Severe Lower Urinary Tract Symptoms Research Articles

Correlation Between Prostate Volume and Lower Urinary Tract Symptoms: A Hospital-Based Study

Background: Lower urinary tract symptoms (LUTS) are manifestations of storage and voiding disorders involving the urinary bladder, urethra and the prostate gland. This study aimed to correlate prostate volume and lower urinary tract symptoms.  Materials and methods: This study was a prospective cross-sectional study carried out among 120 males aged 40 years and above who presented with LUTS for prostate ultrasonography at the Radiology department within a period of six months. Informed consent and ethical approval were obtained from participants before commencement of the study. Severity of LUTS was evaluated using the International Prostate Symptom Score (IPSS). Each question was scored between 0 to 5 and the sum recorded as total IPSS score. The total score was graded as mild (0-7), moderate (8-19) or severe (20-35). Quality of life due to urinary symptoms was also evaluated and scored between 0 (delighted) and 6 (terrible). Prostate volume estimation was done by transabdominal ultrasonography using an ultrasound scanner fitted with a 3.5-MHz curvilinear transducer (Logic F6, General Electric, USA, 2017). Measurements were taken and the average values computed; volume calculation was obtained by default using the inbuilt computer algorithm in the ultrasound machine. The data obtained were statistically analyzed using the Statistical Package for Social Sciences (SPSS) software version 24 (International Business Machines, USA, 2016), and the results presented in tables, charts, and percentages. Pearson’s correlation coefficient was used to correlate between variables with P-values < 0.05 considered significant.  Results: Results showed that the cumulative mean age of the participants was 65.1 ± 9.6 years with majority of the participant’s between 60 and 69 years. The most common presenting LUTS was nocturia (98.0%), followed by frequency (92.7%). Overall, the mean IPSS score was 13.2 ± 4.6 while quality of life (QoL) was 4.1 ± 1.2. The mean prostate volume was 69.8 ± 63.5cm3, with 79.2% of the subjects having a prostate volume ≥ 30cm3. Pearson correlation between prostate volume and IPSS was significant (r = 0.304, p = 0.001). Conclusion: The study established a positive significant correlation between prostate volume and International Prostate Symptoms Score (IPSS). This implies that sonographic PV assessment could be useful in objective assessment of LUTS severity and should be considered in management decisions and follow-up of patients with lower urinary tracts symptoms. 

Transurethral Resection of the Prostate in Younger Men: Effectiveness and Long-term Outcomes.

This study aims to investigate the efficacy and outcomes of transurethral resection of the prostate (TURP) in the context of younger male patients. Males aged ≤55 who underwent TURP at Rambam Health Care Campus from January 2011 to August 2023 were retrospectively reviewed. Clinicodemographic characteristics, indications for surgery, uroflowmetry, pressure-flow study, and early and late postoperative outcomes were collected. Patients with urethral or bladder abnormalities were excluded. Chi-square and Fisher's exact tests were employed for bivariate analysis. Inclusion criteria were met by 58 men who underwent TURP at a median age of 52 years (interquartile range [IQR] 49.5-54). Median prostate size was 35 mL (24.5-56), with median prostate-specific antigen of 1.4 ng/mL (0.65-3.1). A total of 60% of patients used α-blockers, and 19% used 5α-reductase inhibitors pre-surgery. Overall, 54 (93.1%) had severe lower urinary tract symptoms (LUTS), with 34 (59%) being predominantly emptying and 20 (35%) storage. Most surgeries were performed for refractory LUTS in 38 (66%), followed by urinary retention in 16 (28%). At 6 weeks, 57 (98%) patients were catheter-free. The maximum flow rate and residual volume showed significant improvement from a median of 6.85 mL/s to 17.9 mL/s (P<0.001), and from 120 mL to 10 mL (P=0.0142), respectively. Pathology revealed benign prostatic hyperplasia in 53 (91.4%), and inflammation in 5 (8.5%). A total of 13 auxiliary procedures were required in 12 patients (20.7%) during follow-up: 7 transurethral bladder neck incisions, 3 re-TURP, 1 meatus widening, and 1 patient required artificial urinary sphincter implantation followed by simple cystectomy for end-stage bladder. In young men, TURP showed short-term gains in flowmetry and catheter removal rates, but a sustained need for subsequent procedures in the long run. In this unique population, patients should be carefully selected, and alternative, less aggressive, interventions should be considered.

The severity of lower urinary tract symptoms during the postoperative period as a factor in choosing an approach to surgical treatment for large prostate hyperplasia: holmium enucleation of the prostate (HoLEP) vs laparoscopic simple prostatectomy

Introduction. Analysis of complications after transurethral surgery for benign prostate hyperplasia (BPH) demonstrates that 20 – 30% of patients require prolonged postoperative treatment for severe lower urinary tract symptoms (LUTS) despite improvements in technology and surgical techniques. These complications play a significant role in reducing the quality of life of patients in the postoperative period. Severe storage symptoms and urgent urinary incontinence represent significant challenges in the postoperative phase when performing laser enucleation surgery. There are also limits to standard approaches to perform laparoscopic prostatectomy, which requires the development of improved techniques.Objective. To conduct a comparative assessment of the postoperative dynamics of LUTS in groups undergoing holmium laser enucleation of the prostate (HoLEP), a standard Millin laparoscopic simple prostatectomy (LSP), and a modified LSP.Materials &amp; Methods. This multicenter study included 439 patients who were randomly assigned to 3 groups depending on the surgical treatment technique used for bladder outlet obstruction associated with large-volume BPH: the HoLEP group (n = 151), the standard Millin LSP (n = 142) and the modified LSP, combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis (n = 146). The main criterion assessed during six-months follow-up was the severity of LUTS on the IPSS scale (obstructive and irritative components). Complications that developed during the postoperative observation period were recorded.Results. A lower severity of LUTS was revealed in the group of the modified LSP compared to the standard LSP and HoLEP (p = 0.041 and p = 0.001, respectively). The average irritative component of IPSS was significantly lower in the modified LSP group compared to the standard LSP and HoLEP (p = 0.032 and p = 0.001, respectively). The observed trend continued to the third month after surgery. Comparison of changes in symptom severity six months after surgery demonstrated a significant advantage for the modified LSP both compared to HoLEP (p = 0.017) and a standard LSP (p = 0.032). All three groups showed comparable significant improvements in quality of life.Conclusion. The severity of postoperative storage symptoms is a limitation of HoLEP use, whereas the standard LSP is associated with lower severity of LUTS. The authors' modification of the LSP has the potential to reduce the severity of storage symptoms in patients for up to three months after surgery, and is associated with a low rate of urge incontinence.

Transurethral water vapour therapy (Rezūm) for catheter‐dependent men secondary to benign prostatic hyperplasia: A retrospective study in a Hong Kong population

AbstractAimRezūm is a novel treatment for patients with moderate to severe lower urinary tract symptoms as a result of benign prostatic hyperplasia (BPH). Recently, it has expanded to patients with urinary retention causing catheter dependence and the results are promising in Whites. However, it is unclear how effective Rezūm is in the Chinese population. Here, we report our experience in performing Rezūm on catheter‐dependent Chinese men with BPH and evaluate its safety and efficacy.MethodsA retrospective review of catheter‐dependent patients with BPH who underwent Rezūm from January to August 2022 was conducted. We evaluated the success rate of trial without catheter (TWOC) and compared pre‐ and post‐operative (at 6 months) uroflowmetry results, International Prostate Symptoms Score (IPSS), IPSS Quality of Life Score (IPSS QoL), and prostate volume.ResultsSixty‐three patients had Rezūm performed (44 and 19 patients had refractory urinary retention and obstructive uropathy, respectively) with a mean age of 74 years and a mean prostate size of 53.9 mL. The first attempt at TWOC was successful in 53 patients (85.5%; range 15–44 days post‐operation). By 98 days after the operation, all patients could void spontaneously. The 6‐month follow‐up showed that IPSS and IPSS QoL scores decreased by a mean of 9.0 and 1.8 points, respectively (both P &lt; .01). The mean pre‐operative post‐voided residual urine was reduced by 559 mL (P &lt; .01), with a mean prostate size reduction of 9.4 mL (P &lt; .01). Seven patients had non‐serious complications (Grade 1–2 Clavien–Dindo classification) within 30 days of operation.ConclusionRezūm was shown to be effective and safe in catheter‐dependent Chinese men with BPH.

Association of detrusor wall thickness (DWT) with lower urinary tract symptom severity in benign prostatic hyperplasia: a cross-sectional study

Background and Objective: Benign prostatic hyperplasia (BPH) manifests as lower urinary tract symptoms (LUTS) and prostate gland enlargement, leading to bladder outlet obstruction (BOO) with consequent structural and functional impacts on the bladder. Urodynamic studies are resource-intensive and invasive. DWT assessment offers a cost-effective, reproducible alternative for evaluating LUTS severity in males with BOO, utilizing ultrasonographic examination. Methods: This prospective cross-sectional study, conducted at a tertiary care center from May 2023 to January 2024, included 171 patients with LUTS who underwent transabdominal ultrasound for DWT measurements. LUTS severity, assessed using International Prostate Symptom Scores (IPSS) classified participants into mild and moderate-to-severe symptom groups. Pearson’s correlation coefficient assessed the association between DWT and IPSS, and an independent sample t-test compared means, using a significance level of 5% (P-value ≤ 0.05). Results: This study involved participants aged 65.01±11.55 years with an IPSS score ranging from 1 to 35, with a mean for mild and moderate-to-severe symptom groups were 4±2.12 and 15.93±6.74, respectively. DWT mean of 1.64±0.38 mm for mild, and 2.4±0.43 mm for moderate to severe symptoms. Pearson’s correlation (r=0.697, n=171, P&lt;0.001) indicated a strong DWT-LUTS correlation and a significant DWT mean difference between mild and moderate-to-severe symptom groups was found via an independent t-test (P&lt;0.001, 95% CI: -0.8970 to -0.6414). Conclusion: The study establishes the value of transabdominal ultrasound-detected DWT as a cost-effective, noninvasive, and reproducible tool for assessing LUTS severity in males with BPH.

Assessment of symptoms and signs of benign prostatic hyperplasia using the International Prostate Symptom Score in clinical practice

Introduction: Benign prostatic hyperplasia (BHP) is one of the most common, progressive diseases in elderly men. It is very important to diagnose this disease in its early stages. The international prostate symptom score (IPSS) is a very helpful tool to be used for this purpose. Aims: The main goal of this study was to analyze the signs and symptoms of benign prostatic hyperplasia and its impact on a patient's quality of life. Patients and Methods: This descriptive randomized study included 112 male examinees aged 50-70 years. We used IPSS as a survey tool. Results: The average age of the examinees was 61.02 (± 6,18). 56.3% of examinees had mild symptoms, 31.3% had moderate symptoms and 12.5% of our examinees had severe lower urinary tract symptoms. Nocturia was the most common symptom. Irritative symptoms were present in 76.8% of examinees compared to obstructive symptoms which occurred in 8.9%, and 14.3% had both types of symptoms. Hypertension was the most common comorbidity (in 50.9% of cases). The majority of examinees answered that they would be satisfied with their quality of life if their symptoms do not change in the future. Conclusions: Assessment of symptoms and signs of benign prostatic hyperplasia using IPSS in clinical practice has proven to be useful in the timely approach of clinical physicians.

Single Versus Double Dose Tamsulosin for Patients with Moderate or Severe Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: Prospective Randomized Study

Single Versus Double Dose Tamsulosin for Patients with Moderate or Severe Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: Prospective Randomized Study

Higher Physical Activity is Associated with Reduced Lower Urinary Tract Symptoms in Korean Men.

Identifying and managing risk factors for lower urinary tract symptoms (LUTS) is crucial because it impacts the quality of life of elderly individuals. Lifestyle factors, including physical activity (PA), and their relationship with LUTS have not been well studied. This objective of this study was to investigate the association between PA and LUTS. A total of 7,296 men were included in this cross-sectional study. PA was quantified in metabolic equivalent (MET)-hours per week, and LUTS severity was assessed using the international prostate symptom score. Logistic regression was used to analyze the association between PA and LUTS, including voiding and storage symptoms. The average age of the participants was 57.8 years, and the prevalence of LUTS was 41.3%. After adjusting for potential confounders, PA was inversely associated with the prevalence and severity of moderate-to-severe LUTS, showing a dose-response pattern (all p for trend <0.01). Compared to the minimal activity group, which engaged in <5 MET-hours per week of PA, the odds ratios for moderate to severe LUTS were 0.83 (95% confidence interval [CI]: 0.72-0.97) for men engaging in 15-30 MET-hours per week, 0.82 (95% CI: 0.71-0.95) for 30-60 MET-hours per week, and 0.72 (95% CI: 0.62-0.84) for ≥60 MET-hours per week. The possible protective effect of PA was still observed in the additional analysis for voiding and storage symptoms showing the same dose-response pattern (all p for trend <0.01). A higher PA level was associated with a lower prevalence and severity of total, voiding, and storage LUTS in a dose-dependent manner in Korean men.

Dehydration associates with lower urinary tract symptoms in progressive multiple sclerosis.

Lower urinary tract symptoms (LUTS) are common in persons with progressive multiple sclerosis (pwPMS), who may consequently limit their fluid intake. We aimed to investigate the hypothesis that LUTS associate with objective evidence of inadequate hydration status in pwPMS. In this prospective study, 55 pwPMS were studied over 2 years. A 6-monthly first-morning urine specimen was analysed for urinary osmolality and sodium as hydration markers. LUTS symptom severity in three categories (urgency, voiding and discomfort) was assessed and quantified using a questionnaire. Correlation between LUTS severity and hydration was assessed within subjects and between subjects, controlling for age. Some 274 urine samples with accompanying LUTS data from 55 participants were analysed. Biochemical data showed the expected loss of urine-concentrating capacity with increasing age. Inadequate hydration was observed in 47% of participants. LUTS were very common (87% reported urgency and 89% voiding symptoms). Voiding and discomfort, but not urgency severity, were correlated with hydration markers, both within and between participants. LUTS are very common in pwPMS, and associate with inadequate hydration. The causes and consequences of inadequate hydration in MS need further study, since (i) this will focus greater attention on LUTS management in pwPMS and (ii) dehydration has been associated with reversible cognitive dysfunction and physical underperformance.

Benign prostatic hyperplasia and metabolic syndrome; prevalence and association: a cross-sectional study in Syria

BackgroundBenign Prostatic Hyperplasia (BPH) is considered the most common cause of lower urinary tract symptoms in men aged 40 years and older. BPH is related to sex steroids, but there are increasing studies investigating the relationship between the urinary symptoms and the metabolic syndrome. They still have inconsistent results; some reported a significant positive association, while others found no significant association. In this study, we aim to assess the prevalence rate of metabolic syndrome in BPH patients and whether there is an association between symptoms linked to BPH and metabolic syndrome in the Syrian community.MethodsThe participants of this observational cross-sectional study were benign prostatic hyperplasia patients aged 40-year-old and older from Homs, Syria. An interview questionnaire was performed to collect data from all patients who visited the urology clinic of Homs Military Hospital in the period of January 10 to March 10, 2023. We used the International Prostate Symptom Score (IPSS) to assess the urinary symptoms, and we used the US National Cholesterol Education Program Adult Treatment Panel (NCEP ATPIII) criteria to define the metabolic syndrome.ResultsThe final sample size was 426 patients. The overall prevalence of metabolic syndrome was 46.2%. Patients with metabolic syndrome had higher International Prostate Symptom Score compared to patients without metabolic syndrome (21 vs. 18, P < 0.001), and 59.3% of patients with metabolic syndrome suffered from severe symptoms compared to 36.2% of patients without metabolic syndrome who suffered from severe lower urinary tract symptoms (P < 0.001). There was a positive association between (waist circumference, diabetes, triglycerides) (P < 0.001), HDL (P = 0.014) and higher International Prostate Symptom Score. However, there was no statistically significant association between blood pressure and International Prostate Symptom Score (P = 0.879).ConclusionOur results showed that patients with metabolic syndrome had a higher International Prostate Symptom Score. This idea should be used to design a new benign prostatic hyperplasia/lower urinary tract symptoms treatment.

Fluid intake behavior in women with refractory overactive bladder undergoing third line therapy.

Fluid intake has been shown to be related to urinary symptoms, but no studies to date have investigated the effect of fluid intake on urinary symptoms in women with refractory overactive bladder (OAB). As this group of women are considered to have a possible unique pathophysiologic mechanism of OAB, we investigated the relationship between fluid intake, fluid intake behavior, and urinary symptoms in women with refractory OAB. A prospective cross-sectional study of women with refractory OAB was conducted by assessing the relationship between fluid intake and lower urinary tract symptoms (LUTS) in women undergoing third line OAB therapies. Fluid intake and behavior were measured by the questionnaire based voiding diaryand urinary symptoms were measured by the International Consultation on Incontinence Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). The relationship between fluid intake and symptom severity was assessed using Spearman's rankcorrelation and χ2 tests. Of the 126 individuals undergoing third line therapy for OAB, 60 (48%) underwent intradetrusor onabotulinumtoxinA injection (BTX) injection, 42 (33%) peripheral tibial nerve stimulation,and 24 (19%) sacral neuromodulation.The mean total daily fluid intake was 2567.0 ± SD 1292.4 mL and did not differ significantly across treatment groups. Total fluid intake was weakly correlated with worse filling-type LUTS (r = 0.241, p = 0.007), and there was no relationship between LUTS and caffeinated fluid intake. Half (52%) of the subjects reported current fluid restricting behavior to control urinary symptoms, but this behavior was not correlated with LUTS severity (all p > 0.05). Patients that currently use tobacco have greater LUTS (current = 25.8 ± SD 9.5, former = 14.8 ± SD 6.1, never = 15.0 ± SD 6.1; p < 0.001). BMI was also positively correlated with worse incontinence symptoms (r = 0.351, p < 0.001). Fluid intake along with other lifestyle factors, including tobacco use and weight, are minimally related to the symptomatology seen in women with refractory OAB. Further studies are needed to assess if behaviors change during treatment with third line therapies, and if these behavioral changes may affect treatment response.

Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction.

In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients. We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life. Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications. The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.

Safety and efficacy of prostatic artery embolization in patients with hematuria due to benign prostate hyperplasia

BackgroundBenign prostate hyperplasia (BPH) commonly affects aging men that can result in hematuria. For patients who are not suitable candidates for surgery, prostatic artery embolization (PAE) has emerged as a minimally invasive alternative. This study aimed to assess the safety and efficacy of PAE specifically for treating hematuria in BPH patients who cannot undergo surgery.MethodsThe study included n = 110 participants. PAE was performed, and outcomes of interest, including resolution of hematuria, improvement in lower urinary tract symptoms (LUTS), prostate volume (PV), and quality of life (QoL), were assessed. Adverse events were also analyzed.ResultsThe study demonstrated a 100% clinical success rate in resolving hematuria at 3 months, with no recurrence observed during the 6-month follow-up. Mean hemoglobin levels increased, indicating successful resolution of bleeding. PAE also led to a significant reduction in LUTS severity, as measured by the International Prostate Symptom Score (IPSS). Improvement in the mean maximum urinary flow rate (Qmax) indicated enhanced urinary flow. Additionally, MRI measurements showed a reduction in prostate volume following PAE. These improvements contributed to enhanced QoL for the patients.ConclusionsProstatic artery embolization (PAE) was found to be a safe and effective treatment option for hematuria in BPH patients not suitable for surgery. PAE demonstrated a high success rate in resolving hematuria and resulted in significant improvements in LUTS, prostate volume, and QoL outcomes. These findings have important implications for clinical decision-making and improving patient care for BPH patients with hematuria. Further research and long-term follow-up studies are necessary to validate these findings and assess the durability of PAE outcomes in this patient population.

The Reduction of Male Lower Urinary Tract Symptoms Is Associated With a Decreased Risk of Death.

Male lower urinary tract symptoms have been correlated with an increased risk of death; however, it is unclear if treatment will reduce this risk. Our objective was to determine whether a reduction in lower urinary tract symptoms is associated with a reduced risk of mortality. We conducted a secondary analysis of the MTOPS (Medical Treatment of Prostate Symptoms) randomized trial of placebo, doxazosin, finasteride, or doxazosin and finasteride. Men in the United States between 1993 and 1998 who were >50 years of age with moderate to severe lower urinary tract symptoms were included. We used various Cox regression models to assess the relationship between AUA Symptom Score (modeled as a time-varying exposure) and death. A total of 3,046 men (median age 62, quartiles 57-68) were randomized and had a baseline AUA Symptom Score. For each 1-point improvement in the AUA Symptom Score, the hazard ratio for death was 0.96 (0.94-0.99, P = .01). Our sensitivity analyses found a similar significant reduction in the hazard ratio for death within men who had active treatment, but not among men who were randomized to the placebo arm; our results did not change when men were censored at the time of transurethral prostate resection, with adjustment for potential confounders, or with a shorter observation period after the last study visit. A comparable significant reduction in death was seen with 1-point improvements in the storage (HR 0.94, 95% CI 0.88-0.99, P = .04) and voiding (HR 0.95, 95% CI 0.91-0.99, P = .03) subscales individually. Improvement in male lower urinary tract symptoms was associated with a reduced risk of death. Further study is warranted to determine if the male treatment paradigm should shift toward symptom treatment independent of bother.

Financial strain across 25 years and women’s bladder health: a life course perspective

A small number of cross-sectional studies have found that financial insecurity-a social determinant of health-is associated with lower urinary tract symptoms. This study aimed to examine (1) whether women in the Coronary Artery Risk Development in Young Adult Study with higher levels of financial strain, assessed at 7 time points across 25 years beginning in 1985-1986, were more likely to report lower urinary tract symptoms and impact after the 2010-2011 financial strain assessment and (2) whether healthcare access and comorbidities mediated potential associations. This prospective cohort study recruited Black and White participants aged 18 to 30 years at baseline (1985-1986) from the populations of 4 US cities. The analytical sample was composed of women with complete data for analyses involving financial strain trajectories across 7 assessments (n=841) and mediation tests of data collected at 4 assessments (n=886). The outcome variable was previously developed through a cluster analysis of urinary incontinence severity, urinary incontinence impact, other lower urinary tract symptoms severity, and their impact in 2012-2013, which yielded 4 lower urinary tract symptoms and impact cluster categories: women with no symptom or very mild symptoms and no impact vs women with mild, moderate, or severe symptoms and impact. Financial strain was defined as finding it "very hard," "hard," or "somewhat hard" (vs "not very hard") to pay for the very basics, such as food, heating, and medical care. Using proportional odds logistic regression, cluster categories were regressed on the financial strain trajectory group, adjusting for age, race, education, and parity. For mediation analyses, separate financial strain variables (difficulty paying for the very basics, such as food and heating, and difficulty paying for medical care) were created by combining 1995-1996 and 2000-2001 values. Two healthcare access variables (difficulty receiving care and underutilization of care) and a single comorbidity index (smoking, physical inactivity, body mass index, hypertension, diabetes mellitus, and depressive symptoms) were created by combining 2005-2006 and 2010-2011 values. Regression analyses and structural equation modeling were used to test whether healthcare access and comorbidities mediated associations between financial strain and lower urinary tract symptoms and impact cluster categories. In comparison to women who were consistently not financially strained, women who were consistently strained (odds ratio, 2.10; 95% confidence interval, 1.13-3.91), shifted into being strained (odds ratio, 2.00; 95% confidence interval, 1.29-3.10), or experienced >1 shift in strain (odds ratio, 1.99; 95% confidence interval, 1.46-2.71) had roughly twice the odds of reporting greater lower urinary tract symptoms and impact. Underutilization of healthcare and comorbidities mediated the association between difficulty paying for medical care and lower urinary tract symptoms and impact. In the structural equation model, difficulty paying for medical care and underutilization of care were associated (β=.31; P<.01), as was underutilization of care and greater lower urinary tract symptoms and impact (β=.09; P<.01). Moreover, difficulty paying for medical care and the comorbidity index were associated (β=.34; P<.01), as was the comorbidity index and greater lower urinary tract symptoms and impact (β=.24; P<.01). Collectively, these mediation pathways eliminated a direct association between difficulty paying for medical care and lower urinary tract symptoms and impact. Underutilization of healthcare and comorbidities explained an association between financial strain (difficulty paying for medical care) and lower urinary tract symptoms and impact. Research is needed to confirm the findings and examine other mechanisms that may further explain the association. Accumulated evidence may inform future policies and practices.

Safety and efficacy of tamsulosin 0.4 mg as an initial dose in 1,219 Korean patients with moderate to severe lower urinary tract symptoms: data from a phase IV study

BackgroundAn initial dose of tamsulosin 0.2 mg is frequently prescribed for Asian men. We investigated the safety and efficacy of tamsulosin 0.4 mg as the initial dose in Korean men with moderate to severe lower urinary tract symptoms (LUTSs) in everyday clinical practice. Materials and methodsA phase IV study was conducted in South Korea. Eligible patients were prescribed tamsulosin 0.4 mg for 6 months. We excluded patients with previous exposure to LUTS drugs and patients with an international prostate symptom score (IPSS) < 8. ResultsThe mean total IPSS, storage subscore, voiding symptoms subscore, and quality of life significantly decreased from 18.0, 10.8, 7.2, and 3.8 to 12.8, 7.5, 5.3, and 2.6, respectively, after 6 months of treatment. The number of nocturia episodes significantly decreased from 3.0 to 2.2 in patients who reported at least 2 nocturia events at baseline. A mean reduction in the IPSS was quantitatively equivalent in all age groups. The mean reduction in the IPSS was greater in the IPSS ≥ 20 group than in the IPSS < 20 group (mean reduction in the total IPSS: −2.6 in the IPSS < 20 group; −9.4 in the IPSS ≥ 20 group). All treatment-emergent adverse events were mild. The most frequently recorded treatment-emergent adverse event was dizziness, which was reported in 22 patients (1.8%). ConclusionTreatment of LUTS with tamsulosin 0.4 mg as the initial dose for 6 months in Korean men was effective in improving LUTS and showed a favorable safety profile in a real-life setting.

Identifying possible biomarkers of lower urinary tract symptoms using metabolomics and partial least square regression

IntroductionThe objective of this study was to explore potential novel biomarkers for moderate to severe lower urinary tract symptoms (LUTS) using a metabolomics-based approach, and statistical methods with significant different features than previous reported.Materials and MethodsThe patients and the controls were selected to participate in the study according to inclusion/exclusion criteria (n = 82). We recorded the following variables: International prostatic symptom score (IPSS), prostate volume, comorbidities, PSA, height, weight, triglycerides, glycemia, HDL cholesterol, and blood pressure. The study of 41 plasma metabolites was done using the nuclear magnetic resonance spectroscopy technique. First, the correlations between the metabolites and the IPSS were done using Pearson. Second, significant biomarkers of LUTS from metabolites were further analysed using a multiple linear regression model. Finally, we validated the findings using partial least square regression (PLS).ResultsSmall to moderate correlations were found between IPSS and methionine (-0.301), threonine (-0.320), lactic acid (0.294), pyruvic acid (0.207) and 2-aminobutyric-acid (0.229). The multiple linear regression model revealed that only threonine (p = 0.022) was significantly associated with IPSS, whereas methionine (p = 0.103), lactic acid (p = 0.093), pyruvic acid (p = 0.847) and 2-aminobutyric-acid (p = 0.244) lost their significance. However, all metabolites lost their significance in the PLS model.ConclusionWhen using the robust PLS-regression method, none of the metabolites in our analysis had a significant association with lower urinary tract symptoms. This highlights the importance of using appropriate statistical methods when exploring new biomarkers in urology.

Skeletal Muscle Health, Physical Performance, and Lower Urinary Tract Symptoms in Older Adults: The Study of Muscle, Mobility, and Aging.

Lower urinary tract symptoms (LUTS) and mobility limitations are bidirectionally associated among older adults, but the role of skeletal muscle remains unknown. We evaluated cross-sectional associations of muscle health and physical performance with LUTS. We used data from 377 women and 264 men aged >70 years in the Study of Muscle, Mobility and Aging (SOMMA). LUTS and urinary bother were assessed using the LURN Symptom Index-10 (SI-10; higher = worse symptoms). Muscle mass and volume were assessed using D3-creatine dilution (D3Cr) and magnetic resonance imaging. Grip strength and peak leg power assessed upper/lower extremity physical performance. 400-m walk, Short Physical Performance Battery (SPPB), and Four Square Step Test (FSST) assessed global physical performance. Mobility Assessment Tool-short form (MAT-sf) assessed self-reported mobility. We calculated Spearman correlation coefficients adjusted for age, body mass index, multimorbidity, and polypharmacy, chi-square tests, and Fisher's Z-test to compare correlations. Among women, LURN SI-10 total scores were inversely correlated with FSST (rs = 0.11, p = .045), grip strength (rs = -0.15, p = .006), and MAT-sf (rs = -0.18, p = .001), but not other muscle and physical performance measures in multivariable models. LURN SI-10 was not associated with any of these measures among men. Forty-four percent of women in the lowest tertile of 400-m walk speed versus 24% in the highest tertile reported they were at least "somewhat bothered" by urinary symptoms (p < .001), whereas differences among men were not significant. Balance and grip strength were associated with LUTS severity in older women but not men. Associations with other muscle and physical performance measures varied by LUTS subtype but remained strongest among women.

Parental perception of paediatric lower urinary tract dysfunction during the COVID‐19 shutdown

AbstractWe aimed to investigate how staying at home and stress from the pandemic shutdown impacts lower urinary tract symptoms in paediatric patients. The COVID‐19 pandemic shut down most of the world in March 2020. In the state of Virginia, a mandatory Stay‐at‐Home order was issued requiring students to participate in school from home. Paediatric patients often have difficulty complying with standard urotherapy while at school, with timed voiding being particularly hard to maintain. To our knowledge, only one other study investigated lower urinary tract dysfunction (LUTD) in children during the COVID‐19 shutdown. This study compared lower urinary tract symptoms (LUTS) in paediatric patients seen in their bladder dysfunction clinic for their initial 6 months of treatment during the shutdown to patients treated before the shutdown. Of the studies available that examine how the school environment effects lower urinary tract symptoms, all show a lack of education among teachers and school nurses, classroom rules that oppose adherence to standard urotherapy, and facilities that are often inadequate and unhygienic. Stress is known to have a bidirectional effect on LUTD, so we also investigated the effect of parental stress from the shutdown on LUTD. Parents of patients followed in our bladder dysfunction clinic were given a survey to evaluate the use of a timed voiding regimen, improvement in LUTS and perceived parental stress during the COVID shut down of 2020. Spearman's rank correlation coefficient (rho) was calculated to measure the correlation of the survey responses. We received 42 responses from 202 surveys administered (20.8%). Only 21.4% of respondents maintained timed voiding while at home, despite 78.6% indicating improved bathroom access. A small number (4.8%) indicated total resolution of voiding symptoms. Half of the respondents (50%) indicated some degree of improvement in LUTS, though almost the entire remaining population saw no change in their symptoms (42.9%). Only a very small number indicated slightly worse LUTS (7.1%) and none indicated that symptoms were much worse. There was no correlation between dysfunctional voiding scoring system (DVSS) scores and improvement in bathroom access. There was a moderate correlation between perceived parental stress and their child's DVSS score, Rho = 0.54 p = 0.0002. Additionally, DVSS scores were weakly, negatively correlated with improvement in LUTS, Rho = −0.3 p = 0.047. Despite the majority of parents perceiving increased access to bathrooms during the Stay‐at‐Home order, a minority of patients were maintained on timed voiding regimens while at home. About half of parents still indicated some degree of improvement in their child's LUTS. There was a correlation between parental stress and their child's dysfunctional voiding score. This survey highlights that the relationship between timed voiding, bathroom access, and severity of LUTS is complex and compliance with timed voiding remains a challenge to adhere to.

A Novel Nomogram for Identifying the Patients at Risk for Rapid Progression of Advanced Hormone-Sensitive Prostate Cancer.

The goal of this study was to assess the prognostic impact of the lower urinary tract symptoms (LUTS) in advanced prostate cancer (PCa) patients before progression to castration-resistant prostate cancer (CRPC). A retrospective analysis of the follow-up data for 152 CRPC patients was performed. Severe LUTS symptom was defined as an International Prostate Symptoms Score (IPSS) ≥20 at baseline. Cox regression analysis was conducted to assess CRPC prognostic factors. Nomogram model was created and assessed using the concordance index (C-index), calibration curves, receiver operating characteristic (ROC) curves, and decision curve analyses (DCA). The median CRPC free survival of patients with severe LUTS was 20.5 months, significantly longer than that (7.5 months) of less symptomatic patients. Furthermore, severe LUTS, the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, and Gleason sum were determined to be independent prognostic markers and combined to establish a nomogram, which performed well in the customized prediction of CRPC progression at 6th, 12th, 18th and 24th month. The C-index (0.794 and 0.816 for the training and validation cohorts, respectively), calibration curve, and ROC curve all validated the prediction accuracy. DCA curve showed that it could be effective in helping doctors make judgments. The Nomogram-related risk score separated the patients into two groups with notable progression differences. Severe LUTS was significantly associated with decreased risk for rapid progression to CRPC. The developed nomogram could help identify patients who are at a high risk of rapid CRPC progression and provide tailored follow-up and therapeutic advice.