corresponds to 135 fewer (153 to 96 fewer) per 1000 men in the TUMT group. TUMT, however, probably results in a large increase in the need for retreatment (risk ratio (RR) 7.07, 95% CI 1.94 to 25.82; 5 studies, 337 participants, moderate certainty) (usually by repeated TUMT or TURP); based on zero cases per 1000 men in the TURP group, this corresponds to 90 more (40 to 150 more) per 1000 men in the TUMT group. There may be little to no difference in erectile function between these interventions (RR 0.63, 95% CI 0.24 to 1.63; 5 studies, 337 participants; low certainty). However, TUMT may result in fewer cases of ejaculatory dysfunction compared to TURP (RR 0.36, 95% CI 0.24 to 0.53; 4 studies, 241 participants; low certainty). TUMT versus sham Based on data from four studies with 483 participants we found that, when compared to sham, TUMT probably reduces urologic symptom scores using the IPSS at short-term follow-up (MD -5.40, 95% CI -6.97 to -3.84; moderate certainty). TUMT may cause little to no difference in the quality of life (MD -0.95, 95% CI -1.14 to -0.77; 2 studies, 347 participants; low certainty) as measured by the IPSS quality-of-life question on a scale from 0 to 6, with higher scores indicating a worse quality of life. We are very uncertain about the effects on major adverse events, since most studies reported no events or isolated lesions of the urinary tract. TUMT may also reduce the need for retreatment compared to sham (RR 0.27, 95% CI 0.08 to 0.88; 2 studies, 82 participants, low certainty); based on 194 retreatments per 1000 men in the sham group, this corresponds to 141 fewer (178 to 23 fewer) per 1000 men in the TUMT group. We are very uncertain of the effects on erectile and ejaculatory function (very low certainty), since we found isolated reports of impotence and ejaculatory disorders (anejaculation and hematospermia). There were no data available for the comparisons of TUMT versus convective radiofrequency water vapor therapy, prostatic urethral lift, prostatic arterial embolization or temporary implantable nitinol device. TUMT provides a similar reduction in urinary symptoms compared to the standard treatment (TURP), with fewer major adverse events and fewer cases of ejaculatory dysfunction at short-term follow-up. However, TUMT probably results in a large increase in retreatment rates. Study limitations and imprecision reduced the confidence we can place in these results. Furthermore, most studies were performed over 20 years ago. Given the emergence of newer minimally-invasive treatments, high-quality head-to-head trials with longer follow-up are needed to clarify their relative effectiveness. Patients' values and preferences, their comorbidities and the effects of other available minimally-invasive procedures, among other factors, can guide clinicians when choosing the optimal treatment for this condition.

Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem?

The aim of this study was to determine whether well timed start of medical and surgical treatment of benign prostatic obstruction (BPO) influences the treatment's effectiveness and thus the patients' overall functional outcomes and quality of life. Pharmacological therapy even in high-volume (>80 cm3) BPH typically begins with α-blockers sole and only subsequently are 5ARI added. Several studies showed that acute urinary retention (AUR) developed more frequently in men who suffered severe lower urinary tract symptoms (LUTS) and who did not start combination therapy immediately. Moreover, there are no strict criteria which determine the right time for performing surgery in patients with mild and moderate LUTS, especially when pharmacological therapy fails. However, sometimes, the surgery does not eliminate all the symptoms, as it deals effectively with BPO, but does not treat an overactive bladder. Also, data show that surgery should be performed as soon as possible and be more radical after the first episode of AUR. A combination of α-blockers and 5ARI makes for a good starting point where the treatment of high volume BPH is concerned. Ideally, surgery should be performed immediately or as soon as possible in patients with the first episode of AUR and 'anatomic' BPH tissue removal is preferable (dissection of tissue along the prostate capsule to remove its maximum volume).

Effectiveness and Safety of Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms from Benign Prostatic Hyperplasia in Men with Concurrent Localized Prostate Cancer

PurposeTo assess the effectiveness and safety of prostatic artery embolization (PAE) on lower urinary tract symptoms (LUTS) in the setting of localized prostate cancer (PCa). Materials and MethodsThis was a retrospective, single-center, institutional review board-approved study from December 2016 to June 2020 of 21 patients (median age, 72; range, 63–83 years) with moderate LUTS and localized PCa. Clinical effectiveness was evaluated at 6 and 12 weeks using International Prostate Symptom Score (IPSS) and quality of life (QoL) improvement. Seventeen patients were scheduled to receive definitive radiotherapy (RT) after PAE; 13 patients completed RT. Short-term imaging signs of oncologic progression were evaluated at 6 and 12 weeks defined by at least one of the following on magnetic resonance imaging: increased Prostate Imaging-Reporting and Data System score of index lesion(s) to at least 4, new extracapsular extension, seminal vesicle involvement, or pelvic lymphadenopathy. Nonparametric Wilcoxon signed-rank test was used for analysis. ResultsIPSS improved by a median of 12 (n = 19, P < .0001) and 14 (n = 14, P < .0001) at 6 and 12 weeks, respectively. QoL improved by a median of 2 (n = 19, P < .0001) and 3 (n = 3, P < .0001) at 6 and 12 weeks. Prostate volume decreased by a median of 24% (n = 19, P < .0001) and 36% (n = 12, P = .015) at 6 and 12 weeks. No patients demonstrated disease progression at 6 (n = 16) or 12 (n = 8) weeks by imaging. No patients experienced increased prostate-specific antigen after RT, grade ≥3 adverse events, or greater genitourinary toxicity. ConclusionsPAE is effective and safe for the treatment of men with LUTS from benign prostatic hyperplasia in the setting of concomitant, localized, non-obstructive PCa.

Neurilemoma of Seminal Vesicle: A Case Report

Neurilemmoma of the seminal vesicle is an extremely rare tumor. We report a neurilemmoma of right seminal vesicle. A 67-year-old man presented with moderate lower urinary tract symptoms. A magnetic resonance imaging of prostate performed due to high level of prostate specific antigen revealed a 8.1x8.1x7.1 cm, arising from right seminal vesicle. Laparoscopic resection of tumor was performed. The histopathology showed neurilemmoma arising from seminal vesicle.&#x0D;  

Identifying Prostate Cancer Among Men with Lower Urinary Tract Symptoms

BackgroundIn men aged above 50yr, lower urinary tract symptoms (LUTS), benign prostate hyperplasia, and prostate cancer are common urological conditions. Current guidelines for general practitioners frequently recommend prostate-specific antigen (PSA) testing in patients with LUTS for the detection of prostate cancer. ObjectiveTo assess the performance of PSA, PSA density, and the Stockholm3 blood test for identification of prostate cancer among men with LUTS. Design, setting, and participantsIn this post hoc analysis of a population-based diagnostic trial (STHLM3, n=58 588), 4588 men aged 50–69 yr, without previous prostate cancer, with International Prostate Symptom Score (IPSS) data, and having PSA≥3ng/mL were identified. Men with at least moderate LUTS, defined as an IPSS score of ≥8, were included. PSA density and Stockholm3 scores were calculated. InterventionParticipants underwent 10–12-core systematic prostate biopsies. Outcome measurements and statistical analysisThe primary outcome was significant prostate cancer (sPCa) defined as International Society of Urological Pathology (ISUP) grade ≥2. Logistic regression analysis adjusted for age and previous biopsy status was performed. The area under the receiver operating characteristic curve (AUC) was calculated, and decision curve analysis was performed. Results and limitationsOut of 4588 men, 1544 (34%) reported at least moderate LUTS. The median age was 64yr, and 11% had undergone a previous prostate biopsy. The Stockholm3 test showed superior discrimination for sPCa to PSA density, which in turn showed superior discrimination to PSA (AUC 0.77 vs 0.70 vs 0.61, p< 0.02). Calibration of the Stockholm3 test was adequate. Performing biopsy only in men with PSA ≥5 ng/mL saved 64% of biopsies, but resulted in missing 52% of detectable sPCa. Recommending biopsy for men with PSA density ≥0.07 resulted in sparing 26% of biopsy procedures and delaying the diagnosis of 12% of sPCa cases, with a 6.1% risk of sPCa among unbiopsied men. Recommending men with Stockholm3≥0.11 for biopsy resulted in sparing 53% of biopsy procedures and delaying the diagnosis of 20% of sPCa cases, with a 5.1% risk of finding sPCa in unbiopsied men. ConclusionsPSA density and the Stockholm3 blood test were superior to PSA for the identification of prostate cancer among men with LUTS. Patient summaryIn this analysis of a large Swedish study, we find that the use of prostate-specific antigen (PSA) density or the Stockholm3 blood test instead of only PSA might improve the detection of prostate cancer among men with lower urinary tract symptoms.

The combination of waterjet ablation (Aquabeam®) and holmium laser power for treatment of symptomatic benign prostatic hyperplasia: early functional results.

IntroductionThe aim of this study was to assess the short-term functional outcomes and the efficacy of hemostasis performed with holmium laser performed following prostatic hydroablation with the Aquabeam® system.Material and methodsBetween June 2019 and July 2020, 53 consecutive patients underwent Aquabeam® with our modified hemostasis approach with holmium laser. The following standard preoperative assessments were retrospectively recorded: prostate volume; International Prostate Symptom Score (IPSS) and Quality of Life (IPSS-QoL); uroflowmetry including Qmax and post void residual volume (PVR).ResultsFifty-three patients consecutively underwent aquablation and holmium laser hemostasis. Median age at surgery, median prostate-specific antigen (PSA) and median prostate volume were 62 years (IQR: 57–66), 2.95 ng/ml (IQR: 1.6–4.8) and 55 ml (IQR: 43–65), respectively.Median operative time was 60 minutes (IQR: 40–80). Median catheterization time and length of hospital stay were 2 days (IQR: 1–3) for both parameters. The median hemoglobin decrease between the preoperative values and those assessed on the second day was equal to 1.25 g/dl (IQR: 0.7–1.85).Continence rate was 100% at catheter removal. Thirty-six patients (72%) reported anterograde ejaculation preservation. IPSS (6, 3–21) and Qmax (19, 9–26) changed dramatically between baseline and 3 months follow-up.ConclusionsThe combination of Aquabeam® and holmium laser energy for hemostasis is a safe, reproducible technique to relieve moderate lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) while preserving ejaculation in younger and sexually active individuals. The short-term results showed a lower rate of complications; the encouraging functional results confirm that this can be a valid surgical approach for treatment of BPH.

Metabolic syndrome is associated with prostate enlargement: a systematic review, meta-analysis, and meta-regression on patients with lower urinary tract symptom factors.

Background:Metabolic syndrome (MetS) is defined by at least three of the following five criteria: blood pressure ⩾130/85 mmHg, fasting blood glucose ⩾5.6 mmol/l, triglycerides concentration ⩾1.7 mmol/l, waist circumference ⩾102 cm (for men), and high-density lipoprotein cholesterol concentration <1.03 mmol/l (for men). MetS has been associated with worse lower urinary tract symptoms (LUTS) and higher International Prostate Symptom questionnaire scores.Materials and Methods:MEDLINE, Cochrane, ClinicalTrials.gov, and SCOPUS were critically appraised for all peer-reviewed manuscripts that suitably fulfilled our protocol’s inclusion criteria established a priori. Meta-analytical and meta-regression calculations were performed in R using the Sidik–Jonkman and Hartung–Knapp random effects model and predefined covariates.Results:A total of 70 studies (n = 90,206) were included in qualitative synthesis. From these, 60 studies focused on MetS and LUTS: 44 reported positive correlations, 5 reported negative correlations, 11 reported no association, and 10 studies focused on MetS and total prostate volume (TPV). MetS positively correlated with moderate LUTS [odds ratio (OR)  = 1.56, 95% confidence interval (CI) = 1.35–1.80], severe LUTS (OR = 2.35, 95% CI = 1.82–3.03), overactive bladder (OAB; OR = 3.2, 95% CI = 1.6–5.8), and nocturia severity (OR = 2.509, 95% CI = 1.571–4.007) at multivariate analysis. A total of 30 studies (n = 22,206) were included in meta-analysis; MetS was significantly associated with higher TPV (mean differences = 4.4450 ml, 95% CI = 2.0177–6.8723), but no significant predictive factors for effect sizes were discovered.Conclusion:Our meta-analysis demonstrates a significant association between the aggravating effects of MetS, which commonly coexists with obesity and benign prostate enlargement.