Urinary Tract Symptoms In Patients Research Articles

Features of lower urinary tract symptoms in patients with multiple system atrophy

Background: Multiple system atrophy (MSA) is a fatally progressive neurodegenerative disease characterized by variable combinations of parkinsonism, cerebellar ataxia and autonomic dysfunction. Lower urinary tract dysfunction, as a manifestation of autonomic failure is one of core clinical features for a diagnosis of MSA, yet it is often underrecognized especially in the early stage of the disease Objective: The study aimed to describe lower urinary tract symptoms and residual urine volume in early MSA. Subjects and methods: This was a cross-sectional study including MSA patients with disease duration of less than 5 years. Demographic and clinical characteristics were collected. All participants were assessed with UMSARS, IPSS, OABSS scores, and abdominal ultrasound was performed to measure residual urine volume. Results: 32 MSA patients were recruited, all of whom reported lower urinary tract symptoms. Urge incontinence was the most common symptom (93.8%). Symptoms related to voiding were found in 85.7% of MSA-C patients and 88.9% of MSA-P patients. Postvoid residual urine volume > 100 ml was recognized in 28% of patients. There is no statistically significant difference observed in the rate of PVR abnormalities between the MSA-C and MSA-P subgroups (p> 0.05). Conclusion: Lower urinary tract symptoms and abnormal residual urine volume are frequently present even in the early stage of MSA with no significant differences between different clinical subtypes.

COVID-19’s effects on symptoms associated with benign prostatic hyperplasia

PurposeThe objective of this study was to identify the relationship between COVID-19 and lower urinary tract symptoms in patients with benign prostatic hyperplasia.Materials and methodsData from forty outpatients who had recovered from COVID-19 and had previously been diagnosed with and treated medically for benign prostatic hyperplasia were assessed. Pre- and post-COVID-19 assessments were also conducted for prostate volume, total serum PSA concentration, and lower urinary tract symptoms. Hospitalizations related to COVID-19, the time interval between COVID-19 recovery and urologist referrals, and comorbidities were considered. Independent Student’s t-tests or chi-square tests were used to compare changes in all variables. For the Spearman rank correlation analysis, only variables with a univariate analysis of p < 0.10 were included in the multiple regression models, with the significance threshold set at two-tailed p < 0.05.ResultsAfter COVID-19, there was an increase in IPSS (12.87 ± 3.76), total serum PSA (1.56 ± 0.87), and prostate volume (10.68 ± 11.73). Multiple linear regression analysis of the independent predictors of IPSS increase revealed pre-COVID-19 IPSS with intermittency and straining as leading symptoms and bladder catheterization during COVID-19. Pre-COVID-19 frequency and nocturia status were found to be independent predictors of increased blood volume, hospital treatment for COVID-19, and bladder catheterization. A weak stream, UTI, and hypertension were found to be independent predictors of a PSA increase. The time from COVID-19 recovery to urologist referral was shorter in patients with post-COVID-19 IPSS increase (p < 0.05).ConclusionDetermining the predictors of the effects of COVID-19 on worsening BPH symptoms is essential for continued monitoring and treatment.

Comparing embolic particles for prostatic artery embolization to treat lower urinary tract symptoms in patients with benign prostatic hyperplasia.

Compare the safety and efficacy of polyvinyl alcohol particles (PVA) versus trisacryl gelatin microspheres (Embospheres) versus hydrogel microspheres coated with polyzene-F (Embozenes) for prostatic artery embolization (PAE) to treat patients with benign prostatic hyperplasia (BPH). A single-center prospective cohort study from 2019 to 2023, including patients with international prostate symptom score (IPSS) ≥ 15 and/or quality of life score (QoL) ≥ 4. Allocation to embolic agents was performed chronologically: 100-300 µm PVA (n = 53), followed by 300-500 µm Embospheres (n = 50), and finally, 400 µm Embozenes (n = 50). All patients were evaluated at baseline and at 1 and 6 months after PAE with IPSS/QoL; peak urinary flow rate, post-void residual volume, and prostate volume with ultrasound and prostate-specific antigen. Adverse events and the need for prostatic re-interventions were assessed. There were no significant baseline differences between the three groups except for patient age (62.5 years PVA; 66.1 years Embospheres and 66.6 years Embozenes; p = 0.019). There were no major adverse events and no differences between groups regarding minor adverse events. All outcome measures improved significantly from baseline, with no significant differences between groups. Mean ± standard deviation IPSS/QoL improvement at 6 months: -10.7 ± 7.9/-2.2 ± 1.7 PVA; -10.4 ± 7.3/-2.0 ± 1.5 Embospheres; -10.4 ± 7.0/-2.2 ± 1.6 Embozenes (p = 0.987). Re-intervention rates after 6 months: 9% (n = 5/53) PVA; 14% (n = 7/50) Embospheres; 8% (n = 4/50) Embozenes (p = 0.591). PAE with PVA particles, Embospheres, and Embozenes is equally safe and effective in treating BPH-related lower urinary tract symptoms. This is the first prospective study showing equivalence between the most frequently used embolic agents for prostatic artery embolization. Different particles can be used interchangeably for prostatic artery embolization. The improvements in measured metrics were the same between groups, with no differences in adverse events. The need for prostatic medication and re-intervention rates were the same at 1 and 6 months after embolization.

Infiltrating lipid-rich macrophage subpopulations identified as a regulator of increasing prostate size in human benign prostatic hyperplasia.

Macrophages exhibit marked phenotypic heterogeneity within and across disease states, with lipid metabolic reprogramming contributing to macrophage activation and heterogeneity. Chronic inflammation has been observed in human benign prostatic hyperplasia (BPH) tissues, however macrophage activation states and their contributions to this hyperplastic disease have not been defined. We postulated that a shift in macrophage phenotypes with increasing prostate size could involve metabolic alterations resulting in prostatic epithelial or stromal hyperplasia. Single-cell RNA-seq of CD45+ transition zone leukocytes from 10 large (>90 grams) and 10 small (<40 grams) human prostates was conducted. Macrophage subpopulations were defined using marker genes. BPH macrophages do not distinctly categorize into M1 and M2 phenotypes. Instead, macrophages with neither polarization signature preferentially accumulate in large versus small prostates. Specifically, macrophage subpopulations with altered lipid metabolism pathways, demarcated by TREM2 and MARCO expression, significantly accumulate with increased prostate volume. TREM2+ and MARCO+ macrophage abundance positively correlates with patient body mass index and urinary symptom scores. TREM2+ macrophages have significantly higher neutral lipid than TREM2- macrophages from BPH tissues. Lipid-rich macrophages were observed to localize within the stroma in BPH tissues. In vitro studies indicate that lipid-loaded macrophages increase prostate epithelial and stromal cell proliferation compared to control macrophages. These data define two new BPH immune subpopulations, TREM2+ and MARCO+ macrophages, and suggest that lipid-rich macrophages may exacerbate lower urinary tract symptoms in patients with large prostates. Further investigation is needed to evaluate the therapeutic benefit of targeting these cells in BPH.

Lower Urinary Tract Symptoms in Patients with COVID-19: Results of a Cross-sectional Study

Lower Urinary Tract Symptoms in Patients with COVID-19: Results of a Cross-sectional Study

THE ROLE OF LATE-ONSET HYPOGONADISM IN THE PATHOGENESIS OF MORPHO-FUNCTIONAL CHANGES IN THE URINARY BLADDER DUE TO BENIGN PROSTATIC HYPERPLASIA

Introduction. One of the key characteristics of the lower urinary tract is its hormone dependence. Pathophysiological mechanisms of lower urinary tract symptoms in patients with benign prostatic hyperplasia include infravesical obstruction, formation of a fibrous framework in the urinary bladder, disruption of the urothelial barrier, and changes in the nervous and vascular networks of the pelvis. However, to date, there is a lack of data on the pathophysiological relationship between testosterone deficiency and morpho-functional changes of the bladder. The purpose of this study is to investigate the role of age-related hypogonadism in the pathogenesis of morpho-functional changes in the urinary bladder among patients with benign prostatic hyperplasia. The results of the examination of 70 patients with benign prostatic hyperplasia, aged from 47 to 83 years (mean age 67.94 ± 7.42 years), were analyzed. The first group consisted of 20 patients, whose disease duration was 4 ± 1.8 years. They had an International Prostate Symptom Score (IPSS) of 16 ± 4.5 points, a maximum flow rate (Qmax ) of 15.8 ± 2.4 ml/s, an average flow rate (Qave) of 12.8 ± 2.8 ml/s, and no post-void residual. The second group included 20 patients with incomplete bladder emptying, with a disease duration of 5.8 ± 3.5 years. Their IPSS was 26 ± 3.9 points, Qmax was 10.8 ± 2.5 ml/s, Qave was 4.4 ± 1.4 ml/s, and post-void residual was 150.1 ± 80.8 ml. The third group comprised 30 patients who had undergone cystostomy, with a disease duration of 10.6 ± 3.3 years. Before cystostomy, their IPSS was 33.1 ± 1.88 points, and post-void residual was 1093.3 ± 458.8 ml. During surgery, all patients with benign prostatic hyperplasia were taken a biopsy from the anterior wall of the bladder. In benign prostatic hyperplasia patients in the stage of bladder compensation, the level of testosterone was 15.39±1.44 nmol/l, the Aging Males Symptoms indicator was 24.80±5.78 points. Morphometric analysis of bladder tissue demonstrated the following: the diameter of the lumen of arterioles was 27.96±2.14 μm, the thickness of the arteriole wall was 16.03±1.83 μm, the Kernoghan index for arterioles was 1.22±0.17, the specific gravity of connective tissue made 4.48±0.82%, the diameter of SMCs was 7.46±1.66 μm. In benign prostatic hyperplasia patients in the stage of bladder subcompensation, the level of testosterone was 10.92±2.24 nmol/l, the Aging Males Symptoms index was 37.9±8.0 points. Morphometric analysis of bladder tissue revealed the following: the diameter of the arteriole lumen was 23.78±1.62 μm, the thickness of the arteriole wall was 18.30±1.32 μm, the Kernoghan index for arterioles was q1.65±0.18, the specific gravity of the connective tissue made up 11.80±1.22%, the diameter of SMCs was 7.07±1.93 μm. In benign prostatic hyperplasia patients in the stage of bladder decompensation, the level of testosterone is 9.66±2.13 nmol/l, the Aging Males Symptoms index is 55.80±6.69 points. Morphometric analysis of bladder tissue showed the following: the diameter of the arteriole lumen was 19.0±2.08 μm, the thickness of the arteriole wall – 21.01±1.57 μm, the Kernoghan index for arterioles was 2.41±0.32, the specific gravity of the connective tissue made up 29. 46±1.35%, the diameter of SMCs was 4.75±1.87 μm. The obstructive component is not the only causal factor of bladder decompensation in patients with benign prostatic hyperplasia. A decrease in the level of testosterone triggers a cascade of pathological processes that negatively affect the morpho-functional state of the prostate gland and worsen the results of surgical treatment of patients with benign prostatic obstruction.

Correlation of serum interleukin-8 levels and prostate volume to the degree of lower urinary tract symptoms in patients with benign prostate enlargement: a cross-sectional study

BackgroundBenign prostatic enlargement (BPE) and lower urinary tract symptoms (LUTS) are pro-inflammatory cytokine interleukin-8 (IL-8)-associated which causes epithelial hyperplasia of the prostate transitional zone. This study aimed to determine the correlation between the levels of IL-8 serum and the prostate volume with the degree of LUTS severity in patients with BPE.MethodsDetermination of the correlation between serum IL-8 levels and prostate volume with the LUTS severity degree was conducted using a cross-sectional approach. The International Prostate Symptom Score was used to measure the LUTS severity degree, the enzyme-linked immunosorbent assay (ELISA) technique was used to measure the serum IL-8 level, and the transabdominal ultrasonography (TAUS) was used to measure the prostate volume. The sample used in this study was 32 patients with BPE grouped by the degree of LUTS severity of the patients. The correlation between variables was then analyzed using the Pearson correlation test.ResultsThe prostate volume was higher in severe LUTS degree (38.19 cc) than in the mild LUTS degree (13.05 cc). The levels of serum IL-8 were higher in the severe LUTS degree (21.65 pg/mL) than in the mild LUTS degree (8.44 pg/m). Both the levels of serum IL-8 and the degree of LUTS did not have a significant correlation with the volume of prostate (p > 0.05). On the other side, the prostate volume and the degree of LUTS severity had a significant positive correlation (p = 0.001, R = 0.913).ConclusionThe prostate volume and the levels of serum IL-8 are higher in the severe LUTS degree. There is a trend of increasing prostate volume with the severity of LUTS symptoms and higher serum IL-8 levels. The severity of prostate enlargement can be assessed by measuring the levels of IL-8 in the serum.

Pelvic Floor Functional Exercise Improves Lower Urinary Tract Symptoms after Uterine Fibroid Surgery.

This study aims to determine the effect of pelvic floor function exercise on the improvement of lower urinary tract symptoms in patients with uterine fibroid surgery. The clinical data of 188 patients who underwent uterine fibroid surgery in our hospital from February 2020 to December 2022 were retrospectively analysed. The patients were divided into a control group and an observation group according to the nursing methods recorded in the data. The observation group received targeted nursing combined with pelvic floor function exercise based on routine intervention. General demographic data, disease and surgery-related characteristics of the patients were collected. Propensity score matching was used to balance the baseline data of the two groups. Lower urinary tract symptoms, pelvic floor function, pelvic floor muscle strength and quality of life were compared between the two groups after matching. A total of 130 patients were included in the two groups, and their baseline data were not statistically significant. At 3 months after the operation, the total incidence of lower urinary tract symptoms in the observation group (10.77%) was lower than that in the control group (30.77%, p < 0.05). Before the intervention, the pelvic floor function, pelvic floor muscle strength and quality of life scores of the two groups were basically the same (p > 0.05). At 3 months after the operation, the pelvic floor function score of the observation group was lower than that of the control group, but the pelvic floor muscle strength index and quality of life score of the observation group were higher than those of the control group (p < 0.05). Targeted nursing combined with pelvic floor function exercise for patients with uterine fibroids surgery can prevent the occurrence of lower urinary tract symptoms and improve the pelvic floor function, pelvic floor muscle strength and quality of life of patients and is thus worthy of promotion.

Impact of Polypharmacy and Risk Factors for Exacerbation of Lower Urinary Tract Symptoms in Patients with Urological Conditions: A Retrospective Study in a Japanese Municipal Hospital.

Polypharmacy exacerbates lower urinary tract symptoms (LUTS). Japan exhibits a higher prevalence of concomitant medication use in drug therapy than other countries. Previous age- and sex-specific reports exist; however, none include patients of all ages. Therefore, this retrospective study determined the impact of polypharmacy and its associated risk factors on LUTS exacerbation in outpatients with urological conditions. We included patients receiving medication who visited the Department of Urology at the Gifu Municipal Hospital (Gifu, Japan) between January, 2018 and December, 2018. The association between LUTS and polypharmacy and the risk factors for LUTS exacerbation were investigated. Patients were categorized into two groups according to their polypharmacy status. We performed propensity score matching and compared the International Prostate Symptom Score (IPSS) between the groups using the unpaired t-test. Multiple logistic regression analysis was performed to examine the risk factors, including "polypharmacy" and "taking multiple anticholinergic medications" for LUTS exacerbation. When comparing the IPSS between the groups, the polypharmacy group was found to have significantly higher scores than the non-polypharmacy group in six items, including "total score" and "storage score." Multiple logistic regression analysis results showed high significance in three items, including "polypharmacy" (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.03-2.71) and "taking multiple anticholinergic medications" (OR = 8.68, 95% CI: 1.05-71.7). In conclusion, this study revealed that "polypharmacy" and "taking multiple anticholinergic medications" were risk factors for LUTS. Particularly, "polypharmacy" is associated with storage symptom exacerbation. Therefore, eliminating "polypharmacy" and "taking multiple anticholinergic medications" is expected to improve LUTS.

Prevalence of Double Incontinence and Lower Urinary Tract Symptoms in Patients with Fecal Incontinence: A Single-center Observational Study.

Double incontinence (DI), which is the co-occurrence of fecal incontinence (FI) and urinary incontinence (UI), increases with age and has a greater negative impact on the quality of life (QOL) than either incontinence alone. We aimed to assess lower urinary tract symptoms (LUTS) in patients with FI to elucidate the prevalence and characteristics of DI. This study enrolled consecutive patients who visited our hospital with FI symptoms. FI was evaluated using the Cleveland Clinic Florida Fecal Incontinence Score (CCFIS). LUTS were assessed using the International Prostate Symptom Score (IPSS), QOL score (IPSS-QOL) and Overactive Bladder Symptom Score (OABSS). This study evaluated 140 patients (96 women [mean age: 70.7 years] and 44 men [mean age: 74.4 years]). The mean IPSS was significantly higher in men than in women (12.0 vs. 7.5, p = 0.003). A positive correlation was found between IPSS and CCFIS in women (r = 0.256, p = 0.012) but not in men. For both sexes, the older group (aged ≥70 years) had higher OABSS scores and more urge UI instances than the younger group (aged ≤69 years). Of the 140 patients with FI, 78 (55.7%) had DI, and DI was more common in women than in men (63.5% vs. 38.6%, p = 0.006). The characteristics of LUTS and UI in patients with FI were comparable to those in the general population for both sexes; however, the prevalence of DI was much higher among patients with FI than that in the general population.

Lower urinary tract symptoms in patients with inflammatory bowel diseases: A cross-sectional observational study

BackgroundInflammatory Bowel Diseases (IBD), Crohn's Disease (CD), and Ulcerative Colitis (UC) may have extraintestinal manifestations, including disorders of the urinary tract. The prevalence of lower urinary tract symptoms (LUTS) in IBD patients remains unclear. AimsAssess the prevalence of LUTS in patients with CD or UC, evaluate the variables implicated in any difference in LUTS prevalence between CD or UC, and assess any relationship between disease activity and LUTS MethodsLUTS were evaluated in 301 IBD patients through standardised questionnaires: Bristol Female Lower Urinary Tract Symptoms (BFLUTS), NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and International Prostate Symptom Score (IPSS). IBD activity was determined through the Crohn's Disease Activity Index (CDAI), Partial Mayo Score (PMS), and Total Mayo Score (TMS). ResultsBFLUTS total score for females was 6 (3–11). Patients with a higher age at diagnosis had worse filling symptoms (p = 0.049) and a worse quality of life (p = 0.005). In males, 67.1% had mild, 28.5% moderate, and 4.4% severe IPSS symptom grades. The overall NIHCPSI prevalence of chronic prostatitis-like symptoms was 26.8%. The questionnaires revealed some significant differences in the subgroups analysed. ConclusionLUTS should be evaluated in IBD patients by urologic-validated questionnaires for prompt diagnosis and early treatment.

Lower Urinary Tract Symptoms in Patients With Chronic Low Back Pain: A Cross-Sectional Study.

This study aimed to determine the extent of lower urinary tract symptoms (LUTS) in patients with chronic low back pain (CLBP) and the relationship between LUTS and patients' clinical and functional factors. Patients aged 40 to 80 who were admitted with CLBP were included. Demographic data and the duration of CLBP and LUTS were noted. Anteroposterior and lateral lumbar radiographs and lumbar MRI findings were recorded. Short Form 36 (SF-36) and the Oswestry Disability Index (ODI) were used for functional status assessment. For the LUTS evaluation, patients were asked to tick the symptoms from the list of LUTS prepared. We included 90 patients with CLBP. The frequency of urinary incontinence was 81.1%. The mean number of LUTS was 2.81±3.22. The LUTS rates were higher in patients with vertebral height loss (p = 0.03), with central (p = 0.02) and lateral spinal narrow canals (p = 0.03), and with facet hypertrophy (p = 0.04). The rates of LUTS were lower in patients with decreased lumbar lordosis (p = 0.02). The ODI and LUTS were found to be related (p = 0.01). The role limitations due to physical problems of the SF-36 subgroups and LUTS were significantly correlated (p = 0.01). The incidence of the coexistence of CLBP and LUTS is high. Patients cannot match and report LUTS among their complaints, so physicians should inquire about LUTS in patients with CLBP and carry out the appropriate diagnosis and treatment.

Prognostic Factors for Resolution Delay of Lower Urinary Tract Symptoms in Patients with Prostate Cancer after Low-Dose-Rate Brachytherapy.

Urinary storage symptoms after low-dose-rate brachytherapy (LDR-BT) with iodine-125 have been noted to be less likely to improve to baseline compared to voiding symptoms. This study aimed to evaluate the chronological changes in the overactive bladder symptom score (OABSS) and the time-to-resolution of OABSS in patients undergoing LDR-BT. Patients with prostate cancer who underwent LDR-BT at Gifu University Hospital were enrolled. The OABSS was evaluated before and after LDR-BT. Patients were divided into the OABSS resolution and resolution delay groups, and the association between OABSS resolution delay and clinicopathological covariates was evaluated. In total, 237 patients were enrolled in this study, with a median follow-up of 88.3 months. The OABSS in both groups worsened at 3 months following operation and gradually recovered at 9 months; however, the OABSS in the resolution delay group tended to worsen again after that. In the multivariate analysis, preoperative OABSS and the change from baseline to maximal OABSS were associated with OABSS resolution. To our knowledge, this is the first study to evaluate the delayed resolution of OABSS after LDR-BT in patients with prostate cancer. A low baseline OABSS and significant changes in the OABSS from baseline were independent predictors of delayed OABSS resolution.

An Investigation of Subsequent Lower Urinary Tract Symptoms in Patients With a History of Infection of COVID-19 at Tadbir Clinic in Urmia City During the Period From December 2020 to July 2021

Introduction More associated symptoms have been reported with the increasing number of COVID-19 cases worldwide. However, the precise impact of the disease on the urinary system and related urinary symptoms has yet to be adequately evaluated. The present study aims to investigate the subsequent lower urinary tract symptoms in patients attending Tadbir Clinic in Urmia City who have a history of infection due to COVID-19 within less than two months. Methods This study evaluated patients referred to the Urology Department of Tadbir Clinic in Urmia City between December 2020 and July 2021 who had tested positive for COVID-19 by RT-PCR within the past two months. The patient’s hospitalization history and the occurrence or exacerbation of urinary symptoms were recorded, and they completed the International Prostate Symptom Score (IPSS) questionnaire. Results This study included 150 patients with a mean age of 44.12 years, including 80 males and 70 females. None of the patients had severe urinary symptoms. 92.7% of the patients had mild urinary symptoms, and 7.3% had moderate urinary symptoms. The prevalence of moderate urinary symptoms was significantly higher in females than in males (P-value = 0.04). Individuals with moderate urinary symptoms had a higher mean age than those with mild urinary symptoms (P-value = 0.03). Among patients with or without a history of hospitalization, including those with a history of intensive care unit (ICU) admission, there was no significant difference in the severity of urinary symptoms (P-value = 0.5). Nocturia was the most common symptom reported by patients after the COVID-19 infection. Conclusion The severity of urinary symptoms was higher in females than males, and individuals with more severe urinary symptoms were generally older. There was no significant difference in terms of hospitalization history or the occurrence of severe urinary symptoms. Nocturia and frequency were the most prevalent symptoms among the patients.

Holmium Laser Enucleation of the Prostate vs Robot-Assisted Simple Prostatectomy for Lower Urinary Tract Symptoms in Patients with Extremely Large Prostates ≥200 cc: A Comparative Analysis.

Introduction and Objectives: Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of ≥200 cc. Materials and Methods: Between 2009 and 2020 a total of 53 patients with a prostate volume of ≥200 cc were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and postvoid residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification. Results: Patients treated with RASP had significantly larger prostate volumes compared with HoLEP (median 226 cc vs 204.5 cc, p = 0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 mL/s vs +10.70 mL/s, p = 0.724) and a reduction of the IPSS score (-12.50 vs -9, p = 0.246) as well as improvement of the QoL (-3 vs -3, p = 0.880). Median operative time was similar in both groups (150 minutes vs 132.5 minutes, p = 0.665). The amount of resected tissue was lower in the RASP group (134.5 g vs 180 g, p = 0.029) and there was no significant difference in postoperative prostate-specific antigen (1.2 ng/mL vs 0.8 ng/mL, p = 0.112). Despite a similar median catheterization time (3 days vs 2 days, p = 0.748), the median hospitalization time was shorter in the HoLEP group (4 days vs 3 days, p = 0.052). Complication rates were similar in both groups (32% vs 36%, p = 0.987). Conclusion: Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates ≥200 cc. These findings will require external validation at other high-volume centers.

Benefits of Repeat Prostatic Artery Embolization on Persistent or Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

To evaluate the benefits of repeat prostatic artery embolization (rePAE) for patients with persistent or recurrent symptoms after initial prostatic artery embolization (PAE). This is a single-center retrospective study of all patients who underwent a rePAE between December 2014 and November 2020 for persistent or recurrent lower urinary tract symptoms. Symptoms were assessed before and after PAE and rePAE, using the International Prostate Symptom Score and quality of life (QoL) questionnaires. Patient characteristics, anatomical presentations, technical success rates, and complications of both procedures were collected. Clinical failure was defined as one of the following: less than 2 points' decrease in QoL, a QoL score higher than 3, acute urinary retention, and secondary surgery. A total of 21 consecutive patients (mean age: 63.8 ± 8.1; [40-75] years) who underwent rePAE were included. The median follow-up after PAE was 27.7 [18.1-36.9]) months and 8.9 [3.4-10.8] months after rePAE. rePAE was performed at a mean of 19 ± 11.1 [6.9-49.6] months following PAE, and the overall clinical success rate was 33% (7/21). In patients undergoing rePAE because of persistent symptoms, the clinical success rate (18%) was non-significantly lower than that for patients treated for recurrent symptoms (50%) [OR 4.5 (95% CI 0.63-32 P = 0.13)]. The main anatomical revascularization pattern was recanalization of the native prostatic artery (29/45, 66%). Patients who experience recurrent symptoms after PAE may benefit more from rePAE than those with persistent symptoms after PAE. Clinical success rates seem to be relatively low in both clinical scenarios.

Development of a self‐management scale for lower urinary tract symptoms in patients with cancer after radical prostatectomy

AbstractHow can nurses assess the self‐management of lower urinary tract symptoms (LUTS) in patients with cancer after radical prostatectomy (RP)? Patients with prostate cancer who have undergone RP experience multiple LUTS. This study aimed to develop a self‐management scale for LUTS in patients with cancer following RP (SMS‐LUTS‐RP), as well as to verify its reliability and validity. LUTS has physical, social, and psychological consequences for patients. As a result, patients are forced to self‐manage their LUTS and LUTS‐related issues. However, no indicators exist to assess self‐management of LUTS. A total of 246 individuals were surveyed. A 49‐item scale draft, whose content validity and face validity were confirmed, was used to develop a questionnaire for patients with LUTS after RP. The reliability and validity were determined using by item analysis, exploratory factor analysis, confirmatory factor analysis, and Cronbach's α coefficient. The exploratory factor analysis produced the following 18 items on five extracted factors: ‘monitoring of urinary status,’ ‘coping with daily life difficulties due to LUTS,’ ‘collaboration with medical professionals,’ ‘continued training to improve LUTS,’ and ‘living with LUTS.’ The goodness‐of‐fit‐index (GFI) for confirmatory factor analysis was 0.876, and the root mean square error of approximation was 0.075. Cronbach's α coefficient was 0.754–0.820. SMS‐LUTS‐RP has desirable psychometric properties and can assess the cognitive and behavioural aspects of self‐management of LUTS in patients with cancer who have undergone a RP. This scale can be used to provide individualized self‐management support according to living conditions.

Effects of Mirabegron vs Tamsulosin in Reducing Lower Urinary Tract Symptoms in patients with Indwelling Double J Stents

Aim: To compare the mean IPSS score after treatment with tamsulosin versus mirabegron in patients with double J stent related lower urinary tract symptoms. Study design: Randomized controlled trial. Place and duration of study: Department of Urology Shaikh Zayed Hospital, Lahore from 2nd May 2019 to 1st November 2019. Methodology: One hundred patients of both genders aged between 18-60 years having DJ stent related symptoms (IPSS score ≥7) were enrolled. Patients were randomized into 2 groups based on treatment. Patients in Group A were given mirabegron while the one in Group B were treated with tamsulosin. Outcome variable was mean IPSS score 3 weeks after treatment which was noted and compared between the groups. Results: The mean age was 38.6±10.9 years. There were 59 (59.0%) male and 41 (41.0%) female patients with a male to female ratio of 1.4:1. The IPSS score at baseline ranged from 14 to 23 with a mean of 18.18±2.77. The follow-up IPSS score was significantly lower in patients treated by mirabegron as compared to tamsulosin (6.28±0.86 vs. 9.60±0.86; p-value&lt;0.001). Similar significant difference was noted between the groups across various subgroups based on patient’s age, gender and baseline IPSS score. Conclusion: Mirabegron was superior to conventional practice of tamsulosin in the treatment of DJ stent related symptoms in terms of significantly lower mean IPSS score after 3 weeks of treatment. Keywords: DJ stent, Lower urinary tract symptoms, Mirabegron, Tamsulosin

Correlation Analysis between Hypogonadal Symptoms and Changes in Body Composition and Physical Fitness after Testosterone Treatment in Men with Testosterone Deficiency.

This study analyzed changes in body composition and physical fitness in men with testosterone deficiency (TD) after testosterone treatment (TT) and examined the correlations of body composition and physical fitness with serum testosterone levels and hypogonadal symptoms. Seventy patients with TD were divided into control (group I, n=23) and experimental (group II, n=47) groups. Patients in the experimental group were administered intramuscular testosterone enanthate (250 mg) for six months. The aging males symptom scale (AMS) score, international prostate symptom score (IPSS), body mass index, waist circumference, and serum laboratory values were measured at baseline and at the end of the study. Bioelectrical impedance analysis was used to assess the patients' body composition. Seven types of basic exercise tests were used to evaluate the patients' physical fitness. After six months, there were no significant differences in group I, while group II had significantly improved IPSS and AMS scores; increased hemoglobin, hematocrit, prostate-specific antigen, and testosterone levels and skeletal muscle mass; and waist circumference, and body fat mass. All elements of the physical fitness test were significantly improved in group II, with the exceptions of flexibility and endurance. Decreased waist circumference was correlated with changes in testosterone levels in group II, and the IPSS, cardiorespiratory fitness, and agility were correlated with improved hypogonadal symptoms. TT improved the hypogonadal and lower urinary tract symptoms in patients with TD and improved body composition, physical fitness, and metabolic syndrome parameters. Increased testosterone and improved hypogonadal symptoms were correlated with a decrease in waist circumference and an improvement in cardiorespiratory fitness and agility. As such, when implementing TT, we should consider whether these areas may be improved, as this can help to predict the effect.

Clinical significance of prostate volume and testosterone reduction on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy

To investigate the effect of both prostate volume and serum testosterone changes on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy. A total of 167 patients who received androgen deprivation therapy for prostate cancer treatment from January 2010 to August 2020 were enrolled in this retrospective study. Changes in the International Prostate Symptom Score (IPSS) in the patient groups stratified by prostate volume and the amount of testosterone reduction were assessed every 4 weeks until 12 weeks after androgen deprivation therapy initiation. Longitudinal mixed models were used to assess the adjusted effects of prostate volume and testosterone reduction on IPSS change. All mean values of IPSS-total score (IPSS-total), voiding subscore (IPSS-vs), and storage subscore (IPSS-ss) significantly decreased from baseline to week 12 in both patients with small (< 33 mL) and large (≥ 33 mL) prostates. The mean values of IPSS-total, IPSS-vs, and IPSS-ss similarly decreased in patients with large prostate with a baseline IPSS-total of ≥ 13. However, in those with small prostate, IPSS-ss specifically remained unchanged, while IPSS-total and IPSS-vs significantly decreased. In addition, only in patients with small prostate (< 33 mL), patients with lesser testosterone reduction (< Δ400 ng/dL) showed greater improvement in IPSS-ss by 7.5% compared with those with greater testosterone reduction (≥ Δ400 ng/dL). In conclusion, although androgen deprivation therapy generally improves lower urinary tract symptoms, it may worsen specifically storage symptoms in patients with relatively small prostate and greater testosterone reduction. Our finding suggests that testosterone may influence lower urinary tract symptoms in these patients.