Troublesome Lower Urinary Tract Symptoms Research Articles

Day case Rezum™ water vapour therapy for urinary retention secondary to benign prostatic hyperplasia

Objectives: Rezum (Boston Scientific) water vapour therapy is an effective day case minimally invasive surgical treatment (MIST) for men with troublesome lower urinary tract symptoms (LUTSs) due to benign prostatic obstruction. The potential place for MISTs in the treatment of patients with urinary retention or permanent catheter dependence is currently unclear. Patients and Methods: A total of 48 patients presenting with retention of urine (out of a total of 524 patients) over a 4-year period from 2017 underwent Rezum treatment. All patients were followed up at 3, 6 and 12 months after the procedure. At each visit, flow rate, post void residual urine, and patient reported outcome measures (PROMs) including International Prostate Symptom Score (IPSS) were recorded. Results: A total of 34 patients had an indwelling catheter prior to treatment and 14 were self-catheterising. The mean age was 67 years (standard deviation (SD) = 3) with a mean prostate volume of 56 mL (SD = 6). The average number of injections per case was 8 (SD1), which included median lobe (ML) treatment in one man. 75% of the patients passed their post treatment trial without catheter (TWOC). IPSS improved to 6 ( p = 0.001) in 12 months. Conclusion: The results from this cohort of patients are encouraging. Further evaluation with longer follow-up is required. The addition of MISTs to the portfolio of options for men with retention of urine may offer a streamlined and efficient alternative to the conventional treatments, and help therefore to reduce the national waiting list, and allow men a more rapid solution avoiding prolonged catheterisation. Level of evidence: Not applicable.

Bladder training for urinary tract symptoms in Parkinson disease: A randomized controlled trial.

ObjectiveTo assess the feasibility and efficacy of bladder training for troublesome lower urinary tract symptoms (LUTS) in Parkinson disease (PD).MethodsIn this single-center, single-blinded, randomized controlled trial, participants with a history of PD and LUTS were randomized to a 12-week bladder training program (BT) or conservative advice (CA). Outcome measures included a 3-day volume frequency diary, International Consultation on Incontinence Questionnaire (ICIQ)–Overactive Bladder Module, and ICIQ—Quality of Life Module. Co–primary endpoints were (1) patient perception of change and (2) change in number of urgency episodes at 12 weeks. Secondary endpoints included change in ICIQ scores, number of micturitions, and volume voided.ResultsThirty-eight participants were randomized (18 to CA, 20 to BT). Both CA and BT were associated with significant improvements in volume voided, number of micturitions, symptom severity scores, and measures of quality of life (all p < 0.05). At 12 weeks, compared to CA, BT was associated with significant superiority on patient perception of improvement (p = 0.001), significantly greater reductions in number of voids in 24 hours (mean decrease 2.3 ± 0.8 voids vs 0.3 ± 0.5 [p < 0.05]), and greater reductions in interference with daily life (2.1 ± 0.8 point improvement vs 0.3 ± 0.7 point deterioration [p < 0.05]). BT was not associated with change in urgency episodes (mean change 2.4 ± 1.5 urgency episodes vs 3.5 ± 1.5 [p NS]). At 20 weeks, BT remained associated with greater improvement in interference in daily life. Loss of significance in other measures may reflect loss of power from loss to follow-up.ConclusionThis controlled trial demonstrated the potential benefits of BT for LUTS in PD.Classification of evidenceThis study provides Class III evidence that for patients with PD and LUTS, BT significantly increased patient perception of improvement but did not significantly reduce urgency episodes.

Evolving Novel Chemical Entities for Management of Benign Prostatic Hyperplasia.

Proliferation of the smooth muscle and epithelial cells within the prostatic transition zone in older men leads to benign prostatic hyperplasia (BPH), which is hallmarked by the troublesome lower urinary tract symptoms. The affair responsible for the initiation and promotion of disease is still unresolved, though alpha-blockers and 5α-reductase inhibitors are used as management options for relief from the dynamic and static components respectively. Combination therapy including both the alpha blocker and 5α-reductase inhibitor is emerging as inclusive parcel for treatment. However, selective androgen receptor modulators (SARM) and selective estrogen receptor modulators (SERM) are the other management resources, which are in the limelight. This review gives a glimpse of BPH and the various chemical entities which have been reported in literature till date for the condition since 2005.

Clinical implications of underactive bladder.

Underactive bladder (UAB) is a common urologic condition but a complex disease that causes troublesome lower urinary tract symptoms. Currently, management of UAB remains unsatisfactory. Also, many urological diseases can be combined with UAB. In these combined cases, the treatment results may be affected by UAB component. This review focuses on the clinical implications of UAB in patients with common urologic conditions, including bladder outlet obstruction, overactive bladder syndrome and stress urinary incontinence.

Gender Differences in Coping Strategies for Troublesome Lower Urinary Tract Symptoms Prior to Seeking Treatment

Objective: This study tried to explore gender differences in Lower urinary tract symptoms (LUTS) and disparities in adaptation strategies used to cope with LUTS. Materials and Methods: From July 2013 to December 2013, 184 consecutive patients who came to a tertiary center seeking medical treatment for LUTS including stress urinary incontinence (SUI), overactive bladder (OAB), and mixed urinary incontinence (MUI) were recruited in this study. OABSS, IPSS and UDI-6 were used to evaluate severities of these symptoms and IIQ-7 was used to measure the impact of these three symptoms on the quality of life. Patients’ coping strategies were also compared to evaluate gender differences. Results: In total, 184 patients (81 men and 103 women) were recruited into this study. The LUTS between genders were significant. Women had significantly more SUI and MUI than that of men, but men had significantly more OAB. The LUTS in men seemed to have less impact on quality of life than in women. Preventive toileting use before going out, restricting fluid intake, or seeking treatment at primary care clinics were adaptive strategies used by both genders. However, one-third of the women used incontinence pads or performed pelvic floor exercises to prevent urine leakage and nearly one-fourth of the women avoided contact with cold water or performed urge strategies to control the urge to void. Conclusions: Gender differences in LUTS are significant. Similar LUTS also result in different impact on men and women. Women used more coping strategies than men to handle their bothersome LUTS.

Lower urinary tract symptoms associated with prostatitis.

Approximately 50% to 60% of men with chronic prostatitis experience troublesome lower urinary tract symptoms (LUTS). Individual interventions yield statistically significant but minimally important improvements in clinical trials. Research has shown that categorizing patients with prostatitis by phenotype is an effective way to rationally select therapy and maximize the impact on symptom reduction and improve quality of life.

Lower urinary tract symptoms associated with prostatitis

Approximately 50% to 60% of men with chronic prostatitis experience troublesome lower urinary tract symptoms (LUTS). Individual interventions yield statistically significant but minimally important improvements in clinical trials. Research has shown that categorizing patients with prostatitis by phenotype is an effective way to rationally select therapy and maximize the impact on symptom reduction and improve quality of life.

Emerging Treatment Options for Benign Prostatic Obstruction

Benign prostatic obstruction (BPO) affects an increasing number of men with age. It can cause troublesome lower urinary tract symptoms, can have a negative impact on quality of life, and may be associated with significant morbidity. Currently available medication and surgical treatments are limited by adverse events, invasiveness, and patient compliance. This has driven research into the pathogenesis of benign prostatic hyperplasia and led to the development of novel pharmacological agents and minimally invasive therapeutic interventions. This review highlights emerging treatment options for BPO.

Is there a discrepancy between patient and physician quality of life assessment?

Quality of Life (QoL) assessment remains integral in the investigation of women with lower urinary tract dysfunction. Previous work suggests that physicians tend to underestimate patients' symptoms and the bother that they cause. The aim of this study was to assess the relationship between physician and patient assessed QoL using the Kings Health Questionnaire (KHQ). Patients complaining of troublesome lower urinary tract symptoms (LUTS) were recruited from a tertiary referral urodynamic clinic. Prior to their clinic appointment they were sent a KHQ, which was completed before attending. After taking a detailed urogynecological history, a second KHQ was filled in by the physician, blinded to the patient responses, on the basis of their impression of the symptoms elicited during the interview. These data were analyzed by an independent statistician. Concordance between patient and physician assessment for individual questions was assessed using weighted kappa analysis. QoL scores were compared using Wilcoxons signed rank test. Seventy-five patients were recruited over a period of 5 months. Overall, the weighted kappa showed relatively poor concordance between the patient and physician responses; mean kappa: 0.33 (range 0.18-0.57). The physician underestimated QoL score in 4/9 domains by a mean of 5.5% and overestimated QoL score in 5/9 domains by a mean of 6.9%. In particular, physicians underestimated the impact of LUTS on social limitations and emotions (P < 0.05). This study confirms that physicians often differ from patients in the assessment of QoL. This is most likely due to a difference in patient-physician perception of "significant" LUTS and clearly demonstrates the importance of patient evaluated QoL in routine clinical assessment.

Brachytherapy for prostate cancer: is the pretreatment prostate volume important?

To prospectively determine the effect of prostate volume on lower urinary tract symptoms (LUTS) in terms of changes in the International Prostate Symptom Score (IPSS), and to determine whether prostate volume affects the retention rate after brachytherapy, as there is concern that patients with larger prostates might develop more troublesome LUTS after brachytherapy. We prospectively identified 100 consecutive patients who had brachytherapy for prostate cancer, using a real-time three-dimensional seed implantation technique, at one institution. At each follow-up review the IPSS was recorded. To determine the effect of prostate volume on the IPSS after treatment the patients were divided into two groups according to prostate volume at brachytherapy (<50 and >or=50 mL). The median patient age was 62 years, the overall median prostate volume was 42 mL and the median intraoperative D90 was 190 Gy. The pretreatment IPSS was 4 and 8 for the <50 and >or=50 mL groups, respectively, and at 3 months after brachytherapy the median IPSS increased to 18 and 20 for the two groups, respectively. Eleven patients went into acute retention of urine after brachytherapy (six in the >or=50 mL group). This study shows that patients with prostates of >or=50 mL have an IPSS comparable with those who have prostates of <50 mL. Large prostates should not be considered an exclusion criterion when an intraoperative planning technique is used for brachytherapy.

An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis.

The majority of patients with multiple sclerosis (MS) develop troublesome lower urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are potential pharmacological targets. In an open trial we evaluated the safety, tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis sativa in patients with advanced MS and refractory LUTS. Patients took extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD; 2.5 mg of each per spray) for eight weeks followed by THC-only (2.5 mg THC per spray) for a further eight weeks, and then into a long-term extension. Assessments included urinary frequency and volume charts, incontinence pad weights, cystometry and visual analogue scales for secondary troublesome symptoms. Twenty-one patients were recruited and data from 15 were evaluated. Urinary urgency, the number and volume of incontinence episodes, frequency and nocturia all decreased significantly following treatment (P <0.05, Wilcoxon's signed rank test). However, daily total voided, catheterized and urinary incontinence pad weights also decreased significantly on both extracts. Patient self-assessment of pain, spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon's signed rank test) with pain improvement continuing up to median of 35 weeks. There were few troublesome side effects, suggesting that cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.

What Do Women Want?

In Brief Objectives: The primary aim of this study was to determine what women perceive as ‘cure’ and to assess treatment acceptability. The secondary aim was to identify any relationship between symptom severity and treatment expectations. Methods: Women were recruited prospectively from a tertiary referral urodynamic clinic. All complained of troublesome lower urinary tract symptoms and had been referred for further investigation. Prior to urodynamic studies assessment of lower urinary tract symptoms was performed using the King's Health Questionnaire while subjective assessment of expectations regarding ‘cure’ was performed using a specially designed questionnaire based on structured qualitative clinical interviews. This questionnaire included questions relating to what symptoms patients would find acceptable following treatment, what treatments they would find acceptable, and what their overall expectations were. Results: One hundred consecutive women were recruited. Mean age was 47.5 years (range: 20–73 years) and mean duration of symptoms 6.0 years (range: 6 mths–40 years). Results concerning overall expectations of treatment, acceptability of symptoms and acceptability of treatments were analyzed. Overall 43% of women hoped for a good improvement in urinary symptoms so there was less effect on their quality of life. The majority of women would find large or frequent episodes of urinary leakage, nocturia, urgency and urge incontinence unacceptable. Minor surgery was more popular than major procedures. There was no correlation between quality of life score and acceptability of symptoms (r = −0.031; P = 0.756) or quality of life scoring and acceptability of treatment (r = 0.127; P = 0.245). Sub group analysis by urodynamic diagnosis and duration of symptoms did not alter the findings. Conclusions: The majority of women have realistic expectations regarding outcome and are able to tolerate the inconvenience of minor lower urinary tract symptoms. There is no correlation between quality of life impairment and concept of cure implying that expectations of treatment are not influenced by symptom severity. The primary aim of this study was to determine what women perceive as ‘cure’ and to assess treatment acceptability.

Lower urinary tract symptoms, benign prostatic obstruction and the overactive bladder.

Lower urinary tract symptoms (LUTS), benign prostatic obstruction (BPO), and the overactive bladder have increasing prevalence with age in both men and women (with the obvious exception). The question is, are they interrelated or independently related to age? The specific issue is whether BPO causes the overactive bladder. There are two pieces of evidence that might appear to suggest such a cause and effect. First, the overactive bladder is more common in men than in women of the same age, although physiologically, men are 5-10 years older at the same biological age. Second, the overactive bladder resolves in two-thirds of individuals after surgical interventions such as transurethral prostatectomy. The symptoms suggestive of an overactive bladder are the most troublesome, even though they may not be the most prevalent. Long-term follow-up studies with repeated urodynamic investigations have shown that the incidence of the overactive bladder and its attendant symptoms increases despite there being no deterioration in outlet obstruction over follow-up periods of 10 and 20 years. These data, and others, indicate that the situation is not as straightforward as some believe. The statement that 'the overactive bladder is secondary to BPO' cannot be made, as there are too many unanswered questions and pieces of the puzzle that do not fit. The overactive bladder is undoubtedly associated with BPO, and it leads to the most troublesome LUTS in older men. Epidemiological research, coupled with urodynamic evaluation, may provide further evidence. We also need better and more relevant models (e.g. ageing animals), together with further histological and other biological data before the waters become crystal clear.

Interstitial radiofrequency therapy of the prostate in the management of acute urinary retention.

To evaluate in a prospective study the efficacy of interstitial radiofrequency therapy (IRFT) of the prostate in relieving acute urinary retention in patients with benign prostatic hyperplasia. Twenty-seven patients presenting in acute urinary retention who failed at least one trial of voiding one week after presentation were treated with IRFT of the prostate. During the 6-month follow-up, the International Prostate Symptom Score (IPSS), urinary flow rate, post-void residual volume (PVR) and serum creatinine were determined and changes in erectile and ejaculatory functions recorded. The treatment was considered successful if the patient resumed normal voiding, without compromising renal function and without troublesome lower urinary tract symptoms necessitating further treatment. Of the 26 evaluable patients, 77% resumed normal voiding. At 6 months after treatment, the mean (SD) IPSS had decreased from 15.0 (8.3) to 8 (5.4), the PVR from 950 (203) to 88 (60) mL and the maximum flow rate was 10.5 (4.36) mL/s. IRFT of the prostate is a safe and effective treatment, at least in the short-term, for relieving acute urinary retention in patients with benign prostatic hyperplasia. The longer term follow-up is continuing.

Troublesome lower urinary tract symptoms in the community: a prevalence study.

To determine the prevalence of troublesome lower urinary tract symptoms (LUTS) in men and women in the community. Interview-based prevalence survey. Metropolitan and rural communities in South Australia, September, 1995. Probability sample of 1204 men and 1686 women (aged over 18 years) weighted to reflect the age and sex distribution of the South Australian population. Presence of storage (irritative) and voiding (obstructive) symptoms, based on the International Prostate Symptom Score questionnaire; satisfaction with urinary condition (quality-of-life measure); and visits to a doctor for urinary symptoms in the preceding 12 months. The prevalence of one or more troublesome LUTS was 26% (318/1204) for men and 39% (662/1686) for women (all ages) and 48% (314/649) for men and women over 65. The most common troublesome symptoms in men and women were nocturia and frequency. Symptoms were significantly age-related in men, but less so in women, in whom symptom prevalence exceeded 30% for all age groups. Ten per cent of men (123/1204) and 15% of women (249/1686) had visited a doctor for a urinary problem in the previous 12 months. Nine per cent of men (104/1204) and 16% of women (274/1686) were substantially dissatisfied with their urinary condition. Symptom prevalence and dissatisfaction with urinary condition were significantly associated with visiting the doctor (P < 0.0001), but only 28% (88/318) of men and 27% (179/662) of women with troublesome LUTS saw a doctor, and 63% (65/104) of men and 59% (162/274) of women dissatisfied with their urinary condition did not seek medical help. Although the prevalence of troublesome LUTS in the community is high, the number of people whose quality of life is substantially affected is much lower. The impact of these symptoms upon quality of life is a major reason for patients to see a doctor, yet many who are "bothered" by the symptoms do not do so.

Urodynamic Effects of Doxazosin in Men with Lower Urinary Tract Symptoms and Benign Prostatic Obstruction

Urodynamic investigations provide an objective, quantitative evaluation of urinary function in patients with benign prostatic obstruction (BPO). The effects of doxazosin, a selective alpha 1-adrenoceptor antagonist, on urodynamic measurements were investigated in three double-blind, placebo-controlled clinical studies of the treatment of BPO. 302 normotensive and mildly hypertensive men with BPO were evaluated. Patients were randomized to receive doxazosin (1-4 mg o.d.) or placebo for 4-29 weeks. Doxazosin significantly improved free urinary flow rates compared with placebo. Urodynamic studies confirmed that doxazosin was effective in improving urinary flow, and also showed a reduction in detrusor pressure, resulting in decreased voiding time and increased voided volume. Analysis of pressure-flow data demonstrated a significant reduction in a measure of urethral resistance in doxazosin-treated patients. These results indicate that doxazosin is an important treatment option for patients with troublesome lower urinary tract symptoms and BPO.