Evaluation of Risk Factors of Postoperative Urinary Retention in Male Patients Undergoing Surgery Under Spinal Anaesthesia : A Prospective Study

Background : Postoperative Urinary Retention (POUR) is common after regional anaesthesia with a reported incidence between 5% and 70%. POUR can lead to significant morbidity with additional surprise and mental trauma to the patient when unwarned. This study aimed to assess the occurrence of POUR in male patients undergoing Surgery under Spinal Anaesthesia and to study the risk factors related to it. Methods : 692 male patients were analysed prospectively for the need for catheterisation which was defined as 搕he inability to void in the immediate Postoperative period with accompanying discomfort and a palpable Bladder.� All such patients were catheterised as an emergency. A record was made about the mean age, surgical condition, comorbidities, duration of Surgery, use of intra-operative sedatives, intra-operative fluid infused and International Prostate System Score (IPSS). Results : The overall mean age of patients with POUR was 46 years. The incidence of POUR was highest among Perianal Surgeries ie, 52/70 (13%) followed by Hernia Surgeries, 18/70 (6.3%). An appreciable reduction was observed in urinary retention after administration of intra-operative sedatives (p=0.022) and lower IPSS (p=0.001). Factors such as age, intra-operative fluid administration, duration of Surgery and previous history of Diabetes did not reach statistical significance as being predictive of urinary retention. Conclusion : An IPSS greater than 7 increases the risk of Postoperative Urinary Retention while the use of intraoperative Sedative in combination with Spinal Anaesthesia decreases the risk. In high-risk patients undergoing perianal procedures, pre-operative patient counselling about the possibility of Postprocedure retention is recommended.

Establishment and internal validation of a risk prediction model for urinary incontinence after transurethral holmium laser enucleation of the prostate / 现代泌尿外科杂志

【Objective】 To establish a model for predicting the risk of urinary incontinence after holmium laser enucleation of the prostate (HoLEP). 【Methods】 The clinical data of 258 patients with benign prostatic hyperplasia (BPH) who underwent HoLEP in our hospital during Jan.2019 and Feb.2022 were retrospectively analyzed. According to the occurrence of urinary incontinence after surgery, they were divided into the urinary incontinence group (n=84) and non-urinary incontinence group (n=174). Lasso regression was used to screen the predictors of urinary incontinence after HoLEP. Logistic regression was used to establish a suitable model, and a nomogram of urinary incontinence after HoLEP was drawn. Bootstrap was used to verify and draw the calibration curve of the model, calculate the C index, and draw the clinical decision curve to further verify the accuracy and identification ability of the model. 【Results】 Predictors including International Prostate Symptom Score (IPSS), Quality of Life Score (QoL), body mass index (BMI), diabetes, prostate volume (PV), and prostate-specific antigen (PSA) were selected, based on which a prediction model was constructed. The area under the receiver operating characteristic (ROC) curve of the prediction model was 0.766 0, and the 95% confidence interval was 0.704-0.828. Bootstrap internal validation showed a C-index of 0.766 2, and the calibration model curve coincided well with the actual model curve. The clinical decision curve analysis showed that the model had high accuracy, and net benefit in the probability of urinary incontinence was within 10% to 82%. 【Conclusion】 IPSS, QoL, diabetes, prostate volume, and PSA are predictors that can affect the occurrence of urinary incontinence after HoLEP. The model has high accuracy, identification ability and net benefit.

The prognostic significance of pretransplantation evaluation of IPSS-R and WPSS in patients with myelodysplastic syndrome undergoing allogeneic hematopoietic stem cell transplantation / 中华血液学杂志

Objective: This study aimed to explore the prognostic value of the revised international prognostic scoring system (IPSS-R) and the WHO prognostic scoring system (WPSS) in patients with myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: The clinical data of 184 patients with MDS who received allo-HSCT from July 2016 to June 2019 were retrospectively analyzed. IPSS-R and WPSS were performed at diagnosis and before transplantation. The prognostic values of IPSS-R and WPSS and potential risk factors were explored. Results: With a median follow-up of 21.9 (0.5-47.5) months, the two-year overall survival (OS) and progression-free survival (PFS) rates were (75.1±3.4)% and (71.6±3.6)% , respectively. The two-year cumulative relapse rate and nonrelapse mortality rate were (11.9±0.1)% and (16.5±0.1)% , respectively. There were no significant differences in OS and PFS between the IPSS-R ≤3.5 and >3.5 groups at diagnosis (P=0.409; P=0.724). No significant differences in OS and PFS between the WPSS ≤2 and >2 groups (P=0.426; P=0.726) were observed as well. When the patients were reevaluated before transplantation, the OS and PFS of the IPSS-R ≤3.5 group were significantly better than >3.5 group [OS: (88.6±4.1)% vs (65.8±5.3)% , P=0.003; PFS: (87.6±4.2)% vs (60.5±5.8)% , P=0.002]. However, there were no significant differences in OS and PFS among the WPSS ≤2 and >2 groups (P=0.584; P=0.565). In addition, the OS and PFS of the improved group based on IPSS-R were significantly better than those of the unimproved group before transplantation [OS: (83.8±4.6)% vs (69.3±5.8)% , P=0.027; PFS: (82.8±4.4)% vs. (64.0±7.2)% , P=0.006]. Multivariate analysis indicated that a pretransplant IPSS-R of >3.5 (P=0.021, HR=2.510, 95% CI 1.151-5.476) and TP53 mutation (P=0.047, HR=2.460, 95% CI 1.014-5.971) were independent risk factors for OS, whereas a pretransplant IPSS-R of >3.5 (P=0.017, HR=2.457, 95% CI 1.175-5.141) and pretransplant cytogenetic poor and very poor (P=0.008, HR=2.765, 95% CI 1.305-5.856) were independent risk factors for PFS. Conclusion: A pretransplantation evaluation of IPSS-R could help determine the prognosis of patients with MDS undergoing allo-HSCT. In addition, patients with improved IPSS-R scores before undergoing allo-HSCT had a better prognosis.

Influencia de la modalidad de respuesta, edad y nivel de educación en el cuestionario internacional de síntomas prostáticos (IPSS) / Influence of the response modality, age and level of education in the international prostate symptoms questionnaire (IPSS)

OBJETIVOS: evaluar la influencia de la modalidad de respuesta (paciente vs. asistido por urólogo) en el cuestionario IPSS (International Prostate Symptom Score) y su relación con la edad y nivel de educación. MATERIALES Y MÉTODOS: Análisis prospectivo de 74 pacientes que acudieron a la consulta de urología por síntomas de Hiperplasia Prostática Benigna (HPB) con o sin tratamiento para su patología y que no hayan completado anteriormente el cuestionario internacional de síntomas prostáticos (IPSS). Los cuestionarios fueron completados en la misma consulta urológica, primero por el paciente y luego con ayuda del urólogo. Se categorizó por edad y nivel de educación. Se evaluó la diferencia entre los puntajes de IPSS obtenidos con la forma autocompletada y con asistencia del urólogo y si esta diferencia estaba relacionada con la edad y con el nivel de educación. Los datos fueron analizados utilizando test no paramétrico para datos apareados de Wilcoxon. RESULTADOS: no se encontró diferencia estadísticamente significativa entre el cuestionario completado por el paciente y el asistido por el urólogo. La media del score total fue de 13,66, y 13,67, respectivamente (p: 0.86). Al analizar los subgrupos, con respecto a la edad y al nivel de educación, tampoco se encontraron diferencias estadísticamente significativas. CONCLUSIÓN: en nuestra población de estudio, el cuestionario IPSS no fue influenciado por la modalidad de administración, tampoco por la edad ni por el nivel de educación.

OBJECTIVES: to evaluate the influence of the response modality (patient vs. urologist-assisted) in the IPSS questionnaire (international prostate symptom score) and its relationship with age and education level. MATERIALS AND METHODS: Prospective analysis of 74 patients who came to the urology clinic for symptoms of Benign Prostatic Hyperplasia (BPH) with or without treatment for their pathology and who have not previously completed the international prostate symptoms questionnaire (IPSS). The questionnaires were completed in the same urological consultation, first by the patient and then with the help of the urologist. It was categorized by age and education level. The difference between the IPSS scores obtained with the self-completed form and with the assistance of the urologist and whether this difference was related to age and level of education was evaluated. The data were analyzed using non-parametric test for paired Wilcoxon data. RESULTS: no statistically significant difference was found between the questionnaire completed by the patient and the one assisted by the urologist. The average of the total score was 13.66, and 13.67, respectively (p: 0.86). When analyzing the subgroups, regarding age and level of education, no statistically significant differences were found. CONCLUSION: In our study population, the IPSS questionnaire was not influenced by the modality of administration, neither by age nor by level of education.

Comparative Evaluation of Relationship between Prostate Volume and Lower Urinary Tract Symptoms

Lower Urinary tract symptom (LUTS) is a common presentation among elderly male patients in urology clinical practice. International Prostate Symptom Score (IPSS) have contributed much to the objective and quantitative evaluations of LUTS in terms of the elucidation of its pathogenesis and changes accompanied with treatments. Aim: The objective of this study was to evaluate the relationship between IPSS and prostate volume in patients with LUTS. Methods: This prospective study included 58 male patients with lower urinary tract symptoms (LUTS). The IPSS was evaluated using questionnaire and the prostate volume of each patient was then estimated by transabdominal ultrasound. Results: There is a significant relationship between IPSS and prostate volume measured through trans-abdominal ultrasonography. The Total IPSS increases with the prostate volume, as a significant positive relationship between IPSS total score and prostate volume was recorded. Conclusion: There is a significant positive relationship between IPSS total score and prostate volume

Male lower urinary tract symptoms in correlation with age, quality of life scores, parameters of uroflowmetry and prostate size, a single institution study

OBJECTIVE@#To correlate male lower urinary tract symptoms between age, quality of life scores,parameters of uroflowmetry and prostate size.@*PATIENTS AND METHODS@#Two hundred eight males were included in this study. Uroflowmetry parameters,age, International Prostate Symptom Score (IPSS), Quality of Life (QoL) scores and prostate sizewere gathered. For correlation, distribution of age, uroflowmetry parameters and prostate size werefirst compared to IPSS. Analysis of variance was used to compare age of patients, while Kruskall-wallis test was used to compare the QoL, uroflowmetry parameters, and prostate size on each IPSSgroups. Ordinal logistic regression analysis was used to correlate IPSS to age, quality of life,uroflowmetry parameters, and prostate size both for multivariate and univariate analysis.@*RESULTS@#There was no significant correlation between age and IPSS. However, on profile distribution,the age distribution between symptom scores were statistically similar. Qol scores were directlyproportional to IPSS. Thus, patients with a worse QoL score were more likely to have higher IPSS.Qmax scores decreased as symptom severity increased. Patients with higher Qmax scores are lesslikely to have higher IPSS scores. Voided volume was observed to decrease as IPSS severity increased,but this was not statistically significant. Patients with higher post void residual scores were morelikely to have higher IPSS. There was also no significant correlation between prostate size and IPSS.@*CONCLUSION@#There were no significant correlation between IPSS and age, voided volume and prostatesize. On the other hand, patients with a worse QoL score and a high post void residual had higherIPSS. Patients with a high Qmax, are less likely to have an elevated IPSS.

Relación entre IPSS y uroflujometría en pacientes con síntomas urinarios / Relationship between IPSS and Uroflowmetry in Patients with Urinary Symptoms

Introducción Los cuestionarios clínicos para los síntomas urinarios se diseñaron para objetivar los síntomas urinarios y de esa forma evitar estudios invasivos y costosos, con la división entre síntomas urinarios de vaciado y llenado, sin embargo, los pacientes presentan síntomas que hacen difícil el discernimiento entre obstrucción infravesical, detrusor hipocontractil o incluso detrusor hiperactivo. Determinar la correlación entre la uroflujometría y la severidad de los síntomas usando el IPSS (International Prostate Symptom Score) en pacientes síntomas urinarios, comparados con urodinamia y determinar su correlación con el diagnostico de obstrucción infravesical, detrusor hipocontráctil o detrusor hipocontráctil Métodos Estudio retrospectivo en el cual se recolectaron 27 hombres que consultaron por síntomas urinarios de vaciado y asistieron al Hospital Universitario de la Samaritana en Bogotá, Colombia entre abril del 2016 y abril del 2017. El IPSS se realizó a todos los pacientes con el cuestionario autoadministrado. Adicionalmente se realizó uroflujometría y urodinamia con el equipo de urodinámia Medical Measurement System SN077116. Resultados La edad promedio fue 67,26 años (37­86), IPSS leve del 22%, moderado 59% y severo 19%, con patrones de uroflujometricos campana 26%, meseta 41% intermitente 33%, el 37% presentaron un Qmax menor del 10%, el cual se consideró obstructivo y una PdetQmax menor de 40, en un 37%, lo cual es congruente con los resultados de la uroflujometria, además de relacionarse con residuo postmiccional elevado. Conclusión Existe una correlación entre el IPSS y el Qmax, comparado con patrones urodinámicos, la utilización de los índices como métodos no invasivos para el ahorro de costos si es comparable con hallazgos urodinámicos. Sin embargo, existe un porcentaje no despreciable de pacientes con Qmax menor de 10 que no corresponden a obstrucción infravesical. Es necesario tener en cuenta que hasta el 23% de los pacientes pueden presentar IPSS moderado o severo sin que el origen sea obstructivo.

Introduction Clinical questionnaires for urinary symptoms were designed to perform an objective evaluation of urinary symptoms and thus avoid invasive and expensive studies. However, patients present symptoms that make difficult the discernment between infravesical obstruction and hypocontractile detrusor. The aim of this study is to determine the correlation between uroflowmetry and symptom severity using the IPSS (International Prostate Symptom Score) in patients with urinary symptoms, compared with urodynamics and to determine its correlation with the diagnosis of infra-vesical obstruction or hypocontractile detrusor. Methods Observational retrospective study in which the clinical records of the patients who consulted for urinary emptying symptoms at La Samaritana University Hospital in Bogotá, Colombia, between April 2016 and April 2017 were reviewed. The IPSS was performed in all patients. Additionally, uroflowmetry and urodynamics were documented with the Medical Measurement System SN077116. Results A total of 27 patients were included in the study. The average age was 67.26 years. The mild IPSS was found in 22% of the patients, moderate 59% and severe 19%. Patterns were identified in uroflowmetry with bell curves in 26% of patients, plateau 41% and intermittent in 33%. 37% of the patients had a Qmax lower than 10 mL/s which was considered obstructive and a PdetQmax less than 40 cm H2O in 37%, which is consistent with the results of uroflowmetry, in addition to being related to high postvoid residual volume. Conclusion There is a correlation between IPSS and Qmax associated with urodynamic patterns. The use of indices as non-invasive methods to reduce costs is comparable with the urodynamic findings; however, there is a non-negligible percentage of patients with Qmax less than 10 mL/s who do not correspond to infravesical obstruction. It is necessary to take into account that up to 23% of patients can have moderate or severe IPSS without the origin of the symptoms being obstructive.

A Clinical Study On Effect Of Gokshura Kwatha In The Management Of Mutraghata W. S. R. To B.p.h

Introduction: 慚utraghata� can be equated with group of obstructive uropathic disorders. As explained in Sushrutha Samhitha, it is of 12 types and 慥atasthila� is one among them, which is closely similar to Benign Prostatic Hyperplasia. BPH is a progressive disease of advancing age. Histologically the inner zone of the periurethral gland undergoes hypertrophy and an adenoma is formed. Usually men around 60 years, suffer from mild, moderate and severe grade of BPH. Objectives: To evaluate the efficacy of Gokshura kwatha in the management of Mutragatha/ B.P.H. and to improve quality of life of BPH sufferer. Method: It is a single blind, clinical study on diagnosed cases of B.P.H, Gokshura kwatha was given for 60 days (20ml BD) with Sita and honey with follow-up of 4 months. Changes in subjective criteria (by IPSS Index) and objective criteria (by USG) were recorded before and after treatment. Result: Gokshurakwatha shown more significant relief on associated symptoms of Mutraghata including, burning sensation, painful micturition, pus and blood discharge etc. Interpretation: On the basis of the beneficial effects of Gokshura kwatha churna, it can be opined that it gives good result symptomatically. Conclusion: The subjective features were relieved significantly. But observed, no much difference in the objective criteria. The effect of Gokshurakwatha on the straining significantly reduced, prostate size has not reduced significantly. As for follow up period, relief of symptoms observed to be sustained up to one month in majority of patients.

Relationship Between Grades Of Prostatomegaly On Dre And Prostate Volume On Sonography With Lower Urinary Tract Symptoms: To Believe Your Finger Or The Ultrasound Probe!!!

Elderly men presenting with Lower Urinary Tract Symptoms (LUTS) constitutes around a third of urological practice with prevalence as high as 10-41 % in men older than 40 years. Its adverse impact on the Quality of Life (QoL) makes it imperative for the clinician to guide therapy based on sound diagnostic principles. Clinical evaluation of LUTS secondary to BPH involves International Prostate Symptom Score (IPSS) assessment, digital rectal examination (DRE), urodynamics and sonological evaluation of prostate. Our study aims to correlate the grades of prostatomegaly on DRE and prostate volume on sonography with LUTS assessed by IPSS in elderly males.

Relationship between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with urinary tract symptoms

ABSTRACT Objective: To evaluate correlation between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with lower urinary tract symptoms. Material and Methods: This is a cross sectional study conducted at a university Hospital. Sixty-seven adult male patients>50 years of age were enrolled in the study after signing an informed consent. Qmax and voided volume recorded at uroflowmetry graph and at the same time VPSS were assessed. The education level was assessed in various defined groups. Pearson correlation coefficient was computed for VPSS and Qmax. Results: Mean age was 66.1±10.1 years (median 68). The mean voided volume on uroflowmetry was 268±160mL (median 208) and the mean Qmax was 9.6±4.96mLs/sec (median 9.0). The mean VPSS score was 11.4±2.72 (11.0). In the univariate linear regression analysis there was strong negative (Pearson's) correlation between VPSS and Qmax (r=848, p<0.001). In the multiple linear regression analyses there was a significant correlation between VPSS and Qmax (β-http://www.blogapaixonadosporviagens.com.br/p/caribe.html after adjusting the effect of age, voided volume (V.V) and level of education. Multiple linear regression analysis done for independent variables and results showed that there was no significant correlation between the VPSS and independent factors including age (p=0.27), LOE (p=0.941) and V.V (p=0.082). Conclusion: There is a significant negative correlation between VPSS and Qmax. The VPSS can be used in lieu of IPSS score. Men even with limited educational background can complete VPSS without assistance.

Clinical Observation of Fire-needle Acupuncture for Benign Prostatic Hyperplasia / 上海针灸杂志

Objective To observe the therapeutic efficacy of fire-needle acupuncture in treating benign prostatic hyperplasia. Method Sixty subjects were randomized into two groups by using the sealed envelope method. The control group was intervened by conventional medications; after classified into four syndrome types, down diffusion of damp-heat, liver qi stagnation, turbid stagnation and kidney qi deficiency, the treatment group was majorly treated with fire-needle acupuncture in addition to filiform-needle acupuncture. Fire-needle acupuncture was performed at Guanyuan (CV4), Qugu (CV2) and bilateral Dahe (KI12), once a week, for continuous 6 months; the filiform-needle acupuncture was majorly at Baihui (GV20) and Qihai (CV6) with adjunctive points modified according to different syndromes, twice a week, 8 sessions as a treatment course, for 5 courses in total. Result The improved rate was significantly higher in the treatment group than in the control group (P<0.05);the residual urine volume was significantly changed after the intervention in both groups (P<0.01), and the decrease in the treatment group was more significant than that in the control group (P<0.05). Conclusion Fire-needle acupuncture can improve the symptoms of benign prostatic hyperplasia and lower the residual urine volume.

Clinical Observation of Acupuncture plus Moxibustion for Prostatic Hyperplasia / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture plus moxibustion in the treatment of benign prostatic hyperplasia.Method Sixty cases of benign prostatic hyperplasia were randomly divided into two groups, 30 cases in the treatment group, 30 cases in the control group. The treatment group was intervened by Acupuncture and moxibustion, while the control group was by orally takingJingzhu Qianlie Longbitong capsules. The International Prostate Symptom Score (IPSS), Quality of Life score (QOL), maximal urinary flow rate (Qmax), residual urine volume (RUV) were compared before and after 3 courses of treatment. Result The total effective rate was 93.3% in the treatment group, versus 66.7% in the control group, and the difference was statistically significant (P<0.05); the IPSS score, QOL score, Qmax, and RUV were significantly changed in both groups after intervention (P<0.05).Conclusion The treatment group and the control group both show improvements in IPSS, QOL score and Qmax and reduction of RUV, which proves that acupuncture plus moxibustion can produce a content efficacy in treating benign prostatic hyperplasia.

Prostate-Specific Antigen testing in men between 40 and 70 years in Brazil: database from a check-up program

Objectives To evaluate the PSA in a large population of Brazilian men undergone to check up, and correlate the PSA cutoffs with prostate size and urinary symptoms. Materials and Methods This is a cross sectional study performed with men between 40 and 70 years undergone to check-up. All men were undergone to urological evaluation, digital rectal examination, prostate-specific antigen, and ultrasonography The exclusion criteria were men who used testosterone in the last six months, or who were using 5 alpha-reductase inhibitors. Results A total of 5015 men with an average age of 49.0 years completed the study. Most men were white and asymptomatic. The PSA in the three different aging groups were 0.9 ± 0.7ng/dL for men between 40 and 50; 1.2 ± 0.5ng/dL for men between 50 and 60; and 1.7 ± 1.5ng/dL for men greater than 60 years (p=0.001). A total of 192 men had PSA between 2.5 and 4ng/ml. From these men 130 were undergone to prostate biopsy. The predictive positive value of biopsy was 25% (32/130). In the same way, 100 patients had PSA >4ng/mL. From these men, 80 were undergone to prostate biopsy. In this group, the predictive positive value of biopsy was 40% (32/100). The Gleason score was 6 in 19 men (60%), 7 in 10 men (31%) and 8 in 3 men (9%). Conclusions The PSA level of Brazilian men undergone to check up was low. There was a positive correlation with aging, IPSS and prostate size. .

Primary myelofibrosis: risk stratification by IPSS identifies patients with poor clinical outcome

OBJECTIVES: To evaluate whether risk scores used to classify patients with primary myelofibrosis and JAK-2 V617F mutation status can predict clinical outcome. METHODS: A review of clinical and laboratory data from 74 patients with primary myelofibrosis diagnosed between 1992 and 2011. The IPSS and Lille scores were calculated for risk stratification and correlated with overall survival. RESULTS: A V617F JAK2 mutation was detected in 32 cases (47%), with no significant correlation with overall survival. The patients were classified according to the scores: Lille - low, 53 (73.%); intermediate, 13 (18%); and high, 5 (7%); and IPSS- low, 15 (26%); intermediate-1, 23 (32%); intermediate-2, 19 (26%); and high, 15 (31%). Those patients presenting a higher risk according to the IPSS (high and intermediate-2) had a significantly shorter overall survival relative to the low risk groups (intermediate-1 and low) (p = 0.02). CONCLUSIONS: These results emphasize the importance of the IPSS prognostic score for risk assessment in predicting the clinical outcome of primary myelofibrosis patients.

Analysis of Lower Urinary Tract Symptoms Associated with Prostate Findings in Occupational Taxi Drivers and Office Workers in Uijeongbu, Korea

PUROPOSE: To analyze lower urinary tract symptoms associated with prostate findings in occupational taxi drivers compared to office workers in Uijeongbu, Korea. MATERIAL AND METHODS: A population-based cross-sectional survey was conducted among drivers and office workers in Uijeongbu, Korea. All participants filled out the International Prostate Symptom Score (IPSS) questionnaire and the age, career, height and body weight were also recorded. They had uroflowmetry (UFM), transrectal ultrasound (TRUS) and prostatic cancer screening testing (PSA). We evaluated the parameters and compared them between the two groups. RESULTS: There was no significant difference in age, career and BMI between the two groups (p<0.01). For each group, the IPSS was closely related to the maximal flow rate (Qmax) (p<0.01). The mean value of the IPSS was 13.53+/-7.70 in the taxi drivers and 9.71+/-5.72 in office workers; therefore, the IPSSs showed a difference between the two groups (p=0.041). However, there were no significant differences among the other parameters between two groups. The value of Qmax was not significantly different in the comparisons between the two groups (p=0.973). CONCLUSIONS: Although the IPSS in taxi drivers was higher than in office workers, the objective parameters studied were not significantly different between the two groups. Therefore, there was no clinical evidence of higher morbidity associated with prostate abnormalities in taxi drivers compared to office workers.

The role of bilateral inferior petrosal sinus sampling in the diagnosis of Cushing's syndrome

Adrenocorticotropin hormone (ACTH)-dependent Cushing's syndrome is most often due to a pituitary corticotroph adenoma, with ectopic ACTH-secreting tumors representing approximately 15 percent of cases. Biochemical and radiological techniques have been established to help distinguish between these two entities, and thus aid in the localization of the neoplastic lesion for surgical resection. The test that offers the highest sensitivity and specificity is bilateral inferior petrosal sinus sampling (BIPSS). BIPSS is an interventional radiology procedure in which ACTH levels obtained from venous drainage very near the pituitary gland are compared to peripheral blood levels before and after corticotropin hormone (CRH) stimulation. A gradient between these two locations indicates pituitary Cushing's, whereas the absence of a gradient suggests ectopic Cushing's. Accurate BIPSS results require hypercortisolemia to suppress normal corticotroph ACTH production and hypercortisolemia at the time of the BIPSS to assure excessive ACTH secretion. In some cases, intrapituitary gradients from side-to-side can be helpful to localize small corticotroph adenomas within the sella. BIPSS has rare complications and is considered safe when performed at centers with experience in this specialized technique.

A síndrome de Cushing (SC) ACTH-dependente é mais freqüentemente devida a um adenoma corticotrófico da hipófise, com os tumores ectópicos secretores de ACTH representando aproximadamente 15 por cento dos casos. Técnicas bioquímicas e radiológicas foram estabelecidas para permitir a distinção entre essas duas entidades e, assim, auxiliar na localização da lesão neoplásica para ressecção cirúrgica. O teste que oferece a mais alta sensibilidade e especificidade é a coleta bilateral de amostras de sangue do seio petroso inferior (BIPSS). BIPSS é um procedimento de intervenção radiológica no qual os níveis de ACTH obtidos da drenagem venosa bem próxima da hipófise são comparados com os níveis sanguíneos periféricos antes e após estímulo com corticorrelina (CRH). Um gradiente entre essas duas localizações indica SC hipofisário, enquanto a ausência de gradiente sugere SC ectópica. Resultados acurados na BIPSS requerem a presença de hipercortisolemia e que ela suprima normalmente a produção de ACTH pelo corticotrofos por ocasião da BIPSS para garantir a secreção excessiva de ACTH. Em alguns casos, os gradientes intra-hipofisários de um lado para outro podem ser úteis na localização de pequenos adenomas corticotróficos no interior da sela. A BIPSS raramente apresenta complicações, sendo considerada segura quando realizada em centros com experiência nessa técnica especializada.

Assessment of Sexual and Voiding Function after Total Mesorectal Excision with Pelvic Autonomic Nerve Preservation in Male Rectal Cancer Patients

PURPOSE: The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function. METHODS: We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68 male rectal cancer patients. RESULTS: There were significant differences of mean maximal flow rate and voided volume before and after surgery (18.9+/-5.7 vs 13.7+/-7.0, 240+/-91.9 vs 143+/-78, P0.05). The total IPSS (International Prostate Symptom Score) was increased after surgery from 6.2+/-5.8 to 9.8+/-5.9 (P<0.05). There were no changes of score for one of each seven IPSS items in from 49 patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically decreased after surgery (18.2+/-9.3 vs 13.5+/-9.0, 8.4+/-4.2 vs. 4.4+/-2.9, 5.8+/-2.9, vs. 4.4+/-2.9, 6.1+/-2.4 vs. 4.8+/-2.0, 6.1+/-2.2 vs. 4.5+/-2.3, P<0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were markedly decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 months (erectile function: P=0.04, intercourse satisfaction: P=0.011, orgasmic function: P=0.03), lower rectal cancer (erectile function: P=0.02, intercourse satisfaction: P=0.036, orgasmic function: P=0.027) were significant factors. CONCLUSIONS: TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and sexual function.

Survey of lower urinary tract symptoms in 2811 men in Wuhan City / 中华泌尿外科杂志

Objective To assess the prevalence and presentation of low urinary tract symptoms (LUTS) in Chinese men. Methods A random sample was obtained from men dwelling at communities,factories,institutions and colleges in a district in Wuhan City.By completion of the questionnaire and exclusion of individuals with operation and trauma history,2811 men (age range,20～82 years) were assigned into 6 groups according to 10-year age stratum.Frequency of symptoms and severity of discomfort were assessed using the International Prostate Symptom Score (IPSS). Results The 2811 men accounted for 71.7% of the surveyed population. The occurrence of LUTS was as follows.In 20～29 year group,only 5 (0.6%) of 798 men had mild LUTS (IPSS,1～7).In 30～39 year group,55 (12.1%) of 453 men had mild LUTS.In 40～49 year group,143 (26.6%) of 537 men had LUTS;of them 118 were of mild LUTS,20 of moderate (IPSS,8～19),5 of severe (IPSS,20～35).In 50～59 year group,244 (52.5%) of 465 men had LUTS;of them 109 were of mild,117 of moderate,18 of severe.In 60～69 year group,240 (65.6%) of 366 men had LUTS;of them 78 were of mild,138 of moderate,24 of severe.In≥70 year group,162 (84.4%) of 192 men had LUTS;of them 47 were of mild,68 of moderate,47 of severe.Differences between age groups in incidence rates of LUTS were significant (?2=998.385,P

Effects of Hormones and Age on Prostate Volume and Symptom Score in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Although benign prostatic hyperplasia (BPH) has been shown to increase with age and be influenced by sex hormones, the relationship between aging and hormonal influences on growth of prostate is still unresolved. We studied the relationship of age and androgen on volume of prostate and symptoms of benign prostatic hyperplasia. MATERIALS AND METHODS: Two hundred and ten men with BPH were evaluated using transrectal ultrasonography, and international prostate symptom score for BPH. In all patients, the following parameters were obtained by serum analysis: prostate-specific antigen (PSA), luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone, free testosterone, dihydrotestosterone (DHT) and prolactin. RESULTS: With age, there was a significant increase in the prostate volume, serum LH, FSH, and PSA, and a significant decrease in serum free testosterone. However, prostate volume and IPSS were not correlated with measured serum hormones. CONCLUSIONS: Our data do not suggest that testosterone act on the development of BPH and lower urinary tract symptoms. However, because the levels of circulating hormones do not necessarily reflect their intraprostatic concentrations, molecular biologic studies and prospective clinical studies may be needed to establish the linkage between hormones levels and BPH.

Correlation of Lower Urinary Tract Symptoms with Prostate Volume Parameters including Resistive Index and Presumed Circle Area Ratio in the Evaluation of Benign Prostatic Hyperplasia

PURPOSE: Prostate volume has been known to be poorly correlated with various parameters used to assess the severity of benign prostatic hyperplasia (BPH). However, recently there were reports that the ratio between transition zone(TZ) volume and prostate volume, which termed the TZ index might served as a useful proxy for evaluating worsening obstruction. The purpose of this study was to determine if transrectal ultrasound(TRUS) measurement of RI(resistive index), PCAR (presumed circle area ratio) correlate with the parameters of prostate volume(total prostate volume, TZ volume, TZ index), Qmax, international prostate symptom score(IPSS) or age. This study was conducted to reveal the relative effects of ultrasonic appearance of BPH on urinary symptoms. MATERIALS AND METHODS: A total of 81 men aged 50 to 89 years with moderate symptom of BPH(IPSS> or =8) underwent measurement of RI, PCAR, total prostate and TZ volume at transrectal ultrasonography. All men were requested to undergo uroflowmetry and complete the IPSS. The IPSS was compared to age, Qmax, prostatic volume, RI and PCAR using simple and multiple regression analysis. RESULTS: Simple regression analysis demonstrated that IPSS correlated with age(r=0.050, p<0.05), Qmax(r=0.253, p<0.05), TV(r=0.096, p<0.05) and PCAR(r=0.266, p<0.05). However, multiple regression analysis showed that age, Qmax and PCAR were significant independent determinants of the IPSS. CONCLUSIONS: As a parameter representing the degree of BPH in terms of the severity of lower urinary symptoms, simple and multiple regression analysis confirmed that the IPSS was influenced considerably by age, peak flow rate and PCAR.