Lower Urinary Tract Symptoms

Objective: In this study, we aimed to investigate the effect of diabetes-related metabolic changes and chronic complications on lower urinary tract (LUT) functions. The study included 286 adult patients with type 1 and type 2 diabetes mellitus (DM). All patients' demographic data, diabetes-specific history, laboratory and physical examination findings were recorded. All the data were compared with uroflowmetric parameters and the scores of questionnaires used for evaluation of LUT symptoms and functions. Results: In the presence of diabetic peripheral neuropathy (DPN), average urinary flow rate (Q ave ), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score and the Overactive Bladder-questionnaire Short Form (OAB-q SF) score were significantly affected. In the presence of stage 3 or over diabetic nephropathy (DN), ICIQ-SF score was significantly higher. Also, in elderly group, Q ave and OAB-q SF score were significantly affected. The Q ave was lower both in patients who underwent any surgery due to diabetic complications and in patients with DM-related diseases. Q ave and OAB-q SF score were significantly lower in males. Type 2 DM was associated with postvoid residual (PVR) increase and Q ave decrease. Poor glycemic control was associated with lower OAB-q SF score. Finally, vitamin D deficiency was found to be associated with an increase in PVR volume. The present study showed that DPN, stage 3 or over DN, aging, DM-related diseases and surgeries, male gender, type 2 DM, poor glycemic control and vitamin D deficiency cause a tendency to develop any kind of LUT dysfunction.

In the management of temporomandibular joint (TMJ) disorders, dental practioner should conduct the reversible, conservative, and inexpensive treatment modalities prior to the irreversible and invasive treatment. That is to say, behavioral, pharmacologic, and physical therapy should be conducted firstly, and then the occlusal appliance therapy could be considered. If patients do not react to these conservative treatments, we have to consider surgical treatments. If the accurate diagnosis is confirmed by intimate history taking, clinical and imaging examinations, we can rehabilitate the normal TMJ function and relieve the clinical symptoms with only conservative treatments in most TMJ disorder cases.

Objectives. Urinary tract involvement is a seldom-reported manifestation of SSc that could compromise patients' quality of life. This study compares lower urinary tract symptoms (LUTS) in SSc patients and in healthy subjects and their association with clinical and diagnostic parameters. Methods. LUTS were assessed through self-reported questionnaires in 42 SSc patients and 50 matched healthy subjects. Statistical analyses were performed to explore LUTS in the two populations and their association with SSc variables, including nailfold videocapillaroscopy patterns, SSc-related antibodies and DXA parameters. Results. SSc patients showed significantly higher prevalence and severity of urinary incontinence (UI) and overactive bladder (OAB) than healthy controls (P < 0.005, P < 0.01). SSc was a strong predictor of LUTS, independent of demographic data, comorbidities and treatments (odds ratio 5.57, 95% CI 1.6418.88). In SSc patients OAB positively correlated with sarcopenia (P < 0.001), and both OAB and UI significantly correlated with reduced BMD (P < 0.05, P = 0.001). UI positively correlated with Scl70 antibodies (P < 0.05) and ciclosporin treatment (P = 0.001) and negatively with RNA polymerase III antibodies (P < 0.05); OAB positively correlated with calcinosis (P < 0.005) and negatively with methotrexate treatment (P < 0.05). Nailfold videocapillaroscopy 'active' and 'late' patterns were predominant among SSc patients presenting urinary symptoms, although no statistical correlation was found. For the first time urinary tract involvement was found to be significantly higher in SSc patients than in healthy matched controls. In addition, sarcopenia, bone damage and calcinosis appeared significantly correlated with LUTS, suggesting a possible interplay.

Background: Combination therapy with dutasteride and tamsulosin provides significantly greater benefit than either monotherapy for various patient-reported outcomes in men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and prostatic enlargement. Objective: To investigate whether combination therapy is more effective than either monotherapy in reducing the relative risk for acute urinary retention (AUR), BPH-related surgery, and BPH clinical progression over 4 yr in men at increased risk of progression. Design, setting, and participants: The Combination of Avodart 1 and Tamsulosin (CombAT) study was a 4-yr, multicenter, randomised, double-blind, parallel-group study in 4844 men !50 yr of age with a clinical diagnosis of BPH, International Prostate Symptom Score !12, prostate volume !30 cm 3 , prostate-specific antigen 1.5-10 ng/ml, and maximum urinary flow rate (Q max ) >5 and 15 ml/s with minimum voided volume !125 ml. Intervention: Oral daily tamsulosin, 0.4 mg; dutasteride, 0.5 mg; or a combination of both. Measurements: The 4-yr primary end point was time to first AUR or BPH-related surgery. Secondary end points included BPH clinical progression, symptoms, Q max , prostate volume, safety, and tolerability. Results and limitations: Combination therapy was significantly superior to tamsulosin monotherapy but not dutasteride monotherapy at reducing the relative risk of AUR or BPH-related surgery. Combination therapy was also significantly superior to both monotherapies at reducing the relative risk of BPH clinical progression. Combination therapy provided significantly greater symptom benefit than either monotherapy at 4 yr. Safety and tolerability of combination therapy was consistent with previous experience with dutasteride and tamsulosin monotherapies, with the exception of an imbalance in the composite term of cardiac failure among the three study arms. The lack of placebo control is a study limitation. Conclusions: The 4-yr CombAT data provide support for the long-term use of dutasteride and tamsulosin combination therapy in men with moderate-to-severe LUTS due to BPH and prostatic enlargement. Clinicaltrials.gov identifier: NCT00090103 ().

Purpose: Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT. Material and Methods: We interviewed 372 parents of children who had completed TT up to 48 months before the interview. The questionnaires were applied at school exits when parents went to pick their children up and at public parks. Questions included demographics, aspects related to TT, dysfunction voiding symptom score and evaluation of constipation. Results: The interviews were performed at a mean of 15.3±10.4 (0 to 47) months after the end of TT. Girls accounted for 53% of the sample. The mean age at fi nishing TT was 31.6±9.3 months and similar in both genders (p=0.77). TT occurred before school entry in 45.7% of the children and medical advice for TT was sought only by 4.8% of the parents. No association was observed of age at completing TT and presence of lower urinary tract symptoms (LUTS) (p=0.57) and/or constipation (p=0.98). In the univariate analysis, prematurity (OR=2.7 [95% CI 2.3-3.1], p <0.0001) and mothers who work outside their household (OR=1.8 [95% CI 1.4-2.3], p <0.0001) were associated to delayed TT. Children completed TT at a mean of 2 years and 7 months of age. The age of completing TT was not related to LUTS and/or constipation. Premature children and those whose mothers work outside the home fi nish TT later.

ABSTRACTObjectivesTo evaluated the accuracy of a single question on nocturia to identify men with moderate and severe LUTS.MethodsWe evaluated men aged ≥40 years who presented for medical evaluation at two different urological clinics. They completed the IPSS and the Nocturia Single Question Scale (NSQS). NSQS consists of a single question assessing nocturia frequency ranging from 0 to 4. The severity of LUTS using NSQS (index test) versus IPSS (reference standard) was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative.ResultsThe accuracy of the NSQS to discriminate patients with severe LUTS based on the ROC curve was 75% (CI 95% 73 – 82%; p&lt;0.001).ConclusionPatients without nocturia or a single void/night (NSQS &lt;2) have low probability, while NSQS ≥ 3 has a high probability of having moderate or severe LUTS. NSQS is an acceptable alternative to the IPSS, being a fast and simple tool to identify men according to LUTS’s se...

Objectives: Children with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to estimate the age toilet training starts and completes in children with DS compared to children with normal psychomotor development and to evaluate the method and type of toilet training most frequently used, as well as its association with lower urinary tract symptoms and functional constipation. Methods: A case---control study was carried out from 2010 to 2015. All parents completed a questionnaire designed to assess the toilet training process. Lower urinary tract symptoms were assessed through the application of the Dysfunctional Voiding Symptom Score. The presence of functional constipation was assessed according to the Rome III criteria. Results: The study included 93 children with Down syndrome and 204 children with normal psychomotor development (control group [CG]). The mean age of toilet training onset was 22.8 months in those with DS and 17.5 months in the CG (p = 0.001). In children with DS, the mean age when completing toilet training was 56.2 months and 27.1 months in the CG (p = 0.001). Among children with DS, females completed toilet training earlier (p = 0.02). The toilet training method used most often was child-oriented approach in both groups. No association was observed with

Lower urinary tract symptoms (LUTS) are common complaints in the adult male population and have a negative affect in the quality of life and represent an economic burden for the healthcare system worldwide. The International Prostatism Symptom Score (IPSS) is a validated tool for assessing these symptoms, but patients with low literacy may have difficulties comprehending and completing it accurately. The Urgency, Weak Stream, Incomplete Emptying, and Nocturia (UWIN) questionnaire was developed as a shorter tool in the assessment of LUTS to improve accuracy and minimize error. This study aimed at performing cross-cultural adaptation to Brazilian Portuguese and validation of UWIN questionnaire for patients with LUTS. The cross-cultural adaptation followed the steps of conceptual, item, semantic, operational, and pre-test equivalence to obtain the UWIN-Br version. The IPSS (gold standard) and UWIN-Br were coadministered, and information regarding the uroflowmetry examination was also r...

Aim : The aim of the present study was to determine the frequency of lower urinary tract symptoms (LUTS), assess the impact of LUTS on quality of life (QOL) and compare the results with recent reports from other population-based studies. Methods : A total of 266 men participated in the study. The men were stratified into 10-year age groups between 40 and 79 years. All participants were asked to complete a questionnaire that included a Turkish translation of the International Prostate Symptom Score (IPSS) with QOL questions, and void into a uroflowmeter to obtain voided urine volume, peak and mean flow rate. Results : While 14.8% of men had no symptoms (IPSS = 0), 24.9% had moderate to severe symptoms (IPSS > 7). Severity of symptoms increased with age ( P = 0.0018). There was a strong relationship between bother score and IPSS ( rs = 0.79, P = 0.0001). Fifty-five percent of moderately symptomatic and 78% of severely symptomatic men reported poor QOL (QOL score ≥ 3). The results of the survey provide a general picture of the symptomatology and urinary flow profiles of elderly men living in Turkey. The prevalence of LUTS in the Turkish community is fairly high, it increases with age and has an impact on QOL that is not negligible.

Stres üriner inkontinans (SÜİ) Uluslararası Kontinans Cemiyeti tarafından fiziksel efor, öksürme ya da hapşırma esnasında istemsiz idrar kaçırma olarak tanımlanmaktadır (1). Üriner inkontinans toplumda yüksek oranlarda görülmesi, yaşam kalitesini ve cinsel fonksiyonları olumsuz yönde etkilemesi nedeniyle önemli bir sağlık problemidir (2). 17 bin katılımcıyı içeren 4 Avrupa ülkesinin katıldığı bir ankette, kadınların %35'inde üriner inkontinans saptanmıştır ve SÜİ en yaygın inkontinans tipini oluşturmuştur. Çalışmada kadınların %30'u karışık tip inkontinans tariflerken %50'sinde sadece SÜİ bulunmaktadır (3). İdrar kaçırma hakkında halk bilinçli olmasına rağmen bunun daha az rapor edildiği bilinmektedir. Utanma, cerrahi korkusu, yaşlanmanın bir doğal sonucu olarak düşünme ve eldeki tedaviler hakkında yeterli bilgi sahibi olmama gibi nedenlerden dolayı kadınların sadece üçte birinin tedavi almak amacıyla sağlık kuruluşuna başvurduğu tahmin edilmektedir. SÜİ'nin tedavisinde davranış tedavileri, pelvik taban kas egzersizleri, elektrik stimülasyonu, bariyer metotlar, bulking ajanlar ve cerrahi olmak üzere çeşitli seçenekler bulunmaktadır. Bazı ürojinekologlar SÜİ için primer tedavide cerrahi kullanma eğiliminde olsa da özellikle ko-morbidite nedeniyle cerrahi tedavi uygulanamayan ve cerrahi istemeyen hastalar için cerrahi dışı tedavi yöntemler de kullanılmaktadır. Kadın kontinansı bazı anatomik ve fonksiyonel mekanizmaların karşılıklı etkileşimi sayesinde sürdürülür. SÜİ patogenezi ile ilişkili anatomik faktörlerin arasında üretral destek, mesane boynu ve üretral kas fonksiyonu yer almaktadır (4). Bu faktörler farmakolojik yöntemler ile tedavi edilemezler. SÜİ'na sahip kadınlarda yaş eşleştirilmiş kontinan kadınlar ile karşılaştırıldığında dinlenme üretral basınçları azalmış olarak saptanmıştır (5). Üretral basınçların artması ile SÜİ'ta iyileşmesi olabileceği fikri rasyonel görünmektedir. Ürethral kapanma basıncını arttıran faktörler arasında üretral düz kas tonusu ve lamina propriadaki özelliklerden yer almaktadır. Üretra içi basıncı etkileyen faktörler hakkında hala veriler yetersiz olmasına rağmen, üretral tonusun önemli bir kısmının alfa adrenerjik reseptör stimülasyonu sonucu üretra düz kas hücresi içine salınan nörepinefrinin sağladığına dair farmakolojik kanıtlar bulunmaktadır. Östrojen eksikliği olan yaşlı kadınlarda mukozal fonksiyonların bozulması da SÜİ için Derleme Review ÖZ Üriner inkontinans kadınları zayıflatan ve sıkıntıya sokan yaygın bir durumdur ve genellikle rapor edilmez ve tedavi edilmezler. Stres üriner inkontinans (SÜİ) en yaygın inkontinans tipini oluşturmaktadır. SÜİ yüksek prevalansı ve yaşam kalitesine olumsuz etkileri nedeniyle önemini korumakta olan bir hastalıktır. Bu durum sosyal izolasyon, psikolojik rahatsızlık, fiziksel aktivitelerden kaçınma ve seksüel disfonksiyonla ilişkilidir. SÜİ'nin tedavisinde konservatif, medikal tedavi ve cerrahi yer almaktadır. Stres üriner inkontinansın tedavisi bireyselleştirilmelidir. Medikal tedavi, cerrahi olmak istemeyen ya da cerrahinin kontraendike olduğu kadınlarda alternatif bir seçenek olabilir. Ameliyat olamayan ya da ameliyatı istemeyen hastalar için de cerrahi dışı yöntemler bir seçenek olabilmektedir. Cerrahi dışı tedavi seçeneklerinden birisi de farmakoterapidir. Alfa reseptör agonitleri, beta reseptör agonistleri, beta reseptör antagonistleri, trisiklik antidepresanlar, antikolinerjikler, serotonin-adrenalin geri alım inhibitörleri ve östrojenleri içeren çeşitli ilaçlar kullanılmaktadır. Bu ilaçlar içerisinde SÜİ tedavisi için onay alan tek ilaç duloksetindir. Bu derlemede diğer ajanlarla birlikte duloksetin tedavisinin özellikleri ve dikkat edilmesi gereken noktalar ele alınmıştır.

Urinary incontinence is a widespread debilitating and distressing condition in women and generally under-reported and undertreated. Stress urinary incontinence (SUI) is the most common type of incontinence.This condition is associated with social isolation, psychological impairement, restriction of physical activities and sexual dysfunction. Treatment options for SUI include conservative, medical treatment and surgery.Treatment of SUI should be individualized.Pharmacotherapy may be alternative options in womenwho do not wish to undergo a surgery or whose the surgery is contraindicated. Various drugs, including alpha receptor agonists, beta receptor antagonists, serotonin-adrenaline re-uptake inhibitors, and estrogen have been used. Among these agents, duloxetine is the only drug that has obtained approval for the treatment of SUI. In this review, the features of duloxetine therapy together with the other agents and the important aspect to be considered are discussed.

PURPOSE Lower urinary tract symptoms are very common in older men. We conducted a systematic review and meta-analysis to evaluate the effects of selfmanagement interventions on these symptoms. We included randomized controlled trials comparing the effect of self-management interventions (alone or combined with drug therapy) with usual care or drug therapy alone in men with lower urinary tract symptoms. Two independent reviewers screened retrieved articles, extracted data, and assessed the risk of bias of included studies. The primary outcome was lower urinary tract symptom severity. Where data were available, we calculated mean differences (MDs) between the interventions. RESULTS Analyses were based on 8 studies among 1,006 adult men. Seven of these studies were judged to be at high risk in 2 of the 7 domains of bias. The nature of the self-management interventions varied across studies. There was a clinically important reduction in the 35-point International Prostate Symptom Score at 6 months favoring self-management interventions compared with usual care (MD = -7.4; 95% CI, -8.8 to -6.1; 2 studies). The reduction in score with self-management was similar to that achieved with drug therapy at 6 to 12 weeks (MD = 0.0; 95% CI, -2.0 to 2.0; 3 studies). Self-management had a smaller, additional benefit at 6 weeks when added to drug therapy (MD = -2.3; 95% CI, -4.1 to -0.5; 1 study). CONCLUSIONS We found moderate-quality evidence (suggesting reasonable certainty in estimates) for the effectiveness of self-management for treating lower urinary tract symptoms in men. We therefore recommend the use of self-management interventions for this patient population.

Lower urinary tract symptoms are highly prevalent and a large proportion of these symptoms are known to be associated with a dysfunction of the afferent pathways. Diagnostic tools for an objective and reproducible assessment of afferent nerve function of the lower urinary tract are missing. Previous studies showed first feasibility results of sensory evoked potential recordings following electrical stimulation of the lower urinary tract in healthy subjects and patients. Nevertheless, a refinement of the methodology is necessary. This study is a prospective, randomized trial conducted at Balgrist University Hospital, Zürich, Switzerland. Ninety healthy subjects (forty females and fifty males) without lower urinary tract symptoms are planned to be included in the study. All subjects will undergo a screening visit (including standardized questionnaires, 3-day bladder diary, urinalysis, medical history taking, vital signs, physical examination, neuro-urological examination) followed by ...

Background ChatGPT has recently emerged as a novel resource for patients’ disease-specific inquiries. There is, however, limited evidence assessing the quality of the information. We evaluated the accuracy and quality of the ChatGPT’s responses on male lower urinary tract symptoms (LUTS) suggestive of benign prostate enlargement (BPE) when compared to two reference resources. Methods Using patient information websites from the European Association of Urology and the American Urological Association as reference material, we formulated 88 BPE-centric questions for ChatGPT 4.0+. Independently and in duplicate, we compared the ChatGPT’s responses and the reference material, calculating accuracy through F1 score, precision, and recall metrics. We used a 5-point Likert scale for quality rating. We evaluated examiner agreement using the interclass correlation coefficient and assessed the difference in the quality scores with the Wilcoxon signed-rank test. Results ChatGPT addressed all (88/...

BackgroundErectile dysfunction (ED) is the inability to achieve and maintain a steady erection for sexual performance. Erectile dysfunction (ED) is becoming more common in the general population, particularly among elderly men with lower urinary tract symptoms and those with benign prostatic hyperplasia. This rise in erectile dysfunction has also been attributed by several other etiologies, which includes inflammatory, mechanical, psychological, occlusive vascular, trauma, endocrine, neurologic, chemical and extra factors (prostatectomy, old age). The purpose of the study was to assess erectile dysfunction in patients with benign prostate hyperplasia before treatment using international index of erectile function (IIEF) tool.MethodologyHospital-based cross-sectional study from March 2021 to June 2022, which involved 188 patients clinically diagnosed with benign prostatic enlargement. Convenient sampling method was used to recruit participants and structured questionnaires were used ...

Benign prostatic obstruction (BPO) is a common condition in older men that often result in lower urinary tract symptoms (LUTS). LUTS associated with Benign Prostate Enlargement (BPE) may have significant negative impact on patients’ health-related quality of life as can certain treatments for the condition. This study aimed to determine the impact of medical therapy on health-related quality of life among patients on treatment for BPO.This was a hospital based descriptive study carried out in urology public and private clinics from April to December 2017. All diagnostic and treatment options of patients were decided by attending clinicians of which Patients aged ≥40 years on medical treatment for BPO were included. Symptom and Health Related Quality Life (HRQL) were measured at baseline and at 3 months using the International Prostate Symptom Score (IPSS) and the Benign Prostatic Hyperplasia Impact Index score (BII) tools. A total 150 patients were included in the analysis with a me...

Neurologic urinary incontinence (NUI) my be caused by various disease affecting the nervous system controlling the lower urinary tract. The urinary tract dysfunction depends on the location and the extent of neurological lesion. Type of urinary dysfunction depends on the site, extent and the evolution of the lesion. Patients with lesion above the pons have reflex contraction of the detrusor but the cortical regulation of voiding is lost. Lesion in the suprasacral spinal cords my caused detrusor urethral sphincter dysinergia. Incontinence is a result of detrusor over reactivity. Detrusor becomes areflectic when the lesion is in the conus. In the case of lesion in cauda equina or lesion in peripheral nerves, urine retention or stress incontinence has been developed. Brain tumor can cause NUI in 24% of patients. In a group of patients with tumor in posterior fosse, voiding difficulty was reported in 30% of patients. The incidence of NUI caused by dementia is not known. In older age is ...

Resumen.-OBJETIVO: Determinar la utilidad diagnóstica de los datos aportados por la historia clínica para el diagnóstico de obstrucción del tracto urinario inferior (OTUI) en los pacientes con retención aguda de orina (RAO). MÉTODOS: Se realizó un estudio transversal en una serie de 70 pacientes (19 mujeres y 51 varones) de edad media 61, 5 años (desviación típica 20,7 años), sometidos a estudio urodinámico por presentar RAO. Los pacientes fueron interrogados sobre sus antecedentes patológicos. Se les realizó además una exploración clínica, valorando el tamaño prostático en varones, presencia de prolapsos genitales en mujeres, y una exploración neurourológica. El estudio urodinámico consistió en una flujometría libre, un estudio de presión/ flujo con registro simultaneo de la actividad electromiográfica perineal, y una cistografía o videocistografía mic-

With the emergence of minimally invasive therapies for the management of symptoms of benign prostatic hyperplasia (BPH), as well as the reality of a changing medical economic environment, there is a need for a reliable local anesthesia protocol. The protocol described here for prostate anesthetic block is a safe, economical, and effective way to perform interstitial laser coagulation and other minor endoscopic urologic procedures in the office setting. Most patients experience little discomfort and recover quickly, with prompt return to normal activities. Urologists should be aware of and comfortable with these techniques.

Objectives: This study aims to determine the efficacy and safety of soy isoflavones in controlling the symptoms and signs of lower urinary tract symptoms due to benign prostate hyperplasia (BPH). Design: This was a prospective, randomized, double-blind, placebo-controlled pilot study. Setting: This trial was conducted at two hospitals in Hong Kong between May 2006 and September 2007. Participants: One hundred and seventy-six (176) participants diagnosed with BPH were recruited from outpatient clinics. Participants with lower urinary tract symptoms were recruited through newspaper and radio interviews, posters placed at government outpatient clinics, and a public seminar offered by the investigators. Interventions: Participants were randomly assigned to either intervention (40 mg of isoflavones daily from Soylife 40) or placebo groups in a double-blind fashion. Main outcome measures: The primary outcome parameter of peak urine flow rate and the second outcome parameters of postresidual urine volume, lower urinary tract symptoms, testosterone, prostate-specific antigen, quality of life, diet, and safety profile (liver and renal function) were collected. All parameters were assessed at baseline, 6 months, and 12 months in a 12-month study period except testosterone, prostate-specific antigen, and safety profile, which were assessed at baseline and at 12 months. Results: The peak urine flow rate (Qmax), postresidual urine volume, International Prostate Symptoms Scores (IPSS), and 36-Item Short Form Health Survey (SF-36) significantly improved from baseline to the 12th month within both groups. However, when compared between groups, Qmax ( p = 0.055) and incomplete emptying subscore in IPSS ( p = 0.05) were marginally/statistically different between the two groups from the 6th to the 12th months, in addition to the general health domain of SF-36 from the baseline to 12th month ( p = 0.02) and from the 6th month to the 12th month ( p = 0.055). Isoflavones were generally safe and well tolerated. Conclusions: This randomized control pilot study showed only slight superiority of isoflavones over placebo over 12 months with otherwise surprising beneficial effects in both groups. Tolerability of isoflavones was excellent; thus it has laid foundations for further studies of isoflavones in BPH with focus on dosage and possible specificity of the effect.

Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with neoplasms, mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive procedure that has shown promising results in managing LUTS and massive intractable prostatic hematuria in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure, even without massive bleeding, and requires discontinuation of vitamin K antagonists and antiplatelet therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria, highlighting recent developments in this technique, including prospective cohort studies, and focusing on long-term outcome, safety, and complication management of patients with prostatic neoplasms who develop significant hemorrhagic symptoms. Additionally, we present a case report and a simple algorithm for treating intractable bleeding in a 92-year-old man with PCa and massive hematuria.

Introduction: The clinical usage of the ureteral stent caused several stent-related symptoms (SRSs), including lower urinary tract symptoms, pain, general health, work performance, sexual matter and additional problems. This study aims to evaluate the effectiveness between tamsulosin and solifenacin combined with tamsulosin for SRSs.Methods: This double blind randomized controlled trial used 50 patients. Between September 2020 and February 2021, patients underwent double-J stenting after retrograde ureteroscopy were analyzed. All patients would be randomized in a 1:1 ratio in a 1:1 ratio to receive either tamsulosin 0,4 mg (Group A: 25 participants) or tamsulosin 0,4 mg & solifenacin 5 mg combination (group B: 25 participants).We used the Ureteral Symptoms Score Questionnaire (USSQ) as an outcome measure at 1s, 2nd, 3rd and 4th weeks after stent insertion. Results: Group A was found more in women, while in group B was more in men. The highest age in group A and group B was 50-60 yea...

Aims: Chronic, infrequent voiding may be a risk factor for lower urinary tract symptoms (LUTS) in women. To inform this hypothesis, we conducted a rapid literature review and meta-analysis of LUTS by occupation as an indirect measure of infrequent voiding behaviors. Methods: Two independent medical librarians searched Pubmed.gov studies (1990-2017) on adult women for occupations, industries, and workplace environment and LUTS outcomes: overactive bladder (OAB), urinary incontinence (UI), urinary tract infections (UTIs), and individual voiding and storage LUTS. Two authors reviewed full text articles meeting content criteria. Among studies with similar UI definitions, we estimated the prevalence of monthly UI using a random effects meta-analysis model. Of 1078 unique citations identified, 113 underwent full article review and 33 met inclusion criteria. Twenty-six of these studies examined specific occupation groups, including nurses/midwives (n = 6 studies), healthcare workers/support staff (n = 6), military personnel (n = 3), teachers (n = 3), and other groups (n = 7), whereas eight compared findings across broad occupation groups. UI was reported in 30 studies (23% using validated measures), OAB in 6 (50% validated), and UTIs in 2 (non-validated). In pooled models, the degree of heterogeneity was too high (I 2 = 96.9-99.2%) among the studies to perform valid prevalence estimates for LUTS. Current literature limits the ability to evaluate LUTS by occupation types. Future studies should characterize voiding frequency and toilet access in a consistent manner by occupation and explore its relation to LUTS development.

Background: Little research to date has investigated the spectrum of bladder health in women, including both bladder function and well-being. Therefore, we expanded our previous baseline analysis of bladder health in the Boston Area Community Health (BACH) Survey to incorporate several additional measures of bladder-related well-being collected at the 5-year follow-up interview, including one developed specifically for women. Methods: At follow-up, participants reported their frequency of 15 lower urinary tract symptoms (LUTS), degree of life impact from and thought related to urinary symptoms or pelvic/bladder pain/discomfort, and perception of their bladder condition. Prevalence ratios were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. The BACH Survey was approved by the New England Research Institutes Institutional Review Board and all participants provided written informed consent. Results: Generally similar findings were observed in the 5-year cross-sectional analysis as at baseline, irrespective of how we categorized LUTS or measured bladder-related well-being. Approximately one in five women (16.2%-18.0% of 2527 eligible women) reported no LUTS and no diminished bladder-related wellbeing, the majority (55.8%-65.7%) reported some LUTS and/or diminished well-being, and a further one in five (16.9%-26.6%) reported the maximum frequency, number, or degree of LUTS and/or diminished well-being. Measures of storage function (urinating again after <2 hours, perceived frequency, nocturia, incontinence, and urgency) and pain were independently associated with bladder-related well-being. Conclusions: Our similar distribution of bladder health and consistent associations between LUTS and bladderrelated well-being across multiple measures of well-being, including a female-specific measure, lend confidence to the concept of a bladder health spectrum and reinforce the bothersome nature of storage dysfunction and pain.

AimsChronic, infrequent voiding may be a risk factor for lower urinary tract symptoms (LUTS) in women. To inform this hypothesis, we conducted a rapid literature review and meta‐analysis of LUTS by occupation as an indirect measure of infrequent voiding behaviors.MethodsTwo independent medical librarians searched Pubmed.gov studies (1990‐2017) on adult women for occupations, industries, and workplace environment and LUTS outcomes: overactive bladder (OAB), urinary incontinence (UI), urinary tract infections (UTIs), and individual voiding and storage LUTS. Two authors reviewed full text articles meeting content criteria. Among studies with similar UI definitions, we estimated the prevalence of monthly UI using a random effects meta‐analysis model.ResultsOf 1078 unique citations identified, 113 underwent full article review and 33 met inclusion criteria. Twenty‐six of these studies examined specific occupation groups, including nurses/midwives (n = 6 studies), healthcare workers/suppo...

Background: Little research to date has focused on lower urinary tract symptom (LUTS) prevention and bladder health promotion in women. To address this gap, the Prevention of LUTS Research Consortium developed the following working bladder health definition: ''A complete state of physical, mental, and social well-being related to bladder function [that] permits daily activities [and] allows optimal well-being.'' To begin to inform and quantify this definition, we used data from the Boston Area Community Health Survey, drawing upon its rare collection of information on LUTS and LUTS-specific interference with activities. Methods: At baseline, participants reported their frequency of 15 LUTS and interference with 7 activities. Prevalence ratios (PRs) were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. Results: Of the 3169 eligible participants, 17.5% reported no LUTS or interference, whereas the remaining 82.5% reported some frequency of LUTS/interference: 15.1% rarely; 21.7% a few times; 22.6% fairly often/usually; and 22.9% almost always. LUTS independently associated with interference were urgency incontinence, any incontinence, urgency, nocturia, perceived frequency, and urinating again after <2 hours (PRs = 1.2-1.5, all p < 0.05). Conclusions: Our findings suggest that bladder health exists on a continuum, with approximately one in five women considered to have optimal bladder health (no LUTS/interference), the majority to have intermediate health (LUTS/interference rarely to usually), and a further one in five to have worse or poor health (LUTS/ interference almost always). These findings underscore the need for LUTS prevention and bladder health promotion.

To investigate the relationship between pontine lesion characteristics on MRI and lower urinary tract symptoms (LUTS) in patients with multiple sclerosis (MS). We performed a prospective cohort study of patients with MS and LUTS who were undergoing brain/spine MRI. Patients were administered the American Urological Association Symptom Score (AUA-SS), Medical, Epidemiologic, and Social Aspects of Aging questionnaire (MESA), and Urogenital Distress Inventory questionnaire (UDI-6), underwent Kurtzke Expanded Disability Status Scale (EDSS) scoring by a neurologist, and had their MRIs reviewed by a neuroradiologist. The relationships between symptom scores and lesion number, size, and location were analyzed. There were 42 patients that completed the study and 20 (48%) had one or more pontine lesions. Total AUA-SS and UDI-6 were related to multiple Short Form Health Survey (SF-36) scales and not EDSS scoring. Weak urinary stream measured on the AUA-SS (P = 0.028), and urgency incontinence...

Background: Benign prostatic hyperplasia (BPH) is a common health problem faced by aging men and can be associated with bladder outlet obstruction (BOO). BPH patients usually suffer from lower urinary tract symptoms (LUTS) including obstructive and irritative urinary symptoms. The purpose of the current study was to clarify the correlation between MRI-derived prostate measurements and BPH-induced symptoms and findings including International Prostate Symptom Score (IPSS), uroflowmetry, and Postvoid residual urine (PVR). Methods: In all, 34 patients (mean age was 58 ± 8 years, range 43 to 73 years) were examined by prostate MRI, uroflowmetry, postvoid residual urine, and fulfilled International Prostate Symptom Score questionnaire in this prospective study. The MRI-derived measurements including total prostate volume, transition zone volume, transition zone index, prostatic urethral angle, intravesical prostatic protrusion, and anterior fibromuscular stroma distance were correlated with International Prostate Symptom Score, uroflowmetry including maximum flow rate (Q max ) and Q max grades, and postvoid residual urine using Pearson correlation coefficients (r) and multiple linear regression. Relationship between BPH types was correlated with the same parameters using one-way analysis of variance. Results: We found a strong significant correlation between total prostate volume, transition zone volume, and transition zone index with International Prostate Symptom Score, Q max , Q max grades, and postvoid residual urine; however, in multiple linear regression analysis, all of them were found to be significant parameters for International Prostate Symptom Score. Also, our study showed a strong significant correlation between anterior fibromuscular stroma distance and intravesical prostatic protrusion with International Prostate Symptom Score and postvoid residual urine; however, in multiple linear regression analysis, only intravesical prostatic protrusion was found to be a significant parameter for postvoid residual urine. Our results also revealed a significant correlation between BPH types with Q max , Q max grades, International Prostate Symptom Score, and postvoid residual urine. Conclusion: Several MRI-derived prostate parameters (total prostatic volume, transition zone volume, transition zone index, prostatic urethral angle, intravesical prostatic protrusion, anterior fibromuscular stroma distance, and BPH types) correlating significantly with the International Prostate Symptom Score, uroflowmetry parameters (Q max and Q max grades), and postvoid residual urine.

Background: Assessment of bladder outlet obstruction (BOO) is standard clinical practice in patients with lower urinary tract symptoms (LUTS). This is currently achieved through pressure-flow studies. Research indicates that progressive functional impairment of the bladder due to BOO is associated with haemodynamic changes. Near-infrared spectroscopy (NIRS) is an optical method of monitoring tissue oxygenation and haemodynamics via changes in concentration of the chromophores oxyhaemoglobin (O 2 Hb) and deoxyhaemoglobin (HHb). Objective: To report a noninvasive technique and mathematic method of analysis for assessment of BOO in male subjects using NIRS and to test the independent ability of NIRS data to distinguish between patients with and without obstruction using a classification and regression tree algorithm (CART). Design, setting, and participants: A prospective cohort study to evaluate subjects presenting for urodynamic assessment of LUTS using standard urodynamic studies with simultaneous transcutaneous NIRS monitoring. The NIRS data (magnitude and pattern of changes in O 2 Hb and HHb) were analysed, and a CART algorithm was constructed. Sixty-four males referred for evaluation of LUTS were studied at a tertiary care, university-based research and clinical facility. Measurements: Clinical symptoms were classified using the International Prostate Symptom Score (IPSS). Pressure-flow studies were done with simultaneous transcutaneous NIRS monitoring of the detrusor. Pressure-flow studies were classified according to the Abrams-Griffiths nomogram. NIRS data documented changes in the concentration of the chromophores O 2 Hb and HHb. Results and limitations: IPSS scores ranged from 12 to 34, with a mean of 19. The pressure-flow nomogram found 30 patients with BOO, 16 patients without BOO, and 18 patients with equivocal results. The CART found a misclassification error of 4% with 88% specificity and 94% precision. The NIRS instrument and algorithm were new; no asymptomatic subjects were studied. Conclusion: Using a CART algorithm, noninvasive NIRS data during voiding had independent discriminatory ability related to classification of BOO.

The main objective of this paper is to examine the psychometric properties of the Malay Version of the Hospital Anxiety and Depression Scale (HADS), tested on 67 husbands of the women who were diagnosed with breast cancer. The eligible husbands were retrieved from the Clinical Oncology Clinic at three hospitals in Kuala Lumpur, Malaysia. Data was collected at three weeks and ten weeks following surgery for breast cancer of their wives. The psychometric properties of the HADS were reported based on Cronbach&#39; alpha, Intraclass Correlation Coefficients (ICC), Effect Size Index (ESI), sensitivity and discriminity of the scale. Internal consistency of the scale is excellent, with Cronbach&#39;s alpha of 0.88 for Anxiety subscale and 0.79 for Depression subscale. Test-retest Intraclass Correlation Coefficient (ICC) is 0.35 and 0.42 for Anxiety and Depression Subscale, respectively. Small mean differences were observed at test-retest measurement with ESI of 0.21 for Anxiety and 0.19 fo...

To estimate the frequency of lower urinary tract symptoms (LUTS) and sexual dysfunction in patients with systemic sclerosis (SSc) and associate these symptoms with clinical and functional parameters including disability and quality of life. Patients with SSc seen in Cochin hospital, Paris, between February and April 2010 were assessed for disease type, LUTS by the Urinary Symptom Profile scale, sexual dysfunction by the Feminine Sexual Function Index (FSFI) and International Index for the Erectile Function (IIEF-5), global disability by the Health Assessment Questionnaire and McMaster Toronto Arthritis Patient Preference Disability Questionnaire, anxiety and depression by the Hospital Anxiety and Depression scale, and quality of life by the Medical Outcomes Survey Short Form 36. The most frequent LUTS among the 73 patients included (13 males) were overactive bladder (n=11, 84.6%) and dysuria (n=8, 61.5%) for males and overactive bladder (n=51, 85%) and incontinence (n=29, 48.3%) for...

Adequate medical practice has been emphasized for the increasing elderly population. The authors have long provided Long-Term Acute Care (LTAC). Concerning clinical problems related to urinary tract infection (UTI), we propose the Gatch-up 45-degree positioning as a preventive measure for UTI. The case involves a 68-year-old female who underwent the Gatch-up procedure for 1 hour, twice a day, over a period of 1 month. Post-void residual (PVR) urine volume was measured and compared between the previous month and the intervention period. The average PVR significantly decreased from 245 mL to 80 mL (p < 0.05), representing a 67.3% reduction. This suggests further indications and potential future development for this procedure.

Background Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes. Case presentation A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for &gt; 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of th...

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. 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. 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

Background. Benign prostatic hyperplasia is the most common cause of lower urinary tract obstruction in the elderly male. Aim. To evaluate the effectiveness, safety, and outcome of open prostatectomy in a Nigerian teaching hospital. Material and Methods. Two hundred and fifty-three men with lower urinary tract obstruction clinically due to benign prostatic hyperplasia (BPH) underwent open prostatectomy over a ten-year period (January 2001–December 2010). Data on patients including age, clinical, laboratory, and histology were reviewed and analyzed to determine treatment outcome. Results. A total of 253 patients were studied. Their mean age was 69.11 ± 10.9 years (range 50–98). The most common symptoms at presentation included frequency 229 (90.5%) and poor stream 225 (88.9%). The most common complications at presentation were stones in 41 (16.2%) and bleeding in 37 (14.6%). The most common comorbid conditions were hypertension and diabetes found in 72 (28.5%) and 23 (9.1%), respecti...