Urinary Symptom Score Research Articles

Rezūm water vapor thermal therapy in patients with benign prostatic hyperplasia: Initial real-world data from Japan.

Benign prostatic hyperplasia (BPH) is prevalent in older men. As surgery can be high risk in this group, minimally invasive procedures are preferrable. This study aimed to assess the initial results of minimally invasive Rezūm water vapor thermal therapy (WVTT) in patients with BPH. This single-center retrospective study included 25 consecutive patients with BPH who underwent WVTT between September 2022 and July 2023. Parameters including age, Charlson Comorbidity Index and Geriatric 8 (G8) scores, operative time, and number of vapor injections were evaluated. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, and Core Lower Urinary Tract Symptom Score (CLSS) were used to assess symptoms before the procedure, and at 1 and 3 months after it. Urinary function indicators such as single voiding volume, maximum flow rate (MFR), and post-void residual volume were assessed at the same time points. The mean patient age was 76.0 years and the mean prostate volume was 54.8 mL. The mean G8 score was 14.4 and the Charlson Comorbidity Index score averaged 1.2. The mean operative time was 6.84 min, and included a mean of 4.8 vapor injections. Three months after WVTT, significant improvements were observed in the maximum flow rate (P = .02), post-void residual volume (P = .001), and urine volume (P < .001), as well as in the IPSS incomplete emptying (P = .01) and weak stream (P = .01) domains. No significant changes were observed in the remaining IPSS domains or in the Overactive Bladder Symptom Score or CLSS. This study provides the first report on Rezūm WVTT outcomes in Japan using the CLSS assessment tool. The initial results indicate a promising experience with this new treatment method. With a rapidly aging population, the incidence of BPH is expected to increase, making the minimally invasive Rezūm system a valuable addition to BPH treatment options.

Long-Term Quality-of-Life Outcomes After Prostate Radiation Therapy With or Without High-Dose-Rate Brachytherapy Boost: Post Hoc Analysis of TROG 03.04 RADAR

Adding high-dose-rate brachytherapy (BT) boost to external beam radiation therapy (EBRT) improves biochemical control but may affect patient-reported quality of life (QOL). We sought to determine long-term QOL outcomes for EBRT+BT versus EBRT alone. This was a post hoc analysis of the Trans-Tasman Radiation Oncology Group 03.04 Randomized Androgen Deprivation and Radiotherapy (TROG 03.04 RADAR) trial. Only patients who received 74 Gy conventionally fractionated EBRT (n = 260) or 46 Gy conventionally fractionated EBRT plus 19.5 Gy in 3 fractions high-dose-rate BT boost (n = 237) were included in this analysis. The primary endpoint was patient-reported QOL measured using the European Organisation for Research and Treatment of Cancer QOL (EORTC QLQ-C30) and prostate-specific QOL module (EORTC QLQ-PR25) questionnaires. We evaluated temporal changes in QOL scores, rates of symptom resolution, and the proportion of men who had decrements from baseline of >2 × the threshold for minimal clinically important change (2 × MCIC) for each domain. At 5, 17, and 29 months after radiation therapy, the EBRT+BT group had 2.5 times (95% confidence interval [CI], 1.4-4.2; P < .001), 2.9 times (95% CI, 1.7-4.9; P < .001), and 2.6 times (95% CI, 1.4-4.6; P = .002) greater odds of reporting 2 × MCIC in urinary QOL score compared with EBRT. There were no differences beyond 29 months. EBRT+BT led to a slower rate of urinary QOL symptom score resolution up to 17 months after radiation therapy compared with EBRT (P < .001) but not at later intervals. In contrast, at the end of the radiation therapy period and at 53 months after radiation therapy, the EBRT+BT group had 0.65 times (95% CI, 0.44-0.96; P = .03) and 0.51 times (95% CI, 0.32-0.79; P = .003) the odds of reporting 2 × MCIC in bowel QOL symptom scores compared with EBRT. There were no significant differences in the rate of bowel QOL score resolution. There were no significant differences in global health status or sexual activity scores between the 2 groups. There were no persistent differences in patient-reported QOL measures between EBRT alone and EBRT+BT. BT boost does not appear to negatively affect long-term, patient-reported QOL.

Health-related quality of life of metastatic prostate cancer patients treated with prostate Radiotherapy

BackgroundThe impact of prostate radiotherapy on patient-reported health-related quality of life (HRQoL) significantly influences the outcomes of metastatic prostate cancer. We measured and compared HRQoL of metastatic prostate cancer patients who received cytoreductive prostate radiotherapy.MethodsBetween November 23, 2020, and November 21, 2022, we recruited 70 metastatic prostate cancer patients at the Department of Clinical Oncology at Suez Canal University Hospital. Patients were eligible if they had synchronous and metachronous histopathological confirmed metastatic adenocarcinoma and an Eastern Cooperative Oncology Group performance status ≤ 2. Random allocation was performed for either definitive local radiotherapy concurrent with the standard androgen deprivation therapy (ADT) or to the standard ADT alone. Definitive radiotherapy was delivered conventionally (70 Gy/35 fractions) or through the hypofractionated regimen (55 Gy/20 fractions). Patients completed the comprehensive European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-PR25) at baseline, then at three-month intervals for one year. The primary endpoint was patient-reported HRQoL, with secondary endpoints including toxicity and radiographic progression-free survival (rPFS). Mean HRQoL scores between groups were compared using the independent samples t-test.ResultsWe observed clinically significant improvements in urinary and bowel functions between baseline, 3-month, 6-month, and 12-month intervals after receiving definitive prostate radiotherapy. Patients in the radiotherapy group had significantly lower urinary symptoms scores than the control group. However, sexual activity and functioning showed significant deterioration.ConclusionCytoreductive prostate radiotherapy in metastatic prostate cancer patients significantly improved urinary functioning, preserved bowel functioning but was associated with worsening of sexual functioning.Trial RegistrationThis trial was registered on (27/04/2023) with pactr.samrc.ac.za, PACTR202305854600529, URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25510.

Effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injury.

This study evaluated the effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injuries (SCIs). A total of 214 patients with SCIs treated in our hospital from October 2019 to October 2021 were included in the retrospective analysis and divided into a general care group (n = 107) and a comprehensive care group (n = 107), based on the care that they received. Patients in the general care group received general functional nursing, whereas those in the comprehensive care group received a comprehensive functional nursing intervention. The Rivermead Mobility Index (RMI), Barthel Index (BI), and Berg Balance Score (BBS) were used to evaluate patient neurobehavioral ability before and after nursing. Changes in cardiopulmonary function indexes, left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), vital capacity (VC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and maximal voluntary ventilation (MVV) were measured before and after nursing. The number of micturition, maximum micturition volume, bladder volume, residual urine volume, and lower urinary tract symptom (LUTS) score were recorded, and the improvement in bladder function were measured before and after nursing. The Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores were used to evaluate patients' emotional state. After nursing, the RMI, BI, BBS score, FEV1, FEV1/FVC, MVV, maximum micturition volume, bladder volume, and SF-36 scores of the comprehensive care group were significantly higher than those of the general care group, and the LVEDD, LVESD, micturition time, residual urine volume, and LUTS, HAMA, and BDI scores of the comprehensive care group were significantly lower than those of the general care group. In patients with SCIs, comprehensive functional nursing can promote the recovery of neurocognition, bladder function, and cardiorespiratory function, and improve their quality of life. Comprehensive functional nursing is worthy of clinical application.

Partial gland ablation using high-intensity focused ultrasound versus robot-assisted radical prostatectomy: a propensity score-matched study.

We compared the clinical outcomes of robot-assisted radical prostatectomy (RARP) and partial gland ablation (PGA) using high-intensity focused ultrasound (HIFU) in localized prostate cancer. We analyzed 3,859 patients who had undergone RARP and PGA using HIFU. According to the propensity score for each treatment, 137 patients after PGA were matched to 3,722 patients after RARP at a 1:4 ratio using the nearest neighbor method. The matched cohort comprised 685 subjects (RARP, 548; PGA, 137), with a median follow-up period of 22months. Treatment failures were identified in 13.9% and 9.1% of patients in the PGA and RARP groups, respectively, after a median follow-up of 36months postoperatively. Kaplan-Meier analyses revealed significantly longer failure-free (P<0.001) and salvage-free survival (P=0.003) in the RARP group than in the PGA group. There was no significant difference in the postoperative urinary symptom score (P=0.748), but the postoperative erectile function score was significantly higher in the PGA group (P<0.001). The rate of urinary incontinence (any pad) was significantly lower in the PGA group than that in the RARP group (P<0.001). Postoperative complications were more frequent in the PGA group (P=0.003); however, there was no significant difference in high-grade complications (≥3) (P=0.467). PGA using HIFU showed statistically inferior oncological outcomes compared with RARP for failure-free survival and salvage-free survival. However, functional outcomes regarding postoperative incontinence and erectile dysfunction were more favorable in the PGA group.

Brazilian Portuguese translation, cross-cultural adaptation, and content validation of the pediatric lower urinary tract symptom score

BackgroundEarly screening instruments for professionals are important to reduce the cost and time of diagnosing pediatric lower urinary tract dysfunction. This study aimed to translate, cross-culturally adapt, and validate pediatric lower urinary tract symptom scores. MethodsThis methodological study was conducted in 2019 in two phases: translation and cross-cultural adaptation, and content validation. In the first phase, we used translators, specialists, and 30 parents of children with voiding dysfunction. In the second phase, validation was performed by 11 pediatric urology specialists. FindingsThe instrument was translated and adapted to Brazilian Portuguese and presented an excellent level of verbal comprehension. Further, the instrument presented a good content validity index >0.8 for all items, except for the nomenclature and clarity of two items, as indicated by the Cronbach's alpha value of 0.75 for internal consistency. DiscussionThe final version showed semantic, idiomatic, experiential, and conceptual equivalence with the original instrument, indicating that it is adequate for other assessments of psychometric qualities. Practice implicationsThe translation and adaptation of an important instrument for diagnosing lower urinary tract dysfunction in children to other countries helps nurses identify the disease early and monitor the treatment.

Delineating the Diagnostic Concordance Between Pediatric Lower Urinary Symptoms Scoring and Voiding Diary in Pediatric Lower Urinary Tract Dysfunction.

This retrospective research endeavored to conduct a comparative evaluation of the Pediatric Lower Urinary Tract Symptoms Scoring (PLUTSS) system and the Voiding Diary (VD). The correlation between these diagnostic tools, their prognostic value for treatment outcomes in pediatric Lower Urinary Tract Dysfunction (LUTD), and their relationship with patients' sociodemographic characteristics were also explored. The study data for the cohort established between December 2005 and September 2006 were obtained from a specialized thesis, while the subsequent expansion from 2022 to 2023 involved a prospective approach, including an additional 73 patients, resulting in a total of 113 pediatric patients (79 females and 34 males). Comprehensive diagnostic evaluations, such as urinalysis, urine culture, renal function tests, urinary tract ultrasound, uroflowmetry-electromyography (EMG), and post-voiding residual urine measurement (PVR), were conducted. The patient's symptoms were assessed using the Pediatric Lower Urinary Tract Symptom Score (PLUTSS) and a two-day-three-night voiding diary. The correlation between the PLUTSS and VD was not absolute but substantial concerning daytime frequency and incontinence. Notably, PLUTSS emerged as the primary predictor of treatment outcomes. No significant association was discerned between sociodemographic characteristics, such as socioeconomic status, sibling count, toilet training, school performance, patientpersonality, and LUTD diagnosis or prognosis. The findings underscore the prognostic value of PLUTSS for treatment outcomes in pediatric LUTD. Although a significant correlation was observed between PLUTSS and VD, they are not interchangeable. As a result, concurrent utilization of both tools is endorsed for comprehensive diagnosis, follow-up, and treatment planning in pediatric LUTD.

Female sexual dysfunction and lower urinary tract symptoms associated with vulvovaginal atrophy symptoms: Results of the GENJA study.

To investigate the main symptoms of female sexual dysfunction (FSD) and lower urinary tract symptoms associated with vulvovaginal atrophy (VVA) symptoms as the core symptoms of genitourinary syndrome of menopause. We extracted the data of 4134 Japanese women aged 40-79 years who participated in the GENitourinary syndrome of menopause in JApanese women (GENJA) study. All participants responded to web-based questionnaires assessing their health situation, including the Vulvovaginal Symptoms Questionnaire, the Female Sexual Function Index (FSFI), and the Core Lower Urinary Tract Symptom Score. Multivariable regression and multivariable logistic regression analyses were applied to analyze the association between VVA symptoms and FSD, and between VVA symptoms and lower urinary tract symptoms. Multivariable regression analysis revealed that VVA symptoms were associated with lower scores for arousal, lubrication, orgasm, satisfaction, and pain domains in the FSFI in sexually active women (p < 0.01). Regression coefficients were higher for lubrication and pain domains than for the other domains. Multivariable logistic regression analysis revealed that women reporting VVA symptoms were more likely to have increased daytime urinary frequency, nocturia, urgency, slow stream, straining to void, feeling of incomplete emptying, bladder pain, and feeling a bulge/lump from or in the vagina (p < 0.05). Adjusted odds ratios were particularly high for straining to void, feeling of incomplete emptying, and bladder pain. Vulvovaginal atrophy symptoms were significantly associated with decreased lubrication and dyspareunia in FSD, and urinary symptoms of straining to void, feeling of incomplete emptying, and bladder pain.

Intradetrusor OnabotulinumtoxinA Injections at the Time of Holmium Laser Enucleation of the Prostate for Men with Severe Storage Symptoms.

Introduction: Intradetrusor onabotulinumtoxinA (OTA) injection is a well-established treatment option for refractory overactive bladder; however, its use at the time of holmium laser enucleation of the prostate (HoLEP) for men with bladder outlet obstruction (BOO) and severe storage symptoms has not been previously reported. Materials and Methods: We retrospectively identified men with BOO and severe storage symptoms who underwent treatment with 200 U of intradetrusor OTA (Botox®) at the time of HoLEP. Patients were propensity score matched to a cohort of HoLEP-only patients based on age, Michigan Incontinence Symptom Index (M-ISI) score, preoperative urinary retention, urge incontinence, and prostate size. Perioperative, postoperative, and patient-reported outcomes were examined between groups. Results: We identified 82 men who underwent HoLEP, including 41 patients in the OTA group and 41 patients in the control group. There was no difference in operative times (59 minutes OTA vs 55 minutes control, p = 0.2), rates of same-day trial of void (TOV) (92% OTA vs 94% control, p = 0.7), or rates of same-day discharge (88% OTA vs 85% control, p = 0.6) between groups. There was no difference in temporary postoperative urinary retention (7% OTA vs 2% control, p = 0.3) between groups. Patients who received OTA injections had a significant reduction in their incontinence scores at 3-month follow-up (M-ISI -8, interquartile range [IQR]: -13 to 0, p < 0.001), whereas control patients did not (M-ISI -5, IQR: -8 to -1, p = 0.2). There was no difference in rates of 90-day complications between groups (OTA 10% vs control 5%, p = 0.7). Conclusions: Intradetrusor OTA at the time of HoLEP is safe and is associated with improved urinary incontinence scores and AUA Symptom Score. Rates of same-day discharge and same-day TOV after HoLEP were not affected by OTA. These findings support the role of OTA as an adjunct to surgical intervention in men with incontinence in the presence of BOO.

Urinary Symptom Profile in Early Multiple System Atrophy (P9-9.002)

<h3>Objective:</h3> Evaluate the Urinary Symptom Profile (USP) in patients with multiple system atrophy (MSA). <h3>Background:</h3> MSA is a rapidly progressive neurodegenerative disease that presents with motor and autonomic symptoms. Urinary symptoms can occur at any time along the disease process; however, no study has characterized patient reported urinary symptoms in MSA. The Urinary Symptom Profile (USP) is a validated, patient-reported assessment for stress urinary incontinence (SUI), overactive bladder (OAB), and low stream (LS). We applied this scale to a cohort of early MSA patients from the bioMUSE Natural history study. <h3>Design/Methods:</h3> 16 participants, (8 females), mean age 62 (range 49–79), mean duration of motor symptoms of 3 years, completed the Unified Multiple System Atrophy Rating Scale (UMSARS) Part I, the Natural History and Neuroprotection in Parkinson Plus Syndromes-Parkinson Plus scale (PPS), and the Urinary Symptom Profile (USP) questionnaire. The PPS and UMSARS total urinary symptom scores were correlated with the total USP score using a t-distribution and the Spearman’s rank correlation. <h3>Results:</h3> The mean USP score was 14.06, (4–30). One participant had a bladder stimulator and 3 were taking medications for urinary symptoms. Total USP scores positively correlated with total urinary symptom scores from the UMSARS (p = 0.075, r² = 0.458) and PPS (p = 0.002, r² = 0.713). Across this cohort, the most severe complaints were related to urinary urgency (OAB avg = 8.4), and reduced amount of time to hold urine (SUI avg = 2.63). Subscale analysis indicates the most common symptoms relate to OAB, and least common were SUI. <h3>Conclusions:</h3> In early MSA, urinary symptoms are greatest in relation to overactive bladder, specifically urgency and frequency. These results suggest that the USP can be used for comprehensive evaluation of urinary complaints and give important insights to the concerns of patients early in disease. <b>Disclosure:</b> Miss Iregui has nothing to disclose. Ms. Wynn has nothing to disclose. Miss Hay has nothing to disclose. Cynthia Wong has received personal compensation for serving as an employee of Alterity Therapeutics. Dr. Stamler has received personal compensation for serving as an employee of Alterity Therapeutics. Dr. Claassen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva Neuroscience. Dr. Claassen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Spark . The institution of Dr. Claassen has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Alterity. Dr. Claassen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Teva Neuroscience. Dr. Claassen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for HD Insights. The institution of Dr. Claassen has received research support from NIH. The institution of Dr. Claassen has received research support from CHDI. The institution of Dr. Claassen has received research support from HDSA. The institution of Dr. Claassen has received research support from Department of Defense. The institution of Dr. Claassen has received research support from Griffin Family Foundation. The institution of Dr. Claassen has received research support from Neurocrine. The institution of Dr. Claassen has received research support from Vaccinex. The institution of Dr. Claassen has received research support from AbbVie. The institution of Dr. Claassen has received research support from CHDI. The institution of Dr. Claassen has received research support from Genentech/ Roche. The institution of Dr. Claassen has received research support from Prilenia. The institution of Dr. Claassen has received research support from Neurocrine/ HSG.

Change in Prostate Volume and Symptom Improvement in Men Treated With Rezūm Water Vapor Therapy

To evaluate the change in prostate volume (PV) and relationship to improvement in urinary symptom scores following Rezūm therapy. Quality of life outcomes and PV were assessed at baseline and 12months postprocedure. Percent change from baseline in outcomes and PV were calculated, as was the number of Rezum injection to baseline PV ratio. Association between total number of injections and changes in outcomes and PV were evaluated using linear regression models. A total of 49 men (mean age=67.8; standard deviation=9.4) underwent the procedure between April 2019 and September 2020, with a median baseline PV of 71.5 cc (range 24-150) and median number of vapor injections of 11.0 (range 4-21). At 12months, the median percent change in PV was -34.0% (interquartile range: -49.2%, -16.7%), with 45/49 (91.8%) patients having reduced volume. Among the 45 patients with reduced volume at 12months, every 10% increase in volume reduction was associated with a 7.5% (95% confidence interval, 1.4%-13.6%; P=.02) improvement in the International Prostate Symptom Score. There was no significant association between total number of injections or injection to baseline volume ratio and change in PV. In this cohort of men treated with Rezūm therapy for benign prostatic hyperplasia, it was demonstrated that there is a correlation between greater PV reduction and greater symptomatic improvement. This study showed no association between more injections or the ratio of injections to PV changes, refuting the claim that more injections are better.

PD14-03 PREDICTION OF RESPONSE TO OAB MEDICATIONS USING DEEP LEARNING AND ARTIFICIAL INTELLIGENCE – A LURN RESEARCH STUDY

You have accessJournal of UrologyCME1 Apr 2023PD14-03 PREDICTION OF RESPONSE TO OAB MEDICATIONS USING DEEP LEARNING AND ARTIFICIAL INTELLIGENCE – A LURN RESEARCH STUDY H Henry Lai, Heming Zhang, and Fuhai Li H Henry LaiH Henry Lai More articles by this author , Heming ZhangHeming Zhang More articles by this author , and Fuhai LiFuhai Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prediction of response to treatment is important in clinical decision-making. However this is challenging because the LUTS population is heterogeneous, and factors associated with treatment response are poorly understood. We used novel artificial intelligence (AI) models to analyze the high-dimensional, sparse and mixed-type data collected on men and women with LUTS enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN), for a deeper understanding of predictors of treatment response. METHODS: We developed a novel deep graph neural network (GNN) model LUTSPheNet to solve these challenges. First, the complex data were converted into a patient-phenotype graph that linked study participants with 181 phenotypic features. The “DeepWalk” model was used to convert the patient and phenotype nodes into phenotypically semantic numerical vectors (see Figure 1). The heterogenous phenotypic nodes with different data types were converted into the same numerical vector type, and were used as the input of an interpretable graph attention network (GAT) model to predict drug response of individual participants. Response to OAB medications (anticholinergics and/or beta-agonists) was classified as responders vs. non-responders based on changes in urgency urinary incontinence, urgency, or frequency symptom scores on the LUTS Tool. RESULTS: OAB medications were taken by 243 participants. Symptom data before and after treatment were available from 134. 87 (65%) were responders. Using the 5-fold cross validation, LUTSPheNet achieved a 71.6% accuracy in predicting responders. The top-ranked participant characteristics predicting response to OAB medications include: current smoker; incontinence during sleep; stress incontinence with physical activities; pain or discomfort in the bladder area; higher PROMIS anxiety, depression, constipation, diarrhea scores; and good pelvic floor contraction strength on Oxford Scale (females only). CONCLUSIONS: Deep learning and artificial intelligence models are novel ways to identify clinical features predicting responders to OAB medications. A web-based prediction tool is being developed to help clinicians predict the probabilities of response to medications based on patient characteristics. Source of Funding: NIH/NIDDK © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e413 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information H Henry Lai More articles by this author Heming Zhang More articles by this author Fuhai Li More articles by this author Expand All Advertisement PDF downloadLoading ...

Difference in symptom manifestation between postmenopausal and premenopausal women in acute uncomplicated cystitis: A multi-institutional pilot study.

We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy. This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020. After registration, we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score (CLSS) questionnaire. After treatment, pyuria disappeared in 60 of the 66 patients (14 premenopausal and 46 postmenopausal). The CLSS total score (range) changed from 13 (3-29) to 4 (0-18) with a significant improvement in all CLSS items. At baseline, nocturia, urgency, and urgency incontinence were more prominent in postmenopausal women than in premenopausal women. In contrast, baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women. After treatment, the CLSS total score was still higher in postmenopausal women, as reflected by the relatively higher scores for nocturia and urgency, irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups. Our results suggest that if storage symptoms persist, they should be carefully interpreted according to menopausal status.

MP67-10 CLINICAL FACTORS ASSOCIATED WITH EARLY RETURN OF URINARY CONTROL FOLLOWING RETZIUS-SPARING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP67-10 CLINICAL FACTORS ASSOCIATED WITH EARLY RETURN OF URINARY CONTROL FOLLOWING RETZIUS-SPARING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Ruben Blachman-Braun, Dinno F Mendiola, Carole Lahana, Chad R. Ritch, Sanoj Punnen, Bruno Nahar, Dipen J Parekh, and Mark L Gonzalgo Ruben Blachman-BraunRuben Blachman-Braun More articles by this author , Dinno F MendiolaDinno F Mendiola More articles by this author , Carole LahanaCarole Lahana More articles by this author , Chad R. RitchChad R. Ritch More articles by this author , Sanoj PunnenSanoj Punnen More articles by this author , Bruno NaharBruno Nahar More articles by this author , Dipen J ParekhDipen J Parekh More articles by this author , and Mark L GonzalgoMark L Gonzalgo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A potential side effect following radical prostatectomy is urinary incontinence. Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) has been associated with improved urinary control outcomes. We investigated the impact of clinical variables and intraoperative surgical findings on recovery of urinary control following RS-RARP. METHODS: Data was collected from a single-surgeon, single-institution prospective database of patients who underwent RS-RARP from May 2020 to July 2022 with≥3 months of follow up. Those without EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) or unknown prostate size at baseline were excluded. Daily pad use and EPIC-CP urinary incontinence symptom score domain (EPIC-CP UISS) were used to assess continence status. Multivariable-adjusted logistic regression was performed to assess clinical variables associated with 3-month continence (EPIC-CP UISS≤3) following surgery. RESULTS: A total of 295 men were analyzed, 49 (16.6%) had a median lobe (ML) confirmed intraoperatively, 27 (9.2%) required bladder neck reconstruction (BNR) using a tennis-racket suturing technique, and 139 (47.1%) had bilateral nerve-sparing (BNS). A total of 145 (49.2%) and 224 (76.6%) men reported using 0 or 0-1 pad per day ≤1 week following catheter removal, respectively. At 3-month follow up, 65.4% and 86.1% of men reported using 0 or 0-1 pad per day, respectively; 81.7% of men had EPIC-CP UISS ≤3. Approximately 90% and 97% of men reported using 0 or 0-1 pad per day 12 months following surgery, respectively. Diabetes mellitus (DM) was associated with worse continence (OR=0.403, p=0.027), and BNS was associated with better continence (OR=3.595, p=0.003) at 3 months. Prostate size, presence of a ML, and BNR were not associated with worse urinary control at 3 months (Table 1). CONCLUSIONS: Early continence rates after RS-RARP are encouraging with the majority of men being completely dry or using 0-1 pad per day within 1 week of catheter removal and by 3 months following surgery. DM has a negative impact and BNS has a positive impact on return of early continence. Age, prostate size, presence of ML, and BNR did not have a significant impact on early recovery of urinary control after RS-RARP. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e946 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruben Blachman-Braun More articles by this author Dinno F Mendiola More articles by this author Carole Lahana More articles by this author Chad R. Ritch More articles by this author Sanoj Punnen More articles by this author Bruno Nahar More articles by this author Dipen J Parekh More articles by this author Mark L Gonzalgo More articles by this author Expand All Advertisement PDF downloadLoading ...

PD41-10 AQUABLATION FOR BPH-RELATED LUTS: FUNCTIONAL AND ENDOSCOPIC RESULTS UP TO TWO YEARS AFTER THE INTERVENTION

PD41-10 AQUABLATION FOR BPH-RELATED LUTS: FUNCTIONAL AND ENDOSCOPIC RESULTS UP TO TWO YEARS AFTER THE INTERVENTION

MP73-17 WHOLE GLAND ABLATION USING HIGH-INTENSITY FOCUSED ULTRASOUND VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE-MATCHED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP73-17 WHOLE GLAND ABLATION USING HIGH-INTENSITY FOCUSED ULTRASOUND VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE-MATCHED STUDY Jin Noh, Gyoohwan Jung, Hae Sung Lee, Jun Hyun Nam, Jung Kwon Kim, Sangchul Lee, Seong Jin Jeong, Jong Jin Oh, Seok-Soo Byun, Sung Kyu Hong, and Hakmin Lee Jin NohJin Noh More articles by this author , Gyoohwan JungGyoohwan Jung More articles by this author , Hae Sung LeeHae Sung Lee More articles by this author , Jun Hyun NamJun Hyun Nam More articles by this author , Jung Kwon KimJung Kwon Kim More articles by this author , Sangchul LeeSangchul Lee More articles by this author , Seong Jin JeongSeong Jin Jeong More articles by this author , Jong Jin OhJong Jin Oh More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , and Hakmin LeeHakmin Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We compared the clinical outcomes of robot-assisted radical prostatectomy (RARP) and whole gland ablation (WGA) using high-intensity focused ultrasound (HIFU) in localized prostate cancer. METHODS: We analyzed 3,806 patients who had undergone RARP and WGA using HIFU. According to the propensity score for each treatment, 84 patients after WGA were matched to 3,722 patients after RARP at a 1:4 ratio using the nearest neighbor method. RESULTS: The matched cohort comprised 420 subjects (RARP, 336; PGA, 84), with a median follow-up period of 26 months. Treatment failures were identified in 16.7% and 15.5% of patients in the WGA and RARP groups, respectively. Kaplan-Meier analyses revealed no significantly failure-free (p=0.999) and salvage-free survival (p=0.548) in the RARP group than in the WGA group. There was no significant difference in the postoperative urinary symptom score (p=0.630), but the postoperative erectile function score in group of preoperative international index of erectile function (IIEF)≥17 was significantly higher in the WGA group (p=0.030). The rate of urinary incontinence (any pad) was lower in the WGA group than that in the RARP group (10.7% vs 20.2%, p=0.057). Postoperative complications were more frequent in the WGA group (p<0.001); however, there was no significant difference in high-grade complications (≥3) (p=0.201). CONCLUSIONS: WGA using HIFU showed statistically similar oncological outcomes compared with RARP for failure-free survival and salvage-free survival. However, functional outcomes regarding erectile function in selective group and postoperative incontinence were more favorable in the WGA group. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1042 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin Noh More articles by this author Gyoohwan Jung More articles by this author Hae Sung Lee More articles by this author Jun Hyun Nam More articles by this author Jung Kwon Kim More articles by this author Sangchul Lee More articles by this author Seong Jin Jeong More articles by this author Jong Jin Oh More articles by this author Seok-Soo Byun More articles by this author Sung Kyu Hong More articles by this author Hakmin Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

The role of the bladder diary in phenotyping men with LUTS.

The aim of this study was to compare the clinical characteristics of men with lower urinary tract symptoms(LUTS) grouped by 24-hurine output determined from a bladder voiding diary. An online database was queried to identify men who completed a 24-hour bladder diary (24HBD), and the Lower Urinary Tract Symptom Score (LUTSS) questionnaire from 2015 to 2019 using a mobile app. Data from the bladder diary and questionnaire were contemporaneously matched within a 2-week period. Additional data, including maximum uroflow (Qmax ) and postvoid residual urine (PVR), were obtained from the electronic medical record (EMR). The cohort was divided into three groups: normal, oliguria, and polyuria based on their 24-hour voided volume (24HVV). The LUTSS, 24HVV, maximum voided volume (MVV), maximum flow rate (Qmax ), and PVRwere compared between those with oliguria and polyuria. A total of 327 men (mean age 62, SD: 19) completed the LUTSS questionnaire and contemporaneous 24HBD. Of these, 61% had a normal 24HVV, 13% had oliguria, and 26% had polyuria. A total of 147 patients from the study cohort had contemporaneous Qmax and PVR abstracted from the EMR. There was no difference in symptom severity, bother, or PVR among the three patient groups. However, several objective metrics were significantly correlated with urine output. Men with oliguria, as compared to men with polyuria were older (65 vs. 55years) and had lower MVV (260vs.470 mL), fewer voids/24 h (8 vs. 13),and lower Qmax (8.5vs. 18.3 mL/s). These observations suggest that men with oliguria or polyuria and LUTS constitute easily distinguished phenotypes that might require different diagnostic and therapeutic algorithms. Those with oliguria were older, and had lower MVVs and much lower uroflows, suggesting that they are more likely to have underlying disorders such as bladder outlet obstruction and detrusor underactivity or may be patients with overactive bladder who reduced fluid intake to improve symptoms.

Toileting Behaviors and Lower Urinary Tract Symptoms Among Female Physicians and Medical Students.

A greater understanding of the relationship between toileting behaviors and lower urinary tract symptoms (LUTS) has the potential to generate awareness and improvement of overall bladder health in specific populations. The aim of the study was to investigate the prevalence and correlation between maladaptive toileting behaviors and LUTS among female medical trainees and attending physicians. We surveyed female medical students, residents, fellows, and attending physicians at an academic hospital, capturing demographics, voiding behaviors, LUTS, and fluid intake using the Bristol Female Lower Urinary Tract Symptoms Short Form, the Toileting Behavior-Women's Elimination Behaviors, and the Beverage Intake Questionnaire. A total of 146 medical students and physicians participated in the study. Eighty-three percent reported at least 1 LUTS, most commonly storage symptoms, particularly incontinence (30%, stress urinary incontinence > urgency urinary incontinence). Altered toileting behaviors included "worrying about public toilet cleanliness" (82%), "emptying the bladder before leaving home" (81%), "delaying emptying their bladder when busy" (87%), and "waiting until they could not hold urine any longer" (57%). Total Toileting Behavior-Women's Elimination Behaviors scores were significantly associated with total Bristol Female Lower Urinary Tract Symptoms scores (β = 0.27; 95% CI, 0.12-0.42; P<0.01). This remained true after adjusting for total fluid intake in medical students (β = 0.41, P<0.01) and resident physicians (β = 0.28, P = 0.03) but was not correlated among attending physicians (β = -0.07, P = 0.77). Female physicians and medical students experience a high prevalence of LUTS. Many engage in maladaptive toileting behaviors, which highly correlate with LUTS (especially among medical students and residents) and may lead to impaired bladder health.

The effect of intravesical stent length and Propiverine on ureteral stent related symptoms - Prospective controlled trial

Objective: Ureteral double J stents are widely utilized in urolithiasis. Disturbing stent-related symptoms may occur while the stent is in location. Various medical agents and stent-related solutions were examined for this problem. However, a definite drug has still not been found. We aimed to research the effect of propiverine on stent-related symptoms.Material and Methods: Patients who underwent ureteroscopic stone surgery between June 2020 and May 2022 were included in the study. While the control group was untreated, the treatment group received 45 mg of propiverine daily after 1 week of the operation. Stent-related symptoms were assessed by ureteral stent symptom questionnaire (USSQ) at the end of 1st week and 3rd week of surgery. In addition, the intravesical stent parts of all patients were quantitatively measured with a ruler during stent removal at the end of 3 weeks.Results: A total of 177 patients were assessed in the study. Eighty-seven patients were control and 90 patients of them were treatment group. According to USSQ, urinary symptoms scores, body pain scores, general health scores, work performance scores, sexual health scores, additional problem scores, and global quality of life (QoL) scores were found to decrease in the treatment group (p&amp;lt;0.001 All domains). Intravesical stent length was found positive correlation with the urinary symptom score (1st week) of all patients.Conclusion: Stent-related symptoms are more likely in patients with longer intravesical stent length. Propiverine successfully relieves stent-related symptoms.

Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study.

To determine whether sacral transcutaneous electrical nerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs). A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3 months. Symptom progression was assessed using the voiding calendar and the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS), excluding questions 3 and 4 -referring to enuresis- so that progression of daytime symptoms only (LUTS variable) was analyzed. 66 patients -50% of whom were female- were included, with a mean age of 9.5years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1 baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions (8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume in the voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresis was the only variable refractory to S-TENS. Complication rate was 3% (2 patients with dermatitis in the S-TENS application area). S-TENS is effective and safe in the short-term in patients with OB refractory to Achs. Further studies assessing long-term efficacy and potential relapses are required.