Treatment Of Lower Urinary Tract Symptoms Research Articles

Botulinum toxin in male lower urinary tract symptoms (LUTS): What can we expect?

During the last two decades botulinum toxin has also conquered urology. Botulinum toxin reduces the contractility and sensitivity of the detrusor muscle and relieves pain. It is therefore apromising drug whose use in men also appears promising. The following article highlights the practical relevance of botulinum toxin for male lower urinary tract symptoms (LUTS). But first of all, adistinction must be made between use in male LUTS due to benign prostate syndrome (BPS) and use in cases of overactive bladder (OAB) alone. Adifferentiated diagnosis and treatment of male LUTS is therefore essential.

Paediatricians’ perspectives in treating lower urinary tract symptoms: a qualitative exploratory needs assessment study

BackgroundPaediatric lower urinary tract symptoms (LUTS) are common experiences among school-aged children, with prevalence rates reaching as high as 20%. Paediatricians are often first-line stakeholders in providing treatment for these...

Prevalence and impact on daily life of lower urinary tract symptoms in Japan: Results of the 2023 Japan Community Health Survey (JaCS 2023).

A large-scale nationwide epidemiological survey of lower urinary tract symptoms (LUTS) was conducted via the Internet in 2023 to clarify the current prevalence of LUTS and evaluate its impact on daily life in Japan. The survey was conducted among individuals aged 20-99 years old who had anonymously registered with a Japanese online research company. The survey consisted of 48 questions related to LUTS and daily life. A total of 6210 participants (3088 females and 3122 males), who were selected by probability sampling based on the composition of the Japanese population (age range: 20-99), were recruited. The overall prevalence of LUTS was 77.9% among the subjects aged ≥20 and 82.5% among those aged ≥40. The prevalence of LUTS differed between the sexes and trends toward significant increases in prevalence with age were seen for almost all LUTS. Furthermore, the prevalence of overactive bladder (OAB) was 11.9% among the subjects aged ≥20 and 13.8% among those aged ≥40. This study also showed that LUTS negatively affected daily life. However, the percentage of subjects who visited a physician to receive treatment for LUTS was low, including for participants with a history of treatment for LUTS, although this increased with age. The prevalence of LUTS, including OAB, increased with age and negatively affected daily life. However, since the percentage of patients who visit a physician to receive treatment for LUTS remains low, further educational activities regarding LUTS are necessary.

Urodynamic Findings of The Patients with Parkinson’s Disease: A Single Tertiary Center Results

Objective :In Parkinson’s disease (PD), lower urinary tract symptoms (LUTS) are common with a prevalence ranging from 25% to 57%. Patients who are resistant to medical treatment for LUTS may require urodynamic examination and pressure flow study (UD-PFS) to better comprehend the bladder's dynamics. To be able to comprehend the pathophysiology of LUTS, UD-PFS examinations should be performed. In this study, the demographics and clinical properties of PD patients were presented along with their UD-PFS examinations.
 Method : The data of 155 patients with PD followed up between 2010-2020 were retrospectively analyzed. UD-PFS was applied to 42 PD patients resistant to medical treatment of LUTS. Patients' demographic and clinical data with their UD-PFS findings were studied separately.
 Result : Twenty-eight of the patients underwent UD-PFS were male, and 14 were female. In UD, the first urinary sensation was 86.00±68.77cc, and the maximum cystometric capacity was 322.07±194.25cc. Sixteen patients had a hypo-compliant bladder, 25 (59.5%) had a normo-compliant bladder. In PFS, Q max and peak detrusor pressure during voiding were 12.72±10.08 mL/sec and 43.93±15.56 cm-H2O, respectively. Stress-type urinary incontinence was detected in 6 (15%) of the patients. When evaluating the detrusor activity, neurogenic detrusor overactivity in 18 (44%) patients, detrusor areflexia in 8 (19%) and normal UD-PFS in 16 (22%) patients.
 Conclusion: The majority of the patients presented with neurogenic detrusor overactivity accompanied by diminished bladder capacity and hypersensitivity. In the selected PD patients who are resistant to medical treatment with LUTS clinics, UD-PFS provides useful scientific information about the LUTS clinics of patients and may be helpful in treatment management.

Female Bladder Dysfunction Following Boari Bladder Flap Ureteral Reconstruction

ObjectivesTo describe our institution’s experience with Boari flap ureteral reconstruction, specifically focusing on the development of postoperative lower urinary tract symptoms (LUTS). MethodsA retrospective review of all Boari flaps performed at our institution between 2013 and 2023 was performed, excluding patients with urothelial carcinoma and males, given the frequency of LUTS from benign prostatic hyperplasia. Primary outcome was the development of new onset LUTS and subsequent treatment. Secondary outcomes included postoperative infections and ureteral stricture. Results29 total patients were identified. Mean age was 52.2 years (Standard deviation (SD) 13.1). Mean follow-up was 22.3 months (SD 25.3). Primary reasons for ureteral reconstruction were radiation damage (37.9%) and iatrogenic surgical injury (37.9%). A concurrent psoas hitch was performed in 18/29 (62%) cases, nephropexy was utilized in 1/29 (3.4%) cases, and contralateral bladder pedicles were ligated in 10/29 (34.5%) for increased bladder mobilization. Postoperatively, 8 patients (27.6%) developed new-onset LUTS, effectively managed with oral anticholinergics. Recurrent UTIs occurred in 5 patients (17.2%) and pyelonephritis in one (3.4%) patient. Two patients (6.9%) developed ureteral strictures, one treated with ileal ureter replacement and the other with ureteral balloon dilation. ConclusionsBoari bladder flap ureteral reconstruction leads to moderate rates of new onset LUTS postoperatively, which is important information when counseling women on reconstructive options. Boari flap ureteral reconstruction has a high success rate and serious complications are rare. In the setting of ureteral injury, reconstruction using Boari flaps with or without psoas hitch should be considered for definitive management.

Cost-effectiveness of a primary healthcare intervention to treat male lower urinary tract symptoms: the TRIUMPH cluster randomised controlled trial

ObjectivesTo estimate the cost-effectiveness of a primary care intervention for male lower urinary tract symptoms (LUTS) compared with usual care.DesignEconomic evaluation alongside a cluster randomised controlled trial from a UK...

Minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS): promise or panacea?

The increasing importance of treatment of lower urinary tract symptoms (LUTS), while avoiding side effects and maintaining sexual function, has allowed for the development of minimally invasive surgical therapies (MISTs). Recently, the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia (BPH) to the management of nonneurogenic male LUTS. The aim of the present review was to evaluate the efficacy and safety of the most commonly used MISTs: ablative techniques such as aquablation, prostatic artery embolization, water vapor energy, and transperineal prostate laser ablation, and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device (iTIND). MISTs are becoming a new promise, even if clinical trials with longer follow-up are still lacking. Most of them are still under investigation and, to date, only a few options have been given as a recommendation for use. They cannot be considered as standard of care and are not suitable for all patients. Advantages and disadvantages should be underlined, without forgetting our objective: treatment of LUTS and re-treatment avoidance.

Transperineal laser ablation as treatment for benign prostatic obstruction: Safety, feasibility and functional outcomes-A pilot study.

Standard surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) requires anaesthesia and hospitalization. Transperineal laser ablation (TPLA) is a novel minimally invasive treatment for BPO, which has been performed using local anaesthetics and conscious sedation. The aim of this study is to assess safety, feasibility and functional outcomes of TPLA for the treatment of LUTS in men fit also for standard surgery. This prospective, multicentre, interventional pilot study included 20 patients. Eligible patients were men ≥40 years of age, with urodynamically proven bladder outlet obstruction, a peak urinary flow of 5-15 mL/s and a prostate volume of 30-120 cc. All subjects underwent Soractelite™ TPLA using the Echolaser® X4 system. Two to four fibres were placed in the prostate, whereafter laser light induced coagulative necrosis. Twelve months of follow-up included uroflowmetry, an ultrasound of the prostate and PROMs (IPSS and IIEF). Twenty patients were treated with TPLA using local anaesthetics and optional sedation. Sixteen patients were treated in an outpatient setting, using only local anaesthetics in 12 of them; four were treated in the operating room, whereof two under general anaesthesia. No device related adverse events occurred, nor did any grade ≥3 adverse events during follow-up. Post-TPLA, 10 men continued spontaneous voiding, and 10 men developed a urinary retention treated by a temporary indwelling catheter for 15.2 ± 3.5 days. At 12 months, Qmax improved from 9.7 ± 3.5 to 14.9 ± 6.0 (p = 0.015), IPSS improved from 21.3 ± 5.2 to 10.9 ± 5.5 (p < 0.0001), QoL improved from 4.9 ± 0.9 to 1.9 ± 1.1 (p < 0.0001), IIEF-15 total score remained stable and 11/13 patients (85%) preserved antegrade ejaculation. TPLA is a safe and feasible treatment for men with LUTS due to BPO. TPLA can be performed in an outpatient setting under only local anaesthetics. Functional and quality of life outcomes improved significantly at 12 months, and erectile function remained stable.

Immediate effect of alpha-blockers in predicting LUTS improvement in BPH patients.

Indications for treating Benign Prostatic Hyperplasia include reversing signs and symptoms or preventing the progression of the disease. Alpha-blockers are the most effective, least costly, and best tolerated of the drugs for relieving LUTS. The aim of the study is to investigate the immediate impact of alpha-blocker medications on lower urinary tract symptoms (LUTS). About 100 patients were included in the study-50 patients in each of the groups A (tamsulosin) and B (silodosin). The first visit was the baseline examination before starting alpha-blockers and included history, DRE, UFM, USG KUBP with PVR, IPSS, serum PSA, serum creatinine, urine analysis, urine culture, and sensitivity. All above parameters were also at 1 week, 1 month, and 3 months following starting of alpha-blockers respectively, and compared with baseline. As of the first, second, third, and fourth visits, the mean Qmax in group A was 10.3 ± 3.3 s, 15.08 ± 2.80 s, 15.66 ± 3.18 s, and 15.12 ± 3.24 s, respectively, while in group B it was 10.1 ± 3.1 s, 14.88 ± 2.80 s, 15.18 ± 3.18 s, and 15.08 ± 3.24 s, respectively (p < 0.001). The mean voiding time was 40.87 ± 23.91 s, 36.41 ± 20.73 s, 34.85 ± 21.37 s, and 32.07 ± 21.81 s, respectively in group A, and 41.27 ± 15.49 s, 37.23 ± 21.34 s, 38.59 ± 20.83 s, and 33.10 ±22.08. In group A, the mean PVR and IPSS scores were improved and also improved in group B. The first dose of tamsulosin and silodosin improves UFM and predicts the mid-term change in UFM as well as IPSS indices in the treatment of BPH-related LUTS.

Neurogenic Lower Urinary Tract Symptoms, Fatigue, and Depression-Are There Correlations in Persons with Multiple Sclerosis?

The symptoms of multiple sclerosis (MS) frequently include fatigue, depression, and neurogenic lower urinary tract symptoms (LUTS), causing severe burdens on affected individuals. The relationships between these symptoms have not been intensively researched and there are no studies on the detailed influence of the different neurogenic LUTS. We aimed to investigate the relationships between fatigue, depression, and neurogenic LUTS as recorded in bladder diaries by persons with MS. We analyzed the bladder diaries of 274 people and their scores on the Fatigue Scale for Motor and Cognitive Functions and the Centre for Epidemiologic Studies Depression Scale (German version). The neurogenic LUTS were defined as urgency, reduced voided volume, increased standardized voiding frequency, nocturia, and urinary incontinence. Those suffering from incontinence, nocturia, reduced voided volume, or urgency had higher fatigue scores compared to those without these symptoms. Those with nocturia showed significantly higher scores for depression. The severity of urgency and voided volume had the greatest effect on the severity of individuals' fatigue and depression levels. With increasing urgency, the risk of clinically significant fatigue and depression was expected to increase. Urgency and voided volume correlated most with fatigue and depression. A prospective longitudinal study investigating fatigue/depression after the successful treatment of neurogenic LUTS is needed to clarify causality and offer possible treatment options for fatigue and depression.

Novel minimally invasive treatments for lower urinary tract symptoms: a systematic review and network meta-analysis.

To review and compare the effectivity of novel minimally invasive treatments (MITs) to transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) in men. Medline, Embase, and Cochrane databases were searched from January 2010 to December 2022 for randomized controlled trials (RCTs) evaluating MITs, compared to TURP or sham, in men with LUTS. Studies were assessed by risk of bias tool, and evidence by GRADE. Functional outcomes by means of uroflowmetry and IPSS were the primary outcomes, safety and sexual function were secondary outcomes. As part of this review, a network meta-analysis (NMA) was conducted. MITs were ranked based on functional outcome improvement probability. In total, 10 RCTs were included, evaluating aquablation, prostatic urethral lift, prostatic artery embolization (PAE), convective water vapor thermal treatment or temporary implantable nitinol device. All MITs showed a better safety profile compared to TURP. Functional outcome improvement following aquablation were comparable to TURP. In the NMA, aquablation was ranked highest, PAE followed with the second highest probability to improve functional outcomes. Other novel MITs resulted in worse functional outcomes compared to TURP. Level of evidence was low to very low. Five MITs for treatment of LUTS were identified. Aquablation is likely to result in functional outcomes most comparable to TURP. Second in ranking was PAE, a technique that does not require general or spinal anesthesia. MITs have a better safety profile compared to TURP. However, due to high study heterogeneity, results should be interpreted with caution.

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.....

Predicting Prostate Surgery Outcomes from Standard Clinical Assessments of Lower Urinary Tract Symptoms To Derive Prognostic Symptom and Flowmetry Criteria

BackgroundAssessment of male lower urinary tract symptoms (LUTS) needs to identify predictors of symptom outcomes when interventional treatment is planned. ObjectiveTo develop a novel prediction model for prostate surgery outcomes and validate it using a separate patient cohort and derive thresholds for key clinical parameters. Design, setting, and participantsFrom the UPSTREAM trial of 820 men seeking treatment for LUTS, analysis of bladder diary (BD), International Prostate Symptom Score (IPSS), IPSS-quality of life, and uroflowmetry data was performed for 176 participants who underwent prostate surgery and provided complete data. For external validation, data from a retrospective database of surgery outcomes in a Japanese urology department (n = 227) were used. Outcome measurements and statistical analysisSymptom improvement was defined as a reduction in total IPSS of ≥3 points. Multiple logistic regression, classification tree analysis, and random forest models were generated, including versions with and without BD data. Results and limitationsMultiple logistic regression without BD data identified age (p = 0.029), total IPSS (p = 0.0016), and maximum flow rate (Qmax; p = 0.066) as predictors of outcomes, with area under the receiver operating characteristic curve (AUC) of 77.1%. Classification tree analysis without BD data gave thresholds of IPSS <16 and Qmax ≥13 ml/s (AUC 75.0%). The random forest model, which included all clinical parameters except BD data, had an AUC of 94.7%. Internal validation using the bootstrap method showed reasonable AUCs (69.6–85.8%). Analyses using BD data marginally improved the model fits. External validation gave comparable AUCs for logistic regression, classification tree analysis, and random forest models (all without BD; 70.9%, 67.3%, and 68.5%, respectively). Limitations include the significant number of men with incomplete baseline data and limited assessments in the external validation cohort. ConclusionsOutcomes of prostate surgery can be predicted preoperatively using age, total IPSS, and uroflowmetry data, with prognostic thresholds of 16 for IPSS and 13 ml/s for Qmax. Patient summaryThis study identified key preoperative factors that can predict outcomes of prostate surgery for bothersome urinary symptoms, including which patients are at risk of a poor outcome.

Pathogenetic Effects of Global Stress on the Dynamic Component of Benign Prostatic Hyperplasia in Men in Ukraine

The military situation in Ukraine significantly worsened the quality of medical care for the population. Of all Ukrainian men the age category from 30 to 60 years old who take part in military operations is the most effective one. Another, no less important part of the male population is the old persons, who, as a result of military operations, have limited opportunities to receive medical care. Currently, observing by urologist, required for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) due to combat operations in the country, is often performed via distance curation. The doctor needs a clear understanding of the patient’s medical history, taking into account his psychological and somatic status, the use of medicines. Stress negatively affects men’s health, worsening the hormonal background, mental state and aggravating problems of the genital and urinary systems. Psychological stress is a factor in the exacerbation or occurrence of urological complaints, which can lead to the pathological activation of certain parts of the sympathetic nervous and hormonal systems, the development of LUTS by BPH. Tamsulosin is considered to be the most recognized and widely used treatment for LUTS in patients with BPH. The classic medicament approach of BPH monotherapy is the use of Serenoa repens extract. The distance appointment of selective α-adrenoblockers, both in monotherapy and in combinations, is an important measure of providing specialized urological care to the population.

Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement.

Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate, which can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH is common. The extract of the berry of the American saw palmetto or dwarf palm plant, Serenoa repens (SR), which is also known by its botanical name of Sabal serrulatum, is one of several phytotherapeutic agents available for the treatment of BPH. To assess the effects of Serenoa repens in the treatment of men with LUTS consistent with BPH. We performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Web of Science, and LILACS), trials registries, other sources of grey literature, and conference proceedings published up to 16 September 2022, with no restrictions on language or publication status. We included randomized controlled trials of participants with BPH who were treated with Serenoa repens or placebo/no treatment. Two review authors independently assessed studies for inclusion at each stage and undertook data extraction and risk of bias assessment and GRADE assessment of the certainty of the evidence. We considered review outcomes measured up to 12 months after randomization as short term, and beyond 12 months as long term. Our main outcomes included urologic symptom scores, quality of life, and adverse events. For this update, we narrowed the review question to only comparisons with placebo. We included 27 studies (of which 9 were new) involving a total of 4656 participants, 19 studies comparing Serenoa repens with placebo, and 8 studies comparing Serenoa repens in combination with other phytotherapeutic agents versus placebo. Most studies included men aged > 50 (mean age range 52 to 68) with moderate urologic symptoms (International Prostate Symptom Score [IPSS] range 8 to 19). Ten studies were funded by the pharmaceutical industry; two studies were funded by government agencies; and the remaining studies did not specify funding sources. Serenoa repens versus placebo or no intervention Results for this comparison are based on predefined sensitivity analyses limited to studies at low risk of bias. Serenoa repens results in little to no difference in urologic symptoms at short-term follow-up (3 to 6 months; IPSS score range 0 to 35, higher scores indicate worse symptoms; mean difference (MD) -0.90, 95% confidence interval (CI) -1.74 to -0.07; I2 = 68%; 9 studies, 1681 participants; high-certainty evidence). Serenoa repens results in little to no difference in the quality of life at short-term follow-up (3 to 6 months; IPSS quality of life domain range 0 to 6, higher scores indicate worse quality of life; MD -0.20, 95% CI -0.40 to -0.00; I2 = 39%; 5 studies, 1001 participants; high-certainty evidence). Serenoa repens probably results in little to no difference in adverse events (1 to 17 months; risk ratio (RR) 1.01, 95% CI 0.77 to 1.31; I2 = 18%; 12 studies, 2399 participants; moderate-certainty evidence). Based on 164 cases per 1000 men in the placebo group, this corresponds to 2 more (38 fewer to 51 more) per 1000 men in the Serenoa repens group. Serenoa repens results in little to no difference in urologic symptoms at long-term follow-up (12 to 17 months, IPSS score, MD 0.07, 95% CI -0.75 to 0.88; I2 = 34%; 3 studies, 898 participants; high-certainty evidence). Serenoa repens results in little to no difference in quality of life at long-term follow-up (12 to 17 months, IPSS quality of life, MD -0.11, 95% CI -0.41 to 0.19; I2 = 65%; 3 studies, 882 participants; high-certainty evidence). There were no data on long-term adverse events for this comparison. Serenoa repens in combination with other phytotherapy versus placebo or no intervention Different phytotherapeutic agents that include Serenoa repens may result in little to no difference in urologic symptoms compared to placebo at short-term follow-up (12 to 24 weeks, IPSS score, MD -2.41, 95% CI -4.54 to -0.29; I2 = 67%; 4 studies, 460 participants; low-certainty evidence). We are very uncertain about the effects of these agents on quality of life (very low-certainty evidence). These agents may result in little to no difference in the occurrence of adverse events; however, the CIs included substantial benefits and harms (12 to 48 weeks, RR 0.91, 95% CI 0.58 to 1.41; I2 = 0%; 4 studies, 481 participants; low-certainty evidence). Based on 132 cases per 1000 men in the placebo group, this corresponds to 12 fewer (55 fewer to 54 more) per 1000 men in the combined phytotherapeutic agents with Serenoa repens group. Serenoa repens alone provides little to no benefits for men with lower urinary tract symptoms due to benign prostatic enlargement. There is more uncertainty about the role of Serenoa repens in combination with other phytotherapeutic agents.

Potential drug-drug interactions in males living with HIV who use drugs to treat lower urinary tract symptoms.

Lower urinary tract symptoms (LUTS) are becoming more prevalent in the ageing population of males living with HIV. Drugs to treat LUTS are known for both their potential role as victims in drug-drug interactions (DDIs) and their side effects. We aimed to evaluate the current use of drugs to treat LUTS and to assess potential DDIs in our cohort of adult males living with HIV. This was a retrospective review of pharmacy records. We recorded the combination antiretroviral therapy (cART) regimen and any use of drugs to treat LUTS (anatomical therapeutic chemical codes G04CA/CB/CX and G04BD). Potential DDIs were assessed using the interaction checker developed by the University of Liverpool (https://www.hiv-druginteractions.org/checker). A total of 411 adult males living with HIV were included in this analysis. The median (interquartile range [IQR]) age was 53 (41-62) years. Nineteen (4.6%) patients used one or more drugs to treat LUTS. As expected, older patients were more likely to be receiving treatment for LUTS: Q1 (20-40 years) = 0%; Q2 (41-52 years) = 2%; Q3 (53-61 years) = 7%; Q4 (62-79 years) = 10%. Seven potential DDIs between cART and LUTS treatment were noted in six of the 19 (32%) patients. Following medication reviews of these six patients, the following interventions were proposed: evaluate safe use of alpha-blocker (n = 4), change in cART (n = 2), and dose reduction of the anticholinergic agent (n = 1). Treatment for LUTS coincided with cART in 7%-10% of patients aged above the median age of 53 years in our cohort. Improvements in DDI management appeared to be possible in this growing cohort of males living with HIV and with LUTS.

Advanced Sensoring Technologies for Evaluation and Management of Lower Urinary Tract Symptoms

AbstractNowadays, urination dysfunction caused by lower urinary tract symptoms (LUTS) has been a nonnegligible issue owing to its influences on patients’ physical and mental health, and in particular, the detection of the urination process and analysis of the urine samples of the patients have been the priority for diagnosis and treatment of LUTS. In this article, the existing perception of LUTS, such as the etiologies of LUTS and current approaches for LUTS evaluation in the clinic, is systematically summarized. Furthermore, several novels lower urinary tract (LUT) status‐sensing systems used for monitoring physiological indexes, including intravesical pressure, urine flow rate, residue urine volume, bladder volume, and biomarkers in urine, are introduced. It is believed that this presentation will make a contribution to deepening the comprehension of LUTS and promote the development of rapid, accurate, and convenient LUT testing techniques.

(119) The Effect of Tadalafil and Dutasteride Combination on Lower Urinary System Symptoms and Erectile Functions in Patients with and without Prostate Median Lobe

Abstract Introduction Alpha blockers, 5 alpha reductase inhibitors, anticholinergics and tadalafil are used in the treatment of LUTS due to BPH. Objective The aim of this study was to evaluate the effect of daily tadalafil+dutasteride treatment on lower urinary tract symptoms (LUTS) and erectile functions in male patients with and without a median prostate lobe. Methods Male patients over the age of 40 who applied to the Urology Outpatient Clinic due to LUTS/ED between January 2018 and December 2022 were included in the study. Ethics committee approval was obtained for the study. Detailed medical and sexual histories of the patients were taken. The International Prostate Symptom Index was used for the LUTS, and the International Erectile Function Index-Erectile Function section was used for the erectile function. PSA and total testosterone levels of the patients were recorded. Maximum urine flow rate (Qmax) was measured by uroflowmetry. Prostate volume, presence of median lobe, median lobe volume and post-void residual urine volume (PMR) were measured by transabdominal ultrasound. Then, patients with moderate and severe LUTS and prostate volume over 40 cc were divided into 2 groups as those with and without middle lobe. The patients were started on tadalafil 5mg and dutasteride 0.5mg daily. IPSS, IIEF-EF, Qmax, PV and PMR changes of the patients were compared after 24 weeks of treatment. Results A total of 96 patients were included in the study (42 with a median lobe (group-1), 54 without a median lobe (group-2). The mean age of the patients was 56.25±13.47, and the mean BMI was 29.12±7.76. The mean IPSS value of the patients was 14.25±6.69, and the IIEF-EF value was 12.11±9.93. Mean PSA value 2.25±1.36 ng/ml, total testosterone value 345.67±123.21 ng/ml, mean PV 46.71±23.22 ml, Qmax value 8.24±3.36 m/s, PVR 54.32±25.52 was ml. There was no significant difference between the baseline IPSS, IIEF-EF, PSA and Qmax values between the two groups (p&amp;gt;0.05). After daily tadalafil+dutasteride treatment, mean IPSS value of the patients at the 24th week controls was 5.42±4.09 (p&amp;lt;0.001), IIEF-EF score was 20.97±3.67p&amp;lt;0.001), PV was 38.20±10.68 ml (p= 0.021), the Qmax value was found to be 12.45±7.68 m/s (p&amp;lt;0.001). Significant improvements were observed in IPSS, IIEF-EF and Qmax values in both groups compared to the beginning of treatment when the parameters of the groups were changed at the beginning and at the 24th week. When the 24th week data of the two groups were compared, it was found that the IPSS decrease in group-2 was higher than in group-1 (p=0.012). IIEF-EF scores (p=0.034) and Qmax (p=0.001) values were found to be higher than group-1. Conclusions Daily tadalafil+dutasteride treatment is an effective and safe treatment combination in male patients with LUTS/ED. In the presence of the median lobe, the response from tadalafil+dutasteride treatment decreases. The 24-week preliminary results of the study allowed us to have an idea of the long-term results. Further studies are needed to evaluate the effect of tadalafil+dutasteride combination in the treatment of LUTS/ED. Disclosure No

The Efficacy of Cyclooxygenase-2 Inhibitors for the Male Treatment of Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis.

To investigate the potential use of cyclooxygenase-2 (COX-2) inhibitors in the treatment of lower urinary tract symptoms (LUTS) in male patients, we conducted a comprehensive meta-analysis. Our study involved the identification and collection of randomized controlled trials (RCTs) from leading databases including PubMed, MEDLINE, EMBASE, and Cochrane Library. The primary objective of this analysis was to evaluate the effectiveness of COX-2 inhibitors for the treatment of LUTS. Our analysis involved six short-term (within 3 months) RCTs involving 707 patients. We found that COX-2 inhibitor treatment significantly improved the International Prostate Symptom Score (IPSS) of patients (mean difference [MD] = -2.99, 95% confidence interval (CI): -3.65 to -2.33, p < .00001), nocturia frequency (MD = -1.90; 95% CI: -3.18 to -0.61, p = .004), and maximum flow rate (Qmax) (MD = 1.02; 95% CI: 0.06 to 1.98, p = .04). However, no significant differences were found between patients in terms of changes in prostate-specific antigen (PSA) (MD = 0.02; 95% CI: -0.39 to 0.43, p = .92) and total prostate volume (TPV) (MD = -2.93; 95% CI: -6.45 to 0.59, p = .10). Therefore COX-2 inhibitors are an effective treatment for LUTS.

Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation.

Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH. However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function. In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies. Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function. Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.