The clinical features of nocturnal enuresis in adult men and women / 中华泌尿外科杂志

Objective:To discover the clinical features of nocturnal enuresis (NE) in adults and to detect factors that correlated with the symptom severity.Methods:This cross-sectional study recruited NE subjects from September 2017 through December 2020. All patients had experienced enuresis at least once per week and with a symptom duration of 3 months or longer. Followed by documentation of history and medical records, three-day bladder diary was adopted to assess their voiding pattern, and urodynamic parameters were obtained to evaluate lower urinary tract function.Results:A total of 106 NE patients (43 male and 63 female) were identified. There is no statistical difference regarding the average age (men: 57.8±15.6 vs. women: 56.1±14.0, P>0.05) and BMI (men: 23.9±3.4 vs. women: 23.3±4.3, P>0.05) between men and women. Comorbidities are extremely common in NE patients (n=85, 80.2%), with the incidence rate higher in men compared to women [88.4% (38/43)vs. 74.6% (47/63), P<0.05]. Hypertension (n=58, 54.7%), hyperlipemia (n=41, 38.7%), diabetes mellitus (n=38, 35.8%), coronary heart disease (n=22, 20.8%) were the most frequently reported conditions. On bladder diaries, subjects were frequently manifested nocturnal polyuria (NP, 47/106, 44.3%), reduced nocturnal bladder capacity (NBC, 74/106, 69.8%), or combination of both(33/106, 31.3%). Urodynamic studies suggested that the incidence of reduce bladder compliance, detrusor overactivity (DO), stress incontinence, bladder outlet obstruction(BOO), detrusor underactivity(DU)and detrusor hyperreflexia with impaired contractility(DHIC)was 27.4%(29/106), 39.6%(42/106), 17.9%(19/106), 9.4%(10/106), 25.5%(27/106)and 15.1%(16/106), respectively. Women were more likely to suffer from stress urinary incontinence [2.3%(1/43) men vs. 28.6% (18/63) women, P<0.01], while men were prone to have bladder outlet obstruction [ 23.3%(10/43) men vs. 0 women, P<0.01]. Correlation analysis demonstrated that obesity( r=0.63, P<0.01), systemic comorbidities( r=0.40, P<0.01), presence of NP( r=0.50, P<0.01) and NP+ NBC( r=0.47, P<0.01), post-void residual( r=0.53, P<0.01), reduced compliance( r=0.21, P=0.04), DU( r=0.28, P<0.01), stress incontinence( r=0.42, P<0.01)and DHIC ( r=0.35, P<0.01)are positively correlated with NE severity. Whereas, reduced Q max( r=-0.35, P<0.01), low capacity( r=0.21, P=0.03), and reduced bladder sensation( r=-0.21, P=0.03) correlate negatively with NE severity. Conclusions:The presence of NE is not only a sign of bladder dysfunction, but also an implication of obesity, systematic chronic diseases, urine production malfunctioning. Therefore, a thorough history regarding the lower urinary tract function and systemic comorbidities should be taken carefully, so that, an integrated and personalized treatment can be carried out.

Uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos. Hospital Central Universitario Dr. Antonio María Pineda / Use of uroflowmetry in the study of lower urinary tract symptoms in male patients. Central University Hospital Dr. Antonio María Pineda

La uroflujometría es un estudio no invasivo del tracto urinario inferior que entrega información objetiva del flujo urinario y es ampliamente recomendado por las guías europeas en el estudio de pacientes con sintomatología urinaria baja. Se realizó un estudio descriptivo transversal cuyo propósito fue describir el uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos que acudieron a la consulta de Servicio de Urología del Hospital Central Universitario Dr. Antonio María Pineda de la ciudad de Barquisimeto, estado Lara durante el lapso 2018- 2019. La muestra estuvo conformada por 150 pacientes. Los resultados indican que el 62% de la muestra corresponde a pacientes entre 60 y 70 años de edad de los cuales 52% manifestaron síntomas urinarios leves. La uroflujometría evidenció que 56% de los pacientes tienen un flujo máximo entre 10 y 20 ml/seg lo cual sugiere una probable obstrucción al flujo de salida; 78% de los pacientes presentan un flujo promedio entre 0 a 10 ml/seg. El 53% de los pacientes mostró un volumen de vaciado < 300 ml y 49% un tiempo de flujo máximo entre 30 y 50 segundos. En conclusión, la uroflujometría es un examen simple y rápido que proporciona información útil sobre la salud de las vías urinarias inferiores(AU)

Uroflowmetry is a non-invasive study of the lower urinary tract that provides objective information on urinary flow and is widely recommended by European guidelines for the study of patients with lower urinary tract symptoms. We performed a cross-sectional descriptive study to describe the use of uroflowmetry for the study of lower urinary tract symptoms in males who attended the Servicio de Urología of the Hospital Central Universitario Dr. Antonio María Pineda (Barquisimeto, Lara state) during the 2018- 2019 period. The sample was made up of 150 males. The results show that 62% of the sample included males between 60 and 70 years old and 52% complained of mild urinary symptoms. Uroflowmetry results showed that 56% of patients had a maximum flow between 10 and 20 ml/sec suggestive of urinary tract obstruction; 78% had an average flow between 0 and 10 ml/sec while 53% had a micturition volume < 300 ml and 49% had a maximum flow time between 30 and 50 seconds. Uroflowmetry is a simple and fast test which provides useful information about the health of lower urinary tract(AU)

Isolated Bladder Endometriosis: A Rare Case Report.

Endometriosis is defined as presence of functional endometrial glands and stroma beyond the normal confines of the uterus.1,2 Overall incidence is 10 to 20% of women in reproductive age, with peak incidence between 30 and 45 years.2 About 40% of women with infertility and 60% of those presenting with chronic pelvic pain have endometriosis.1 About 1% of women with endometriosis have urinary tract involvement, of which 84% involve the bladder. Urinary bladder endometriosis as a part of deep infiltrating pelvic endometriosis is known, but isolated bladder involvement is extremely rare. Patients present with vague and distressing urinary symptoms mimicking recurrent cystitis, hence strong clinical suspicion with prompt recognition of this entity is important to avoid prolonged morbidity.2 We report a case of isolated bladder endometriosis in a 28-year-old female with previous two cesarean sections. Open partial cystectomy was performed. Histopathology of the excised mass was diagnostic.

Acute adrenal insufficiency as the primary manifestation of extrapulmonary tuberculosis: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Acute adrenal insufficiency (AI) is a life-threatening condition. While Addison’s disease (AD) is rare, in developing countries, tuberculosis (TB) still remains as the primary cause in 7 to 20% of cases. Urinary TB is also the third most common form of extrapulmonary disease. We report a case of 37-year-old male who presented with weakness, anorexia, weight loss, dysuria, flank pain and low grade fever. Examination revealed hypotension, hyperpigmentation, hyponatremia, hypoglycemia and low serum cortisol. He was diagnosed to have adrenal crisis due to Addison’s disease and extrapulmonary TB manifesting as urinary tract infection (UTI). He was treated with corticosteroids and anti-TB medications. Urologic reconstructive surgery was subsequently planned.

Comparison of Pre-Operative and Post-Operative Post Void Residual Urine Volume in Urogenital Prolapse.

Background: Post Void Residual Urine (PVR) is a key marker for the evaluation of the efficacy of bladder emptying particularly in women with pelvic organ prolapse and lower urinary tract dysfunction. Objectives of the present study were to compare pre and postoperative post void residual urine volume and to know the relation of PVR to urinary symptoms and prolapse. Methods: 65 patients admitted with urogenital prolapse. Detailed history, general physical examination was done as per predesigned and pretested proforma. Grading for prolapse was done by POP-Q, Baden walker halfway. PVR was measured before and after operation Results: Age has shown significant relation with the raised PVR > 50 ml (p=0.007). Out of 65 cases, 11 had second, 48 had third degree and 6 had procedentia according to Baden Walker system. Urge and stress incontinence were complained by 43% and 26% of patients respectively and increased frequency and nocturia was complained by 68% and 65% of patients. Storage symptoms were not significantly associated with degree of prolapse or raised PVR. Straining to void, incomplete emptying and has to reduce to void were present in 42, 46 and 47 patients respectively and showed significant association with degree of prolapse. Except incomplete emptying other two were associated with raised PVR. Conclusion: Vaginal hysterectomy with anterior colporrhaphy was effective procedure in reducing elevated PVR in prolapse patients.

Prevalence of enuresis and urinary symptoms at age 7 years in the 2004 birth cohort from Pelotas, Brazil / Prevalência de enurese e sintomas miccionais aos sete anos na coorte de nascimentos de 2004, Pelotas, Brasil

OBJECTIVE: To determine the prevalence of enuresis, urinary, and bowel symptoms and associated factors in children aged 7 years in a birth cohort. METHODS: A pre-coded questionnaire was applied to 3,602 children who belonged to a birth cohort initiated in 2004 in Pelotas, Brazil. During home visits at 12, 24, and 48 months and at age 7 years, mothers answered a questionnaire with demographic questions and characteristics of bladder and bowel habits of children using a urinary symptom score. Poisson regression was used for the hierarchical multivariable analysis, with robust variance. RESULTS: The prevalence of enuresis was 10.6%;11.7% in males and 9.3% in females; enuresis was monosymptomatic in 9.8% of the children (10.8% of males and 8.3% of females); 37.4% had symptoms up to once a week; 32.9%, two to four times a week; and 26.2%, every day, with no difference between genders. The most common urinary symptoms were urinary urgency (22.7%) and urinary retention maneuvers (38.2%). In the multivariate analysis, it was observed that the number of urinary symptoms and the number of children at home showed a direct association with the presence of enuresis, whereas maternal education was inversely associated. CONCLUSIONS: Enuresis is a prevalent condition and should be investigated in clinical practice, especially in children of lower socioeconomic status. A detailed history of urinary habits detects associated urinary symptoms, which is important for adequate classification of enuresis and subsequent management. .

OBJETIVO: Determinar a prevalência de enurese, sintomas urinários e intestinais e fatores associados em crianças de sete anos, em uma coorte de nascimentos. MÉTODOS: Foi aplicado um questionário pré-codificado em 3.602 crianças pertencentes à coorte de nascimentos iniciada em 2004, em Pelotas, RS. Em visitas domiciliares realizadas aos 12, 24 e 48 meses e aos sete anos, as mães responderam um questionário com questões sociodemográficas e sobre as características e hábitos miccionais e intestinais das crianças, utilizando um escore de sintomas miccionais. Para a análise multivariável hierarquizada, utilizou-se regressão de Poisson com variância robusta. RESULTADOS: A prevalência de enurese de foi 10,6%, sendo 11,7% nos meninos e 9,3% nas meninas; a enurese foi monossintomática em 9,8% das crianças (10,8% dos meninos e 8,3% das meninas); 37,4% apresentavam o sintoma até uma vez por semana; 32,9%, duas a quetro vezes por semana; e 26,2% todos os dias, sem diferença entre os sexos. Os sintomas urinários mais frequentes foram urgência miccional (22,7%) e manobras de contenção urinária (38,2%). Na análise multivariável, observou-se que o número de sintomas miccionais e o número de crianças em casa mostraram relação direta com presença de enurese, enquanto que a escolaridade materna apresentou relação inversa. CONCLUSÕES: A enurese é uma patologia prevalente e deve ser investigada em consultas de rotina, especialmente em crianças com menor nível socioeconômico. Uma história detalhada sobre hábitos urinários pode detectar sintomas miccionais associados, importantes para uma adequada classificação da enurese e posterior manejo. .

Urinary dysfunction with detrusor hyperactivity in women with Parkinson's disease cannot be blamed as a factor of worsening motor performance / Disfuncao urinaria com hiperatividade detrusora nao e fator de risco para progressao do desempenho motor em mulheres com doenca de Parkinson

Introduction Detrusor hyperactivity is the leading cause of urinary dysfunction in Parkinson's disease (PD). There are few studies correlating PD clinical aspects with this autonomic feature. Methods A cohort of 63 women with PD were prospectively examined for assessment of clinical aspects and disease severity using unified Parkinson's disease rating scale and Hoehn-Yahr scale, respectively. The urologic function was evaluated by the urodynamic study. Two groups were categorized at this time - groups with and without detrusor hyperactivity. After seven years, the same parameters were re-evaluated. Results Progression of the disease on mental scores was found in the group with detrusor hyperactivity. On follow-up, clinical symptoms and severity did not show significant worsening between the groups. Conclusion Detrusor hyperactivity is a frequent urodynamic finding in PD, and even though it is associated with dopaminergic dysfunction, it cannot be blamed as a factor of worsening motor performance, but is probably associated with poor cognitive and mental prognosis. .

Introdução Hiperatividade detrusora (HD) é a principal causa de disfunção urinária na doença de Parkinson e poucos estudos correlacionam aspectos clínicos da doença com este componente autonômico. Métodos Foi avaliada uma coorte de 63 pacientes com DP quanto aos aspectos clínicos e gravidade global da doença utilizando as escalas UPDRS e Hoehn-Yahr. A função urológica foi avaliada através de estudo urodinâmico. Foram então categorizados dois grupos: pacientes com e sem HD. Após sete anos os mesmos parâmetros foram reavaliados. Resultados Houve progressão da doença quanto aos escores mentais no grupo com HD. Na reavaliação dos grupos os sintomas motores não evidenciaram piora significante. Conclusão HD é um achado urodinâmico frequente em pacientes com DP. Embora associada à disfunção dopaminérgica, HD não pode ser considerada fator de risco para piora do desempenho motor, mas provavelmente está associada com pior prognóstico mental e cognitivo. .

Can the delivery method influence lower urinary tract symptoms triggered by the first pregnancy?

INTRODUCTION AND OBJECTIVES: The increase of the intensity of urinary symptoms in late pregnancy and postpartum has been well documented by several authors, but their causes remain uncertain, partly because of its probable multifactor origin. There are also controversies whether the etiology of lower urinary tract symptoms during pregnancy is the same as postpartum and whether the method of delivery could influence the risk of onset of urinary symptoms. This study aimed to evaluate the urinary symptoms triggered during pregnancy and its evolution in the late puerperium, correlating them with the delivery method. MATERIALS AND METHODS: A longitudinal study was conducted, which included 75 primigravidae women, classified according to method of delivery as: (VD) vaginal delivery with right mediolateral episiotomy (n = 28); (CS) elective caesarean section (n = 26); and (EC) emergency caesarean section (n = 21). Urinary symptoms were assessed in the last trimester of pregnancy and at 45 days (± 10) of puerperium with validated versions for Portuguese language of the following questionnaires: International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). RESULTS: It was observed that frequency, urgency, nocturia and urge incontinence, triggered during pregnancy, decreased significantly in the postpartum period, regardless of the delivery method (p = 0.0001). However, symptoms related to urinary loss due to stress persisted after vaginal delivery (p = 0.0001). CONCLUSIONS: Urgency, frequency and nocturia triggered during pregnancy tend to disappear in the late postpartum period, regardless of the delivery method, but the symptoms related to urinary loss due to stress tend to persist in late postpartum period after vaginal delivery.

Assessing Quality of Life Related to Voiding Symptoms and Sexual Function in Menopausal Women

PURPOSE: To evaluate the correlation between lower urinary tract symptoms (LUTS) and premature ejaculation (PE) in Korean men older than 40 years. MATERIALS AND METHODS: In total, 258 men older than 40 years completed the International Prostate Symptom Score (IPSS; total score, storage symptoms [ST], and voiding symptoms [VD]), a 5-item version of the International Index of Erectile Function (IIEF-5), and the Premature Ejaculation Diagnostic Tool (PEDT). The study examined the relationship between LUTS and PE. In the PEDT, PE is defined as a score > or =11. RESULTS: The prevalence of PE was 29.1% with the PEDT versus a self-reported value of 49.5%. The prevalence of PE was 30.9% in 40 to 59-year-old men (21.3%) and 28.1% in 60 to 79 year-old men (78.7%). In men 40 to 59 and 60 to 79 years old, the mean PEDT, IPSS, and IIEF-5 scores were 8.65 and 7.88, 13.5 and 12.38, and 15.83 and 13.69, respectively. No significant correlations were observed between the total and subscale scores of the IPSS (p=0.204) and the PEDT (p=0.309) with increasing age, whereas a significant negative correlation was detected between the IIEF-5 and age (p=0.002). The PEDT score was significantly correlated with the IPSS-ST (r=0.326, p<0.001), IPSS-VD (r=0.183, p=0.005), IPSS-total (r=0.310, p<0.001), and IIEF-5 total (r=-0.248, p<0.001). CONCLUSIONS: LUTS, especially storage symptoms, were related to PE. In elderly men, control of both erectile dysfunction and LUTS may play an important role in managing PE.

Use of the international prostate symptom score in the assessment of severity of lower urinary tract symptoms in men / Uso do escore internacional dos sintomas prostáticos para avaliação da gravidade dos sintomas urinários em homens

Prevalence of urinary symptoms are very common among men over 40 years due to an increase in prostate volume known as benign prostatic hyperplasia (BPH). Several studies have shown a decline in quality of life for patients with severe lower urinary tract symptoms (LUTS). Objective: To investigate the severity of LUTS among men aging over 40 years concerning the feasible impairment in quality of life. Material and Methods: 117 men over 40 years who had attended at the urology outpatient unit were interviewed. The International Prostate Symptom Score (IPSS) was used to evaluate the severity of LUTS. Results: The most frequent complaint of the patients was the frequent waking at night with the urge to urinate (of these subjects 44,4% reported waking more than twice a night to urinate). 73,5% of the patients had mild symptoms, and 6% had severe symptoms. 37,2% of these subjects over the age of 61 years had moderate symptoms, and 14% had severe symptoms. 82,9% of patients was satisfied with their urinary condition. 54,2% of subjects having moderate symptoms and all subjects with severe symptoms reported some level of dissatisfaction. Conclusion: There is a close relation between the scores for urinary condition and patients? satisfaction. The International Prostate Symptom Score assess the severity of urinary symptoms and their impairment on quality of life as an important step toward an individualized treatment for patients.

Urinary Difficulty in Brain Lesion: Impact on Quality of Life: Multicenter Prospective Epidemiologic Study

OBJECTIVE: To asses the prevalence of urinary difficulty and the relationship of urinary difficulty and type of brain lesion from multicenter prospective epidemiologic study. METHOD: 394 patients including outpatients and inpatients who visited from multicenter department of rehabilitation medicine from January 2008 to June 2008 were evaluated. Study based on international prostate symptom score (IPSS) and Quality of life (QoL) score were assessed, and the correlation between the two indexes was analyzed. RESULTS: 140 patients (35.5%) complained urinary difficulty as patient's main symptom, while IPSS score was 13.7 showing above moderate symptom at 77.5%. For patients complained urinary difficulty, the average of quality of life score was 3.1. Among stroke, 37% of infarction and 34% of hemorrhage complained urinary difficulty while 40% of traumatic brain injury did. Patients with ACA infarction reported urinary difficulty most frequently. Nocturia (71%), frequency (53.3%), incomplete emptying (30%) were the most frequent symptoms. Sixty-six patients (46%) complaining urinary difficulty were taking medications and anticholinergics were most widely used (75%). Scores of IPSS and QoL according to type and site of brain lesion didn't show meaningful difference while QoL score correlated significantly with IPSS score (p<0.05). CONCLUSION: Among all the brain lesion patients, 35.5% complained urinary difficulty while IPSS and QoL score according to type and site of brain lesion didn't show meaningful difference. Urinary difficulty affects the life quality of brain lesion patients.

Comparison of Voiding Parameters According to the Subtypes of SS-Penogram in Patients with Both Erectile Dysfunction and Lower Urinary Symptoms / 대한남성과학회지

PURPOSE: We investigated the results of voiding parameters according to the subtypes of audiovisual stimulation (AVS)- and sexual stimulation (SS)-penogram in patients with both erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Sixty seven patients with ED and LUTS were included in this study. Erectile function was evaluated by international index of erectile function (IIEF)-5, AVS-penogram, and SS-penogram. After AVS-penogram, SS-penogram was performed 30 minutes after taking mirodenafil (100mg) orally. We also evaluated voiding function with international prostatic symptom score (IPSS), quality of life score (QoL), urinary flow rate (UFR), residual urine volume (RV), and transrectal ultrasonograpy (TRUS). Voiding functionparameters were analyzed according to the subtypes of AVS- and SS-penogram. RESULTS: Although there was tendency that the IIEF-5 scores were lower in patients who showed decreased erectile responses on AVS-penogram, but it did not reach the statistical significance (p= 0.09). The RV was significantly increased as the erectile function worsens based on AVS-penogram (p= 0.003). However, no significant relationship was found betweenresults of SS-penogram and voiding function parameters. CONCLUSIONS: Our results revealed some relationship between voiding function and erectile function evaluated by AVS-penogram, but not by SS-penogram, in patients with both ED and LUTS. AVS-penogram, as well as IIEF questionnaire, may play an important role in predicting voiding function in patient with both conditions .

Lower Urinary Tract Symptoms in Chronic Stroke Survivors: Frequency and Impact on Quality of Life

OBJECTIVE: To assess the prevalence of lower urinary tract symptoms in chronic stroke patients and their impact on the perceived quality of life. METHOD: Thirty-eight patients who had suffered unilateral stroke at least 3 months prior to enrollment and showed no severe communication disorder were evaluated. Frequency of lower urinary tract symptoms and their impact on the quality of life were assessed using the Korean version of the International Prostate Symptom Score (IPSS) and an impact question. The correlation between each symptom score and the perceived quality of life was analyzed. RESULTS: Overall, 89.5% of the participants were symptomatic, of which 58.9% complained of moderate to severe symptoms. Nocturia, frequency, and straining were the most frequent symptoms and urgency was the least. The `quality of life' score showed a high correlation with the total IPSS score (p<0.05). Logistic regression analysis showed that obstructive symptom was a significant predictor for dissatisfaction. CONCLUSION: The frequencies of lower urinary tract symptoms are high in chronic stroke patients. And they have significant influence on the perceived quality of life in chronic stroke survivors.

Estimation of Benign Prostatic Hyperplasia Prevalence in Korea: An Epidemiological Survey Using International Prostatic Symptom Score(IPSS) in Yonchon County / 대한비뇨기과학회지

The prevalence of urinary symptoms associated with benign prostatic hyperplasia(BPH) was studied in a community-based, representative sample of 519 men over 50 years old for estimation of prevalence of BPH in Korea. Symptoms were assessed by the Korean version of International Prostatic Symptom Score(IPSS). Only 5(1%) men reported having undergone prostate surgery due to BPH and excluded from analysis. Among 514 men, nocturia and weak stream were the most prevalent symptoms and urgency was the least. Based on the IPSS, 31.7% of the men were free of urinary symptoms(IPSS 0), 45.1%, 18.7% and 4.5% of the men were minimally(IPSS 1-7), moderately(IPSS 8-19) and severely(IPSS 20-35) symptomatic, respectively. The proportion of severely symptomatic men approximately doubled with each decade of age. A good correlation was found between the total symptom score and the single disease-specific quality of life score that is included in the IPSS. Our estimation indicated that in 1995 approximately 800,000 Korean men had moderate to severe urinary symptoms that were likely to be associated with BPH. These results suggest that the prevalence of BPH in Korean men is substantially similar to Caucasian.