Urinary Incontinence, Quality of Life, and Risk Factors in a Geriatric Cohort.

INTRODUCTION: The aim of the study was to evaluate the prevalence of urinary incontinence (UI) and its subtypes, associated clinical factors, and impact on quality of life (QoL) in a geriatric population aged 80 years or older. METHODS: Male and female residents (inclusion criterion: 80 years or older) of three Viennese senior citizen homes were personally interviewed with the aid of a structured questionnaire based on the Bristol Female Lower Urinary Tract Symptom Questionnaire within a 12-month period. UI was defined as any involuntary loss of urine during the past 4 weeks. Several demographic parameters were obtained additionally. RESULTS: 434 participants with a mean age of 86.8 years (women: 87.6 years; men: 86.1 years) were included. UI was present in 52.5% (57% female vs. 23% male, p < 0.001), stress UI affected 36% (41% female vs. 5% male, p < 0.001), urge UI 38% (40.5% female vs. 23% male, p < 0.01), and mixed UI 28% (24% female vs. 5.0% male, p < 0.01). While the overall prevalence of UI remained rather stable in the four age cohorts (80-84 years, 85-89 years, 90-94 years, >94 years), there was a constant decline of SUI paralleled by an increase of UI and - to a lesser extent - of MUI with age. 36.5% (33% female vs. 57% male) participants did not report any negative impact on QoL, while a severe reduction of QoL was present in 31% of cases (35% female vs. 10.0% male). Risk factors for UI and its subtypes included female sex, reduced/no mobility, hysterectomy, and number of births. CONCLUSION: This study provides data on the high prevalence of UI in a low-morbid geriatric cohort and evaluates gender-specific differences in UI prevalence, associated risk factors, and QoL.

Active stone removal is a safe option for ocotogenarians and nonagenarians with nephrolithiasis.

PURPOSE: To assess the contemporary in-hospital management of octogenarians and nonagenarians with renal calculi. MATERIAL AND METHODS: A multicentric retrospective evaluation of patients aged ≥ 80 years hospitalized with kidney stones between 01/2000 and 12/2019. Stone and patient related data were collected, including stone size and location, geriatric status and comorbidities. Surgical treatment patterns and outcome were assessed. RESULTS: A total of 299 patients (57% female) with kidney stones were analyzed. Mean age was 84.7 years. Patients were largely multimorbid (ASA ≥ 3 in 70%) and about 25% were classified as frail. Active stone treatment was performed in 65% and 35% were treated with urinary diversion (stent or nephrostomy). Prognostic factors for receiving an active stone treatment were age < 90 years, male sex, stone size and quantity, and performance status. Mean overall survival was 23.7 months and when stratified to treatment mean survival were 21 months after urinary diversion, 28 months after URS, 29 months after PCNL and 45 months after SWL. CONCLUSION: Age, frailty and performance-status as well as stone size and quantity are predictors for active stone treatment. Octogenarians and nonagenarians, who are considered fit for surgery, tend to live long enough to profit from active stone treatment.

Ureteral calculi in octogenarians and nonagenarians: Contemporary in-hospital management-A joint study by the endourological section of the Austrian Association of Urology.

AIM: To assess contemporary in-hospital management of octogenarians and nonagenarians with ureteral calculi. MATERIALS AND METHODS: Review of patients aged ≥80 years hospitalized due to ureteral calculi. Data was extracted from eight Austrian centers of urology. Stone and patient related data were recorded. Treatment patterns in acute and elective settings were assessed. RESULTS: A total of 759 patients hospitalized with ureteral calculi were analyzed. Out of them, 643 were octogenarians (80-89years) and 116 nonagenarians (90-99 years). In an acute setting, simple de-obstruction with urinary diversions outnumbered active stone treatments like URS and SWL (62.6% vs. 26.9% vs. 10.5%). Decision making whether patients underwent active stone treatment was driven by stone location (OR = 0.28, p<0.0001), impaired renal function (OR = 0.28, p = 0.01) and indwelling urethral catheters (OR = 0.23, p = 0.01) but not by age or extend of mobility (all p>0.05). In elective settings, 81.5% of procedures were active stone treatments-mainly URS (76.9%), while DJ stent or nephrostomy replacements were noted in 14.2% and 4.3%. Octogenarians (OR = 14, p<0.0001) and patients capable of walking (OR = 4.51, p = 0.01) had significantly higher odds of receiving active stone. Stone free rates and complications rates with URS were similar between octogenarians and nonagenarians (p = 0.98 and p = 0.58). CONCLUSION: In acute settings, age and extend of mobility were not found to be independent predictors for active stone treatment. In elective settings, after having received urinary diversions, reduced mobility and nonagenarians were less likely to undergo stone removal treatments. Safety and efficacy of URS seems to be similar in octogenarians and nonagenarians.

Anxiety and depression analyses of patients undergoing diagnostic cystoscopy.

PURPOSE: To prospectively assess anxiety and depression in patients undergoing diagnostic cystoscopy. METHODS: Patients presenting for outpatient diagnostic cystoscopy were recruited from four European urological departments. Anxiety and depression were assessed with the 'Hospital Anxiety and Depression Scale' (HADS) before cystoscopy and after 1 week. Statistical analyses, including the Chi-square test, univariate, and multivariate logistic regression analyses, were carried out with SPSS v. 21 (IBM Corp., Armonk, NY). RESULTS: Prior to cystoscopy, 30.2 % of patients were anxious and 24.8 % depressive (n = 442). In the post-examination period, anxiety declined to 24.5 %, while depression was unchanged (24.4 %). Pre-cystoscopy anxiety was significantly more common in women (41.8 vs. 24.5 %, p < 0.0001), patients aged <65 years (34.9 vs. 25.9 %, p = 0.04), and in those being examined with rigid cystoscopes (35.7 vs. 23.9 %, p = 0.007). In multivariate regression analyses, female gender (OR 2.6, p < 0.0001), <65 years of age (OR 1.7, p = 0.03), and coexistence of depression (OR 7.8, p < 0.0001) were independently associated with elevated pre-cystoscopy anxiety. Anxious (OR 2.1, p = 0.03) and depressive (OR 2.1, p = 0.01) patients had higher odds of experiencing moderate or severe pain during cystoscopy. Bladder cancer diagnosis did not significantly change patient's anxiety (p = 0.23) or depression (p = 0.7) during the 1 week of follow-up. CONCLUSIONS: Women, patients aged <65 years, depressive patients and those being examined with rigid devices had higher rates of anxiety prior to cystoscopy. Anxious and depressive patients experienced more pain during cystoscopy. Bladder cancer diagnosis seems to have a minor effect on anxiety and depression during the first week after diagnosis.

Impact of the use of bowel for urinary diversion on perioperative complications and 90-day mortality in patients aged 75 years or older.

OBJECTIVE: A potential strategy to decrease the high complication rate of radical cystectomy (RC) in the elderly is to avoid the use of bowel for urinary diversion. The aim of this study was to address this issue in a multicentre study of patients aged ≥ 75 years. PATIENTS AND METHODS: We performed a retrospective, multicentre study of a consecutive series of patients aged ≥ 75 years who underwent RC for muscle-invasive bladder cancer between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification. RESULTS: A total of 256 patients (68% men, mean age 79.6 years) were analysed. 204 (80%) patients received a urinary diversion with use of bowel and 52 (20%) a ureterocutaneostomy (UC). Patients with UC were older (82.0 vs. 78.9 years, p < 0.001) and had a higher ASA score (2.6 vs. 2.3, p = 0.007), while the mean Charlson score was lower (4.2 vs. 5.6, p < 0.001). Patients with UC had a shorter operating time (279 vs. 311 min, p = 0.002) and a shorter period in the intensive care unit (0.9 vs. 2.2 days). The overall rate of severe complications graded as Clavien III-V was significantly lower in the UC group (11.5%) as compared to patients receiving bowel for urinary diversion (25.0%) (p = 0.003). Severe (Clavien grade III-V) medical (3.9 vs. 10.3%) and surgical (2.1 vs. 14.1%) complications were all less frequent in the UC group. Inpatient, 30- and 90-day mortality was 5.8, 7.7 and 17.3% in the UC group as compared to 3.9, 5.9 and 6.9% in the bowel cohort, respectively. CONCLUSION: UC following RC is associated with a lower complication rate in geriatric patients. The constantly increasing cohort of geriatric, multimorbid patients requiring cystectomy might justify reconsideration of this form of diversion.

Perioperative complications and 90-day mortality of radical cystectomy in the elderly (75+): a retrospective, multicentre study.

OBJECTIVE: To assess perioperative complications and 90-day mortality of radical cystectomy (RC) in elderly patients with muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS: This is a retrospective, multicentre (n = 11) study of a consecutive series of patients ≥75 years who underwent RC for MIBC between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification. RESULTS: A total of 256 patients with a mean age of 79.6 years (range 75.0-86.6) were analysed. Urinary diversion with the use of bowel was performed in 79.5% and ureterocutaneostomy in 20.5%, with a higher proportion in the ≥80 cohort (32.2 vs. 14%; p = 0.001). 41.4% of patients had an uneventful postoperative course (Clavien grade 0) and 26.6% developed severe complications (Clavien grade III-V). In a multivariable regression analysis, the Charlson comorbidity index (odds ratio 1.5 per unit increase; p < 0.001) and the body mass index (odds ratio 1.13 per kg/m(2) increase; p = 0.015) were predictors for the development of complications. The 90-day mortality rate was 9% and the independent correlates thereof were the development of severe medical complications (p = 0.004), the American Society of Anesthesiologists (ASA) score (p = 0.03) and age (p = 0.005). CONCLUSIONS: Morbidity and 90-day mortality of RC in the elderly remain substantial. The interrelation between comorbidity, complication rate and 90-day mortality underlines the need for a comprehensive geriatric assessment of elderly patients with MIBC in whom RC is indicated.

Prostate cancer at the peripheral end of prostate biopsy specimen predicts increased risk of positive resection margin after radical prostatectomy: results of a prospective multi-institutional study.

PURPOSE: To test a novel technique of processing prostate biopsy specimen by marking the peripheral end (PE) as a predictive tool for positive resection margin after radical prostatectomy (RP) or for locally advanced carcinoma of the prostate (PC). METHODS: Prospective, multi-institutional study of a consecutive cohort of men who underwent prostate biopsy with marking the peripheral biopsy end and subsequent RP at the same institution. RESULTS: The study cohort comprised 445 men with a mean age of 63 years (40-77 years). Overall, PE-positive cores were found in 174 men (39.1 %) and R1 status was diagnosed in 132 men after RP (29.7 %). In the multivariate analysis, the presence of at least one PE-positive core was correlated with an increased risk of R1 status (OR 2.29, 95 % CI 1.31-4.00, p = 0.003) and was the strongest predictor followed by Gleason score, PSA and percentage of positive cores. Including all predictive parameters, a nomogram with a concordance index of 72.1 % was calculated. In the pT3/pT4 subgroup, PE positivity was the only predictive factor for R1 status (OR 3.03, 95 % CI 1.36-6.75, p = 0.006). In pT2 stage, no single factor was predictive for R1 status. PE-positive biopsies were not predictive for pT3/pT4 stages. CONCLUSIONS: PC at the peripheral end of prostate biopsy specimen predicts an increased risk of R1 status in subsequent RP. This simple and cheap technique may contribute to an increased accuracy of risk stratification for curative treatment for PC.

The relationship between cerebral white matter hyperintensities and lower urinary tract function in a population based, geriatric cohort.

INTRODUCTION: White matter hyperintensities (WHM) in cerebral MRI-scan have been suspected to be involved in the pathogenesis for geriatric LUTS. Aim of this study was to investigate this association in a geriatric cohort. MATERIALS AND METHODS: The VITA-study is a prospective, population-based study initiated 2000/2001. All inhabitants of a well-defined area in Vienna aged 75 years were recruited and underwent detailed regular visits including cerebral MRI-scans. Subcortical and periventricular WMHs were classified according to the Fazekas-classification. In 2010, all subjects alive were contacted to complete the Bristol LUTS questionnaire. RESULTS: Two hundred seventeen participants (75 men, 142 women), all 85 years old, entered this analysis. Urgency, frequency, and nocturia was present in 39 (50.7%), 53 (52%), and 55 (73.3%) men and 79 (55.6%), 81 (78.2%), and 68 (47.9%) women, respectively. OAB symptoms were seen in 55% of women and 50% of men. At baseline, WMH were present in 68.2% and this percentage increased to 85.7% at the most recent follow-up. Several symptoms were more prevalent in participants without WMH as compared to those with WMH, (urgency: 71% vs. 53%, P=0.06, nocturia: 77% vs. 53%, P=0.01: OAB-symptoms: 71% vs. 51%, P=0.05. Only frequency was more prevalent in participants with WMH (77% vs. 68%, P=0.27). In general, sub-categorization into periventricular and subcortical WMH confirmed these data. Furthermore the amount of WMH-burden did not correlate to LUT dysfunction. CONCLUSION: This study failed to demonstrate a clear association between several aspects of LUTS and WMH in a rather healthy, population-based 85-year-old cohort.

Comparison of radical cystectomy with conservative treatment in geriatric (≥80) patients with muscle-invasive bladder cancer.

INTRODUCTION: The aim of this study was to compare overall survival in elderly patients (≥ 80 years) with muscle-invasive bladder cancer (MIBC) undergoing either radical cystectomy (RC) or conservative treatment. MATERIAL AND METHODS: We performed a retrospective, comparative analysis of overall- and cancer-specific survival in octagenarians with MIBC (≥ pT2) submitted to RC or conservative treatment. Uni- and multivariable Cox regression analysis were performed to assess predictors of overall survival. Cumulative hospital stay was also analyzed for all patients. RESULTS: The RC-group consisted of 33 patients with a mean age of 82.3 years (IQR 80.4-85.4 years) and the bladder preservation a cohort of 35 patients aged 83.8 years (IQR 81.8-88.2 years). No difference was detectable for overall survival (15.9 months versus 9.5 months; p = 0.18) and cancer-specific survival (23.5 months versus 19.5 months p = 0.71) or 90-day mortality (6.1% versus 14.3%; p = 0.43) between the two groups. Patients who received conservative treatment had a shorter cumulative length of hospital stay (p = 0.001). Age at the time of transurethral resection of the bladder (TUR-B) was an independent predictor of the overall survival (p = 0.004). CONCLUSIONS: In this retrospective study, no clear survival benefit was observed for patients ≥80 years submitted either to radical cystectomy or conservative treatment. There was however a trend favoring radical cystectomy but this did not approach statistical significance. Octagenarians that underwent RC however spent more of their remaining lifetime in the hospital than those treated conservatively.

Comparison of Radical Cystectomy with Conservative Treatment in Geriatric ( 80) Patients with Muscle-Invasive Bladder Cancer

Introduction The aim of this study was to compare overall survival in elderly patients (≥ 80 years) with muscle-invasive bladder cancer (MIBC) undergoing either radical cystectomy (RC) or conservative treatment. Material and Methods We performed a retrospective, comparative analysis of overall- and cancer-specific survival in octagenarians with MIBC (≥ pT2) submitted to RC or conservative treatment. Uni- and multivariable Cox regression analysis were performed to assess predictors of overall survival. Cumulative hospital stay was also analyzed for all patients. Results The RC-group consisted of 33 patients with a mean age of 82.3 years (IQR 80.4-85.4 years) and the bladder preservation a cohort of 35 patients aged 83.8 years (IQR 81.8-88.2 years). No difference was detectable for overall survival (15.9 months versus 9.5 months; p = 0.18) and cancer-specific survival (23.5 months versus 19.5 months p = 0.71) or 90-day mortality (6.1% versus 14.3%; p = 0.43) between the two groups. Patients who received conservative treatment had a shorter cumulative length of hospital stay (p = 0.001). Age at the time of transurethral resection of the bladder (TUR-B) was an independent predictor of the overall survival (p = 0.004). Conclusions In this retrospective study, no clear survival benefit was observed for patients ≥ 80 years submitted either to radical cystectomy or conservative treatment. There was however a trend favoring radical cystectomy but this did not approach statistical significance. Octagenarians that underwent RC however spent more of their remaining lifetime in the hospital than those treated conservatively. .

Radical prostatectomy in Austria from 1992 to 2009: an updated nationwide analysis of 33,580 cases.

PURPOSE: We analyzed the demographics and outcome of radical prostatectomy in Austria in a nationwide series. MATERIALS AND METHODS: We analyzed the records of all 33,580 patients who underwent radical prostatectomy at a public hospital, including 95% of all surgical procedures, in Austria between 1992 and 2009. Patient demographics, perioperative mortality, interventions for anastomotic strictures and urinary incontinence, and overall survival were determined. Data were provided by the Austrian Health Institute. RESULTS: The annual number of radical prostatectomies increased 688% from 396 in 1992 to 3,123 in 2007 and gradually decreased to 2,612 in 2009. Mean ± SD patient age at surgery decreased slightly from 64.4 ± 6.3 years in 1992 to 62.0 ± 6.7 years in 2003. Age has remained at that level since then. Endourological intervention for anastomotic stricture and urinary incontinence was done in 7.5% and 2.8% of cases, respectively. The risk of each intervention increased with patient age and decreased in patients treated within the last 10 years compared to those treated before 2000. The 30-day mortality rate was 0.1%, which increased threefold from the youngest to the oldest age group. Ten-year overall survival decreased from 93% in patients 45 to 49 years old to 63% in those 70 years old or older at surgery. CONCLUSIONS: This nationwide analysis of a country that has had a public, equal access health care system for decades describes some current radical prostatectomy trends. Since 2007, the absolute number of radical prostatectomies has decreased. Data on morbidity, perioperative mortality and overall survival raise caution about performing radical prostatectomy in elderly men, eg those 70 years old or older.

Lower urinary tract symptoms and urinary incontinence in a geriatric cohort - a population-based analysis.

OBJECTIVES: To assess prevalence and severity of lower urinary tract function in 85-year-old men and women. Little is known on the prevalence of lower urinary tract dysfunction in this geriatric age group, which is now the fastest growing sector of the population worldwide. PATIENTS AND METHODS: The Vienna Trans-Danube Aging study (VITA) is a longitudinal, population-based study initiated in 2000 that included men/women aged 75 years living in a well-defined area in Vienna. The main purpose of the VITA study was to identify risk factors for incident Alzheimer's disease. All study participants alive in 2010 were contacted by mail to complete a detailed questionnaire on various aspects of lower urinary tract symptoms (LUTS) and urinary incontinence (UI). RESULTS: The response rate was 68%, resulting in a total of 262 questionnaires available for analysis (men n= 96; women n= 166). All study participants were 85 years of age. Urinary incontinence defined as any involuntary loss during the past 4 weeks was reported by 24% of men and 35% of women (P= 0.04). Stress UI was more frequent in women (39%) than in men (14%, P < 0.01), the difference for urge UI (women 35%, men 25%) was on the border of statistical significance (P= 0.05). Only four individuals (1.5%) needed permanent catheterization. Urgency (women 56%, men 54%) and daytime frequency (women 70%, men 74%) were equally distributed (P > 0.05). Nocturia more often than twice was more prevalent in men (69%) than in women (49%) (P= 0.02). Overactive bladder, according to International Continence Society criteria, was present in 55% of women and 50% of men. No difference regarding quality of life impairment as the result of LUTS and UI was noticed between sexes. A few co-morbidities were identified to correlate with UI and storage symptoms. CONCLUSIONS: These data provide insights into the prevalence and severity of LUTS and UI in individuals in their eighties, to our knowledge the largest population-based study in this age group. Demographic changes in upcoming decades underline the importance of a thorough understanding of lower urinary tract dysfunction in a geriatric population.

Is there an association between lower urinary tract symptoms and cardiovascular risk in men? A cross sectional and longitudinal analysis.

OBJECTIVE: To investigate the association between lower urinary tract symptoms (LUTS) and both coronary vascular disease (CVD) and stroke in men in a cross-sectional and longitudinal setting. MATERIAL AND METHODS: Men aged 30-92 years underwent a free health investigation and completed the International Prostate Symptom Score questionnaire. In the cross-sectional part, the 10-year CVD and stroke risks were estimated according to the Framingham risk score. In the follow-up period (mean 6.1 years) the CVD and stroke events were recorded. RESULTS: Two-thousand ninety-two men aged 47.8 years (SD 11.5) were analyzed. No to mild LUTS were present in 1,738 men, 337 men had moderate LUTS, and 17 had severe LUTS. The 10-year risk (cross-sectional design) for CVD or stroke in men with no to mild, moderate, and severe LUTS was 8.8%, 10.6%, and 15.9% (P <.01) and 6.9%, 7.5%, and 11.7% (P <.01), respectively. Adjusted for age, diabetes, total and low-density lipoprotein cholesterol, the odds ratios for CVD and stroke risk were 0.98 (P = .58) and 0.99 (P = .72) for moderate and 1.28 (P = .03) and 1.66 (P <.01) for severe LUTS. During follow-up, 96 events (CVD or stroke) were recorded: Men with no to mild, moderate, and severe LUTS had 76 (4.4%), 15 (4.5%), and 5 (29.4%) events, respectively. The adjusted (see above) hazard ratios were 0.63 (P = .16) for moderate and 3.82 (P = .01) for severe LUTS. CONCLUSION: Although moderate LUTS do not seem to be a risk factor for CVD and stroke, men with severe LUTS were at increased risk for both according to a cross-sectional and longitudinal analysis. Studies with a larger group of men with severe LUTS are warranted to further substantiate these observations.

Impact of overactive bladder symptoms on sexuality in both sexes.

OBJECTIVES: To define the epidemiological impact of the overactive bladder syndrome (OAB) on sexual life. We therefore analyzed this issue in a large cohort of individuals participating in a health screening project. PATIENTS AND METHODS: A total of 2,365 men and women completed the Bristol Female Lower Urinary Tract Symptoms Questionnaire (BFLUTS). OAB was defined according to the International Continence Society (ICS). The impact of OAB on sexual life was assessed by a single question: 'In general, how do your micturition problems affect your sexual life'. RESULTS: A total of 1.199 men and 1.166 women with were analyzed. The overall prevalence of OAB was 13.9% (n = 329): 9.7% had OAB(dry) and 4.2% OAB(wet). A total of 17.6% (n = 58) of individuals with OAB reported a negative impact of OAB on sexual life as compared to 4.7% of those without OAB (p < 0.001). One of 4 with OAB(wet) reported a negative impact on sexual life (25%) as compared to 14.4% in those with OAB(dry) (p < 0.005). CONCLUSION: Sexual dysfunction is frequently reported in individuals with OAB. Individuals with OAB(wet) are experiencing a more profound impact on sexuality. Therefore, patients with OAB should be assessed regarding sexual dysfunction by the urologist.

Radical cystectomy for bladder cancer in the 70+ population: a nation-wide registry analysis of 845 patients.

AIM: To analyze demographics, perioperative mortality and overall survival of radical cystectomy (RC) in patients aged 70+ years in Austria in a nation-wide registry cohort. PATIENTS AND METHODS: All patients >69 years who underwent RC in public hospitals (covering >95% of all surgical procedures) in Austria between 1992 and 2004 were analyzed. Data were provided by the Austrian Health Institute (ÖBIG). RESULTS: A total of 845 patients aged 70-89 years (mean 74) entered the analysis. The annual number of cystectomies in this age group increased from 27 in 1992 to 79 (+292%) in 2004. The mean length of hospital stay declined from 37.1 days (in 1992) to 27.1 days (in 2004). The 60-day mortality of the entire cohort was 1.5% and increased to 5.2% in patients aged 80+ years. Almost 50% of patients had to be rehospitalized within 30 days. The 5-year overall survival declined from 62% in those aged 70-74 years to 61% in those aged 75-79 years to 46% in the oldest age group (80+ years). CONCLUSIONS: The annual number of cystectomies in patients aged 70+ years increased substantially during the study period. These nation-wide registry data provide insights into the current status of RC in the elderly in Austria and demonstrate that cystectomy in this age cohort can be done with an acceptable perioperative mortality and overall survival.

Is left ventricular systolic dysfunction a risk factor for erectile dysfunction?

OBJECTIVES: To analyze erectile dysfunction (ED) in patients with left ventricular systolic dysfunction (LVSD). METHODS: A consecutive series of men aged 50-65 years undergoing an echocardiography (EC) at the Danube hospital in Vienna was analyzed. All patients completed the International Index of Erectile Function-5 (IIEF-5). LVSD was defined by EC as an ejection fraction (EF) below 55%. RESULTS: A total of 85 men (age, 58.5 years; standard deviation, 4.3) entered the analysis. Mean EF was 60.9% and mean IIEF-5 score 16.8. No ED (IIEF-5, 22-25) was present in 32 men (37.6%), mild ED (IIEF-5, 17-21) in 17 (20%), and 36 (42.4%) had moderate to severe ED (IIEF-5, 5-16). An EF below 55% was seen in 26 men (30.6%). Mean IIEF-5 in men with LVSD was 13.6 compared with 18.2 in those without LVSD (P = .005); the proportion of men with ED (IIEF-5 <22) was 76% in men with LVSD compared with 56.6% in those without LVSD (relative risk, 1.37; P = .05). In a logistic regression analysis adjusted for body mass index and age a declined IIEF-5 score was independently associated with a low EF (

Bladder preservation in octogenarians with invasive bladder cancer.

OBJECTIVES: To analyze mortality and morbidity of octogenarians with newly diagnosed invasive transitional cell cancer (TCC) of the bladder who were managed without cystectomy. METHODS: Retrospective chart review of all patients with newly diagnosed invasive TCC (> or = pT1) in the period of 1997-2007, who were 80 years or older at diagnosis. RESULTS: A total of 71 patients (86 + 4 years, mean + standard deviation [SD], pT1: n = 29; > pT2: n = 42) entered this analysis. In this geriatric population, treatment regimens were highly individualized. After transurethral resection, 61% of pT1-patients received bacillus Calmette-Guerin and 62% of those with > pT2-tumors external beam radiation. Mean overall survival (OS) of the entire cohort (n = 71) was 22 + 26 months for pT1-patients 34 + 33 versus 14 + 15 months for those with > or = pT2-tumors (P = .001). Mean cancer-specific survival was 58 months for pT1-patients and 11 months for > or = pT2-patients (P <.001). OS was correlated to tumor stage and the degree of mobility, to a lesser extent to the American Society of Anesthesiologists (ASA) score, and only marginally to chronologic age. Satisfactorily bladder function was preserved in 73%. pT1-patients spent 16% of their remaining life-span in the hospital compared with 23% for patients with > pT2-tumors. CONCLUSIONS: OS in TCC is dependent on tumor stage, age, mobility, and comorbidities, and a risk-stratified management is necessary. Patients with pT1G3 tumor and low ASA score have satisfying OS with bladder preservation, but in patients with > or = pT2 and ASA 3-4 the prognosis is very bad. It remains questionable whether patients with tumor stages > or = pT2 and ASA 1-2 despite high age would benefit from radical cystectomy.

Chronic pelvic pain and lower urinary tract symptoms in both sexes: analysis of 2749 participants of an urban health screening project.

BACKGROUND: Recent studies question the role of the prostate as the key factor in the pathogenesis of chronic pelvic pain syndrome (CPPS). OBJECTIVE: To compare symptoms related to CPPS and lower urinary tract symptoms (LUTS) in both sexes. DESIGN, SETTING, AND PARTICIPANTS: Participants of a voluntary health examination in Vienna. INTERVENTION AND MEASUREMENTS: All participants completed a detailed questionnaire containing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), with the female homolog of each male anatomical term use on questionnaires for female participants, the International Prostate Symptom Score (IPSS), and additional questions on pelvic pain. Furthermore, all participants underwent a detailed health investigation performed by a general practitioner. RESULTS AND LIMITATIONS: The study cohort comprised 1768 men and 981 women. The mean NIH-CPSI was 7.2+/-0.1 in women and 3.8+/-0.2 in men (p<0.001). In subject up to the age of 70 yr, the NIH-CPSI was higher in women (p<0.001). The NIH-CPSI increased with age in men (p<0.001), yet not in women (p=0.4). The prevalence of symptoms suggestive of CPPS in this selected population was 5.7% in women and 2.7% in men, and was higher in premenopausal women (p=0.03). Until the age of 50 yr, NIH-CPSI pain score in women exceeded that of men (p<0.001). The mean IPSS was higher in women (p<0.001). Storage symptoms were higher in women up to 60 yr, and voiding symptoms were higher in men above 60 yr. In men and women with symptoms suggestive of CPPS, the mean IPSS was significantly higher compared with those without CPPS symptoms (p<0.001). Limitations of our study are (1) that a urological evaluation was not performed and (2) that the questionnaire was not formerly validated for females. CONCLUSION: The preponderance of CPPS in females raises questions about the etiological role of the prostate in all cases with chronic pelvic pain and suggests that other pathomechanisms are likely to be involved.

Symptoms suggestive of chronic pelvic pain syndrome in an urban population: prevalence and associations with lower urinary tract symptoms and erectile function.

PURPOSE: We determined the prevalence of symptoms suggestive of chronic pelvic pain syndrome in an urban population and assessed associations with lower urinary tract symptoms and erectile dysfunction. MATERIALS AND METHODS: Men participating in a voluntary health examination free of charge that was organized by the Department of Preventive Health of the City of Vienna were analyzed. All participants completed 3 validated questionnaires on chronic pelvic pain syndrome (National Institutes of Health-Chronic Prostatitis Symptom Index), lower urinary tract symptoms (International Prostate Symptom Score) and erectile dysfunction (International Index of Erectile Function-5). RESULTS: A total of 1,765 men with a mean +/- SD age of 46.3 +/- 0.3 years (range 20 to 79) entered this study. The mean National Institutes of Health-Chronic Prostatitis Symptom Index score increased from 4.0 +/- 0.3 in the youngest age group of 20 to 29-year-old men to 6.3 +/- 0.6 in those 70 to 79 years old. The overall prevalence of symptoms suggestive of chronic pelvic pain syndrome, defined by a pain score of 4 or greater and perineal/ejaculatory pain, was 2.7% and it revealed no age dependence, such as the pain score. In contrast, urinary symptom and quality of life scores increased with age. International Index of Erectile Function-5 score was 20.6 +/- 0.3 for men without chronic pelvic pain symptoms vs 18.3 +/- 0.7 for men with mild symptoms and 16.5 +/- 1.1 for men with moderate/severe symptoms. A National Institutes of Health-Chronic Prostatitis Symptom Index score in the upper quartile was associated with 8.3-fold increased odds of erectile dysfunction. CONCLUSIONS: The prevalence of symptoms suggestive of chronic pelvic pain syndrome in this large cohort of men participating in a health screening project was 2.7% and it revealed no age dependence. Our study suggests that chronic pelvic pain syndrome has a negative impact on erectile function.

Radical prostatectomy in Austria: a nationwide analysis of 16,524 cases.

OBJECTIVES: To analyse demographics and outcome of radical prostatectomy (RPE) in Austria in a nationwide series. METHODS: All patients (n=16,524) who underwent RPE in public hospitals (covering 95% of all surgical procedures) in Austria between 1992 and 2003 were analysed. Patient demographics, interventions for anastomotic strictures/urinary incontinence/inguinal hernias, perioperative mortality, and overall survival (OS) were determined. Data were provided by the Austrian Health Institute (OBIG). For decades Austria has had a public and equal access health system with compulsory insurance coverage. RESULTS: The annual number of RPEs increased from 396 in 1992 to 2640 (+666%) in 2003; the mean age at surgery declined from 64+/-6.3 yr (1992) to 62.0+/-6.7 yr (2003). An endourologic intervention for anastomotic strictures was performed in 8.5% (45-49 yr: 5.8%; 70-74 yr: 10.8%). An artificial urinary sphincter was implanted in 1.6% with a 5-fold increase from the youngest (0.5%; 45-49 yr) to 2.5% in those aged 70-74 yr. Overall, 6.4% of men underwent an inguinal herniotomy after RPE. The 30-d mortality rate was 0.12%. The 5-yr OS declined from 95% in those aged 50-59 yr to 89.8% in those aged 60-69 yr to 82% in the oldest age group (70-79 yr). CONCLUSIONS: This nationwide analysis describes the current standard of RPE in Austria. The perioperative mortality was low, the risk of total incontinence acceptable, and the OS indistinguishable to the life expectancy of the age-matched male population in Austria.