Preexisting Lower Urinary Tract Symptoms Research Articles

MP80-11 IMPACT OF OBSTRUCTIVE SLEEP APNEA SYNDROME ON TIME TO COMPLETE RECOVERY OF CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: AN ANALYSIS USING PROPENSITY SCORE MATCHING

You have accessJournal of UrologyCME1 Apr 2023MP80-11 IMPACT OF OBSTRUCTIVE SLEEP APNEA SYNDROME ON TIME TO COMPLETE RECOVERY OF CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: AN ANALYSIS USING PROPENSITY SCORE MATCHING Mohammed Shahait, Tuan Thanh Nguyen, Jose Asmar, Ryan W Dobbs, Jeffrey Walker, Jessica L. Kim, Ayah El-Fahmawi, and David I. Lee Mohammed ShahaitMohammed Shahait More articles by this author , Tuan Thanh NguyenTuan Thanh Nguyen More articles by this author , Jose AsmarJose Asmar More articles by this author , Ryan W DobbsRyan W Dobbs More articles by this author , Jeffrey WalkerJeffrey Walker More articles by this author , Jessica L. KimJessica L. Kim More articles by this author , Ayah El-FahmawiAyah El-Fahmawi More articles by this author , and David I. LeeDavid I. Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP) represents a bothersome side effect which may permanently affect patient quality of life. The urinary continence rate after RARP depends on several factors, including baseline continence, age, body mass index (BMI), prostate volume, surgeon experience, pre-existing lower urinary tract symptoms, & surgical technique. Several studies have demonstrated that obstructive sleep apnea syndrome (OSAS) is associated with urge incontinence, overactive bladder, & nocturia. In this study, we sought to further explore the effect of OSAS on urinary continence (UC) after RARP. METHODS: We queried our prospectively collected institutional RARP database & identified 84 patients with OSAS & 131 controls, which were matched for age & BMI, with available follow-up data for UC. To minimize selection bias, we conducted a propensity score-matched analysis. Patient characteristics & UC outcomes were compared between the two groups before & after propensity-score matching. Continence was defined as using zero pads. Kaplan-Meier curves were constructed to assess the difference in UC between the two groups. Results are presented as means with standard deviations & percentages with 95% confidence intervals. RESULTS: A total of 213 patients were included in the analysis, of whom 82 with OSAS & 131 with non-OSAS (control group). The mean age of the total cohort was 61.7±6.96 years, the mean BMI was 30.4±5.36, & 52% of the cohort was classified as obese (BMI ≥30). In post-propensity score-matched analyses, there was no significant difference in baseline demographics & laboratory tests between the two groups (included 82 cases in each group). The median time to UC was 6.6 months for the control group as compared to 13.0 months for the OSAS group (p<0.001). At 12 months the UC rate for the OSAS group was 41.2% (95% CI: 28.9%-51.4%) as compared to 61.7% (95% CI: 28.5%-71.5%) for the control group. At 24 months the UC rate for the OSAS group was 68.7% (95% CI: 56%-77.7%) as compared to 90.8% (95% CI: 79%-96%) for the control group. CONCLUSIONS: On matched analysis, we found that patients with OSAS tended to demonstrate worse UC recovery than patients without OSAS. If these findings were confirmed in other cohorts, it might help urologist to counsel these patients pre-operatively. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1156 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammed Shahait More articles by this author Tuan Thanh Nguyen More articles by this author Jose Asmar More articles by this author Ryan W Dobbs More articles by this author Jeffrey Walker More articles by this author Jessica L. Kim More articles by this author Ayah El-Fahmawi More articles by this author David I. Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Current Pyuria Cutoffs Promote Inappropriate Urinary Tract Infection Diagnosis in Older Women.

Pre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary tract infection (UTI) in older women. The presence of pyuria remains the cornerstone of UTI diagnosis. However, >90% of ASB patients have pyuria, prompting unnecessary treatment. We quantified pyuria by automated microscopy and flowcytometry to determine the diagnostic accuracy for UTI and to derive pyuria thresholds for UTI in older women. Women ≥65 years with ≥2 new-onset LUTS and 1 uropathogen ≥104 colony-forming units (CFU)/mL were included in the UTI group. Controls were asymptomatic and classified as ASB (1 uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Patients with an indwelling catheter or antimicrobial pretreatment were excluded. Leukocyte medians were compared and sensitivity-specificity pairs were derived from a receiver operating characteristic curve. We included 164 participants. UTI patients had higher median urinary leukocytes compared with control patients (microscopy: 900 vs 26 leukocytes/µL; flowcytometry: 1575 vs 23 leukocytes/µL; P < .001). Area under the curve was 0.93 for both methods. At a cutoff of 264 leukocytes/µL, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leukocytes/µL had a poor specificity (36%) and a sensitivity of 100%. The degree of pyuria can help to distinguish UTI in older women from ASB and asymptomatic controls with pyuria. Current pyuria cutoffs are too low and promote inappropriate UTI diagnosis in older women. Clinical Trials Registration. International Clinical Trials Registry Platform: NL9477 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL9477).

The Influence of Vaginal Native Tissues Pelvic Floor Reconstructive Surgery in Patients with Symptomatic Pelvic Organ Prolapse on Preexisting Storage Lower Urinary Tract Symptoms (LUTS).

The aim of this study was to assess the effectiveness of vaginal native tissue repair (VNTR) on preexisting Lower Urinary Tract Symptoms (LUTS) in women with symptomatic pelvic organ prolapse (POP). Two hundred patients who underwent VNTR for symptomatic POP from January 2018 to February 2019 were followed up for 6 months. All patients underwent VNTR, but in the posterior compartment, the rectovaginal fascia was reconnected to the uterosacral ligaments and additionally sutured to the iliococcygeus fascia and muscle. To assess the severity and change in storage phase LUTS before and after surgery, all participants were asked to complete 3 questionnaires: the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF), Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7). The data were assessed with Statistica package version 12.0, using Kalmogorow–Smirnoff, W Shapiro–Wilk tests. Furthermore, one-way analysis of variance was applied with post-hoc Tukey test. The study results indicate that the majority of patients with advanced POP suffered from various LUTS. Among storage symptoms, the occurrence of urinary incontinence (UI) and urgency decreased significantly after surgery. Moreover, ICIQ-SF, UDI-6, and IIQ-7 results showed statistically significant improvement in the impact of UI on the quality of life (QoL) in the vast majority of patients after surgery. VNTR is an effective way to treat not only anatomical, but also functional problems in such patients.

Urinary Retention Following Non-urologic Surgery

To evaluate the literature assessing postoperative urinary retention (POUR) after non-urologic surgeries, including risk factors, as well as short- and long-term consequences. POUR is multifactorial; however, several risk factors, such as male sex, advanced age, and preexisting lower urinary tract symptoms are well established. Procedures that do not involve damage to the urinary or nervous system are rarely associated with long-term consequences, as opposed to colorectal surgery in which long-term voiding dysfunction may be experienced. Improved surgical technique may improve results in these cases. Various preventive methods have been studied. While medical prevention has been efficacious in some cases, physical, noninvasive interventions failed to show a benefit. While general risk factors for POUR are known, the literature assessing these factors varies widely and, in many cases, with conflicting results. With the expansion of ambulatory surgery, it is expected that the POUR will become more frequent. Prospective, well-designed studies are needed to guide the management in these cases.

PD39-06 IMPAIRED SLEEP QUALITY PREDICTS MORE SIGNIFICANT LOWER URINARY TRACT SYMPTOMS IN MALE SHIFT WORKERS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology and Natural History1 Apr 2015PD39-06 IMPAIRED SLEEP QUALITY PREDICTS MORE SIGNIFICANT LOWER URINARY TRACT SYMPTOMS IN MALE SHIFT WORKERS Alexander W. Pastuszak, Jason Scovell, Justin Badal, Aravind Chandrashekar, Tariq S. Hakky, Ranjith Ramasamy, Dolores J. Lamb, and Larry I. Lipshultz Alexander W. PastuszakAlexander W. Pastuszak More articles by this author , Jason ScovellJason Scovell More articles by this author , Justin BadalJustin Badal More articles by this author , Aravind ChandrashekarAravind Chandrashekar More articles by this author , Tariq S. HakkyTariq S. Hakky More articles by this author , Ranjith RamasamyRanjith Ramasamy More articles by this author , Dolores J. LambDolores J. Lamb More articles by this author , and Larry I. LipshultzLarry I. Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men with lower urinary tract symptoms (LUTS) often have disturbed sleep. Similarly, men who work non-standard shifts are also prone to worse sleep quality and its sequelae. Here we assess the risk of LUTS in men working non-standard shifts. METHODS Men presenting to a single andrology clinic between July and October 2014 were given the International Prostate Symptom Score (IPSS) and asked whether they worked non-standard shifts, defined as ‘starting before 7 am or after 2pm, rotating, or regularly including hours outside of the standard 7 am to 6 pm work day.’ Men were also asked to rate various aspects of their sleep on a 4-point Likert scale for each of 11 questions. Serum testosterone (T) levels were measured at the time of survey completion. We compared IPSS scores, ages, and serum T levels between men as a function of sleep quality using ANOVA and independent sample t-test. RESULTS Of the men presenting to clinic, 849 completed the survey and 239 (28%) reported non-standard shift work and were included for further analysis. Men working non-standard shifts had a mean±SD age of 42±11 (range 21-76) years. Of men working non-standard shifts, those who reported problems falling asleep had worse LUTS than those who did not (IPSS score 9 vs. 6, p < 0.001); there were no differences in age (43 vs. 41 years old, p = 0.075) or T levels (636 vs. 605 ng/dl, p = 0.606) between these groups. Men who had difficulties staying asleep had more severe LUTS (IPSS score 6 (‘No Problem,’) vs. 13 (‘Serious Problem’), p = 0.004) as did those who were unable to fall back asleep after awakening (IPSS score 5 (‘No Problem’) vs. 13 (‘Serious Problem’), p < 0.001), with no difference in age (p=0.304) or serum T levels (p=0.080) between groups. Worse LUTS were also observed in men reporting a decreased sense of wellbeing (IPSS score 6 (‘Normal’) vs. 9 (‘Very Decreased’), p < 0.001) and those with decreased physical/mental function (IPSS score 6 (‘Normal’) vs.10 (‘Very Decreased’), p = 0.016), with no difference in age (p=0.393) or serum testosterone (p=0.345). CONCLUSIONS Men working non-standard shifts who have difficulty falling asleep, staying asleep, and falling back asleep report more severe LUTS than men who do not have similar sleep difficulties. Similarly, men who report a decreased sense of wellbeing and decreased physical or mental function as a result of their shift work also have more severe LUTS. These findings implicate sleep quality as a risk factor for LUTS symptom severity, arguing for optimization of sleep habits in men generally, and particularly those with pre-existing LUTS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e832 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander W. Pastuszak More articles by this author Jason Scovell More articles by this author Justin Badal More articles by this author Aravind Chandrashekar More articles by this author Tariq S. Hakky More articles by this author Ranjith Ramasamy More articles by this author Dolores J. Lamb More articles by this author Larry I. Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A prospective observational study of lower urinary tract symptoms before and after surgical removal of a large pelvic mass.

The aim of this study was to assess the impact of the surgical removal of a large pelvic mass on preexisting lower urinary tract symptoms (LUTS) and function. This was a prospective study of planned surgical management of women with a large pelvic mass (uterine or ovarian mass ≥ 7 cm on pelvic ultrasound) who also reported bothersome LUTS (urinary frequency, urgency, incontinence and/or voiding dysfunction). Assessment included structured history and examination, completion of the short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), a 3-day bladder diary and multi-channel urodynamics (UDS) at baseline and 3 months postoperatively. The primary outcome was a reduction in the total mean scores of the UDI-6 and IIQ-7. Secondary outcomes were a change in bladder diary and UDS parameters. Univariate analysis and paired t test were used in the statistical analysis. Twenty-nine women underwent surgical management of a pelvic mass. The most common preoperative urinary symptom was urinary urgency. Two women had overt urinary retention that resolved completely postoperatively. All women completed pre- and postoperative UDI-6 and IIQ-7. The UDI-6 and IIQ-7 demonstrated a highly significant reduction in the mean total scores of 66%, signifying symptom and quality of life improvement. Bladder diary parameters showed significant reductions in daytime urinary frequency and stress incontinence episodes. Maximum and average voided volumes increased by a mean of 60 ml. Only 14 women underwent postoperative UDS. This study provides evidence that the majority of LUTS present preoperatively improve significantly or resolve completely following removal of a ≥ 7-cm pelvic mass.

Does the Presence of Preoperative LUTS Affect Urinary Outcomes after Radical Prostatectomy?

Urinary incontinence is one of the most common adverse effects after radical prostatectomy (RP). Preoperative lower urinary tract symptoms (LUTS), which increase in prevalence with advancing age, have been hypothesized to be related to postoperative urinary continence. We review the literature on the role of preoperative LUTS on postoperative urinary function after RP in patients with clinically localized prostate cancer. The precise role of preoperative LUTS on postoperative urinary continence after RP is unclear due to conflicting conclusions from numerous reports. However, correlating preoperative LUTS to postoperative urinary incontinence may be particularly relevant in three instances: in patients with preoperative voiding or emptying LUTS, in predicting early postoperative urinary continence, and in patients with preoperative urinary incontinence. Also, RP in patients with moderate to severe preexisting LUTS may improve postoperatively as a result of relief of obstruction.

Inhaled Anticholinergic Agents and Acute Urinary Retention in Men with Lower Urinary Tract Symptoms or Benign Prostatic Hyperplasia

To assess the risk of acute urinary retention with the use of inhaled anticholinergic agents in men with lower urinary tract symptoms (LUTS) or benign prostatic hyperplasia (BPH). A literature search was performed with MEDLINE via PubMed from 1967 through May 2012 using the terms inhaled anticholinergics, urinary retention, benign prostatic hyperplasia, lower urinary tract symptoms, tiotropium, and ipratropium. In addition, references from reviewed publications were identified and official labeling was obtained from the manufacturers' Web sites. Only English-language publications were included. Randomized controlled trial data, observational studies, case reports, package labeling, and commentaries regarding men with BPH/LUTS using inhaled anticholinergic agents and the associated development of urinary retention were reviewed. Two case reports; 1 prospective, open-label, single-arm study; and 2 nested case-control studies evaluated or described the use of inhaled anticholinergic agents and the development of acute urinary retention in men with BPH/LUTS. Taken together, the available data demonstrate that treatment with inhaled anticholinergic agents is associated with acute urinary retention in men with preexisting LUTS or BPH. Men with LUTS or BPH who are treated with inhaled anticholinergic agents may develop acute urinary retention, but this cannot be quantified based on the limited information available. Inhaled anticholinergic agents should be used when indicated in men with LUTS or BPH, but close monitoring and patient education should be implemented.

Two-step transurethral surgery of the prostate and permanent implant brachytherapy for patients with lower urinary tract symptoms and low- to intermediate-risk prostate cancer

PurposeProstate brachytherapy is an increasingly used treatment option for low- to intermediate-risk prostate cancer (PCa). However, patients with preexisting lower urinary tract symptoms (LUTS) and PCa, who would otherwise be good brachytherapy candidates, are often contraindicated because of the risk of postoperative urinary morbidity. We report our clinical experience with limited transurethral resection of the prostate (LTURP) and/or transurethral incision of the prostate (TUIP) months before brachytherapy to treat patients with LUTS and low- to intermediate-risk PCa. Methods and MaterialsOf 258 men undergoing prostate brachytherapy at our institution between 1998 and 2011, 42 were treated with planned LTURP and/or TUIP well before (mean, 5.7 months) seed implantation. Transurethral surgery was considered before brachytherapy for patients who at presentation required α-blocker therapy for LUTS, had an International Prostate Symptom Score greater than 14 off α-blockers, or had an elevated postvoid residual (>100mL). Patients only proceeded to brachytherapy once LUTS resolved. ResultsAll 42 patients in our series underwent TUIP (25), LTURP (7), or TUIP/LTURP (10) with mean 5.7 months before prostate brachytherapy for low- or intermediate-risk PCa. Mean International Prostate Symptom Score, peak flow rate, and postvoid residual significantly improved after transurethral surgery, and improvement persisted at the latest followup. No patient developed retention, urethral necrosis, or urinary incontinence after transurethral surgery or brachytherapy (median followup, 39 months and range, 1–121). ConclusionsPlanned LTURP and/or TUIP more than 4 months before brachytherapy is a safe and effective treatment strategy for men with LUTS and low- to intermediate-risk PCa.

Detrusor Activity Is Impaired during Thoracic Epidural Analgesia after Open Renal Surgery

There are no data on lower urinary tract function during postoperative thoracic epidural analgesia (TEA). Because selected segmental blockade can be achieved with epidural analgesia, we hypothesized that lower urinary tract function remains unchanged during TEA within segments T4-T11 after open renal surgery. In a prospective, open, observational, follow-up study, 13 male patients with no preexisting lower urinary tract symptoms (International Prostate Symptom Score < or =7) and postvoid residual less than 100 ml underwent urodynamic investigations the day before open renal surgery (lumbotomy) and 2-3 days postoperatively during TEA. Primary outcome was the difference in postvoid residual before versus after surgery during TEA. The median postvoid residual increased from 25 ml before surgery (range, 0-95) to 420 ml (15-1020) 2-3 days postoperatively (P = 0.002). Maximum detrusor pressure, detrusor pressure at maximum flow rate, and maximum flow rate were significantly reduced during TEA (37 [28-84] to 27 cm H2O [13-51], P = 0.004; 31 [27-52] to 19 cm H2O [0-33], P = 0.003; and 14 [4-35] to 4 ml/s [0-13], P = 0.001), respectively. Bladder capacity and sensation were not changed during TEA. All patients had a postvoid residual determined by ultrasound of less than 100 ml 1 day after removal of the epidural catheter. In contrast to our initial hypothesis, detrusor activity was significantly impaired during TEA after open renal surgery. This resulted in clinically relevant postvoid residuals.

Factors influencing outcome following the tension-free vaginal tape (TVT)

Objectives To evaluate factors influencing the outcome with tension-free vaginal tape (TVT). Study design A prospective questionnaire survey of 100 women undergoing TVT between January 2006 and May 2007 for urodynamic stress incontinence. All women were assessed pre-operatively and 3 months post-operatively using a validated electronic pelvic floor symptoms assessment questionnaire (ePAQ). Using linear regression, the influence of age, severity of stress incontinence and pre-existing lower urinary tract symptoms (LUTS) were assessed on symptomatic improvement of stress urinary incontinence and on quality of life (QoL). Results Women with more severe symptoms preoperatively had a significantly greater improvement in stress incontinence symptoms ( p < 0.001) and quality of life ( p = 0.016). Age and pre-existing LUTS were not associated with adverse outcomes with surgery in terms of improvement in stress incontinence or quality of life. Conclusions Women with more severe stress urinary incontinence may expect greater improvement, both in their stress incontinence and their health-related quality of life (HRQoL) following a TVT. Age and coexisting lower urinary tract symptoms do not impact significantly on TVT outcomes in terms of the reduction in stress incontinence or improvement in HRQoL.