Treatment Of Lower Urinary Tract Symptoms Research Articles

Benign prostatic hyperplasia : New and treatment-relevant aspects from the DGU guidelines

The diagnosis and treatment of lower urinary tract symptoms (LUTS) due to benign prostatic enlargement plays an important role in daily urological practice. Therefore, atargeted and resource-saving approach is essential. Arational base-line work-up of our patients provides the necessary information for obtaining the diagnosis and only needs to be expanded in individual cases. In addition to drug therapy, the modification of lifestyle and the possibility of watchful waiting must not be underestimated. Simple measures such as atimed fluid intake, double micturition in the case of residual urine development, but also bladder reconditioning can significantly improve the quality of life of our patients. Regarding surgical treatment, laser procedures have found their way into many departments and have established themselves in daily routine as areference procedure in addition to transurethral resection of the prostate (TUR-P) and simple open prostatectomy. New, minimally invasive procedures-such as prostatic artery embolization (PAE), the Rezum™- (NxThera Inc., Maple-Grove, MN, USA) or the Aquabeam® (Procept, Redwood City, CA, USA) procedure, but also nonablative procedures such as iTind© (TIND, Medi-Tate, Or Akiva, Israel) or Urolift® (Neotract Inc., Pleasanton, CA, USA)-offer new treatment options to those affected, with the potential to maintain patient's sexual function. As aresult, individual risk assessment and advice on the advantages and disadvantages of all available treatment options-even more than today-will be an important part of LUTS treatment. An individual approach, similar to that used in the treatment of oncological disease, will become standard also in the treatment of benign prostatic syndrome.

MP25-09 SECOND GENERATION OF TEMPORARY IMPLANTABLE NITINOL DEVICE (ITIND) IN MEN WITH LOWER URINARY TRACT SYMPTOMS (LUTS): WHO PROFIT MOST FROM TREATMENT? 2YEAR RESULTS OF THE MT-02-STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP25)1 Apr 2020MP25-09 SECOND GENERATION OF TEMPORARY IMPLANTABLE NITINOL DEVICE (ITIND) IN MEN WITH LOWER URINARY TRACT SYMPTOMS (LUTS): WHO PROFIT MOST FROM TREATMENT? 2YEAR RESULTS OF THE MT-02-STUDY Gregor Kadner*, Valerio Massimo, Manit Arya, Nicolaas Lumen, Brian SH Ho, Sergio Alonso, Claude Schulman, Neil Barber, Daniele Amparore, and Francesco Porpiglia Gregor Kadner*Gregor Kadner* More articles by this author , Valerio MassimoValerio Massimo More articles by this author , Manit AryaManit Arya More articles by this author , Nicolaas LumenNicolaas Lumen More articles by this author , Brian SH HoBrian SH Ho More articles by this author , Sergio AlonsoSergio Alonso More articles by this author , Claude SchulmanClaude Schulman More articles by this author , Neil BarberNeil Barber More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000864.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Assessing medium-term functional results of a novel minimally-invasive treatment for LUTS due to benign prostatic hyperplasia (BPH) with 2nd generation temporary implantable nitinol device (iTind; Medi-Tate Ltd, Israel): 2yr FU of a single-arm, prospective, international multicenter study, and identify preoperative baseline parameters predicting success or failure of iTind treatment. METHODS: 81 men with symptomatic BPH (IPSS≥10, Qmax < 12ml/sec, and PV <75ml) were enrolled. Patients with PVR>250ml, previous prostatic surgery, confounding bladder or sphincter dysfunction, active UTI and haemostatic disorders were excluded. Patients were washed out 1 month for alpha-blockers and 6mos for 5-ARIs. A subgroup of patients with median lobe were assessed separately. The implantation procedure was performed under light sedation and removal was 5-7 days later. OR-time, VAS, complications (CD-Grading System); and functional results (PVR, Qmax, IPSS), QoL and sexual and ejaculatory function were assessed. Follow-up (FU) was done at 1, 3, and 6mos, and 1 and 2yrs. RESULTS: Of the 81 patients initially enrolled, FU included 67 men at 1yr and 51 men at 2yrs. For the 51 men included in the present analysis, median age was 65yrs, median PV 37ml (16-65ml). Qmax 7.6±2.2ml/sec and PVR 65.9±38.5ml. IPSS and QoL scores were 20.51±4.58 and 4.0±0.9, respectively. No intraoperative complications were observed and the average VAS score was 3.2 ±1.6. All objective and subjective measures showed a response to iTind treatment with significant improvements (p<0.0001) from baseline levels at all assessment points: PVR dropped to 14.26±24.0ml, Qmax increased to 16.00±7.43ml/sec. IPSS-score and QoL improved to 8.51±5.51 and 1.76±1.32. Sexual and ejaculatory function was preserved in all patients. Excluding the patients lost at FU, 4 patients required additional medical therapy and 5 patients underwent TURP (6.5%). In conclusion, for the patients followed to 2yrs, the success rate is 82.4%. None of the preoperative parameters recorded predict response to iTind treatment. Patients with median lobe (n=10) did not respond to iTind treatment. CONCLUSIONS: iTind is a safe, minimally-invasive treatment for BPH-related LUTS showing marked and durable improvement of functional parameters, symptoms, QoL, and preservation of sexual function at 2yr FU. Preoperative baseline parameters do not seem to predict success of iTind treatment, except for median lobe which makes the treatment non effective in our study. Source of Funding: NONE. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e394-e394 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregor Kadner* More articles by this author Valerio Massimo More articles by this author Manit Arya More articles by this author Nicolaas Lumen More articles by this author Brian SH Ho More articles by this author Sergio Alonso More articles by this author Claude Schulman More articles by this author Neil Barber More articles by this author Daniele Amparore More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

MP06-06 INCREASED EXPRESSION OF OSTEOPONTIN IN THE PROSTATE IS ASSOCIATED WITH THE CLINICAL PROGRESSION OF BPH

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research & Pathophysiology (MP06)1 Apr 2020MP06-06 INCREASED EXPRESSION OF OSTEOPONTIN IN THE PROSTATE IS ASSOCIATED WITH THE CLINICAL PROGRESSION OF BPH Petra Popovics*, Wisam N. Awadallah, Sarah Kohrt, Thomas C. Case, Nicole L. Miller, Emily Ricke, Wei Huang, Marisol Ramirez-Solano, Qi Liu, Robert J. Matusik, William A. Ricke, and Magdalena M. Grabowska Petra Popovics*Petra Popovics* More articles by this author , Wisam N. AwadallahWisam N. Awadallah More articles by this author , Sarah KohrtSarah Kohrt More articles by this author , Thomas C. CaseThomas C. Case More articles by this author , Nicole L. MillerNicole L. Miller More articles by this author , Emily RickeEmily Ricke More articles by this author , Wei HuangWei Huang More articles by this author , Marisol Ramirez-SolanoMarisol Ramirez-Solano More articles by this author , Qi LiuQi Liu More articles by this author , Robert J. MatusikRobert J. Matusik More articles by this author , William A. RickeWilliam A. Ricke More articles by this author , and Magdalena M. GrabowskaMagdalena M. Grabowska More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000820.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Approximately 30% of men with lower urinary tract symptoms (LUTS) are resistant to medical therapies and progress to surgical intervention. The pathological changes producing LUTS include prostatic proliferation identified histologically as benign prostatic hyperplasia (BPH). Fibrogenic and inflammatory processes are also implicated in LUTS. Identification of new molecular pathways that provoke inflammatory responses and fibrosis, which are not targeted by current therapies, are vital to improve treatments of LUTS. Our study compared the expression of osteopontin (OPN), a pro-inflammatory and fibrotic molecule, in the prostate of patients with BPH characterized as incidental BPH, or as progressed to surgery. We also identified stimulatory signals contributing to the prostatic expression of OPN, as well as, genes that are activated in response to its elevated levels in vitro. METHODS: Immunohistochemistry was performed on prostate sections obtained from patients who had either undergone surgery to relieve LUTS (S-BPH, n=30) or had incidental BPH (I-BPH). I-BPH refers to specimens isolated from the transition zone of prostates after radical prostatectomy for low grade prostate cancer (n=8). Stained slides were captured with a Nuance Multispectral Imaging system and scored with inForm software. Protein level of OPN was determined by Western blot. The ability of prostate cells to secrete osteopontin in response to IL-1β and TGF-β1 and the expressional changes in genes regulated by OPN were determined in stromal (BHPrS-1) and epithelial (NHPrE-1) cell lines by ELISA and qPCR, respectively. RESULTS: The S-BPH group had significantly elevated H-score (p=0.0107, Mann-Whitney U test) and increased protein levels of OPN. OPN expression showed a widespread tissue distribution with a visibly higher level in glandular cells. We found that multiple splice variants of OPN are expressed in stromal and epithelial cells and its secretion is stimulated by TGF-β1 in NHPrE-1 and IL-1β and TGF-β1 in BHPrS-1 cells. Interestingly, we observed an increase in the expression of inflammatory genes in response to OPN including CXCL1, CXCL2, CXCL8, PTGS2 and IL6 in BHPrS-1, but this effect was not replicated in epithelial cell lines. CONCLUSIONS: Increased OPN levels are associated with the progression of BPH which appears to be related to inflammatory processes since OPN secretion by prostate cells is stimulated by cytokines. Pharmacological manipulation of prostatic OPN may have the potential to reduce LUTS by inhibiting inflammatory and fibrotic pathways. Source of Funding: NIDDK K12 DK100022 to PP, CWRU Start-up fund to MMG, 5R01 DK111554-03 to RJM, U54 DK104310 to WAR © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e53-e53 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Petra Popovics* More articles by this author Wisam N. Awadallah More articles by this author Sarah Kohrt More articles by this author Thomas C. Case More articles by this author Nicole L. Miller More articles by this author Emily Ricke More articles by this author Wei Huang More articles by this author Marisol Ramirez-Solano More articles by this author Qi Liu More articles by this author Robert J. Matusik More articles by this author William A. Ricke More articles by this author Magdalena M. Grabowska More articles by this author Expand All Advertisement PDF downloadLoading ...

The effectiveness of tamsulosin in Benign Prostate Hyperplasia (BPH) patients with Lower Urinary Tract Symptoms (LUTS): a multi-centre cohort retrospective study

Introduction: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is a common condition in the ageing male. The first-line treatment of LUTS due to BPH is medical management with α-blockers or 5α-reductase inhibitors (5-ARIs). This study aims to analyze the effectiveness of tamsulosin to improve patients symptoms with LUTS due to BPHMethods: A cohort retrospective study was conducted among 62 respondents with BPH at dr. Soetomo Hospital and Airlangga University Hospital from 2014-2016. The data collected related to characteristics of patients were age, prostate volume, Prostate-Specific Antigen (PSA), IPSS score, IPSS voiding score, IPSS storage score, IPSS quality of life, Qmax, voided volume and post voiding residual urine (PVR). All of the data were analyzed using SPSS version 17.0 for Windows.Results: There were 62 samples with a mean age of 62.28 ± 7.3 years old. The average prostate volume was 36.09 ± 8.3 cc, and the PSA level was 2.8 ± 1.45 ng/dl. Most of the respondents were in moderate LUTS criteria (54.8%). IPSS and Qmax score significantly improved in a comparison between pre-treatment, 1 month and 3 months after treatment (p&lt;0.01). There was no adverse event or severe side effect reported.Conclusion: Tamsulosin 0.4 mg daily resulted in statistically significant improvements of IPSS score, IPSS storage score, IPSS voiding score, IPSS Quality-of-life score, Qmax, Voided Volume and PVR through 1 month, but it also significantly improved IPSS score and uroflowmetry results in 3 months after treatment.

Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors

The epidemiology of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is continuously evolving with an increasing life span and the prevalence of metabolic diseases, including obesity, diabetes, cardiovascular disease, and hypertension. As a result, there is a substantial financial strain on health care. Recent studies and clinical trials have strengthened the relationship of known risk factors of BPH and LUTS. These include metabolic syndrome, diabetes, obesity, hypertension, and elevated serum dihydrotestosterone. Excessive consumption of red meat, saturated fat, bread, poultry, and starch was positively associated with symptomatic LUTS. Efforts to enhance treatment adherence, a healthy diet, and moderate physical exercise were noted as factors that can improve the treatment and management of BPH and LUTS. BPH is a prevalent condition among aging men. As it becomes a clinical entity through the development of LUTS, it significantly reduces the quality of life of those affected through sub-optimal bladder storage, voiding difficulties, and sexual dysfunctions. Many of the risk factors for BPH and LUTS can be reduced through moderate to intense physical exercise and consumption of dietary s-carotene, polyunsaturated fatty acids, linoleic acid, zinc, and vitamin A and C.

Transperineal Laser Ablation Treatment for Lower Urinary Tract Symptoms Due to Benign Prostatic Obstruction: Protocol for a Prospective In Vivo Pilot Study.

BackgroundStandard surgical treatments for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) use a transurethral approach. Drawbacks are the need for general or spinal anesthesia and complications such as hematuria, strictures, and cloth retention. Therefore, a minimal invasive technique under local anesthesia is desired to improve patient safety. Recently, SoracteLite transperineal laser ablation (TPLA) has been introduced as a novel minimal invasive treatment for BPO. The system used is unique because 4 laser sources are independently available. This 1064-nm diode laser induces coagulative necrosis. Moreover, TPLA is unique because it has a transperineal approach and can be performed under local anesthesia in an outpatient setting.ObjectiveThe primary objective of this study is to determine the safety and feasibility of TPLA treatment for men, who are fit for standard surgery, with LUTS due to BPO. The secondary objectives are to determine functional outcomes by flowmetry and patient-reported outcome measures (PROMs), side effects, and tissue changes observed on imaging.MethodsThis study is a prospective, single center, interventional pilot study IDEAL framework stage 2a and will include 20 patients. Eligible patients are men ≥40 years of age, with a prostate volume of 30 to 120 cc, have urodynamically proven bladder outlet obstruction, and have a peak urinary flow of 5 to 15 mL per second. All patients will undergo TPLA of their prostate under local anesthesia by using the EchoLaser system. Depending on the prostate volume, 2 to 4 laser fibers will be placed bilaterally into the prostate. Patient follow-up consists of uroflowmetry, PROMs, and imaging by using contrast-enhanced ultrasound. Total follow-up is 12 months following treatment.ResultsPresently, recruitment of patients is ongoing. Publication of first results is expected by early 2020.ConclusionsTPLA offers the potential to be a novel minimal invasive technique for treatment of LUTS due to BPO in men fit for standard desobstruction. This study will evaluate the safety and feasibility of TPLA and report on functional outcomes and tissue changes observed on imaging following TPLA treatment.International Registered Report Identifier (IRRID)DERR1-10.2196/15687

The prevalence of lower urinary tract symptoms based on individual and clinical parameters in patients with multiple sclerosis

BackgroundMost patients with multiple sclerosis (MS) suffer from bladder dysfunction during the course of the disease. This study was conducted to examine the prevalence of these complications among patients with MS.MethodsThis cross-sectional study was performed on 602 patients with MS who referred to the neurology clinics of Kashani and Alzahra Hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Multistage random cluster sampling was performed and the informed consent form was signed by the subjects. Then, all the data were collected through interviews using the Lower Urinary Tract Symptom Score (LUTSS) developed in accordance with the definitions presented by the International Continence Society (ICS) and the International Prostate Symptom Score (I-PSS) and DASS-21 questionnaire. The data were analyzed using descriptive and inferential statistical tests in SPSS.ResultsThe prevalence rate of lower urinary tract symptoms (LUTS) was 87.6% among all the subjects, with a similar rate among women (88.0%) and men (86.0%). There was a significant difference between men and women in terms of the prevalence of stress urinary incontinence (SUI), intermittent urine flow, hesitancy, straining, and dribbling (P < 0.050). There was no significant difference between women and men in terms of the prevalence of other symptoms (P > 0.050). A significant difference was observed in the degree of LUTS with age, marital status, marriage duration, education, illness duration, clinical course, disability, anxiety, depression, and stress (P< 0.05). Moreover, logistic regression analysis revealed that there was a higher probability of a urinary problems among patients with MS and a high EDSS score [0.67 (0.507–0.903), P = 0.008].ConclusionsA high prevalence of LUTS was found among patients with MS. There was a higher probability of a urinary tract problem among patients with MS and a high EDSS score. Therefore, it is recommended that the health system take the necessary measures regarding timely detection and treatment of LUTS among these patients in order to prevent secondary outcomes and improve the quality of life (QOL) of patients with MS.

Lower urinary tract symptoms and health-related quality of life in Hong Kong primary care: a cross-sectional study.

To estimate the prevalence of lower urinary tract symptoms (LUTS) in primary care using the International Continence Society symptom definition; to evaluate the association between LUTS and health-related quality of life (HRQOL); and to evaluate the treatment gaps. Patients aged 40 and above were randomly recruited in a Hong Kong public primary care. Patients were asked (i) how often they experienced 18 individual LUTS during the past 4weeks and (ii) whether they had sought treatments for their LUTS. The 12-Item Short Form Health Survey version 2 (SF-12 v2) and the modified Incontinence Impact Questionnaire-Short Form (IIQ-7) were used to measure HRQOL. 500 patients completed the survey. 75.8% of the patients had at least one LUTS "at least sometimes", with patients with a combination of storage, voiding, and post-micturition symptoms being the most prevalent (22.2%), followed by a combination of voiding and storage symptoms (14%). Only 14% of LUTS patients had sought treatments for their LUTS. LUTS was associated with a negative effect in all domains of the SF-12 v2 and IIQ-7 and patients with a combination of storage, voiding, and post-micturition symptoms had the worst HRQOL. Finally, having a combination of storage, voiding, and post-micturition symptoms and poorer HRQOL were factors associated with having sought treatments for LUTS. A high prevalence of LUTS but low treatment-seeking rates implied possible unmet needs of LUTS patients in primary care, suggesting the potential for more active interventions to alleviate the negative impact of LUTS on patients' HRQOL.

Pharmacology of the lower urinary tract: update on LUTS treatment.

The number of compounds used in the pharmacological treatment of lower urinary tract symptoms (LUTS) of patients who do not respond to conservative measures has been relatively stable during the last decade, with the exception of the introduction of the new class of β3 adrenoceptor agonists. However, different combinations have been investigated, and the long-term use of these compounds has raised new concerns about adherence and safety. This review summarizes the current state of pharmacology for LUTS, and presents a thorough discussion of the possible challenges concerning their future use. In this narrative review, we analyze the most recent articles related to LUTS pharmacotherapy, after an initial review of mechanisms of bladder function relevant in present clinical practice. The main problems with pharmacotherapy in LUTS are associated with its moderate efficacy, low persistence on treatment, and the incidence of short- and long-term adverse events (AE) associated with some compounds. The long-term AE, such as cognitive impairment in the elderly vulnerable patients associated with antimuscarinic drugs or persistent erectile dysfunction in sexually active men after treatment with 5-α-reductase inhibitors (5-ARI), are some of the problems addressed in this review. Combination therapy taking advantage of the synergistic mechanisms of action between some classes of compounds may overcome AE associated with dose escalation. LUTS pharmacotherapy offers moderate results to most patients but not a full cure. The use of combination drugs to achieve better clinical results, reduce AE and improve both efficacy and adherence, will be used more frequently in the future. The recently raised concern on potential long-term irreversible AE associated with some of these drugs, like antimuscarinics and 5-ARI, are critically important and require further investigation.

Combination Alpha Blocker and Phosphodiesterase 5 Inhibitor Versus Alpha-Blocker Monotherapy for Lower Urinary Tract Symptoms Associated with Benign Prostate Hyperplasia

Purpose: The prevalence of erectile dysfunction (ED) is higher in patients with lower urinary tract symptoms (LUTS). Phosphodiesterase 5 inhibitors (PDE5is) can improve both ED and LUTS and therefore is useful for these patients. Our aim of this study is to evaluate whether combination therapy of alpha blockers and PDE5i is more effective than alpha-blockers monotherapy for the treatment of LUTS. Materials and Methods: A systematic review and meta-analysis were undertaken to assess the difference between the combination therapy and alpha-blockers monotherapy by searching published randomized controlled trials from electronic databases PubMed, Embase, and the Cochrane Library up to April 2018. Results: A total of 13 randomized controlled studies with 1173 patients were included in our meta-analysis. Compared with alpha-blocker monotherapy, the combination therapy obtained a significantly better improvement in International Prostate Symptom Score (IPSS) (1.73, 95% confidence interval [CI]: 1.1–2.35), voiding subscore (0.99, 95% CI: 0.54–1.44), storage subscore (0.57, 95% CI: 0.03–1.1), peak flow rate (0.69 cc/s, 95% CI: 0.27–1.1), and erectile function (EF) symptom score. Meta-regression showed that baseline IPSS, baseline peak flow rate, baseline prostate volume, age, baseline EF symptom score, and dosage of PDE5is were not associated with the difference in IPSS improvement. Conclusion: A combination of alpha blockers and PDE5is has better therapeutic effects than alpha-blocker monotherapy on LUTS related to benign prostate hyperplasia.

Use of Nordic walking in the complex treatment of lower urinary tract symptoms in chronic prostatitis

Lower urinary tract symptoms (LUTS) caused by chronic prostatitis (CP) are a common condition. Standard antibiotic therapy is often not justified, since bacterial prostatitis is presented in up to 10% of the cases, while there is no effect on the risk factors for the development and relapse of the disease. This study is aimed at one of the main risk factors for LUTS - a sedentary lifestyle. To increase the effectiveness of treatment for LUTS in men using the Nordic Walking technique. 84 patients with CP were examined, which were divided into 3 groups. The 1st group (control) included 32 patients who received standard antibacterial therapy. In the 2nd group (primary) - 32 patients who received complex therapy (antibiotic therapy + 4-week course of Nordic walking). The third group (comparison) included 20 patients who were prescribed monotherapy - Nordic walking for 4 weeks. The dynamics of clinical manifestations was assessed using CP Symptom Scale (NIH-CPSI) and the international symptom index for diseases of the prostate IPSS; the volume of residual urine, uroflowmetric data, and the level of leukocytes in the secretion of the prostate gland were estimated. Laboratory studies showed a significantly faster decrease in the number of leukocytes in the secretion of the prostate gland on the 7th and 14th day in the primary (2nd) group (p<0.001). Clinical symptoms according to the NIH-CPSI and IPSS scales significantly regressed in the primary group on the 14th and 28th days of therapy. Uroflowmetric data and the volume of residual urine improved more significantly in the primary group by the 14th and 28th days. Patients receiving combined therapy showed significantly better treatment results in the form of faster normalization of prostate secretion, regression of clinical symptoms, improved urine flow rate and a decrease in residual urine volume after 4 weeks of therapy. When choosing management algorithm for patients with LUTS, it is advisable to use an integrated approach: in addition to antibiotic therapy, Nordic walking is recommended 3 times a week for at least 4 weeks.

Cumulative use of therapeutic bladder anticholinergics and the risk of dementia in patients with lower urinary tract symptoms: a nationwide 12-year cohort study

BackgroundStudies have shown an association between lower urinary tract symptoms (LUTS) and an increased risk of dementia. Whether anticholinergic use contributes to the development of dementia in patients with LUTS remains unknown, especially in Asian populations. This study aims to investigate the association between anticholinergic use and dementia in patients with LUTS.MethodsThis study included patients aged 50 years and over with newly diagnosed LUTS (January 2001 to December 2005), divided into four groups according to their cumulative defined daily doses (cDDDs) of anticholinergics: < 28 cDDDs, 28–84 cDDDs, 85–336 cDDDs, ≥337 cDDDs. Patients were followed up until dementia developed or until the end of 2012.ResultsWe recruited a total of 16,412 patients. The incidence of dementia was 10% in the < 28 cDDD group, 8.9% in the 28–84 cDDD group, 11.5% in the 85–336 cDDD group, and 14.4% in the ≥337 cDDD group (p = .005). In a Cox proportional hazards analysis, the adjusted hazard ratio of dementia was 1.15 (95% CI = 0.97–1.37) in the 85–336 cDDD group, and 1.40 (95% CI = 1.12–1.75) in the ≥337 cDDD group after adjusting for covariates.ConclusionsOur study indicates that higher cumulative anticholinergic exposure is associated with an increase in the risk of incident dementia in patients with LUTS aged 50 years of age and over. Either using one anticholinergic agent or switching anticholinergic agents cumulatively increases this risk. Therapeutic risks and benefits of using anticholinergics in LUTS treatment should be clinically reviewed and weighed.

Association between nocturia and frailty among elderly males in a veterans administration population.

The relationship between frailty and nocturnal voiding is poorly understood. To characterize the association between frailty, as defined by a frailty index (FI) based upon the Canadian Study of Health and Aging (CSHA) criteria, and nocturia, defined by measures of nocturnal urine production. Real-world retrospective analysis of voiding diaries from elderly males with lower urinary tract symptoms (LUTS) at an outpatient urology clinic. Males ≥ 65years with ≥ 2 nocturnal voids were included. A modified FI was calculated from the LUTS database, which captured 39 variables from the original CSHA FI. Patients were divided into 3 groups by modified FI: low (≤ 0.077) (n = 59), intermediate (> 0.077 and < 0.179) (n = 58), and high (≥ 0.179) (n = 41). Diary parameters were compared using the Kruskal-Wallis test and pairwise comparisons with the Wilcoxon rank-sum test and Bonferroni adjustment. The high frailty group was characterized by higher nocturnal urine volume (NUV), maximum voided volume (MVV), nocturnal maximum voided volume (NMVV), and nocturnal urine production (NUP). The presence of comorbid diabetes mellitus did not explain this effect. Elderly males seeking treatment for LUTS with a high frailty burden are disproportionately affected by excess nocturnal urine production. Future research on the mechanistic relationship between urine production and functional impairment is warranted.

Ghrelin Aggravates Prostate Enlargement in Rats with Testosterone-Induced Benign Prostatic Hyperplasia, Stromal Cell Proliferation, and Smooth Muscle Contraction in Human Prostate Tissues.

Epidemiologic studies revealed a context between lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and metabolic syndrome. However, molecular mechanisms underlying this relationship are largely unknown. Prostate enlargement and increased prostate smooth muscle tone are important factors in the pathophysiology of LUTS suggestive of BPH. In the present study, we studied effects of the metabolic hormone ghrelin on prostate enlargement in rats with experimentally induced BPH, growth of cultured stromal cells from human prostate (WPMY-1), and smooth muscle contraction of human prostate tissues. Ghrelin (20 nmol/kg daily, p.o., 2 weeks) increased prostate size in rats with testosterone-induced BPH. Microarray identified 114 ghrelin-upregulated genes (2-fold or more) in these prostates, with possible roles in growth, smooth muscle contraction, or metabolism. 12 genes were selected for further analyses. In human prostate tissues, mRNA levels of 11 of them correlated positively with ghrelin receptor (GHSR) expression, but only two with the degree of BPH. Accordingly, no correlation was evident between GHSR expression level and BPH in human prostate tissues. In WPMY-1 cells, the GHRS agonist MK0677 upregulated 11 of the selected genes. MK0677 induced proliferation of WPMY-1 cells, shown by EdU assay, colony formation, proliferation markers, flow cytometry, and viability. In myographic measurements, GHSR agonists enhanced contractions of human prostate strips. Together, ghrelin may aggravate prostate enlargement, stromal cell growth, and prostate smooth muscle contraction in BPH. Ghrelin may deteriorate urethral obstruction independently from BPH, qualifying the ghrelin system as an attractive new target to be tested for LUTS treatment in BPH.

Medical Therapies for Treatment of BPH: Special Considerations in Elderly Men

Benign prostatic hyperplasia (BPH) is among the most common diseases worldwide, manifesting clinically with lower urinary tract symptoms (LUTS). The prevalence of BPH and LUTS increases with age. There has been an increase in the types of medication available for treatment. The purpose of this review is to examine the recent literature on medication for the treatment of BPH and LUTS as it relates to older adult men. Although many different medication classes have studies showing benefits in the older male population for those with BPH, careful attention needs to be paid to their side effects. Only three medications for BPH (fesoterodine, finasteride, dutasteride) were rated as “beneficial” by the FORTA classification scale. While many medical options exist for the treatment of BPH, their safety and efficacy as it relates to older adults are still under evaluation. Future studies need to examine more closely the effects of these medications on the older male specifically and if the benefits outway the side effects.

Prevalence of Lower Urinary Tract Symptoms in Pregnant Adolescents and the Influencing Factors.

To determine the prevalence of lower urinary tract symptoms (LUTS) and associated risk factors in pregnant adolescents. Descriptive study. The obstetrics and gynecology outpatient departments of a training and research hospital in Turkey. Two hundred six pregnant adolescents younger than the age of 19years. None. Questionnaire-based data and the Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF) were collected from pregnant adolescents. Comparisons were made with independent samples t test, one-way analysis of variance, Mann-Whitney U, and Kruskal-Wallis tests, and linear regression for the analysis of the potential risk factors. The prevalence of at least 1 of the LUTS in pregnant adolescents was 78.6% (162/206). The prevalence of storage symptoms was more than those of urinary incontinence and voiding symptoms. Among LUTS, the prevalence of nocturia, urgency, frequency, bladder pain, and urinary incontinence was 59.3% (122/206), 54.4% (112/206), 39.3% (81/206), 37.4% (77/206), and 27.2% (56/206), respectively. Of pregnant adolescents with LUTS, 30.2% (49/162) of pregnant adolescents with LUTS reported seeking treatment for LUTS in this study. The total median scores from the BFLUTS-SF increased with gestational week, but no statistical significant difference was identified (P>.05). According to the results of the linear regression analysis, daily coffee consumption, smoking, chronic coughing, constipation, and urinary tract infection history were found to be associated with the total mean score on the BFLUTS-SF in pregnant adolescents. LUTS were found to be common among pregnant adolescents, with storage symptoms being the most frequently reported. Prenatal education could increase the number of adolescents who seek treatment, thereby improving the clinical course of LUTS.

Association Between Lower Urinary Tract Symptoms and Falls in Adults Males: Based on the Korean Community Health Survey.

This study aimed to investigate the correlation between lower urinary tract symptoms (LUTSs) and falls considering places where falls can occur in adult males. We analyzed 101 862 males in the 2011 Korean Community Health Survey. LUTSs were assessed using the International Prostate Symptom Score system. The rate of total and indoor falls significantly increased with the LUTS severity, respectively. After adjusting for age and other confounding variables, the odds ratios (ORs) for total falls were significantly high for the mild (OR = 1.63, 95% confidence interval [CI] = 1.54-1.71), moderate (OR = 2.35, 95% CI = 2.16-2.56), and severe groups (OR = 2.83, 95% CI = 2.49-3.22), relative to the normal group. Indoor fall experience was the same for the mild (OR = 1.56, 95% CI = 1.36-1.79), moderate (OR = 2.37, 95% CI = 1.97-2.85), and severe groups (OR = 3.77, 95% CI = 3.00-4.72). Nocturia, hesitancy, and urgency were significantly associated with indoor falls. The association between falls and the degree of LUTS was observed in both the young and the elderly. Therefore, further studies are needed to determine the effects of treatment of LUTS on the risk of falls and the effectiveness of the fall prevention program.

The Complex Relationship Between Lower Urinary Tract Symptoms and Sexual Health.

Lower urinary tract symptoms (LUTS) and sexual health have common links. Medical and surgical treatments for LUTS can significantly affect various domains of sexual health including erectile function, ejaculatory function, and libido. This review summarizes recent findings. Current literature demonstrates a strong association between LUTS, sexual health, and metabolic syndrome. The role of miRNA is also being investigated. Combination medical therapy with phosphodiesterase 5 inhibitors (PDE5-I) shows promise but needs further investigation. Newer surgical therapies for benign prostatic hyperplasia (BPH) aim to preserve sexual function without sacrificing efficacy and durability. Although we are beginning to acknowledge the link between LUTS and sexual health, a better understanding of the underlying biochemistry is needed. Only then can more effective therapies be developed. Further prospective studies should focus on the long-term durability and safety of treatments for both conditions.

Опыт применения препарата Афалаза для лечения симптомов нижних мочевыводящих путей у пациентов с доброкачественной гиперплазией предстательной железы без предшествовавшей терапии

Benign prostatic hyperplasia (BPH) is one of the most common diseases in men over 50 years. The prevalence of the BPH increases with age, and pathologic features of BPH are found in about 90% of men over 80 years. The aim of the study was to study the efficacy and safety of Afalaza for the treatment of lower urinary tract symptoms (LUTS) in treatment-nave patients with BPH. A multicenter study of using Afalaza for the treatment of LUTS in treatment-nave patients with BPH was carried out in 9 urological centers in Moscow. A total of 80 treatment-nave patients with BPH were enrolled. The improvement in the total score of IPSS, IIEF-5 and QoL after 30 weeks of therapy was evaluated as well as changes in prostate volume and maximum urinary flow rate (Qmax). After 30 weeks of therapy, there was a significant decrease in the total IPSS score. A decrease in the total IPSS score by 5.5 points (+37.9%) from 14.5+/-4.0 at the baseline to 9.0+/-4.1 at the visit 9 was seen. The QoL decreased by 1.8 (-38.3%) points from 4.7+/-1.0 at the baseline. The Qmax also changed from 12.7+/-4.6 to 16.4+/-5.7 (+28.3%) after 30 weeks of therapy. At the visit 9, the total IIEF5 score increased by 3.4+/-4.4 (+19.9%) from 17.1+/-4.3 at the baseline. In addition, prostate volume decreased from 42.7+/-11.1 at baseline to 41.0+/-9.8 cc post-treatment (-5.15%). A reduction of post-void residual urine volume from 26.0+/-25.3 at baseline to 17.7+/-24.2 (-31.9%) post-treatment was also shown. The results of a multicenter study demonstrate the efficacy of Afalaza for treatment of treatment-nave patients with LUTS/BPH. Afalaza reduces prostate volume and improves an erectile function.

First- and Second-Generation Temporary Implantable Nitinol Devices As Minimally Invasive Treatments for BPH-Related LUTS: Systematic Review of the Literature.

In the last decade, there has been a growing interest in minimally invasive treatment for benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS). In this field, one of the options currently available is the temporary implantable nitinol device (iTIND) (Medi-Tate®; Medi-Tate Ltd., Or Akiva, Israel). To review the recent data available in the literature regarding the role of the first-generation (TIND) and second-generation (iTIND) devices for the management of BPH with LUTS, especially focusing on follow-up of functional outcomes. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were screened for clinical trials on this topic. Literature evidences regarding implantation of TIND and iTIND for PBH with LUTS are limited. There are only three studies available, one with a medium-term follow-up. The results of these studies suggested that both the TIND and iTIND implantations are safe, effective, and well-tolerated procedures, allowing spare ejaculation in sexually active patients. Current evidences emphasize that the temporary implantable nitinol devices are promising alternatives to the standard minimally invasive surgical options for BPH-related LUTS. Further studies are needed to confirm the effectiveness over a long-term follow-up.