Occurrence Of Lower Urinary Tract Symptoms Research Articles

Objawy ze strony dolnych dróg moczowych — związek z ryzykiem sercowo-naczyniowym

Lower urinary tract symptoms (LUTS) are etiologically heterogeneous group of clinical symptoms, which are related to disorders of the lower urinary tract (bladder, prostate and urethra). LUTS are common break down into two symptoms groups: voiding (obstructive) symptoms or storage (irritative) symptoms. Patients may have mainly voiding symptoms, storage symptoms or a combination of both. The occurrence of LUTS is not limited to specific disease despite the frequent association of these symptoms with the bladder outlet obstruction. Furthermore, they can be an indicator of structural and functional abnormalities of the urinary tract, as well as the indicator of many other non-urological diseases ( e.g. chronic kidney disease, cardiovascular disease, disorders of the central nervous system and endocrine system). In many cases, LUTS are consequence of systemic changes that are caused by cardiovascular risk factors such as diabetes, hyperlipidemia or hypertension. This paper discusses the relationship between the occurrence of LUTS and the cardiovascular disease and the potential clinical implications regarding the management of the patients.

Co-treatment of lower urinary tract symptoms and cardiovascular disease - where do we stand?

IntroductionThe relationship between cardiovascular disease (CVD) and lower urinary tract symptoms (LUTS) is well established. A healthy lifestyle with a good quality diet and regular physical activity is important for reducing the severity of LUTS.Material and methodsA literature search was performed on the subject of association between LUTS and cardiovascular risk.ResultsThe recent data indicates that therapy for cardiovascular risk reduction might also reduce the severity of LUTS (e.g. statins reduce the risk of benign prostatic hyperplasia [BPH] and slow down the progression of LUTS in patients with hyperlipidaemia). Hypertensive patients treated with angiotensin II receptor blockers have a lower severity of LUTS. This paper shortly discusses the relationship between the occurrence of LUTS and CVD and the potential clinical implications regarding the management of the patients.ConclusionsPatients with lower urinary tract symptoms require a holistic approach and cooperation of a urologist and cardiologist to diagnose concomitant cardiovascular diseases as early as possible and implement appropriate treatment. Antihypertensive, antithrombotic, hypolipemic therapies and healthy lifestyles reduce not only cardiovascular mortality, but also might reduce the severity of LUTS.

Introital ultrasound in the diagnosis of lower urinary tract symptoms following anti-incontinence surgery using a synthetic midurethral tape

Introduction and hypothesisSurgical treatment of stress urinary incontinence in women using a synthetic midurethral tape has become a standard procedure. One of the complications observed postoperatively are lower urinary tract symptoms (LUTS). The aim was to analyze the role of introital ultrasound in the identification of patients at risk for developing LUTS after surgical treatment using synthetic tape.MethodsA group of 50 patients suffering from LUTS following anti-incontinence surgery using synthetic tape was included in this study. The patients with pelvic organ prolapse and coexisting overactive bladder-wet before surgery were excluded. The control group consisted of 50 patients after the same treatment without any complications and with a good outcome. Tape visualization was performed using introital two-dimensional ultrasound. The assessment of the Tape Index (T/U) enabled us to divide the study group into the two subgroups with the tape index value of 0.375 as a borderline. The correlation between the tape position and the occurrence of LUTS was evaluated using a Chi-squared test.ResultsIn the group of patients suffering from LUTS, the tape was found to be closer to the bladder neck (the lower edge of the tape was more than 37.5% of the urethral length) and it was statistically significant (Chi-squared = 19.87, p < 0.001).ConclusionsThe tape position in the proximal urethra may have an impact on the postoperative occurrence of LUTS. The simple method of introital ultrasound could allow the identification of patients at risk for the development of LUTS after anti–incontinence surgery using synthetic tape.

Elevated Tumor Necrosis Factor-α and Transforming Growth Factor-β in Prostatic Tissue are Risk Factors for Lower Urinary Tract Symptoms after Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia Patients with Urinary Retention

Background: Lower Urinary Tract Symptoms (LUTS) after Transurethral Resection of the Prostate (TURP) occur in one-third of Benign Prostatic Hyperplasia (BPH) patients, may be caused by persistent prostatic inflammation and fibrosis. Objective: This study aims to evaluate the role of inflammation and fibrosis in pathological mechanism of LUTS among patients with BPH who underwent TURP by assessing their PSA, TNF-α, and TGF-β level. Design, Setting, and Participant: Data in this study were analyzed with the 2-way hypothesis. The study used odds ratio to define the risk factors of LUTS after TURP. The samples of the study are BPH patients after TURP aged 50-80 years old. Interventions: No intervention(s). Outcome Measurements and Statistical Analysis: The data analyzed using SPSS version 21.0 for Windows. Results and Limitations: There were 34 cases of LUTS and 42 controls without LUTS. We found that there were an increased levels of TNF-α (&gt; 46.95 pg/ml) (OR 55.6, 95% Confidence Interval [CI] 11.1-278.4, p=0.00) and TGF-β (&gt; 207.63 pg/ml) (OR 16.7, 95%CI 5.3-52.8, p=0.00). The result of multiple linear logistic regression analysis obtained equation Y= 0.033 x TNF-α + 0.031 x TGF-β. Population Attributable Risk (PAR) % TNF-α is 60%, PAR % TGF-β is 53%. Conclusion: Combination of elevated levels of TNF-α (&gt;46.95 pg/ml) and TGF-β (&gt;207.63) in prostate tissue is the risk factors for the occurrence of LUTS after TURP. Patient Summary: In this study, we enrolled 76 patients who were diagnosed with BPH and urinary retention. After TURP, there were 34 cases of LUTS and 42 controls without LUTS. We found that the levels of TNF-α and TGF-β between cases and controls were significantly different. We conclude that the combination of elevated levels of TNF-α and TGF-β in prostate tissue is the risk factors for the occurrence of LUTS after TURP.

Vulvar lichen sclerosus in women is associated with lower urinary tract symptoms.

Lichen sclerosus (LS) is thought to be primarily a disease of postmenopausal women. Little is reported about lower urinary tract symptoms (LUTS) in association with LS. The aims of this study were to evaluate the odds of having LS-associated LUTS and to identify the predominant type of LS-associated bladder dysfunction. This was a cross-sectional study with two cohorts investigating the association between LS and LUTS and the predominant type of LS-associated bladder dysfunction. The odds of LUTS in women with LS were more than four times higher than in women without LS (OR 4.5, 95% CI 2.6-8.0; p<0.0001). There was no significant difference in the occurrence of LUTS between women who experienced the first LS symptoms before and after the age of 50years (36% and 53%, respectively, p=0.14), or in the occurrence of the different types of LUTS between women with and without LS (p=0.3). The most common type of LUTS was overactive bladder (OAB) in both women with LS (67.3%) and without LS (60%). The most prevalent type of LS-associated LUTS was OAB. The odds of developing LUTS (self-reported) are four times higher in women with LS than in those without. The predominant type of LUTS in women with and without LS is OAB.

Patient-reported lower urinary tract symptoms after hysterectomy or hysteroscopy: a study from the Swedish Quality Register for Gynecological Surgery

Introduction and hypothesisHysterectomy is sometimes considered the cause of lower urinary tract symptoms (LUTS). We hypothesized that hysterectomy for abnormal uterine bleeding and/or symptoms of fibroids is more likely to cause LUTS than a hysteroscopic procedure for the same indications.MethodsTwo groups of women were compared: one group comprised 3,618 women who had had a hysterectomy due to abnormal uterine bleeding or symptoms of fibroids and the other group comprised 238 women who had had hysteroscopic treatment for the same indications. The main outcome measures were occurrence of LUTS before and 1 year after the surgical intervention. The frequencies of LUTS before and after surgery were compared between the groups. Binary logistic regression was used to model the odds of having postoperative urinary leakage and urgency while controlling for uterine size, surgical procedure and preoperative LUTS.ResultsThere were no statistically significant differences between women after hysterectomy and after hysteroscopy in the frequencies of LUTS before or after surgery, when uterine size was comparable. However, there was a difference in the rates of de novo urinary incontinence between women with hysterectomy and women with hysteroscopy (7.6%, 95% CI 6.3–9.0, and 3.2%, 95% CI 1.6–6.5, respectively). Of the women with a large uterus, 58.6% (95% CI 51.5–65.5) reported relief of urinary incontinence and 85.5% (95% CI 82.3–88.4) reported relief of urinary urgency postoperatively.ConclusionsOur results suggest that it is important to individualize preoperative information in women prior to hysterectomy since the outcome concerning LUTS depends on preoperative symptoms and uterine size.

A prevalence study of lower urinary tract symptoms (LUTS) in males

Background: Lower urinary tract symptoms (LUTS) are storage, voiding and post-micturition symptoms affecting the lower urinary tract. LUTS can significantly reduce men's quality of life and may point to serious pathology of the urogenital tract. LUTS are common and not necessarily a reason for suspecting prostatic hyperplasia (BPH). Aims & Objective: This study is aimed to clarify the relationship between lower urinary tract symptoms (LUTS) and their association with various etiopathologies. Materials and Methods: In this study total 600 men above the age of 40 years attending the surgical outpatient department in LG hospital, Maninagar, Ahmedabad (AMC MET Medical College) were suggested to detail history taking including IPSS questionnaire for evaluating LUTS. Abdominal examination, Rectal examination, Nervous system examination were done and Patient were investigated by Ultrasound scanning (Abdominal & Transrectal), Blood tests and urine tests. In selected cases, Prostate Specific Antigen (PSA), flow rate measurement, uroflowmetry and cystourethroscopy were done. Results: Of the 600 men, 222 had specific diseases (37%) responsible for occurrence of LUTS (BPH 45%, stricture urethra 40%, Neurogenic 7.5%, Miscellaneous 7.5%). About 15% of total subjects (90/600) had BPH. Among 400 men who had some degree of LUTS no specific disease was found responsible for these symptoms. Nocturia remained important symptom of LUTS in Bladder outflow obstruction. Conclusion: The study indicated that LUTS are not only because of BPH, but there are many other urological and non-urological factors in the etiology & pathogenesis of LUTS. Nocturia remains important symptom in IPSS. Patient with LUTS need well planned assessment of disease, clear cut understanding of the relevant pathophysiology and proper approach to diagnosis and treatment.

Hysterectomy and Lower Urinary Tract Symptoms: A Nonrandomized Comparison of Vaginal and Abdominal Hysterectomy

Common adverse effects of hysterectomy include lower urinary tract symptoms (LUTS), especially urinary incontinence. A difference in the prevalence of LUTS between patients who have undergone vaginal and abdominal hysterectomy may be an additional factor in the choice between these 2 surgical approaches in women who need a hysterectomy. The possibility of differential effects of the 2 procedures on the development and persistence of urinary incontinence has not been well investigated. This prospective observational multicenter study compared the long-term effect of vaginal and abdominal hysterectomy on LUTS in women with benign disease. The study was conducted between 1999 and 2003 at 13 teaching hospitals in the Netherlands. The occurrence of LUTS was determined among 430 patients undergoing vaginal (n = 112) or abdominal (n = 318) hysterectomy for benign disease other than genital prolapse. Because subjective self-reporting of symptoms after surgery provides a more useful assessment than urodynamic testing, data were obtained by use of a questionnaire completed by the study subjects. Multiple logistic regression analysis was used to adjust for possible confounders. LUTS were more common at 3 years after surgery among patients who underwent vaginal hysterectomy than among those who had abdominal hysterectomy; the adjusted odds ratio was 2.2, with a 95% confidence interval of 1.3 to 4.0 after correction for differences in uteral size, descent of the uterus, and other differences. The results remained statistically significant (odds ratio: 3.0; 95% confidence interval: 1.4–6.2) after adjustment for uteral size, descent of the uterus, parity, and indication for hysterectomy. These findings show that LUTS is more common among patients who undergo vaginal hysterectomy than among those who have abdominal hysterectomy.

The relationship between lower urinary tract symptoms (LUTS), diagnostic indicators of benign prostatic hyperplasia (BPH), and erectile dysfunction in patients with moderate to severely symptomatic BPH

To evaluate the relationship between lower urinary tract symptoms (LUTS), different diagnostic indicators of benign prostatic hyperplasia (BPH), and erectile dysfunction (ED) in a selected group of BPH patients with moderate-or-severe symptoms, for whom either transurethral or open prostatectomy was planned. Between 2003 and 2006, 453 patients were included in this study. LUTS and ED were assessed by validated symptom scales. Maximum and average urine flow rates and post-void residual urine volumes (PVRU) of all patients were measured. Additionally, prostate volumes for all patients were detected with transrectal ultrasound (TRUS). The incidence of LUTS and ED increased significantly with aging (P < 0.001). ED was reported to be 36% in men with moderate LUTS and 94% in men with severe LUTS (P < 0.001). The odds ratio for ED was 28.7 for severe LUTS. When age, IPSS, and IIEF scores were analyzed we observed that the occurrence of LUTS is an age-independent risk factor for the development of ED (P < 0.001). There was a positive correlation between IIEF score, Q (max) (r = 0.441, P < 0.001), and Q (ave) (r = 0.326, P < 0.001), and a negative correlation was found between IIEF score, prostate volume (r = -0.299, P < 0.001), and PVRU (r = -0.486, P < 0.001). The presence of LUTS, particularly severe LUTS, is an independent risk factor for ED. It is crucial to assess ED of the patient before BPH surgery, otherwise ED may be regarded as an outcome of the surgery rather than a preoperative, already existing condition.

Sexual activity and lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) have a profound impact on women's physical, social, and sexual well being. The LUTS are likely to affect sexual activity. Conversely, sexual activity may affect the occurrence of LUTS. The aims of the study were to elucidate to which extent LUTS affect sexual function and to which extent sexual function affect LUTS in an unselected population of middle-aged women in 1 year. A questionnaire was sent to 4,000 unselected women aged 40-60 years. All 2,284 women (57.1%) who completed a baseline questionnaire and a similar questionnaire 1-year later were included. Data comprised age, occurrence of LUTS, hormonal status, and sexual activity. A multiple conditional logistic regression model was used to analyze the relationship between sexual activity and LUTS adjusted for age and hormonal status. At baseline and 1-year later, 49 women (2.2%) had no sexual intercourse, and 298 women (13.0%) either ceased or resumed sexual relationship. Compared to women having sexual relationship, a statistically significant three to sixfold higher prevalence of LUTS was observed in women with no sexual relationship. In women who ceased sexual relationship an increase, although not statistically significant, in the de novo occurrence of most LUTS was observed. In women who resumed sexual relationship an insignificantly decrease in LUTS was observed. In women whose sexual activity was unchanged no change in the occurrence of LUTS was observed. Our study confirms a close association between sexual activity and the occurrence of LUTS. A hypothesis that sexual inactivity may lead to LUTS and vice versa cannot be rejected.

Lower Urinary Tract Symptoms and Erectile Dysfunction: Co-Morbidity or Typical “Aging Male” Symptoms? Results of the “Cologne Male Survey”

Due to demographic developments in industrial nations, age-correlated diseases are becoming more important. From many epidemiological studies we know that the prevalence of benign prostatic hyperplasia (BPH) and the loss of erectile function (= erectile dysfunction or ED) increase with advancing age. Are these two illnesses related or/and independent? We mailed our newly developed and validated questionnaire on male erectile dysfunction (KEED), as well as a set of questions pertaining to voiding problems (IPSS), to a representative population sample of 8000 men from 30 to 80 years of age residing in the city of Cologne. The responses included 4489 evaluable replies (56.1%). The response rates in the different age groups ranged from 41 to 61%. The mean age of the men who answered was 51.8 years. The overall prevalence of ED was 19.2% (n=862), with a steep age-related increase from 2 to 53%. Furthermore, 31.2% (n=1957) of all men complained of lower urinary tract symptoms (LUTS), the prevalence and the intensity of which increased with age. Interestingly, a high co-morbidity was found between ED and voiding problems. Prevalence of LUTS in men suffering from ED was about 72.2% (n=621) vs. 37.7% (1367) in men with normal erections. The odds ratio was evaluated with 2.11. The trivariate analysis showed that the occurrence of LUTS can be considered as an age-independent risk factor for the development of ED (p<0.001). Even though the pathogenetic relationship between LUTS and ED is not yet completely understood, one has to postulate a direct association between these two typical symptom complexes in the aging male.