Primary development of visual uroflow scale / 北京大学学报(医学版)

OBJECTIVE@#To develop the visual uroflow scale (VUS), analyze the relationship of VUS score and index of free uroflowmetry, assess urination function preliminarily and improve the work efficiency in the clinic.@*METHODS@#Male lower urinary tract symptoms (LUTS) patients, who attended the Department of Urology in Peking University People's Hospital from March 2016 to March 2017, were assessed for their urination function according to the Visual Uroflow Scale without help from clinicians before undertaking a free uroflowmetry test. And afterwards, a free uroflowmetry was undertaken, and variables including maximal flow rate (Qmax), the average flow rate (Qave) and voiding volume (VV) was obtained. During the study, 124 cases were collected and 53 cases met the inclusion and exclusion criteria and were included in the study cohort. The Spearman correlation analysis was used for analyzing the correlation of VUS scores with free uroflowmetry variables and age. The validity of VUS was evaluated.@*RESULTS@#Most of the patients could choose the very figure matched with self-condition by first instinct without any help from the clinician. The data were analyzed by Spearman correlation analysis. In the present study, voiding time was positively correlated with the VUS score (correlation coefficient, 0.62, P < 0.05). In the present cohort, the patients chose the third and fourth figures to take longer time to urinate, implying worse LUTS situation. Flow time and VUS scores were positively correlated (correlation coefficient, 0.61, P < 0.05). The patients with higher VUS scores would spend more time on urinate, no matter how long urinary hesitation was. Both Qmax and Qave were negatively correlated with the VUS score (correlation coefficient －0.54, －0.62, P < 0.05). The study illustrated that the VUS score suggested that the Qmax basically and further reflected the urination function. And its relationship to age revealed the decreased urination function of aging male, which had reached a consensus.@*CONCLUSION@#Development of VUS has helped the clinician assess the urination function preliminarily at the first time. Patients are assessed for a VUS score before getting surgery or receiving the drug for treatment, and can be re-assessed after. The VUS score can provide an objective quantitative basis to evaluate the treatment efficacy. In addition, considering that it is convenient, timesaving and easy to understand, the VUS is available for follow-up.

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

Patient-reported ejaculatory function and satisfaction in men with lower urinary tract symptoms/benign prostatic hyperplasia / 亚洲男科学杂志(英文版)

This study aimed to investigate perceived ejaculatory function/satisfaction before treatment for lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and to identify associations between specific categories of ejaculatory dysfunctions (EjDs) and LUTS. A total of 1574 treatment-naïve men with LUTS/BPH were included in this study. All patients underwent routine evaluation for LUTS/BPH including the International Index of Erectile Function and a 5-item questionnaire developed to assess ejaculatory volume/force/pain/satisfaction/latency time. Patients who had sexual intercourse over the past 4 weeks were classified as sexually active group. A total of 783 patients were categorized as sexually active group. Decreased ejaculatory volume and force were reported by 53.4% and 55.7% of 783 sexually active men, respectively. There was a strong correlation between ejaculatory volume and force. Ejaculatory pain/discomfort, premature ejaculation (PE), and delayed ejaculation (DE) were reported in 41.0%, 16.3%, and 41.4% of the patients, respectively. Over 40.0% of men without decreased ejaculation volume/force were satisfied with ejaculatory function, whereas approximately 6.0% of men with decreased volume/force were satisfied with ejaculatory function. About 30.0% of men with decreased volume/force had orgasmic dysfunction, while approximately 10.0% of men without decreased volume/force did. Decreased ejaculatory volume or force was associated with LUTS severity after adjusting for other influential factors including testosterone level, erectile function, and prostate size on ultrasonography, but PE or DE or ejaculatory pain/discomfort was not. In conclusion, a considerable portion of men with LUTS/BPH appear to have a variety of EjDs. Ejaculatory volume/force and satisfaction/orgasm do not always appear to be concordant. Ejaculatory volume or force is independently associated with LUTS severity, whereas PE or DE or ejaculatory pain/discomfort is not.

Alpha antiadrenergic effect of Achyrocline bogotensis extract ("Vira Vira") in isolated rat aortic ring / Efecto antiadrenérgico alfa del extracto de Achyrocline bogotensis ("Vira Vira") en anillos aislados de aorta de rata

The treatment of symptoms of prostatic hyperplasia is among the traditional uses of Achyrocline bogotensis (Kunth) [N.V. "Vira Vira", Compositae] in Colombia. Pharmacological therapy for this disorder depends mainly on alpha-1 antiadrenergic agents, and the mechanism has not been studied previously using A. bogotensis. Objectives: To assess the alpha-1 antiadrenergic effect of the extract obtained from the aerial parts of A. bogotensis in isolated aortic rings from Wistar rats. Methods: The study compared the effects of the ethanol extract of A. bogotensis, prazosin (reference) and DMSO (control) in rings stimulated with phenylephrine (PE) or KCl. The capacity to reduce the PE pressor effect by the ethanol extract (pD2' value) was determined. To quantify the A. bogotensis relaxant potency, increasing concentrations of the ethanol extract (0.1 µg/mL-0.1 mg/mL), were added cumulatively to isolated aortic rings pre-contracted with PE (0.1 µM) or KCl (80 mM). To explore the possible participation of nitric oxide (NO), L-NAME (100 µM) was administered to aortic rings exposed to cumulatively increasing concentrations of PE in isolated aortic rings in the presence of the extract (10 µg/mL). Aqueous, butanol and dichloromethane fractions (10 µg/mL) obtained from the ethanol extract were assayed. Phytochemical screening was also performed. Results: Prazosin and A. bogotensis extract notably reduced the contraction induced by PE whereas their inhibitory effect in rings contracted with KCl were lower. A. bogotensis ethanol extract showed a high capacity for reducing the PE pressor response (pD´2: 5.51) as well as total efficacy for relaxing rings previously precontracted with PE. The relaxant efficacy and potency of A. bogotensis extract against rings previously contracted with KCl were notably lower. L-NAME partly reverted the inhibitory effect of A. bogotensis. Aqueous, butanol and dichloromethane fractions gave inhibitory responses lower than that obtained with the ethanol extract. Phytochemical screening of A. bogotensis extract revealed the significant presence of flavonoid and triterpene metabolites. Conclusions: These results suggest that A. bogotensis elicits a smooth muscle relaxant effect related to the alpha-1 antiadrenergic mechanism. This response is partially NO dependent and seems to be due to interactions among active metabolites likely to be of flavonoid and/or terpenoid nature.

Antecedentes: Uno de los usos tradicionales de la especie Achyrocline bogotensis (Kunth) [N.V. "Vira Vira", Compositae] en Colombia es el tratamiento de los síntomas de la hiperplasia prostática benigna. La terapia farmacológica de este trastorno se basa principalmente en el uso de agentes que ejercen efecto anti-adrenérgico alfa-1, mecanismo no estudiado previamente en esta especie. Objetivos: Evaluar el efecto anti-adrenérgico alfa-1 del extracto de la especie Achyrocline bogotensis (Kunth) en anillos aislados de aorta de ratas Wistar. Métodos: Se comparó el efecto del extracto etanólico de A. bogotensis, prazosin (patrón) y DMSO (control) en anillos aislados de aorta de ratas Wistar estimulados con fenilefrina (PE) o KCl. Se determinó la capacidad del extracto etanólico de A. bogotensis para reducir el efecto contráctil inducido por PE (pD'2 ). Se cuantificó la potencia relajante del extracto etanólico de A. bogotensis (0.1 µg/ mL - 0.1 mg/mL) en anillos de aorta previamente contraídos con PE (0.1 µM) o KCl (80 mM). Se exploró la posible participación del óxido nítrico (NO), administrando L-NAME (100 µM) en anillos de aorta expuestos a concentraciones acumulativas de PE en presencia del extracto etanólico (10 µg/mL). También se comparó el efecto de las fracciones acuosa, butanólica y diclometanólica (10 µg/mL), obtenidas del extracto etanólico, en anillos estimulados con PE. Además, se efectuó un tamizado fitoquímico del extracto. Resultados: Prazosin y el extracto de A. bogotensis redujeron notablemente el efecto de PE mientras su efecto inhibitorio sobre la contracción inducida por KCl fue menor. El extracto etanólico mostró una ostensible capacidad para reducir el efecto contráctil inducido por PE (pD2 ´: 5.51) así como una eficacia total para relajar anillos previamente contraídos con PE. La potencia y eficacia de relajación del extracto de A. bogotensis frente a anillos previamente contraídos con KCl fue notablemente menor. L-NAME revirtió parcialmente el efecto inhibitorio del extracto de A. bogotensis. Las fracciones acuosa, butanólica y diclorometanólica arrojaron respuestas inhibitorias menores que las inducidas por el extracto etanólico. El tamizado fitoquímico del extracto de A. bogotensis mostró la presencia de metabolitos de naturaleza flavonoide y terponoide. Conclusiones: Estos resultados muestran que la especie A. bogotensis ejerce efectos relajantes sobre el músculo liso vinculados con mecanismos de tipo antiadrenérgico alfa-1. Esta respuesta depende en parte de la presencia de NO y parece deberse a la interacción de metabolitos de naturaleza flavonoide y/o terpenoide.

Role of Phosphodiesterase Type 5 Inhibitor on Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms / 대한남성과학회지

There is strong evidence from multiple epidemiological studies that benign prostate hyperplasia (BPH) induced lower urinary tract symptoms (LUTS) are correlated with erectile dysfunction (ED). Although a direct causal relationship is not established yet, four pathophysiological mechanisms can explain the relationship. These include alteration in activity of nitric oxide (NO)-cyclic GMP signal pathway, autonomic hyperactivity, increased Rho kinase/Rho A pathway and pelvic atherosclerosis. Androgens have been suggested to have an important role in the maintenance of the functional and structural integrity of the urinary tract. Sexual function should be assessed and discussed with the patient when choosing the appropriate management strategy for LUTS, as well as when evaluating the patient's response to treatment. Multiple large clinical trials have shown an improvement in LUTS after phosphodiesterase-5 (PDE5)-inhibitor treatment. Sildenafil is a pioneer of this clinical trial and appears to improve both erectile function and LUTS in subjects with ED. Basically PDE5 I with long half life is an appropriate candidate, therefore tadalafil and undenafil had been used to evaluate both diseases. Placebo-controlled trials of tadalafil showed improvement of LUTS secondary to BPH, but none of the studies showed a significant effect on urodynamic measures. PDE5 Is, such as sildenafil and tadalafil, increase the concentration of cGMP in plasma and smooth muscle, facilitating erection of the penis, relaxation of the bladder neck and prostate and subsequent bladder emptying. And theses PDE5 Is increase cAMP and cGMP levels and are more highly distributed in the prostate than plasma. These findings may help in the assessment of the feasibility of using PDE5 Is to concurrently treat both LUTS and ED.

Association between Lower Urinary Tract Symptoms and Erectile Dysfunction / 대한비뇨기과학회지

PURPOSE: The aim of this study was to assess whether there was an association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men. MATERIALS AND METHODS: 79 patients who had LUTS, between January 2002 and July 2004, were randomly retrospectively analyzed. LUTS and ED were assessed by validated symptom scales, including the International Prostate Symptom Score (IPSS), the Danish Prostate Symptom Score1 (DAN-PSS1) and the International Index of Erectile Function (IIEF). The patients were divided into three group according to age; younger than 60 (group I), 60 to 69 (group II), and 70 years or older (group III). RESULTS: The mean age was 62.6+/-9.19 years. Prevalence rate of mild, moderate and severe LUTS were 12.9, 67.7 and 19.4% in group I, 8.3, 58.3 and 33.4% in group II, and 16.6, 54.2 and 29.2% in group III, respectively. The mean IIEF scores by IPSS according to the severity were 39.8, 38.4 and 28.7 in group I and 54.5, 39.8, and 24.3 in group II and 29.5, 16.5 and 15.6 in group III, retrospectively. In each group, the IIEF score decreased with increasing IPSS, LUTS was also shown to be statistically significantly correlated with the presence of ED (p=0.028). No statistical significance was found between the IPSS and DAN-PSS1 (p=0.740). CONCLUSIONS: These results suggested that ED was highly prevalent among patients with LUTS, and erectile function should be evaluated in the patients with LUTS for the management of ED and to improve the quality of life of these patients.

Comparison of Lower Urinary Tract Symptoms and Urodynamic Study in BPH Patients with or without Prostatitis / 대한비뇨기과학회지

PURPOSE: Benign prostatic hyperplasia (BPH) and prostatitis may present similar clinical manifestations, although the severity of their symptoms is different. The differences between BPH patients with prostatitis and those without prostatitis were evaluated to help select appropriate therapeutic modalities and predict the prognosis. MATERIALS AND METHODS: 50 patients with BPH who were not associated with a neurogenic bladder, urethral stricture, diabetes, urinary tract infection or a previous prostate operation were studied. Of the 50 patients, 27 patients were free of prostatitis, and 23 patients had prostatitis. The mean ages of the two groups were 65.9+/-7.3 and 60+/-8.3 years, respectively. The evaluation was performed using the International Prostate Symptom Score (IPSS), uroflowmetry, the residual urine volume and urodynamic studies. Statistical analysis was performed using the Mann-Whitney test and the chi-square scales. RESULTS: According to the IPSS, the straining score was 4.3+/-1.0/3.2+/-1.8 (p<0.05) and the urgency score was 2.4+/- 1.9/3.8+/-1.1 (p<0.05) in BPH patients without or with prostatitis. In the L-PURR, grade 3 and higher, which indicated moderate to severe obstruction, was found in 10 patients with BPH alone (37.1%) and 6 patients with BPH associated with prostatitis (26.1%) (p<0.05). Detrusor instability was identified in 22% (6/27) of patients with BPH alone and 56.5% (13/23) of those with prostatitis (p<0.05). CONCLUSIONS: BPH patients associated with prostatitis had considerably more irritative symptoms, non-obstructive patterns and detrusor instability than those without prostatitis. These findings suggest that the relief of an obstruction by means of surgery alone should be reconsidered when treating BPH with prostatitis.

Epidemiologic Survey Using International Prostate Symptom Score (I-PSS) of Lower Urinary Tract Symptoms (LUTS) in Elderly Men Above 40 Years Old in Seoul Area / 대한비뇨기과학회지

PURPOSE: We tried to determine the prevalence of LUTS and to measure the impact of these symptoms on quality of life (QOL), and to reevaluate the validity of I-PSS in Korea. MATERIALS AND METHODS: A total of 1,356 men ranging from 40 to 79 years old living in Seoul metropolitan area was selected by stepwise random sampling and surveyed with questionnaire including I-PSS. Several risk factors were analyzed to assess the relevance with lower urinary tract symptoms. RESULTS: About 16% had moderate-to-severe LUTS, as assessed by I-PSS more than 7. The prevalence of moderate-to-severe LUTS increased significantly with age (p<0.01); 10%, 16%, 29%, and 45% in the age groups 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years respectively. The most prevalent symptoms were weak stream and nocturia. QOL decreased as urinary symptom severity increased; 5%, 52%, 78% of the men with I-PSS 0 to 7, 8 to 19, and 20 to 35 had poor QOL as assessed by QOL indices more than 2, respectively. A good correlation was found between the total symptom score and the quality of life score that was included in the I-PSS. CONCLUSIONS: Moderate to severe LUTS of elderly men above 40 years old in Seoul metropolitan area are relatively common, and more people suffer from the LUTS as they get older. New modified I-PSS system in Korean elderly men according to the importance of individual symptom in the established I-PSS, will be beneficial in the management of the lower tract symptom associated with BPH.