Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms

ABSTRACT Purpose To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. Materials and methods The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry. Results There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed. Conclusion In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.

Electron microscopic changes of detrusor in benign enlargement of prostate and its clinical correlation

ABSTRACT Aims: To study the ultra structural changes in bladder musculature in cases of BPE and their clinical relevance. Material and Methods: In this descriptive longitudinal, controlled, observational study patients were enrolled into three groups, group 1, group 2A and group 2B. Control group (group-1) consisted of age matched normal male patients, who underwent surveillance or diagnostic cystoscopy for microscopic hematuria or irritative symptoms. Case group (group-2) comprised of patients with BPE, undergoing TURP. Case group (group-2) was further classified into: Category 2A (patients not on catheter) and category 2B (patients on catheter). All relevant clinical parameters like IPSS, prostate size, Qmax, PVR were recorded. Cystoscopy and bladder biopsy were performed in all patients. Various ultrastructural parameters like myocytes, fascicular pattern, interstitial tissue, nerve hypertrophy and cell junction pattern were analyzed under electron microscope and they were clinically correlated using appropriate statistical tests. Results: Control group had significant difference as compared to case group in terms of baseline parameters like IPSS, flow rate and prostate size, both preoperatively and postoperatively, except for PVR, which was seen only preoperatively. There was statistically significant difference in ultrastructural patterns between case and control group in all five electron microscopic patterns. However, no significant difference was found between the subcategories of case groups. Conclusions: BPE is responsible for ultra structural changes in detrusor muscle and these changes remain persistent even after TURP. Nerve hypertrophy, which was not thoroughly discussed in previous studies, is also one of the salient feature of this study.

Preliminary assessment of neck circumference in benign prostatic hyperplasia in patients with metabolic syndrome

ABSTRACT Objectives To investigate the impact of neck circumference (NC) in the treatment of bening prostatic hyperplasia (BPH) patients with metabolic syndrome (MtS). Additionally, we determined dose response to alpha-blockers and cut-off values for NC and waist circumference (WC), in these patients. Materials and Methods Non-randomized, open-labelled, and multi-centre study was conducted between March 2014 and September 2015. The BPH patients were enrolled and were divided into 2 groups: with MtS (Group 1; n=94) and without MtS (Group 2; n=103). Demographic data, anthropometric measurements, blood analyses, uroflowmetric parameters, post voiding residual urine (PVR), prostate volume, quality of life (QoL) index, NC and WC were recorded. Both groups were administered oral alpha-blockers and response to treatment was evaluated. Receiver-operating characteristic (ROC) curves were obtained and significant p was p<0.05 . Results In total, 197 patients were enrolled with mean age of 60.5±8.1 years. Mean NC and WC were higher in MtS patients (p<0.001). Uroflowmetry parameters and QoL indexes were comparable between groups before treatment. International prostate symptom score, uroflowmetry parameters, and QoL significant improved in Group 2 than Group 1, at 1 st and 6 th months of treatment with alpha-blockers. Success rate of treatment was significant higher in Group 2 than Group 1 (p<0.001). Cut-off values were 42.5cm and 113.5cm for NC and WC respectively, for response to alpha-blockers in BPH patients with MtS. Conclusions MtS can be related with BPH and can negatively affect the response to alpha-blocker treatment. NC can be used for predicting response to alpha-blocker treatment in BPH patients with MtS.

Association between ambient temperature and lower urinary tract symptoms: a community-based survey

ABSTRACT Purpose The aim of this study was to evaluate the individual change of International prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) in each patient by temperature conditions. Materials and Methods The severity of lower urinary tract symptoms (LUTS) was explored using the IPSS and OABSS questionnaires that were completed by 2.486 subjects (923 males and 1.563 females) aged 60 years and older. Korea Meteorological Administration data was used to determine daily average temperature and daily temperature difference on the interview dates at each site. Results The mean IPSS and mean age for males was 13.45±8.24 and 75.03±6.20 years, respectively. The mean OABSS and mean age for females was 4.41±3.10 and 73.74±6.03years, respectively. Daily average temperature and daily temperature difference ranged from-3.4-28.3oC and 2.2-16.9oC, respectively. Age was a significantly risk factor for IPSS, OABSS, and QoL (P<0.001, <0.001, and 0.005, respectively). After multiple regression analysis, daily average temperatures did not show a statistically significant change in IPSS and OABSS. Only daily temperature differences were associated with male LUTS. Conclusions While LUTS could be worsened in low temperatures generally, IPSS and OABSS were not affected by daily average temperature conditions. Daily temperature differences may be more influential than daily average temperatures.

The relationship between histological prostatitis and lower urinary tract symptoms and sexual function

ABSTRACT This prospective analysis assessed the effect of histological prostatitis on lower urinary tract functions and sexual function. The patients were separated into two groups as histologically observed prostatitis (Group A) and no prostatitis (Group B) according to the biopsy outcomes. International prostate symptom score, international index of erectile function-5 scores, maximal and average flow rate, and residual urine volumes were compared statistically between groups. There was no significant difference (P>0.05) in baseline age (t=0.64), body mass index value (t=0.51), prostate volume (t=0.87), prostate-specific antigen levels (t=0.43), maximal (t=0.84) and average flow rate (t=0.59), and post-void residual urine volume (t=0.71). Mean international prostate symptom score in patients with prostatitis was numerically but not significantly higher than that in those without prostatitis (t=0.794, P=0.066). Mean international index of erectile function-5 score in the prostatitis group was significantly lower than that in those without prostatitis (t=1.854, P=0.013). Histological prostatitis notably affected sexual function of patients and may serve as a major risk factor for sexual dysfunction while having little effect on lower urinary tract symptoms.

Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention?

Objective To compare the safety and efficacy of combined therapy using sildenafil and tamsulosin for management of acute urinary retention (AUR) with tamsulosin alone in patients with benign prostate hyperplasia (BPH). Materials and Methods 101 patients were enrolled in a randomized placebo-controlled study from June 2009 to April 2012. Patients presenting with an initial episode of spontaneous AUR underwent urethral catheterization and then prospectively randomized to receive tamsulosin 0.4mg plus sildenafil 50mg in group A and tamsulosin 0.4mg plus placebo in group B for three days. Urethral catheter was removed three days after medical treatment and patient’s ability to void assessed at the day after catheter removal and seven days later. Patients who voided successfully were followed at least for three months. Results Mean age of patients was 59.64 ± 3.84 years in group A and 60.56 ± 4.12 years in group B (p value = 0.92). Mean prostate volume and mean residual urine were comparable between both groups (p value = 0.74 and 0.42, respectively). Fifteen patients in group A (success rate: 70%) and nineteen patients in group B (success rate: 62.7%) had failed trial without catheter (TWOC) at 7th day following AUR (p value = 0.3). No significant difference was noted between both groups regarding the rate of repeated AUR at one month and three month follow-up period (p = 0.07 and p = 0.45, respectively). Conclusion It seems that combination therapy by using 5-phosphodiesterase inhibitor and tamsulosin has no significant advantages to improve urinary retention versus tamsulosin alone. .

Obesity may influence the relationship between sex hormones and lower urinary tract symptoms

PurposeThe effects of serum testosterone in the lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) are not well established. The objective of the study is to evaluate the association of sex hormones with LUTS and control the results by patient weight.Materials and MethodsThe study comprised a cross-sectional analysis of 725 men included in a prostate cancer screening program at University of Sao Paulo Medical School. The serum concentrations of total testosterone (TT), free testosterone (FT) and sex hormone binding globulin (SHBG) were measured. Variables analyzed were age, American Urological Association (AUA) symptom score, storage symptoms, voiding symptoms, quality of life score, prostate specific antigen levels and prostate volume. Obesity was measured through the calculation of body mass index (BMI). A regression analysis model was performed.ResultsMedian patient age was 65 years (48 to 94). A higher TT level was significantly associated with a severe AUA symptom score only among patients with a BMI ≥ 25. Median TT was 371, 370 and 427ng/dL (p = 0.017) in patients with mild, moderate and severe LUTS respectively. The multivariate regression analysis in patients with BMI ≥ 25 showed that only age, TT and sex score were related to LUTS.ConclusionsA higher TT is associated with a severe AUA score symptom index only in obese patients. Further analysis are necessary to evaluate the mechanisms through which testosterone may influence LUTS in these patients.

Decline of seminal parameters in middle-aged males is associated with lower urinary tract symptoms, prostate enlargement and bladder outlet obstruction

Purpose We aimed to compare the associations between semen quality, associated reproductive indicators and the main prostate-related parameters in middle-aged men. Materials and Methods: This is a prospective study on 422 middle-aged men who underwent the screening for prostate health. Their reproductive function, semen quality and prostate-related pathologies were investigated. Results Significant associations between semen quality and prostate-related parameters could be seen. Total sperm count and sperm density decreased along with the increase of the I-PSS score and total prostate volume. Also, the related lower urinary tract characteristics showed a negative correlation with main semen parameters for all investigated subjects. No significant differences in age, testicular size, and hormonal parameters were found between the subjects with or without lower urinary tract symptoms and prostate enlargement. Conclusions Our study suggests that altered seminal parameters in middle-aged men are associated with LUTS, prostate enlargement and/or bladder outlet obstruction. Although the assessments of prostate and lower urinary tract symptoms may not replace the semen parameters evaluating the male reproductive status, there is a need for further and more detailed investigations about the pathways behind these associations as well as possible related conditions. .

Evaluation of the resistive index of prostatic blood flow in benign prostatic hyperplasia

OBJECTIVE: The aim of this work is to study the resistive index (RI) of prostatic blood flow by transrectal power Doppler sonography in benign prostatic hyperplasia (BPH) to determine its correlation with other parameters of BPH. MATERIALS AND METHODS: Eighty-two male patients aged 52-86 years with lower urinary tract symptoms (LUTS) due to BPH were included in the study. Patients with prostate cancer, neurogenic bladder, or with other pathology (e.g. prostatitis, bladder stone) were excluded from the study. All patients were evaluated by full history including Internatinoal Prostate Symptoms Score (IPSS), general and local examination (DRE), neurologic examination, uroflowmetry, laboratory investigations including urine analysis, routine laboratory tests and serum prostate specific antigen (PSA). Transrectal ultrasonography was used to calculate the total prostatic volume. Transrectal Power Doppler Ultrasound (PUD) was used to identify the capsular and urethral arteries of the prostate and to measures the RI value. RESULTS: The mean prostate volume was 75.1 ± 44.7 g. The mean RI of the right and left capsular arteries were 0.76 ± 0.06 and 0.76 ± 0.07, respectively. The mean RI of the urethral arteries was 0.76 ± 0.08. There was a high significative correlation between the increase of the RI of the right and left capsular and urethral arteries and the degree of obstruction (P value < 0.001), severity of symptoms (P value < 0.001) and also the prostatic volume (P value < 0.001). CONCLUSION: Resistive index of the prostatic blood flow can be applied as an easy and non-invasive tool to evaluate the lower urinary tract obstruction due to BPH.

Vaporización fotoselectiva prostática con láser KTP: evaluación de los resultados de la técnica en pacientes ambulatorios / Fotoselective vaporization of the prostate with KTP laser: technical evaluation in ambulatory practice

La Resección Transuretral (RTU) es el patrón de oro de tratamiento endoscópico de la obstrucción urinaria secundaria a hiperplasia prostática benigna (HPB), no obstante se describen cerca de un 20 por ciento de complicaciones más otros efectos no deseados que se asumen normales para la técnica. La vaporización fotoselectiva prostática (VFP) con láser KTP permite una eficiente vaporización del reportándose excelentes resultados funcionales. Con la finalidad de evaluar esta técnica en protocolo con pacientes ambulatorios en el Complejo Hospitalario San José, se confecciona el presente estudio. Material y Métodos: Se evalúan pacientes sometidos a VFP con láser KTP en el Complejo Hospitalario San José entre noviembre de 2006 y Julio de 2007. En todos se descartó por clínica y laboratorio cáncer prostático y se les practicó estimación de volumen prostático con ecografía transrectal y medición de residuo urinario postmiccional antes y un mes post-quirúrgico. Además se realizaron cuestionarios de síntomas urinarios (I-PSS) y calidad de vida (QoL), disfunción eréctil (IIEF-5) y uroflujometríano invasiva antes de la intervención y a uno y tres meses post quirúrgico. Se considera además el tiempo de uso de catéter urinario y se estima el volumen de sangrado intraoperatorio. Resultados: Fueron intervenidos un total de 120 pacientes, de los cuales 101 ingresaron en el protocolo presentando 83 de ellos seguimiento mínimo de 3 meses. La actividad se desarrolló en forma ambulatoria en un 92,1 por ciento de los casos. En promedio, el tiempo quirúrgico fue de 65 min, con uso de catéter urinario por 21,8 horas y sangrado de 86,5 ml. Existió una reducción del volumen prostático en un 56 por ciento y del residuo post-miccional de un 74 por ciento. El 14,9 por ciento de los pacientes experimentó una o más complicaciones, destacando disuria en 15 y hematuria en 6 pacientes, con un caso con necesidad de reintervención de urgencia. Se objetivó al mes post quirúrgico...

Transuretral prostatic resection (TURP) is currently the gold standard in the treatment of urinary obstruction secondary to benign prostatic hyperplasia (HPB). However, about 20 percent of complications and secondary conditions are associated with this surgery. Fotoselective prostatic vaporization of the prostate (VFP) with KTP laser efficiently vaporizes the prostate with excellent functional results. We report our protocol in the San Jose Hospital Complex Material and methods: All patients that underwent KTP prostate vaporization between November 2006 and July 2007 were evaluated. Prostate cancer was ruled out with PSA and prostate volume was estimated with TRUS. Residual urinary volume was determined preoperatively and at one month postoperatively. Urinary symptoms, quality of life and erectile dysfunction questionnaires were completed by all patients. Non invasive urodinamic study was performed before and after surgery. Catheter time and complications were evaluated. Results: A total of 120 patients underwent the procedure of whom 101 were included in the protocol. Out of these 83 presented a minimum of 3 months follow-up. Day surgery was performed in 92,1 percent of cases. Mean operative time was 65 min with 21.8 hours of catheter time and 86.5 ml of operative bleeding. Prostatic and residual urine volume was reduced in 56 percent and 74 percent respectively. One or more complications were seen in 14,9 percent of cases (irritative symptoms in 15 and hematuria in 6). One patient required emergency reoperation. Symptom scores were reduced significantly IPSS from 26,7to 8,1, QoL 4,6 to 0,7 and maximum urinary flow from 7.3 to 19.9 ml/s. There was no variation in IIEF-5 questionnaires. Conclusion: Prostatic vaporization with KTP laser is a safe and efficient technique. Increased urinary flow and reduced symptom score favor this technique. KTP seems as a promising alternative to traditional TURP...

Hiperplasia prostática benigna na terceira idade / Benign prostatic hyperplasia

A hiperplasia prostática benigna (HPB) é uma condição tão freqüente na população masculina geriátrica que sua presença pode ser considerada como um achado normal. São as seqüelas ou complicações da HPB que vão ditar a necessidade de tratamento do paciente. As mais freqüentes são: sintomas miccionais, infecção urinária, hematúria e obstrução urinária. Nos últimos anos surgiram várias opções de tratamento para HPB, incluindo medicamentos e alternativas cirúrgicas menos agressivas. Entretanto, a ressecção transuretral da próstata (RTUP) ainda é considerada o padrão-ouro com a qual outras formas de tratamento devem ser comparadas em termos de eficácia(au)

Últimos avances en el diagnóstico de la hiperplasia benigna de próstata / Last advances in the diagnosis of hiperplasia benign of próstat

La Hiperplasia Benigna de Próstata (HBP) es una enfermedad que afecta al 50-80% de los hombres mayores de 50 años. El desarrollo de esta patología involucra el crecimiento prostático en la zona que rodea a la uretra proximal, denominada zona de transición. Un agrandamiento permanente de la próstata conduce progresivamente a retención urinaria, disfunción renal e infección. Así los portadores de HBP requieren un diagnóstico preciso con el fin de seleccionar un tratamiento adecuado y, en consecuencia, mejorar los síntomas y la calidad de vida. Los estudios epidemiológicos son utilizados para definir eventuales asociaciones entre diferentes parámetros de una patología con el propósito de revelar factores de riesgo y su detección temprana. En el caso de la HBP, la interpretación de los estudios epidemiologícos resulta ser más compleja debido a la falta de una definición precisa de esta patología y a la escasa especificidad de los parámetros evaluados en su diagnóstico. Por ello, es de suma importancia la búsqueda de marcadores bioquímicos que resulten útiles para cumplir con este objetivo. En esta revisión se analizan los factores más relevantes que regulan el crecimiento prostático y que podrían influir en la etiología de la HBP así como los parámetros emergentes en el diagnóstico temprano de esta enfermedad.

Prostate Shape and Symptom Score in Benign Prostatic Hyperplasia

Prostates of the same volumes were found to have very variable shapes, that is, combinations of variably elongated width, height, and lengths. These were believed to be possible causes of the differences in the severity of both the obstructions and symptoms in the prostates even when their volumes were similar. We measured the transverse (width), anterior-posterior (height) and longitudinal (length) diameters of the prostates and the transition zone, and their calculated volumes using transrectal ultrasonography. To establish the relationship between the International Prostate Symptom Score (IPSS) and each of the dimensional parameters of the transition zone and the total prostate, 105 consecutive patients (mean age 66.43 +/- 9.24 years with a range o6f 46 to 90) who had voiding dysfunctions that were presumably related to BPH were analyzed using the t-test. Patients with conditions other than BPH were excluded. The results were as follows: 1. There was no significant correlation between the IPSS and any prostate volume parameter in the constant prostate volume conditions, because of the small numbers in each group. However, in the analysis of the total number of cases in all the volume categories, a significant correlation was found between the IPSS and some prostate dimensions; i.e., the longitudinal parameters in the total prostates (p < 0.01), and the transverse (p < 0.05) and longitudinal parameters (p < 0.05) in the transition zones. 2. Further investigations of the statistics of these significant parameters showed that prostates that were longer than 4 cm had significantly more severe symptoms than prostates shorter than 4 cm (p < 0.05), and that prostates with a ratio of length in the transition zone to the length in the total prostate ratio that was greater than 0.8 had significantly higher symptom scores than those with lower ratios (p < 0.05). When evaluating patients who have BPH, it is important to consider the shape of prostate. More aggressive treatment may be indicated in cases where the transition zone lengths exceeds 4 cm and the transition zone to total prostate length ratio exceeds 0.8.

Tratamiento médico de la hiperplasia benigna de la próstata mediante terazocina / Medical treatment of the benign prostatic hyperplasia using terazosin

Para estudiar la eficacia y la seguridad de la terapia alfa bloqueadora en el tratamiento de la hiperplasia prostática benigna de la próstata en nuestra población, tratamos 70 pacientes con dosis ascendentes de Terazocina hasta alcanzar una dosis de 5 mg con lo cual se mantuvieron en tratamiento hasta completar un año. A lo largo de la evaluación se demostraron diferencias estadísticamente significativas en las evaluaciones del Score de síntomas de Madsen y en la uroflujometría no invasiva practicada en los pacientes. No se observaron evidencias objetivas o subjetivas de cambio de tamaño del adenoma. La frecuencia de efectos colaterales fue escasa y sólo un 2,8 por ciento de los pacientes debieron suspender el tratamiento por una marcada intolerancia. De este modo concluimos que el tratamiento médico con Terazocina es efectivo y útil en la hiperplasia benigna de la próstata, y por algún tiempo pospone su intervención o es útil en los pacientes añosos que sean portadores de un al riesgo quirúrgico que les impida ser sometido a una intervención prostática convencional