Labial fusion: A rare cause of obstructive lower urinary tract symptoms in old age females

Lower urinary tract symptoms in females can be due to various factors. Most of the time it is due to simple urinary tract infection and lower urinary tract pathology such as urethral stricture, meatal stenosis, bladder stones, underactive detrusor, and primary bladder neck obstruction. Commonly found neurologic causes among females are detrusor–external sphincter dyssynergia, associated with various brain and spine diseases and diabetic neuropathy. Labial fusion is a rare cause of female voiding difficulty. We herein present two elderly postmenopausal diabetic female patients who had nearly total urethral occlusion due to labial fusion. After thorough history taking and local genitourinary examination, the patients were operated. Treatment included surgical correction followed by the local application of 1% estrogen ointment. Both patients were symptom-free after the procedure. Thus, with a correct diagnosis followed by simple operative procedure, we can treat such patients successfully.

Comparative evaluation of cost-effectiveness of alpha blockers prescribed in patients with non-neurogenic lower urinary tract symptoms due to benign prostatic hyperplasia

Background: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is a common problem among aging men. Several classes of drugs are efficacious and safe, but the first-line treatment is with alpha-1 adrenergic blockers. They provide symptomatic relief and have to be taken for a longer duration to sustain the effect. The preferred alpha-blockers among the stockpile should be efficacious, tolerable, and also cost-effective. Aim and Objective: This study focuses to compare the cost-effectiveness of various alpha blockers prescribed in patients with LUTS-BPH. Materials and Methods: An observational study of 78 patients who were newly diagnosed with LUTS-BPH from April 2014 to May 2015 was conducted. Patients were followed up at 4 weeks and at 12 weeks after the drugs had been prescribed. Efficacy assessment was done on basis of change in International Prostate Symptom Score (IPSS) score over 12 weeks. Average cost-effectiveness ratio of different alpha-blockers prescribed was evaluated and compared with Mann-Whitney U test in order to find the most cost-effective alpha-blocker in the study. Results: All patients were prescribed alpha-blockers either alone or in combination with other drugs. Tamsulosin was prescribed to n = 46, Silodosin to n = 16 and Alfuzosin to n = 16. The efficacy in terms of Mean change in IPSS after 12 weeks of study was 11.34 ± 5.23 for Tamsulosin, 11.70 ± 5.9 for Silodosin and 10.87 ± 4.77 for Alfuzosin and average cost-effectiveness ratio was 108.74, 183.07 and 127.50 for Tamsulosin, Silodosin, and Alfuzosin, respectively. Conclusion: Tamsulosin was the most cost-effective drug among the prescribed alpha-blockers. Since all the prescribed alpha-blockers had comparable efficacy so we concluded that the most cost-effective drug should be preferred for long-duration treatment.

The efficacy and safety of prostatic urethral lift for benign prostatic hyperplasia: a systematic review and Meta-analysis / 中华泌尿外科杂志

Objective:The aim of this study was to evaluate the safety and efficacy of prostatistic urethral lift (PUL) in treating benign prostate hyperplasia(BPH) through systematic review and Meta-analysis.Methods:A systematic literature search on CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane Library and Chinese Clinical Trial Registry to identify the relevant studies and data before September 2021. Information was extracted from each eligible article. All statistical analyses of this Meta-analyses were performed with Review Manager 5.3 and Stata 15.0 software to conduct a Meta-analysis of the symptom improvement of BPH patients before and 3 months and 12 months after PUL. The main evaluation indicators included: International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q max), post-void residual (PVR), and Quality of Life Scale (QOL), Sexual Health Inventory for Men (SHIM). The complication rate of PUL was systematically evaluated. Results:A total of 12 clinical studies were included, and 850 patients accepted the PUL. The results showed that IPSS decreased significantly at both 3 and 24 months after PUL surgery ( MD = -11.77, 95% CI -12.47—-11.07, P<0.05; MD = -9.71, 95% CI-10.76—-8.66, P<0.05), Q max (ml/s) increased to a certain degree ( MD = 3.87, 95% CI 3.37—4.37, P<0.05; MD = 3.68, 95% CI 2.97—4.40, P<0.05), QOL decreased significantly ( MD=-2.57, 95% CI -2.76—-2.38, P<0.05; MD = -2.14, 95% CI -2.38—-2.91, P<0.05), SHIM score was unaffected ( P>0.05), compared with preoperative baseline data. PUL could be performed under local anesthesia, the main perioperative complications reported in the included studies were dysuria (17%±6%), hematuria (14%±5%) and pelvic pain (8%±6%), all of which were transient. Conclusions:PUL in the treatment of BPH has significant short-term and long-term efficacy with low surgical risk and complication rate, and can preserve normal ejaculation function. It is a safe and effective minimally invasive surgery, which can be used for BPH patients with intolerance to general anesthesia surgery or normal sexual function demand.

Evaluation of combination therapy with α and M receptors antagonist for the treatment of double J stents related lower urinary tract symptoms / 中国综合临床

Objective To evaluate the efficacy of combination therapy with α and M receptors antagonist for the treatment of double J stents related lower urinary tract symptoms.Methods From January 2013 to December 2016,one hundred and twenty patients were accepted the doubte J stents indwelling after the ureteral lithotripsy,laparoseopie ureterlithotomy and pyeloureteroplasty.They were divided into four groups randomly,including control group(30 cases,no drugs were taken),tamsulosin group(30 cases,0.2 mg tamsulosin was taken qd),solifenacin group(30 cases,5 mg solifenacin was taken qd),combination group(30 cases,0.2 mg tamsulosin and 5 mg solifenacin were taken qd).The IPSS scores,QOL scores and visual analogue pain scale(VAPS)scores were assessed pre-operation,1 week after operation,and 4 weeks after operation, respectively.Results The total IPSS scores in the combination group 4 weeks after operation was(8.21±2.36) points,compared with the control group((13.68 ± 3.65)points),the tamsulosin group((12.59 ± 3.76) points),the solifenacin group((12.39 ±4.58)points),the difference was statistically significantly lower(F=7.905,P<0.05).And 4 weeks after operation,the QOL scores in the combination group((1.52±0.99)points) was significantly lower than that in the control group((2.86±1.14)points),the tamsulosin group((2.69± 1.21)points)and the solifenacin group((2.74 ± 1.40)points)(F=13.725,P<0.05).While the VAPS scores didn′t show significant differences among those groups(P>0.05).Conclusion α and M receptors antagonist combination therapy can significantly improve lower urinary tract symptom due to indwelling double J stents.

Evaluation of combination therapy with M and α receptors antagonist for the treatment of double-J stent related lower urinary tract symptoms / 中华泌尿外科杂志

Objective To evaluate the efficacy of combination therapy with M and α receptors antagonist for the treatment of double-J stent related lower urinary tract symptoms.Methods From May 2013 to May 2014,131 cases,including 71 male and 60 female cases,were accepted the doubte-J stent indwelling after the ureteral lithotripsy,laparoscopic ureterlithotomy and pyeloureteroplasty.Their data was retrospectively reviewed.The age ranged from 29 to 64 years old,mean (47.4 ± 15.2) years old.They were divided into 4 groups randomly,including group A (control group,n =30),no drugs were taken;group B (tamsulosin group,n =34),0.2 mg tamsulosin was taken qd;group C (solifenacin group,n =32),5 mg solifenacin was taken qd;group D (tamsulosin combined with solifenacin group,n =35),0.2 mg tamsulosin and 5mg solifenacin were taken qd.The IPSS scores,QOL scores and visual analogue pain scale (VAPS) scores were assessed pre-operation,1 week after operation,and 4 weeks after operation,respectively.Results All patients were followed-up until the end of this study.In each time point,the IPSS scores in group A was 9.01 ± 2.79,13.18 ± 3.79 and 13.79 ± 3.76,respectively.In group B,the IPSS scores were 7.89 ± 4.29,12.39 ±3.90 and 12.21 ±3.87,respectively.In group C,the IPSS scores were 7.94 ±4.27,12.70 ±4.01 and 11.98 ±4.69,respectively.In group D,the IPSS scores were 8.21 ±3.18,11.97 ±5.03 and 8.17 ± 3.25,respectively.Significant difference in total IPSS scores and obstruction symptom scores were shown between pre-and post-operation (P ＜ 0.05).Comparing to other groups,group D exhibited the significant improvement in IPSS scores 1 and 4 weeks after the operation (P ＜0.05).4 weeks after operation,the QOL scores in group D was significantly lower than that in other groups (P ＜ 0.05).While the VAPS scores didn t show significant differences among those groups (P ＞ 0.05).Conclusion M and α receptors antagonist combination therapy can significantly improve lower urinary tract symptom due to indwelling double J stents.

Efficacy of Tadalafil n Lower Urinary Tract Symptoms of Patients with Ureteral Stents: A Study Protocol for a Randomized Controlled Trial.

Objectives: Ureteral stenting is a common intervention in endourological procedures. Despite the usefulness of stents, patients may experience various stent-related symptoms. These symptoms can have a significant impact on patients’ health related quality of life. There are several medical modalities for symptom improvement and Phosphodiesterase 5 Inhibitors are recent therapeutic option. This study is designed to evaluate the effects of Tadalafil on alleviation of stent associated symptoms measured by Ureteral Stents Symptom Questionnaire. Design: In this Randomized Controlled Trail patients were randomly assigned to an intervention or Placebo group by a computer based random block design. Patients received encoded drug packages from a central call system. Physicians, patients and statistical analyzers were not aware of the designated intervention. Setting and Conduct: Patients received treatment with Tadalafil or placebo for four weeks after ureteral stent insertion and completed a follow up session four weeks after the intervention. Participants: Male patients who underwent unilateral ureteral stenting in Imam Reza hospital in Tabriz, Iran were enrolled in this study. Patients with history of hypertension, heart and/or respiratory disease, stroke, hypotension, renal failure, consumption of nitrate drugs and a positive urine culture or who had any allergic reaction to Tadalafil were excluded. Interventions: Patients were allocated to receive Tadalafil 10 mg or Placebo daily for four weeks. Outcome Variables: The primary outcome variables were stent related symptoms (urinary symptoms, pain, general health, sex and working status). Secondary outcomes included possible side effects such as cardiovascular, respiratory, gastrointestinal, musculoskeletal and central nervous system problems.

Correlation of the quality of life and lower urinary tract symptoms in patients under intravesical chemotherapy / 中华泌尿外科杂志

Objective To evaluate the quality of life (QoL) in patients undergone intravesical chemotherapy for non-muscle invasive bladder cancer and analyze the correlation of the quality of life and low urinary tract symptoms in this group of patients.Methods 31 male patients and 15 female patients were enrolled from Jan.2012 to Mar.2013.The average age was 54 (35-71) years.Questionnaires of QoL and core lower urinary tract symptom score (CLSS) were given to 46 patients before intravesical chemotherapy and the 1 st,6th month after starting the instillation.Before the instillation,the scores of QoL and CLSS were 55.7±6.2 and 6.5±2.1,respectively,the change of QoL and CLSS were compared to baseline,and then the correlation of the low urinary tract symptoms and quality of life was analyzed.Results At the end of 1st and 6th month,the QoL scores were 74.7±8.1 and 78.5± 10.6.The CLSS scores were 8.9±2.0 and 9.1 ± 1.8,respectively.The differences were significant (P ＜0.05) when compared to the baselines.The areas of working activity and free time were affected much more than other areas,and the scores increased from 8.3±2.1 and 19.2±5.7 to 14.3±5.6 and 23.7±4.2,respectively.The area of free time was found to be associated with local symptoms (r=0.61).Conclusions Intravesical treatment can impair the QoL of patients.Low urinary tract symptom is an important factor and is associated with impairment of QoL,suggesting the relief of local symptoms may improve the overall quality of life.

Clinical value of urinary potassium measurement in ketamine-associated cystitis / 中华泌尿外科杂志

Objective To investigate the relationship of 24 h urinary potassium (K) measurement and the symptoms change in ketamine-associated cystitis.Methods Forty-three ketamine-associated cystitis patients (29 male cases,14 female cases) were analyzed.The average age was 22 (17-29) years.Thirty-two patients without indwelling urinary catheter were categorized as group A,while the other 11 patients with indwelling urinary catheter were in group B.The therapy regimes consisted of anti-inflammatory,antioxidant,relieving spasm and pain,improving the microcirculation and repairing the bladder epithelium barrier.Thirty healthy adults were selected as the controls.Urinary K,sodium (Na) and creatinine (Cr)were determined in 24 h urine samples from all patients and controls before and after treatments.24 h urinary Cr was used as the internal standard.24 h urinary K and Na concentrations of the patients were calculated as relative to the Cr concentrations.The pelvic pain and urgency/frequency symptom (PUF) was used for evaluation before and after the treatments.The differences of urinary K were compared within each group and between groups before and after treatments.In addition,relationship of urinary K and PUF were assessed.Results Urinary Cr concentrations in all groups were not significantly different (P ＞ 0.05).Patients in group A had lower average K-to-Cr ratios than those patients in group B and controls (A 1.80 ± 0.67 vs.B 6.22±0.92 mmolK/mmol Cr,P=0.0001; A 1.80±0.67 vs.controls 6.47 ±0.97 mmol K/mmol Cr,P =0.0001) before treatments.But the ratios of K-to-Cr in group A were not significantly different with group B and controls after treatments (A 6.23 ± 1.42 vs.B 6.02 ± 0.98 mmol K/mmol Cr,A 6.23 ± 1.42vs.controls 6.47 ±0.97 mmol K/mmol Cr,F =0.698,P =0.472).PUF in both groups was not significantly different before treatments.For group A,PUF was negatively correlated with urinary K before and after treatments (before: r=-0.637,P=0.0001; after: r=-0.427,P=0.015).For group B,PUF had no correlation with urinary K before treatment (r=0.581,P =0.188),while there was a negative correlation between them after treatments (r =-0.779,P =0.005).PUF scores in all patients (group A + B)were significantly decreased after treatments when compared to those before treatments (18.12 ± 2.83 vs.22.77 ± 3.63,P =0.0001).Conclusion Urinary potassium measurement may have a role in evaluating the disease status and efficacy of treatments of patients suffered from ketamine-associated cystitis.

Change of clinical and urodynamic parameters in the patients with lower urinary tract symptom caused by detrusor overactivity / 中华泌尿外科杂志

Objective To study the change of clinical and urodynamic parameters in the patients with lower urinary tract symptom (LUTS) caused by detrusor overactivity (DO). Methods Two hundred and twenty-seven patients with LUTS underwent clinical evaluation from October 2006 to December 2008, including Prostate Volume (PV), International Prostate Symptom Score (IPSS), Peak Flow rate (PF) and Residual Urine (RU) measurement. Pressure flow studies were performed. The detrusor overactivity was recorded to classify the patients into 2 groups, DO group and none DO group. The clinical and urodynamic parameters were compared between the two groups. Results Mean patient age was 70 years (range 52 to 89). According to the urodynamic results, there were 126 patients in DO group and 101 patients in none DO group. The mean patients age was older in DO group than the none DO group(P＜0.05). Adjusted by age, the PV, PF, and RU were no different between the two groups(P>0.05). The mean first sensation of bladder, bladder compliance, cystometric capacity, bladder outlet obstruction parameters, single voiding volume and max detrusor pressure during contraction were different between the two groups(P＜0.05). Conclusions The main risk factors of DO are the ageing and BOO. The non invasive parameters such as PV、 PF、 and RU could not be used to judge DO. The changes of urodynamic parameters caused by DO were hyperaesthesia of bladder、lower bladder compliance、 higher max detrusor pressure and lower max cystometric capacity. This study emphasis the importance of the urodynamic studies in the aged patients with LUTS.

The Efficacy and Safety of Tamsulosin 0.2mg/day on Sexual Function in BPH: A Multicenter Open-label, Non-comparative, 3 Months Observational, Phase IV Prospective Study / 대한남성과학회지

PURPOSE: The aim of this study was to assess the efficacy and safety of tamsulosin, 0.2mg/day on sexual function in Korean BPH patients. Patients and Methods: 116 patients (mean age: 60 yrs) with BPH were enrolled in this study and 0.2mg of tamsulosin was administrated every night for 3 months. Primary efficacy was evaluated with changes of IIEF and GEQ. Secondary efficacy parameters were changes of IPSS and QoL, uroflowmetry, changes of total IIEF and IIEF domain score according to the severity of IPSS, and retrograde ejaculation. RESULTS: Before treatment, patients of moderate IPSS (8-19) and severe IPSS (20-35) were 56% and 44% and QoL3 were 33.6% and 66.4%. In primary efficacy evaluation, total IIEF score was significantly increased from 37.0+/- 18.2 to 40.5+/- 18.9 (p<0.01). All domains of IIEF except orgasmic function were significantly improved. GEQ showed improvement of erection in 34.4% and intercourse ability in 30.1%. In secondary efficacy evaluation, IPSS was significantly decreased from 18.4+/- 6.9 to 12.9+/- 6.7 (p<0.01) and QoL was significantly improved from 3.8+/- 1.1 to 2.7+/- 1.4 (p<0.01). Qmax significantly increased from 14.2+/- 8.3 to 16.5+/- 11.3 ml/sec (p<0.01). Total IIEF score and EF domain score were significantly improved from 36.8+/- 18.5 to 41.8+/- 19.1 (p<0.01) and from 13.0+/- 7.1 to 14.7+/- 7.9 (p<0.01) in patients of moderate IPSS but no improvement in severe patients. Retrograde ejaculation occurred in 2 patients (2%). No serious adverse reactions were observed. CONCLUSIONS: Tamsulosin, 0.2mg/day was effective and safe dose for the improvement of LUTS and sexual function for Korean BPH/LUTS patients.

Association of Lower Urinary Tract Symptoms with Irritable Bowel Syndrome in Adult Men : An Internet-based Survey / 대한소화기학회지

BACKGROUND/AIMS: Patients with irritable bowel syndrome (IBS) are more likely to experience certain urinary symptoms. The aims of this study were to investigate the association between lower urinary tract symptoms (LUTS) and IBS, and to determine their impact on the quality of life. METHODS: E-mails were sent to 23,594 men who were registered at an internet survey company. Subjects were requested to fill out the questionnaires regarding IBS and LUTS assessed by the International Prostate Symptom Score (IPSS). RESULTS: Among 601 subjects (mean age, 35.5+/-8.4) included in the final analysis, 118 (19.6%) fulfilled the Rome II criteria for the diagnosis of IBS. The total mean IPSS of IBS subjects was 9.6, which was significantly higher than the 7.0 of non-IBS subjects (p<0.01). When IPSS was subcategorized into mild, moderate, and severe symptom categories, the proportions with the moderate and severe symptoms among IBS subjects were 33.9% and 13.6% respectively, which were significantly higher than those of non-IBS subjects; (26.9 and 5.2%) (p<0.01). In multivariate analysis, statistically significant association was found between IBS and moderate to severe LUTS (OR, 1.91; 95% CI, 1.27-2.88). IBS subjects also showed a poorer quality of life score than non-IBS subjects (2.24 vs. 1.65, p<0.001). CONCLUSIONS: LUTS in adult men with IBS are more severe and have a more negative impact on the quality of life than in non-IBS subjects.

Men's Lower Urinary Tract Symptoms Are Also Mental and Physical Sufferings for Their Spouses

Lower urinary tract symptoms (LUTS) in men may have an adverse effect on spouse health-related quality of life (HRQL), and these effects are probably influenced by cultural and perceptional differences. This study was conducted to explore the impact of LUTS in Korean men on their spousal HRQL in relation to symptom severities and other demographic parameters. A total of 130 spouses, whose husbands had a nocturia, frequency of greater than once per night, who shared a bed with their husbands, and accompanied husbands at consultation, were subsequently enrolled and asked to complete a structured questionnaire. Almost all spouses (98%) suffered one or more inconveniences that affected HRQL to some degree. Sleep disturbance was rated to be most inconvenient. The sleep disturbances were significantly correlated with nocturia frequency and husband co-morbidity. Husband's LUTS caused partners to feel fatigued (62%), embarrassed (79%), concerned about the possibilities of cancer (69%) and surgery (81%), sexual life deteriorated (58%), and dissatisfied, unhappy, or terrible (36%). Spouse's perception on HRQL was found to be well correlated with husband's quality of life. Men with LUTS need to understand that their LUTS is also mental and physical sufferings for their spouses.

Correlation between Serum Testosterone and Lower Urinary Tract Symptoms in Men with Hypogonadism Symptoms / 대한남성과학회지

PURPOSE: We performed this study to estimate the correlation of serum testosterone and lower urinary tract symptom (LUTS) in adult hypogonadism patients. MATERIALS AND METHODS: Medical records of ninety men over forty years old who have LUTS, International Prostate Symptom Score (IPSS) above 7 were reviewed. The correlations of serum testosterone level withage, International Prostate Symptom Score (IPSS), prostate volume, prostate specific antigen (PSA) and maximal flow rate were assessed using Spearman test. The statistical differences of IPSS, prostate volume, PSA and maximal flow rate in 3 groups of patients divided by serum testosterone levels(3.5 ng/ml). RESULTS: Serum testosterone level decreased according to increase of age (r=-0.28, p=0.07). Serum testosterone has no significant correlation with IPSS, prostate volume, PSA and maximal flow rate. There was no significant difference of IPSS, prostate volume, PSA and maximal flow rate according to the levels of testosterone. CONCLUSIONS: Emerging from this analysis, clinical indexes of LUTS may not be connected with testosteronelevel and LUTS may not be affected by hypogonadism. Further more objective and sophisticated studies with large number of subjects are requested for the understanding of pathophysiology of LUTS in hypogonadism.

Urodynamic Analysis of Men with Normal Prostate Less Than 20 gm Combined with Lower Urinary Tract Symptoms

PURPOSE: The cause of lower urinary tract symptoms(LUTS) without diseased causes of urodynamics in men is unclear. The aim of this study was to elucidate reliability of difference of LUTS and its treatment by urodynamic study. MATERIALS AND METHODS: Urodynamic study of 124 patients with LUTS were evaluated by age, international prostate symptom score(IPSS) and PSA. The group of patients were divided according to the chief complaint as irritative symptom group(n=72) and obstructive symptom group(n=42). RESULTS: In irritative symptoms group, 29 patients showed stable bladder which combined with bladder outlet obstruction(BOO)(n=11), detrusor underactivity(DU)(n=2) and normal finding(n=6). 43 patients showed unstable bladder which combined with BOO(n=11) and only detrusor overactivity(DO)(n=32). In obstructive symptoms group, 41 patients showed stable bladder that combined BOO(n=13), DU(n=17) and normal finding(n=11), 11 patients showed unstable bladder that BOO(n=1) and DO(n=10). CONCLUSION: LUTS in men are common and often misdiagnosed. Thus, We must treat the LUTS patients with individual therapy based on urodynamic findings.

The Correlation of an ICS-male Questionnaire for Lower Urinary Tract Symptoms and Bladder Outlet Obstruction Parameters in Korea / 대한비뇨기과학회지

PURPOSE: We investigated the prevalence of lower urinary tract symptoms (LUTS), and the inconvenience of each symptom, using an ICS-male Questionnaire (ICS-mQ) in Korean man. We also evaluated the relationships between symptoms, prostate volume and urodynamic parameters of a bladder outlet obstruction (BOO). MATERIALS AND METHODS: 180 male LUTS patients, from 7 urological institutions, were enrolled in this study. The ICS-mQ was used to measure the severity of the symptoms, with a bothersomeness scale. Transrectal sonography and urodynamic studies, including Schaefer linear passive urethral resistance relation (L-PURR), were performed. RESULTS: The 5 most frequent symptoms were voiding symptoms, such as reduced stream, terminal dribbling, incomplete emptying, intermittency and hesitancy, in that order. However, the 5 most bothersome symptoms included 2 voiding, and 3 storage, symptoms, such as incomplete emptying, urge incontinence, pain in bladder, nocturnal incontinence and hesitancy. 34.4% of the nocturia patients felt quite, or severely, bothered, but only 1.1% felt no problem. The mean value of estimated prostate volume, by sonography, was 29.8+/-14.1ml. There were no correlations between the severity of symptoms and the prostate size. There were also little, or no, correlations between a wide range of symptoms and the urodynamic parameters of BOO. CONCLUSIONS: The most frequent symptoms of male patients with LUTS are voiding symptoms, but they suffered more from storage, than from voiding, symptoms. The severities of the symptoms, or the bothersomeness, were not correlated with the prostate size or the urodynamic parameters of a bladder outlet obstruction. Therefore, the relief of a bladder outlet obstruction is not crucial to relieve the symptoms.

The Correlation of an ICS-male Questionnaire for Lower Urinary Tract Symptoms and Bladder Outlet Obstruction Parameters in Korea / 대한비뇨기과학회지

PURPOSE: We investigated the prevalence of lower urinary tract symptoms (LUTS), and the inconvenience of each symptom, using an ICS-male Questionnaire (ICS-mQ) in Korean man. We also evaluated the relationships between symptoms, prostate volume and urodynamic parameters of a bladder outlet obstruction (BOO). MATERIALS AND METHODS: 180 male LUTS patients, from 7 urological institutions, were enrolled in this study. The ICS-mQ was used to measure the severity of the symptoms, with a bothersomeness scale. Transrectal sonography and urodynamic studies, including Schaefer linear passive urethral resistance relation (L-PURR), were performed. RESULTS: The 5 most frequent symptoms were voiding symptoms, such as reduced stream, terminal dribbling, incomplete emptying, intermittency and hesitancy, in that order. However, the 5 most bothersome symptoms included 2 voiding, and 3 storage, symptoms, such as incomplete emptying, urge incontinence, pain in bladder, nocturnal incontinence and hesitancy. 34.4% of the nocturia patients felt quite, or severely, bothered, but only 1.1% felt no problem. The mean value of estimated prostate volume, by sonography, was 29.8+/-14.1ml. There were no correlations between the severity of symptoms and the prostate size. There were also little, or no, correlations between a wide range of symptoms and the urodynamic parameters of BOO. CONCLUSIONS: The most frequent symptoms of male patients with LUTS are voiding symptoms, but they suffered more from storage, than from voiding, symptoms. The severities of the symptoms, or the bothersomeness, were not correlated with the prostate size or the urodynamic parameters of a bladder outlet obstruction. Therefore, the relief of a bladder outlet obstruction is not crucial to relieve the symptoms.

Changes of Urinary Nerve Growth Factor and Transforming Growth Factor beta-1 in Male Patients with Lower Urinary Tract Symptom / 대한비뇨기과학회지

PURPOSE: Increased expression of the nerve growth factor (NGF) in the urinary bladder may contribute to irritative bladder symptoms in patients with benign prostatic hyperplasia. It has been reported that the transforming growth factor beta (TGF-beta) can initiate NGF synthesis. This study investigated the changes in the urinary NGF and TGF-beta1 in male patients with lower urinary tract symptoms. MATERIALS AND METHODS: The study groups included 25 male patients with lower urinary tract symptom and 10 normal male patients used as the reference controls. The evaluation included history taking, urinalysis, international prostatic symptom score (IPSS), and urodynamics. Voided urine was collected in all patients. The urinary NGF and TGF-beta1 concentration was analyzed by using an enzyme linked immunosorbent assay and these results were compared with the control group. RESULTS: From the analysis of the IPSS, the obstructive and irritative symptom scores were higher. The urodynamic study showed that more than half of the patients had detrusor instability and bladder outlet obstruction (BOO). The NGF and TGF-beta1 urinary concentration were significantly higher in patients with lower urinary tract symptoms compared to the control. Furthermore, the NGF and TGF-beta1 urinary concentration were significantly higher in patients with BOO compared with patients with non-BOO. CONCLUSIONS: NGF and TGF-beta1 may play a role in the lower urinary tract symptoms and these changes can be detected in urine samples. Therefore, these growth factors may be used as markers to evaluate lower urinary tract symptoms.

Impact of Lower Urinary Tract Symptom on Quality of Life in Young Men / 대한비뇨기과학회지

PURPOSE: To evaluate the impact of lower urinary tract symptom (LUTS) on restlessness and quality of life (QoL) in young men. MATERIALS AND METHODS: The National Institutes of Health (NIH) - Chronic Prostatitis Symptom Index (CPSI) was used to identify men with LUTS in a community. The questionnaire also asked about sociodemographic characteristics. A total of 15,264 men, with LUTS without pain, were included in this study. RESULTS: Of the subjects, 521 (3.4%) felt their bladder did not empty fully after urinating more than 20% of the time, while 1,495 (9.7%) had to urinate again within 2 hours more than 20% of the time. Men dwelling in major towns were more likely to report they experienced incomplete emptying (p<0.001) and frequency (p<0.001). As educational level increased, the likelihood of frequency decreased (p=0.033), but that of incomplete emptying did not. In the multivariate model used, men experienced mild incomplete emptying had a 5.2-fold greater risk for restlessness (odds ratio [OR], 5.21; p<0.001) and those experiencing moderate to severe incomplete emptying had a 14.8-fold greater risk (OR, 14.84; p<0.001) than men that did not experience incomplete emptying. Mild frequency was associated with a 6.9-fold greater risk of restlessness (OR, 6.91; p<0.001) and moderate to severe frequency was associated with a 52.7-fold greater risk (OR, 52.67; p<0.001) than no frequency. CONCLUSIONS: The community-based prevalence of LUTS was found to be high in the population studied. The study indicated that demographic variables might influence the prevalence of LUTS in young men. In addition, our findings suggest that young men with LUTS experience a negative impact on their QoL.

Clinical Characteristics of Frequency-Anxiety Syndrome / 대한비뇨기과학회지

PURPOSE: Lower urinary tract symptom in elderly person leads to their psychological anxiety and stress in their travel and further, loss of self esteem that can set limitation during their social activities and their lives. we coined a frequency-anxiety syndrome (FAS) for the patients with lower urinary tract symptom and anxiety. This study was performed to characterize the clinical characteristics of FAS. MATERIALS AND METHODS: 24 FAS patients and 20 controls were included in this study. For the analysis and comparisons, we investigated frequency, urgency, i-nternational prostate symptom score (I-PSS), cystoscopy, and urodynamic study in both groups. We also performed semi-structured psychiatric interview and state-Trait Anxiety Inventory (STAI). RESULTS: In the average I-PSS, FAS group had significantly higher score of 22.9+/-10.9 than control group of 10.6+/-6.5 (p<0.001). The control group had significantly higher quality of life herving problems (QOL) value of 1.8+/-1.2 as compared to FAS group of 5.1+/-0.1 (p<0.005). In STAI, FAS group had significantiy higher score than control group. CONCLUSIONS: There were significant differences between FAS group and control group in regard to lower urinary tract symptom, I-PSS, QOL, and anxiety. The above results suggest that FAS could be considered as independent syndrome.

The Impact of Lower Urinary Tract Symptom on Sexual Function / 대한남성과학회지

PURPOSE: It is well recognized that the incidence of sexual dysfunction in men increases with age. But the impact of lower urinary tract symptom (LUTS) on sexual dysfunction had not been widely studied. We aimed to ascertain the degree of correlation among sexual dysfunction, LUTS and age. MATERIALS AND METHODS: Between September 1998 and May 1999, 350 healthy Korean men over 50 years old living in Taegu and Kyungpook province were enrolled in the study. All of them completed IIEF (International Index of Erectile Function) 5-item questionnaire, International Prostatic Symptom Score(IPSS), digital rectal examination (DRE) and uroflowmetry. The IIEF, 5-item questionnaire consisted of erectile function (EF), sexual intercourse satisfaction (IS), orgasmic function (OF), sexual desire (SD) and overall satisfaction (OS). Each item was stratified into severe, moderate, mild and no dysfunction. Total men were stratified by IPSS, volume of prostate and maximal flow rate. RESULTS: The prevalence of sexual dysfunction was increased with age. The erectile function was decreased in men with severe symptoms (IPSS >20) in comparison to those without symptoms (IPSS 50gm) in comparison to those with normal prostate (volume of prostate < 21gm). The maximal flow rate was not correlated with sexual dysfunction. CONCLUSIONS: There was a significant number of patients with LUTS who have sexual dysfunction. A trend of increasing sexual dysfunction with increasing after urinary symptom severity and volume of prostate was fond. It is valuable to compare the sexual function after treatment of LUTS with it before treatment.