International Prostate Symptom Score Storage Research Articles

Androgenic Alopecia Is Associated With More Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

To evaluate the possible association between androgenic alopecia (AGA) and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). A total of 148 patients aged over 45 with LUTS secondary to BPH were prospectively enrolled in this study. According to the Norwood-Hamilton classification, the patients were divided into two groups: AGA (n = 69) and non-AGA (n = 79). In addition, the cases of AGA were categorized as vertex (n = 39) and frontal baldness (n = 30). The International Prostate Symptom Score (IPSS), uroflowmetry parameters, prostate volume, serum total testosterone (TT), and free and total prostate-specific antigen concentrations of all patients were assessed and compared between the groups. Correlations between the AGA grade and other variables were also investigated. The serum TT level (354 ± 97.1 vs. 308.6 ± 73.1 ng/dL, p = 0.01), total IPSS (16.1 ± 8.1 vs. 13.4 ± 7.7, p = 0.04), IPSS storage subscore (IPSS-S) (7.1 ± 3.5 vs. 5.8 ± 3.6, p = 0.03), and number of nocturia episodes (2.5 ± 1.4 vs. 1.8 ± 1.4, p < 0.01) were significantly higher in the AGA group than in the non-AGA group. There were no significant differences in any of the parameters between the patients with vertex and frontal baldness. The AGA grade showed a significant positive correlation with the TT level (r = 0.407, p = 0.003), IPSS-S (r = 0.164, p = 0.04), and number of nocturia episodes (r = 0.203, p = 0.015). This study demonstrated that among patients with LUTS, those with AGA had worse symptoms and higher TT levels compared with those without AGA of similar age. Furthermore, the AGA grade was positively correlated with the TT level and storage symptoms.

Development and validation of a clinical nomogram to predict prostatic inflammation in men with lower urinary tract symptoms.

Prostatic inflammation is an important etiological component of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). The Prostatic Inflammation Nomogram Study (PINS) aimed to develop and validate a nomogram for predicting the presence of prostatic inflammation in men with LUTS. This non-interventional, cross-sectional, prospective study was conducted in six secondary/tertiary centers across Cyprus, Greece, Italy, Portugal, and Spain. Men (≥40 years) with BPH/LUTS scheduled to undergo prostatic surgery or transrectal ultrasound-guided (TRUS) prostate biopsy were included. Fifteen demographic and clinical participant characteristics were selected as possible predictors of prostatic inflammation. The presence of inflammation (according to Irani score) in the prostatic tissue samples obtained from surgery/TRUS biopsy was determined. The effect of each characteristic on the likelihood a prostate specimen demonstrated inflammation (classified by Irani score into two categories, 0-2 [no/minimal inflammation] or 3-6 [moderate/severe inflammation]) was assessed using multiple logistic regression. A nomogram was developed and its discriminatory ability and validity were assessed. In total, 423 patients (mean age 68.9 years) were recruited. Prostate volume ultrasound (PVUS) > 50 mL, history of urinary tract infection (UTI) treatment, presence of diabetes, and International Prostate Symptom Score (IPPS) Storage score were statistically significant predictors of Irani classification. Logistic regression demonstrated a statistically significant effect for leucocytes detected via urine dipstick, presence of diabetes, PVUS > 50 mL, history of UTIs, and higher IPSS Storage score for the odds of an inflammatory score category of 3-6 versus 0-2. The nomogram had a concordance index of 0.71, and good internal validity. The nomogram developed from PINS had good predictive ability and identified various characteristics to be predictors of prostatic inflammation. Use of the nomogram may aid in individualizing treatment for LUTS, by identifying individuals who are candidates for therapies targeting prostatic inflammation.

Efficacy and safety of Vibegron for the treatment of residual overactive bladder symptoms after laser vaporization of the prostate: A single-center prospective randomized controlled trial (VAPOR TRIAL).

This study aimed to evaluate the efficacy and safety of Vibegron for the treatment of residual overactive bladder (OAB) symptoms after laser vaporization of the prostate (photo-selective vaporization of the prostate, contact laser vaporization of the prostate, and thulium laser vaporization). This randomized, open-label, parallel-group, single-center superiority trial with a 12-week observation (jRCTs071190040) enrolled male patients with OAB aged 40 years or older who had undergone laser vaporization of the prostate for not less than 12 weeks and not more than 1 year earlier. Patients were allocated to receive Vibegron 50 mg once daily or follow-up without treatment for 12 weeks. Forty-seven patients were enrolled between January 2020 and March 2023. The median age (interquartile range) was 75.5 (72.5-78.5) years for the Vibegron group and 76.5 (71.0-81.0) years for the control group. The intergroup difference in the mean change (95% confidence interval) in the 24-hour urinary frequency at 12 weeks after randomization was -3.66 (-4.99, -2.33), with a significant decrease for the Vibegron group. The Overactive Bladder Symptom Score, International Prostate Symptom Score, IPSS storage score, and Overactive Bladder Questionnaire score significantly improved for the Vibegron group. Voided volume per micturition also increased for the Vibegron group. The administration of 50 mg of Vibegron once daily for 12 weeks showed significant improvement compared with follow-up without treatment in bladder storage (OAB) symptoms after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia.

Efficacy and Safety of Vibegron for Persistent Symptoms of Overactive Bladder in Men Being Pharmacologically Treated for Benign Prostatic Hyperplasia: Results From the Phase 3 Randomized Controlled COURAGE Trial.

The efficacy and safety of vibegron, a β3-adrenergic receptor agonist, was assessed among men with symptoms of overactive bladder (OAB) receiving pharmacologic treatment for benign prostatic hyperplasia (BPH) in a phase 3 randomized controlled trial. Men ≥ 45 years with OAB symptoms and BPH, treated with α-blocker with/without 5α-reductase inhibitors, were randomized 1:1 to vibegron or placebo for 24 weeks. Coprimary end points were change from baseline at week 12 in mean daily micturitions and urgency episodes. Secondary end points were change from baseline at week 12 in mean nightly nocturia and daily urge urinary incontinence episodes, International Prostate Symptom Score‒storage score, and volume voided per micturition. Safety was evaluated via adverse events (AEs). Of 1105 participants randomized, 965 (87.3%) completed the trial. At week 12, vibegron was associated with significant reductions vs placebo in daily micturitions (least squares mean difference [95% CI], -0.74 [-1.02, -0.46]; P < .0001) and urgency episodes (-0.95 [-1.37, -0.54]; P < .0001). Vibegron was also associated with significant improvements vs placebo at week 12 in nocturia episodes (least squares mean difference, -0.22 [-0.36, -0.09]; P = .002), urge urinary incontinence episodes (-0.80 [-1.33, -0.27]; P = .003), International Prostate Symptom Score‒storage scores (-0.9 [-1.2, -0.6]; P < .0001), and volume voided (15.07 mL [9.13-21.02]; P < .0001). AE rates were similar in vibegron (45.0%) and placebo (39.0%) arms; AEs occurring in ≥ 2% of participants were hypertension (9.0% vs 8.3%), COVID-19 (4.0% vs 3.1%), UTI (2.5% vs 2.2%), and hematuria (2.0% vs 2.5%). In this trial, vibegron met all primary and secondary end points and was safe and well tolerated in men with OAB symptoms and pharmacologically treated BPH.

Predictors of postoperative storage symptoms in male patients with lower urinary tract symptoms: A retrospective analysis of prostate surgery for benign prostatic enlargement.

This study investigated the effects of prostate surgery on storage symptoms in male patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE). This study aimed to identify patient characteristics associated with improved, unchanged, and deteriorated post-surgical storage symptoms and to identify the risk factors for non-improvement or deterioration. A retrospective analysis of 586 prostate surgeries performed between 2016 and 2022 at Yokosuka Kyosai Hospital was conducted on patients with LUTS and at least one storage symptom preoperatively. Patients with active urinary tract infection, prostate/bladder cancer, urethral strictures, or dementia were excluded. The study enrolled 230 patients and assessed storage symptoms using the International Prostate Symptom Score (IPSS). Overall, storage symptoms improved, remained unchanged, and deteriorated in 87.0%, 5.7%, and 7.4% of patients, respectively. The patients in the deteriorated group were significantly older, whereas those in the no-change group had smaller prostate volumes. Patient-reported outcome scores (IPSS, IPSS-QoL, and BII) were significantly higher in the improved group. The predictors of non-improvement included low IPSS storage score, cardiovascular disease, and diabetes mellitus. Predictors of deterioration included advanced age and low IPSS storage score. Patients with severe LUTS showed greater postoperative improvement in storage symptoms. A low IPSS storage score predicted non-improvement and deterioration. Advanced age, low IPSS storage score, and a history of cardiovascular disease and diabetes mellitus were identified as key predictors. Awareness of these factors may guide preoperative counseling and improve decision-making in prostate surgery, ensuring more personalized and effective treatment strategies.

Use of the International Prostate Symptom Score in men with Multiple Sclerosis

Objective : Men with multiple sclerosis (MS) tend to present with urinary symptoms potentially translating to significant findings on urodynamics (UDS). We sought to assess the reliability and prognostic value of the International Prostate Symptom Score (IPSS) and Quality of Life (QoL) in patients with MS. Methods : A prospective study between July 2014 and August 2016 included 40 consecutive men with MS and lower urinary tract symptoms (LUTs) referred for video UDS. All participants completed the IPSS and QoL assessments. Results were compared and correlated to UDS parameters. Results : Mean (±SD) age, IPSS, and QoL were 53.7 ± 13.5 years, 16.7 ± 8.9 and 4.1 ± 1.4, respectively. The most common presenting symptom and UDS finding were urinary frequency (79%) and detrusor overactivity (68%). 72% had moderate-severe symptoms base on the IPSS. Reduced bladder compliance on UDS was associated with intermittency and straining answers on IPSS (p = 0.02 and p = 0.03). QoL did not predict UDS parameters. Conclusion : QoL and total IPSS scores are likely insufficient for MS and LUTs patient assessment due to the variability of UDS findings. However, in these patients, IPSS storage symptom questions had significant correlation with UDS. Furthermore, presenting symptoms in MS &amp; LUTs did not correlate with UDS findings. Therefore, in patients with MS and LUTs, UDS must be performed for adequate disease assessment

Efficacy and safety evaluation of imidafenacin administered twice daily for continency recovery following radical prostatectomy in prostate cancer patients: Prospective open-label case-controlled randomized trial.

This study aims to prospectively analyze the effects of anticholinergic therapy using imidafenacin on detrusor overactivity occurring after robot-assisted radical prostatectomy (RARP). Patients were followed-up at outpatient visits 2-4 weeks post-surgery (visit 2) to confirm the presence of urinary incontinence. Those confirmed with urinary incontinence were randomly assigned in a 1:1 ratio to the anticholinergic medication group (imidafenacin 0.1 mg twice daily) or the control group. Patients were followed-up at 1, 3, and 6 months post-surgery for observational assessments, including the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). A total of 49 patients (25 in the treatment group and 24 in the control group) were randomized for the study. There were no differences observed between the groups in terms of age, comorbidities, prostate size, or pathological staging. According to the IPSS questionnaire results, there was no statistically significant difference between the medication and control groups (p=0.161). However, when comparing storage and voiding symptoms separately, there was a statistically significant improvement in storage symptom scores (p=0.012). OABSS also revealed statistically significant improvement in symptoms from 3 months post-surgery (p=0.005), which persisted until 6 months post-surgery (IPSS storage: p=0.023, OABSS: p=0.013). In the case of urinary incontinence that occurs after RARP, even if the function of the intrinsic sphincter is sufficiently preserved, if urinary incontinence persists due to changes in the bladder, pharmacological therapy using imidafenacin can be beneficial in managing urinary incontinence.

Correlation between Physician-Administered International Prostate Symptoms Score and Peak Urine Flow Rate in Assessment of Benign Prostatic Enlargement Patients.

To determine the correlation between international prostate symptom score (IPSS) questionnaire, completed by benign prostatic enlargement patients with the aid of their physicians and the peak urine flow rate from uroflowmetry. This was a prospective study carried out over a period of one year (which year and which period). IPSS questionnaire was administered, and uroflowmetry done for 76 consecutive patients from urology clinic of University of Nigeria Teaching Hospital (UNTH) who consented to the study. Seventy-six patients were recruited for the study. The mean age of the patients was 63.53 ± 9.84. Using the international prostate symptom score to assess symptoms severity, 16 patients had mild symptoms, 36 patients had moderate symptoms, while 24 patients had severe symptoms. The means quality-of-life score was 4.42 ± 1.83. Fifty-eight patients had obstructed peak flow rate (Qmax) on uroflowmetry, 14 patients had equivocal Qmax, while 4 patients had normal Qmax. Statistically significant, negative medium correlations were observed between Qmax and total IPSS, Qmax and the IPSS voiding and storage subscores, as well as Qmax and disease specific quality-of-life score (QoL). There is a statistically significant medium negative correlation between total IPSS and Qmax. This negative medium correlation was also observed between Qmax and IPSS subscores and between Qmax and QoL.

Modeling study of the effect of placebo and medical therapy on storage and voiding symptoms, nocturia, and quality of life in men with prostate enlargement at risk for progression

BackgroundModeling studies using large datasets from men with lower urinary tract symptoms/benign prostate enlargement (LUTS/BPE) can predict changes in International Prostate Symptom Score (IPSS) and risk of acute urinary retention/surgery under different treatment regimens and according to predictors (baseline characteristics) that commonly define risk of progression. We assessed the impact of treatments on different symptom types (storage, voiding, and nocturia), quality of life (QoL; IPSS Q8), and BPH Impact Index [BII]).MethodsGeneralized least squares models were used to predict each outcome. Data from the CombAT study were used to predict outcomes for active treatments (dutasteride, tamsulosin, combination therapy). Predictors included: age; IPSS total, storage, voiding, nocturia and QoL (IPSS Q8) scores; BII; prostate volume; maximum urine flow rate (Qmax), prostate-specific antigen, postvoid residual urine (PVR); alpha-blocker usage within 12 months. Data from phase III dutasteride monotherapy studies were used to predict placebo outcomes. Results were visualized using an interactive web-based tool (www.bphtool.com).ResultsCombination therapy provided greater predicted benefit than either monotherapy for all five outcomes for most patient profiles within the CombAT inclusion criteria. PVR and corresponding subscores were significant predictors of change in both storage and voiding subscores. Alpha-blocker use within 12 months, age (storage subscore), and Qmax (voiding subscore) were also significant predictors. PVR, age, Qmax, and nocturia score were significant predictors of change in nocturia. PVR, Qmax, previous alpha-blocker use, total IPSS, and QoL (IPSS Q8) score were significant predictors of change in QoL (IPSS Q8) score. For BII, significant predictors were PVR, age, total IPSS, and BII score. The multivariable effect of covariates and treatments is best visualized through the interactive web-based tool.ConclusionsThis predictive modeling study informs our understanding of how risk factors for disease progression interact and affect treatment impact on different symptom types and QoL scores.

Comparison of add-on medications for persistent storage symptoms after α-blocker treatment in BPH patients – a network meta-analysis

BackgroundPatients with benign prostatic hyperplasia (BPH) receive α-blockers as first-line therapy to treat lower urinary tract symptoms; however, some individuals still experience residual storage symptoms. Antimuscarinics, β3-agonists, and desmopressin are effective add-on medications. Nevertheless, there is currently no evidence for the appropriate choice of the first add-on medication. This systematic review aimed to investigate the clinical benefits of antimuscarinics, β3-agonists, and desmopressin, in addition to α-blockers, for persistent storage symptoms in BPH patients.MethodsA comprehensive literature search of randomized controlled trials (RCTs) comparing the efficacy of different add-on medications in BPH patients with persistent storage symptoms despite α-blocker treatment was conducted. Clinical outcomes included the International Prostate Symptom Score (IPSS), IPSS storage subscore, nocturia, micturition, and urgency. A network meta-analysis was performed to estimate the effect size. Surface under cumulative ranking curves (SUCRAs) were used to rank the included treatments for each outcome.ResultsA total of 15 RCTs were identified. Add-on imidafenacin and mirabegron resulted in significant improvement in all outcomes assessed. Other add-on medications such as desmopressin, tolterodine, solifenacin, fesoterodine, and propiverine showed positive benefits for most, but not all, outcomes. Based on the SUCRA rankings, add-on desmopressin was the best-ranked treatment for IPSS and nocturia, and add-on imidafenacin was the best for the IPSS storage subscore and micturition.ConclusionsBPH patients presenting with persistent storage symptoms despite α-blocker administration are recommended to include additional treatment. Desmopressin and imidafenacin may be considered high-priority add-on treatments because of their superior efficacy compared with other medications.

The effect of bladder function on the efficacy of transurethral prostatectomy in patients with benign prostatic hyperplasia: a retrospective, single-center study.

We investigated the impact and predictive value of bladder function in patients with benign prostatic hyperplasia (BPH) on the efficacy of transurethral prostatectomy. Symptomatic, imaging, and urodynamic data of patients who underwent transurethral prostatectomy at West China Hospital of Sichuan University (Chengdu, China) from July 2019 to December 2021 were collected. Follow-up data included the quality of life (QoL), International Prostate Symptom Score (IPSS), and IPSS storage and voiding (IPSS-s and IPSS-v). Moreover, urinary creatinine (Cr), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and prostaglandin estradiol (PGE2) were measured in 30 patients with BPH and 30 healthy participants. Perioperative indicators were determined by subgroup analyses and receiver operating characteristic (ROC) curve analysis. Among the 313 patients with BPH included, patients with severe micturition problems had more improvements but higher micturition grades postoperatively than those with moderate symptoms. Similarly, good bladder sensation, compliance, and detrusor contractility (DC) were predictors of low postoperative IPSS and QoL. The urinary concentrations of BDNF/Cr, NGF/Cr, and PGE2/Cr in patients were significantly higher than those in healthy participants (all P < 0.001). After evaluation, only DC was significantly related to both urinary indicators and postoperative recovery of patients. Patients with good DC, as predicted by urinary indicators, had lower IPSS and IPSS-v than those with reduced DC at the 1 st month postoperatively (both P < 0.05). In summary, patients with impaired bladder function had poor recovery. The combined levels of urinary BDNF/Cr, NGF/Cr, and PGE2/Cr in patients with BPH may be valid predictors of preoperative bladder function and postoperative recovery.

Efficacy of Tamsulosin Alone versus Tamsulosin Plus Tadalafil in Treatment of LUTS due to BPH: A Comparative Study

1. Background: Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) are common disorders whose prevalence increases with advancing age. Recent large-scale epidemiological studies reported a statistically significant association between these two conditions, independent of age and cardiovascular co-morbidities. Furthermore, a significant association between the increased severity of LUTS and the increased severity of ED has been confirmed. Objectives: The purpose of the study is to offer a clinical evaluation to verify the safety and efficacy of the combination of tamsulosin 0.4 mg/day plus tadalafil 5 mg/day vs. tamsulosin 0.4 mg/day alone to treat patients with LUTS due to BPH. Materials &amp; Methods: This comparative study was conducted in the Department of Urology, Dhaka Medical College Hospital. The duration of this study was 1 year from April 2018 to March 2019. A total of 170 patients, with a history of symptomatic BPH who attended the Urology Outpatient Department, Dhaka Medical College Hospital, were selected as per inclusion and exclusion criteria. Of them, 85 patients were treated with tamsulosin 0.4mg/day in group A whereas 85 patients were treated with tamsulosin 0.4mg/day plus tadalafil 5mg/day in group B. The general medical condition of the patients was evaluated through history, physical examination. The size of the prostate and PVR were evaluated through ultra-sonogram, and Qmax was assessed with uroflowmetry. The outcome of the patient was assessed by IPSS, IPSS total, IPSS voiding subscore, IPSS storage subscore, IPSS nocturia questionnaire, QOL, International Index of Erectile Function (IIEF-5) questionnaire, Qmax, USG of KUBP with MCC with PVR. Follow-up will be recorded in 4 visits in screening, week 0 randomization, 6 and 12. Results: One hundred and forty patients completed the study. Improvements in IPSS score and IPSS-QOL were significant with both treatments but greater with.....

Outcomes of Artificial Urinary Sphincter Implantation in Patients with Detrusor Underactivity and Postprostatectomy Incontinence.

There is insufficient evidence for postoperative outcomes of artificial urinary sphincter (AUS) implantation for postprostatectomy incontinence (PPI) with detrusor underactivity (DU). Thus, we assessed the impact of preoperative DU on the outcomes of AUS implantation for PPI. Medical records of men who underwent AUS implantation for PPI were reviewed. Patients who had bladder outlet obstruction surgery before radical prostatectomy or AUS-related complications that required revision of AUS within three months were excluded. Patients were divided into two groups based on the preoperative urodynamic study including pressure flow study, a DU group, and a non-DU group. DU was defined as a bladder contractility index less than 100. The primary outcome was postoperative postvoid residual urine volume (PVR). The secondary outcomes included maximum flow rate (Qmax), postoperative satisfaction, and international prostate symptom score (IPSS). A total of 78 patients with PPI were assessed. The DU group consisted of 55 patients (70.5%) and the non-DU group comprised 23 patients (29.5%). Qmax was lower in the DU group than in the non-DU group and PVR was higher in the DU group as per a urodynamic study before AUS implantation. There was no significant difference in postoperative PVR between the two groups, although the Qmax after AUS implantation was significantly lower in the DU group. While the DU group showed significant improvements in Qmax, PVR, IPSS total score, IPSS storage subscore, and IPSS quality of life (QoL) score after AUS implantation, the non-DU group showed postoperative improvement in IPSS QoL score. There was no clinically significant impact of preoperative DU on the outcome of AUS implantation for PPI; thus, surgery can be safely performed in patients with PPI and DU.

Lower urinary tract symptoms as an independent predictor of aortic regurgitation in women with cardiac symptoms.

Very few studies have focused on the correlation between structural heart disease and lower urinary tract symptoms. In this study, we applied echocardiography to explore the correlation between lower urinary tract symptoms and structural heart disease. In this single-center, prospective, cross-sectional study, we enrolled adult women undergoing echocardiography for suspected cardiac abnormalities causing cardiac symptoms between February 1, 2021, and March 31, 2021. All participants completed a questionnaire regarding demographic information and lower urinary tract symptoms, which were assessed according to the International Prostate Symptom Score. A total of 165 women aged 69.96 ± 10.20 years were enrolled. The prevalence of moderate-to-severe aortic regurgitation in patients with moderate-to-severe lower urinary tract symptoms was significantly higher than that in patients with mild lower urinary tract symptoms (33.3% vs 13.6%, p = 0.008). The prevalence of other echocardiographic abnormalities was not associated with severity of lower urinary tract symptoms. Multivariable logistic regression analyses revealed that moderate-to-severe lower urinary tract symptoms predicted moderate-to-severe aortic regurgitation ( p = 0.007; odds ratio: 3.560; 95% confidence interval: 1.409-8.993). Furthermore, the International Prostate Symptom Score storage subscore ( p = 0.001; odds ratio: 1.285; 95% confidence interval: 1.111-1.486), except the voiding subscore, was an independent predictor of moderate-to-severe aortic regurgitation. Moderate-to-severe lower urinary tract symptoms, especially storage symptoms, are an independent predictor of the co-existence of moderate-to-severe aortic regurgitation in women with cardiac symptoms. Early cardiological referral of patients with moderate-to-severe lower urinary tract symptoms and cardiac symptoms may improve their general health.

MP76-01 MID-TERM EVALUATION OF IMPACT ON STORAGE AND OBSTRUCTIVE SYMPTOMS WITH REZŪM: OUTCOMES OF A LARGE, MULTI-CENTER, PROSPECTIVE REGISTRY OF REZŪM WATER VAPOR THERAPY BENIGN PROSTATIC ENLARGEMENT

You have accessJournal of UrologyCME1 Apr 2023MP76-01 MID-TERM EVALUATION OF IMPACT ON STORAGE AND OBSTRUCTIVE SYMPTOMS WITH REZŪM: OUTCOMES OF A LARGE, MULTI-CENTER, PROSPECTIVE REGISTRY OF REZŪM WATER VAPOR THERAPY BENIGN PROSTATIC ENLARGEMENT Kevin C. Zorn, Naeem Bhojani, Bilal Chughtai, and Dean Elterman Kevin C. ZornKevin C. Zorn More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , and Dean EltermanDean Elterman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rezūm convective water vapor ablation is a minimally invasive procedure to treat benign prostatic tissue. Herein, we report a prospective, multi-center results of the largest cohort of prostates treated with Rezum in Canada to address mid-term outcomes on IPSS storage and obstructive voiding symptoms. METHODS: A prospective registry was established for Rezūm therapy in Canada (2019) at two high-volume centers. All patients had baseline medical and BPH history documented along with uroflowmetry (Qmax and PVR), and validated questionnaires (IPSS, IPSS QoL, BPHII, IIEF-15, MSHQ-EjD function and bother). Sub-category IPSS-V and IPSS-S were evaluated for the entire cohort, men in retention and those with prostate volume >80 cc vs <80 cc and median lobe vs non-median lobe. IPSS-S was calculated by summing question 1 (incomplete emptying), question 3 (intermittency), question 5 (weak stream), and question 6 (straining to void). IPSS-V was calculated by summing question 2 (frequency), question 4 (urgency), and question 7 (nocturia). RESULTS: 345 men (mean age of 67.4, were treated with Rezūm from April 2019 to October 2022. The mean prostate volume was 72.3 cc (range 17-271) and 64% had a median lobe. 85 patients had prior episode of urinary. Mean number of injections was 10.1(range 2-28). Mean duration of procedure was 3.7 minutes (range 1-13). Mean duration of post-procedure catheterization was 9.8 days. IPSS-S reduced from a baseline score of 9.4 to 8.4 (10%), 6.1 (35%), 4.9 (48%), 4.8 (49%), 4.6 (51%), 4.3 (54%) at 1, 3, 6, 12, 24 and 36 months respectively. Comparatively, IPSS-V reduced from a baseline of 12.7 to 7.7 (39%), 4.1 (67%), 4.3 (66%), 4.3 (66%), 4.6 (64%), 3.7 (70%) at 1, 3, 6, 12, 24 and 35 months respectively. Outcomes were similar among subgroup analysis of men with baseline retention, men with prostate volume >80 cc or those with median lobe (all p>0.05). CONCLUSIONS: Rezum therapy is safe, effective, quick, out-patient, office-based procedure for prostate glands over a wide range of volumes with equally significant improvements in storage and voiding symptoms regardless of prostate volume, median lobe status and baseline urinary retention. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1090 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin C. Zorn More articles by this author Naeem Bhojani More articles by this author Bilal Chughtai More articles by this author Dean Elterman More articles by this author Expand All Advertisement PDF downloadLoading ...

LBA01-02 IMPACT OF MEDICAL TREATMENT ON STORAGE VS VOIDING SYMPTOMS AND NOCTURIA FREQUENCY: A DYNAMIC NOMOGRAM N=9167 MEN WITH PROSTATIC ENLARGEMENT

You have accessJournal of UrologyCME1 Apr 2023LBA01-02 IMPACT OF MEDICAL TREATMENT ON STORAGE VS VOIDING SYMPTOMS AND NOCTURIA FREQUENCY: A DYNAMIC NOMOGRAM N=9167 MEN WITH PROSTATIC ENLARGEMENT Claus Roehrborn, Juan Manuel Palacios, Chandrashekhar Chavan, Stavros Gravas, Matthias Oelke, Marcio Augusto Averbeck, Arunangshu Biswas, Llenalia María García, and Vanessa Cortes Claus RoehrbornClaus Roehrborn More articles by this author , Juan Manuel PalaciosJuan Manuel Palacios More articles by this author , Chandrashekhar ChavanChandrashekhar Chavan More articles by this author , Stavros GravasStavros Gravas More articles by this author , Matthias OelkeMatthias Oelke More articles by this author , Marcio Augusto AverbeckMarcio Augusto Averbeck More articles by this author , Arunangshu BiswasArunangshu Biswas More articles by this author , Llenalia María GarcíaLlenalia María García More articles by this author , and Vanessa CortesVanessa Cortes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is unclear how the interaction of clinical covariates modulates medical treatment response in individual profiles of men with lower urinary tract symptoms/benign prostatic enlargement (LUTS/BPE). We developed a predictive analytics solution using baseline characteristics that commonly define patient risk of disease progression to project the change in storage, voiding and nocturia LUTS, in individual profiles receiving placebo (PBO), dutasteride (DUT), tamsulosin (TAM) or DUT/TAM combination therapy (CT). METHODS: A total of 9167 men with LUTS/BPE at risk of progression from three PBO-controlled DUT trials and one comparing DUT, TAM, and CT were included in the analyses to predict response to placebo up to 24 mo and active treatment up to 48 mo. Baseline characteristics included as predictors were: age, International Prostate Symptom Score (IPSS), total prostate volume (PV), maximum urine flow rate (Qmax), prostate-specific antigen (PSA), postvoid residual urine (PVR), α-blocker (AB) usage within 12 mo, and randomized treatment. A generalized least-squares model was developed for longitudinal IPSS storage and voiding sub-scores. For nocturia IPSS-Q7 a Generalized Additive Mixed Model was used to generate predictions. A ‘placebo response’ model was added to benchmark the predicted outcomes to treatment for 2-year f/u. RESULTS: For most profiles, nocturia, voiding and storage symptoms improved significantly with CT compared to DUT or TAM therapies. Higher PSA and PV values predicted a greater improvement in the outcomes explored in DUT compared to PBO. Higher PSA levels predicted a greater improvement in nocturia with all active treatments. Moreover, higher Qmax levels predicted better nocturia and voiding scores with all active treatments. Higher PVR levels were predictive of lower improvements in voiding scores with all active treatments. Likewise, previous use of AB indicates a lesser improvement in nocturia with TAM compared to CT therapy and on the storage scores with all active treatments. Also, higher PV levels had worse voiding scores with TAM in comparison with CT and DUT. The models were deployed in an interactive web app to help visualize and understand results for any possible combination of predictors up to 4 years. CONCLUSIONS: This predictive modelling based on large data sets contributes to understand how risk factors for disease progression interact and affect treatment impact on different type of symptoms, reinforcing the importance of an individualized approach for LUTS/BPE management. Source of Funding: GSK (study 219073) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1176 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claus Roehrborn More articles by this author Juan Manuel Palacios More articles by this author Chandrashekhar Chavan More articles by this author Stavros Gravas More articles by this author Matthias Oelke More articles by this author Marcio Augusto Averbeck More articles by this author Arunangshu Biswas More articles by this author Llenalia María García More articles by this author Vanessa Cortes More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-07 THE EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyCME1 Apr 2023MP74-07 THE EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON LOWER URINARY TRACT SYMPTOMS Norichika Ueda, Go Tsujimura, Takahiro Imanaka, Sohei Kuribayashi, Koichi Okada, Kentaro Takezawa, Shinichiro Fukuhara, and Norio Nonomura Norichika UedaNorichika Ueda More articles by this author , Go TsujimuraGo Tsujimura More articles by this author , Takahiro ImanakaTakahiro Imanaka More articles by this author , Sohei KuribayashiSohei Kuribayashi More articles by this author , Koichi OkadaKoichi Okada More articles by this author , Kentaro TakezawaKentaro Takezawa More articles by this author , Shinichiro FukuharaShinichiro Fukuhara More articles by this author , and Norio NonomuraNorio Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both late-onset hypogonadism (LOH) syndrome and lower urinary tract symptoms (LUTS) increase with age and decrease quality of life (QOL). The standard treatment for LOH syndrome is testosterone replacement therapy (TRT). Since the prostate is an androgen-dependent organ, TRT may have some effect on LUTS. However, the effect of TRT on LUTS is not fully understood. The number of patients with both LUTS and LOH syndrome is increasing, therefore it is important to understand the relationship between TRT and LUTS. In this study, we retrospectively examined the effect of TRT on LUTS. METHODS: Ninety-four patients who received TRT for LOH syndrome from May 2017 to August 2022 were evaluated. Three months after the first testosterone administration, Aging males Symptoms rating scale (AMS), Sexual Health Inventory for Men (SHIM), Erection Hardness Score (EHS), International Prostate Symptom Score (IPSS), and IPSS QOL score were assessed. IPSS was also evaluated for the voiding and storage subscores, respectively. RESULTS: TRT improved AMS, SHIM and EHS significantly (all p<0.01). In the evaluation of urinary symptoms, TRT did not improve any of the IPSS total scores, IPSS voiding subscores, IPSS storage subscores, or IPSS QOL scores in the LUTS mild group (IPSS: 8 or less), but in the LUTS moderate-severe group (IPSS: 8-35), TRT significantly improved them all (IPSS total scores: 14.2±0.9 vs 9.8±1.1: p<0.001, IPSS voiding subscores: 8. 0±0.6 vs 5.3±0.8: p<0.001, IPSS storage subscores: 6.3±0.6 vs 4.5±0.5: p=0.003, IPSS QOL scores: 3.9±0.2 vs 3.0±0.3: p=0.002, respectively) (Figure 1). CONCLUSIONS: TRT for LOH patients does not exacerbate LUTS but improves LUTS, especially for moderate or severe LUTS patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1071 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Norichika Ueda More articles by this author Go Tsujimura More articles by this author Takahiro Imanaka More articles by this author Sohei Kuribayashi More articles by this author Koichi Okada More articles by this author Kentaro Takezawa More articles by this author Shinichiro Fukuhara More articles by this author Norio Nonomura More articles by this author Expand All Advertisement PDF downloadLoading ...

Age and metabolic syndrome are associated with unsatisfactory improvement in nocturia after holmium laser enucleation of the prostate.

To investigate the association between age, metabolic syndrome (MetS) and improvement in nocturia in patients with benign prostate hyperplasia (BPH) receiving holmium laser enucleation of the prostate (HoLEP). The retrospective study was conducted on patients treated for BPH using HoLEP between January 2021 and May 2022. Lower urinary tract symptoms (LUTS) were measured before surgery and at 3 months postoperatively using the International Prostate Symptom Score (IPSS). The criteria of the Adult Treatment Panel III (ATP III) were adopted to diagnose the MetS. Unsatisfactory improvement in nocturia was defined as <50% reduction in nocturia from baseline on the IPSS. One hundred and seventy-five patients were eventually enrolled, with a median age of 69 years (IQR: 63/73). Unsatisfactory improvement in nocturia was reported in 95 patients (54%) after HoLEP. These patients were older (73; IQR: 67/79 vs. 66; IQR: 60/71, P < 0.001) and more likely to present with higher postoperative total (6; IQR: 4/9 vs. 3; IQR:2/5, P < 0.001), voiding (1; IQR: 0/3 vs. 1; IQR: 0/2, P = 0.017), and storage (4; IQR: 3/6 vs. 2; IQR: 1/4, P < 0.001) IPSS when compared to patients with satisfactory improvement in nocturia. Overall, 63 of 175 (36%) patients were diagnosed with MetS and of these, 44 (70%) reported unsatisfactory improvement in nocturia (P = 0.002) after HoLEP. Multivariate analysis revealed that age (OR = 1.117, 95% CI: 1.068-1.169, P < 0.001) and MetS (OR = 3.613, 95% CI: 1.727-7.562, P = 0.001) were independent risk factors for unsatisfactory improvement in nocturia after HoLEP. Our findings suggest that increased age and MetS were associated with unsatisfactory improvement in nocturia in patients with BPH after HoLEP. Lifestyle management, including weight loss, may be of great importance in the improvement of nocturia.

The Efficacy and Safety of 'Inverted Omega En-bloc' Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Size-Independent Technique for the Surgical Treatment of LUTS.

To evaluate the safety, efficiency, and size-dependency of the 'Inverted omega En-bloc (Ʊ)' holmium laser enucleation of the prostate (HoLEP) in benign prostate hyperplasia (BPH) with lower urinary tract symptoms. A retrospective analysis of 716 consecutive patients who underwent HoLEP under the care of a single surgeon from 2014-2021. These patients were treated using the 'Inverted omega En-bloc' HoLEP technique for BPH. The patients were divided into 3 groups: Group 1 (<40 mL, n=328), Group 2 (40-60 mL, n=221), and Group 3 (≤60 mL, n=167). Perioperative parameters, safety, and functional outcomes were assessed and analyzed. The perioperative parameters, like enucleation time (45.8±26.9 min), morcellation time (13.2±47.5 min), and catheterization duration (1.6±1.2 d) significantly differed to favor smaller prostate sizes (p<0.01). Significant improvements in the IPSS (total, voiding, storage, and quality of life), post-void residual urine, and maximum flow rate were observed 3 months post-HoLEP and continued during the 1-year follow-up period in all groups (p<0.01). The postoperative complications included urethral stricture in 11 patients (1.5%), bladder neck contracture in 12 (1.7%), urinary incontinence in 14 (2.0%), and bladder injuries in 4 (0.6%). Bladder neck contractures occurred only in Group 1. The postoperative surgical management for complications included urethral sounding (n=9, 1.3%), endoscopic internal urethrotomy (n=2, 0.3%), and re-HoLEP for bladder neck contractures in (n=12, 1.7%). The rate of re-HoLEP for regrowing adenomas was 15 (2.1%). Postoperative medications exceeding 6 months were α-blocker (n=22, 3.1%), cholinergics (n=16, 2.2%), anticholinergics (n=58, 8.1%), antidiuretics (n=18, 2.5%), and daily PDE5 inhibitor (n=38, 5.3%). Thirty-four patients (4.7%) had postoperative incidental prostate cancer. The inverted omega En-bloc HoLEP technique is safe and effective for the treatment of BPH. Moreover, 'Inverted omega En-bloc' HoLEP is a size-independent and effective method for all prostate sizes.

Relationship Between Serum Testosterone and Severity of Lower Urinary Tract Symptoms Among Malaysian Men

Background Lower urinary tract symptoms (LUTS) are commonly experienced among ageing males. The increasing prevalence of late-onset hypogonadism suggests a possible relationship between serum testosterone and severity of LUTS. This study examines the association between serum testosterone and severity of lower urinary tract symptoms among Malaysian men, as reflected by the International Prostate Symptom Score (IPSS). Method A total of 163 men with LUTS were enrolled in a cross-sectional study in Hospital Canselor Tuanku Mukhriz, Malaysia. Full examination, IPSS, and serum total testosterone (TT) levels were evaluated. Categorical and continuous correlations were analyzed using chi-square test and age-adjusted Pearson’s partial correlation, respectively. Result Mean age was 66.25 (SD = 7.05), with mean serum TT of 16.74 nmol/L (SD = 6.32). Twenty eight percent (n = 46) had low testosterone levels. Severity of LUTS (mild, moderate, severe) was not found to be dependent on TT status (normal, low, severely low), (χ2 [4, N = 163] = 4.24, P = 0.37). Weak negative correlations between total IPSS and IPSS storage sub-score with serum TT levels were exhibited respectively (r = −0.17, P &lt; 0.05; r = −0.17, P &lt; 0.05). Conclusion Among elderly Malaysian men, severity of LUTS and TT status were not found to be associated, despite a weak negative correlation between IPSS and serum testosterone levels. Nonetheless, with a high prevalence of hypogonadal ageing men, further research regarding serum testosterone measurement among this population may be valuable as part of a multimodal approach to treatment.