Cardiovascular risk factors, ethnicity and infection stone are independent factors associated with reduced renal function in renal stone formers.

BACKGROUND: Recent evidence suggested the link between nephrolithiasis and renal function impairment. We aimed to determine the renal function profile and potential factors associated with reduced renal function amongst renal stone formers in multi-ethnic Asians. METHODS: We conducted a cross-sectional study involving patients undergoing percutaneous nephrolithotomy between May 2015 and December 2019. Reduced renal function was defined as having estimated glomerular filtration rate < 60 ml/min per 1.73 m2. Renal stone samples were collected and quantified using infrared spectroscopy. Potential factors associated with reduced renal function including age, ethnicity, educational level, history of diabetes, hypertension, gout, hydronephrosis, serum uric acid level, and type of renal stone were evaluated using univariable and multivariable analyses. RESULTS: A total of 1162 patients from a multi-ethnic population (Malays 67%, Chinese 19%, Indians 13% and indigenous people 1%) with median age of 57 years (Interquartile range 48-64) were enrolled in the study. Almost a third of patients were found with reduced renal function. Multivariable analysis showed that the odds of having reduced renal function increased with age, ethnicity, lower educational level, history of diabetes, hypertension, gout, bilateral hydronephrosis, elevated serum uric acid level and infection stone. CONCLUSIONS: Reduced renal function varies between ethnicities and all age groups of renal stone formers. In addition to age and ethnicity, cardiovascular risk factors including diabetes and hypertension may also need to be taken into account in managing stone patients with reduced renal function.

Predictive factors of prostate cancer diagnosis with PSA 4.0-10.0 ng/ml in a multi-ethnic Asian population, Malaysia.

OBJECTIVES: To identify the associated factors determining prostate cancer detection using transrectal ultrasound (TRUS)-guided prostate biopsy, within a multi-ethnic Malaysian population with prostate specific antigen (PSA) between 4.0 and 10.0 ng/ml. METHODS: Study subjects included men with initial PSA between 4.0 and 10.0 ng/ml that have undergone 12-core TRUS-guided prostate biopsy between 2009 and 2016. The prostate cancer detection rate was calculated, while potential factors associated with detection were investigated via univariable and multivariable analysis. RESULTS: A total of 617 men from a multi-ethnic background encompassing Chinese (63.5%), Malay (23.1%) and Indian (13.3%) were studied. The overall cancer detection rate was 14.3% (88/617), which included cancers detected at biopsy 1 (first biopsy), biopsy 2 (second biopsy with previous negative biopsy) and biopsy ≥ 3 (third or more biopsies with prior negative biopsies). Indian men displayed higher detection rate (23.2%) and increased risk of prostate cancer development (OR 1.85, 95% CI 1.03-3.32, p < 0.05), compared to their Malay (9.8%) and Chinese (14.0%) counterparts. Multivariable analysis revealed that ethnicity and PSA density (PSAD) are independent factors associated with overall prostate cancer detection rate. A unit increase of PSAD reflected an increase in PSA after controlling for prostate volume. CONCLUSION: Prostate cancer detection in Malaysia is comparatively lower. Our study suggests that ethnicity and PSA density should be considered when recommending first or repeat TRUS-guided prostate biopsy for prostate cancer detection in a multi-ethnic Malaysian population.

A Novel Calculator for Estimating Prostate Volume in Daily Urology Services.

OBJECTIVES: To develop a simple prostate volume (PV) calculator that can aid in managing patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement at daily urology services in developing Asian countries. MATERIALS AND METHODS: We conducted a cross-sectional study of men aged above 40 years with no history of prostate cancer, prostate surgery, or 5α-reductase inhibitor treatment. Serum prostate-specific antigen (PSA) and total PV were measured in each subject. Potential sociodemographic and clinical variables including age, weight, comorbidities, and International Prostate Symptom Score (IPSS) were collected. Of 1034 subjects, 837 were used in building the PV calculator using regression analysis. The remaining 1/5 (n = 197) was used for model validation. RESULTS: There were 1034 multiethnic Asian men (Chinese 52.9%, Malay 35.4%, and Indian 11.7%) with mean age of 60 ± 7.6 years. Average PV was 29.4 ± 13.0 mL while the overall mean of PSA was 1.7 ± 1.7 ng/mL. We identified age, IPSS, weight, and PSA (all P <.05) in the PV regression model. Using the validation set, the coefficient of determination (R2) of this PV calculator was 0.47 where PV = 20.6 + (age - 60) × 0.1 + (IPSS score) × 0.1 + (Weight - 70) × 0.3 + (history of alpha-blocker treatment for LUTS) × 9.6 + PSA × 3.7. The area under curve of this model in predicting PV above 30 mL and 40 mL were 0.82 (95% confidence interval, 0.75-0.88) and 0.91 (95% confidence interval, 0.87-0.96), respectively. CONCLUSION: We develop a PV calculator that is simple and accurate to be used in routine clinical consultation for patients with LUTS. A separate study is important to confirm and to validate the findings in other populations.

Cardiovascular Risk Factors and Ethnicity Are Independent Factors Associated with Lower Urinary Tract Symptoms.

OBJECTIVES: To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting. MATERIALS AND METHODS: We conducted a cross-sectional study of 1021 men aged 40-79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses. RESULTS: There were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian counterparts. Stratified analyses of LUTS demonstrated a mutually exclusive cardiovascular risk factors profile defined by ethnicity. CONCLUSION: Severity of LUTS varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity and cardiovascular risk factors including hypertension and hypercholesterolemia may also need to be taken into account in managing men with LUTS.

Ethnicity is an independent determinant of age-specific PSA level: findings from a multiethnic Asian setting.

OBJECTIVES: To study the baseline PSA profile and determine the factors influencing the PSA levels within a multiethnic Asian setting. MATERIALS AND METHODS: We conducted a cross-sectional study of 1054 men with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The serum PSA concentration of each subject was assayed. Potential factors associated with PSA level including age, ethnicity, height, weight, family history of prostate cancer, lower urinary tract voiding symptoms (LUTS), prostate volume and digital rectal examination (DRE) were evaluated using univariable and multivariable analysis. RESULTS: There were 38 men (3.6%) found to have a PSA level above 4 ng/ml and 1016 (96.4%) with a healthy PSA (≤4 ng/ml). The median PSA level of Malay, Chinese and Indian men was 1.00 ng/ml, 1.16 ng/ml and 0.83 ng/ml, respectively. Indians had a relatively lower median PSA level and prostate volume than Malays and Chinese, who shared a comparable median PSA value across all 10-years age groups. The PSA density was fairly similar amongst all ethnicities. Further analysis showed that ethnicity, weight and prostate volume were independent factors associated with age specific PSA level in the multivariable analysis (p<0.05). CONCLUSION: These findings support the concept that the baseline PSA level varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity may also need to be taken into account when investigating serum PSA concentrations in the multiethnic Asian population.

Prostate cancer screening perspective, Malaysia.

The incidence of prostate cancer in Malaysia is still low compared to the west. This may be due to a true low incidence or lower detection rates. Prostate Awareness Campaigns are held on a yearly basis to educate and encourage males over the age of 50 years to have their prostate examined. Such a campaign was organized in 2005 at the national level involving 12 district hospitals. A total of 2770 participants attended the campaign. 38.7% had no urinary symptoms and attended out of curiosity. Among the symptomatic patients, nocturia was the most bothersome in the majority. 84.6% of the participants also had some degree of erectile dysfunction based on the IIEF questionnaire. 10.4% of participants had a PSA > 4 ng/mL. Malay participants had the highest mean PSA level (2.32 ng/mL) and Indian participants the lowest (1.30 ng/mL). 408 participants were called back for biopsy but only 183 agreed to the biopsy. 30 cancers were detected. At present Malaysia will benefit most by continuing to conduct these awareness programmes to educate the public on prostate disease and hopefully in future patients will be less reluctant to have prostate biopsies taken when indicated.

Nocturia, nocturia indices and variables from frequency-volume charts are significantly different in Asian and Caucasian men with lower urinary tract symptoms: a prospective comparison study.

OBJECTIVE: To describe and compare the patterns of nocturia in Asian and Caucasian men presenting with lower urinary tract symptoms (LUTS), and to identify associations or correlations between LUTS and variables from a frequency-volume chart (FVC), as nocturia is common among men with LUTS, and analysis of FVCs shows nocturnal polyuria and reduced nocturnal bladder capacity (NBC) as the predominant causes in Western patients, but there are few comparisons with other ethnic groups. PATIENTS AND METHODS: Consecutive men aged > or = 40 years, presenting with LUTS and nocturia to an Asian and a Caucasian tertiary centre, were recruited prospectively. The men completed the International Prostate Symptom Score and a 3-day FVC. Men having had bladder outlet surgery and/or receiving anticholinergics were excluded. We computed the nocturia ratio, i.e. the nocturnal urine volume/ 24-h urine volume, nocturia index, predicted nocturnal voids and NBC index (NBCI), and analysed comparisons and correlations. RESULTS: In all, 93 Asian and 200 Caucasian men were recruited prospectively, with a similar age and overall severity of LUTS. The nocturia ratio was larger in the Caucasian men, whereas the NBCI was larger in the Asians (P < 0.001). The prevalence of nocturnal polyuria in men aged > or =60 years (nocturia ratio > or =0.3) was significantly higher in the Caucasian population. Conversely, the prevalence of reduced NBC appeared to be higher in the Asians (based on a NBCI of >2; P < 0.001). CONCLUSIONS: The patterns of nocturia and FVC variables differed significantly in age-matched Asian and Caucasian groups. There are also possible ethnic differences in the causes of nocturia, with nocturnal polyuria being more prevalent in Caucasians.