Lower Urinary Tract Symptoms

To investigate whether autonomic nervous system (ANS) hyperactivity may be a potential cause for the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Twenty-four patients were recruited for this study. Complete physical examinations, urine analysis, uroflowmetry, and postvoid residual urine volume (PVRU) analysis were performed. The potential impact of some factors such as hyperglycemia, obesity, and hyperlipidemia were analyzed. These values were correlated with the various symptom scores. We performed an electromyographic and an electrocardiographic evaluation. The alterations after treatment with 2 different alpha-blockers were also analyzed. The electromyographic and electrocardiographic assessments revealed a minimal increase in ANS activity and it did not change significantly after treatment (P > 0.05). After treatment, maximum flow rate increased and PVRU decreased significantly (P < 0.001 and P < 0.001, respectively); total and...

To determine the prevalence of impaired detrusor contractility (IDC) with and without detrusor hyperactivity (DH) among community-dwelling elderly with lower urinary tract symptoms and to identify which patients are at a greater risk of having a hypocontractile detrusor.

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with α-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with α-blockers or 5α-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5 ng/ ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with α-blockers, or the sixth month with 5α-reductase inhibitors, will be referred to urology. Patients will also be referred to ACTAS UROLÓGICAS ESPAÑOLAS www.elsevier.es/actasuro actas urol esp. 2010;34(1):24-34 actas urol esp. 2010;34(1):24-34

Purpose: We retrospectively analyzed our institutional incidence of hemorrhagic cystitis, identified risk factors, and examined associations of risk factors with disease severity and genitourinary complication rates. Materials and Methods: We reviewed charts of all consecutive pediatric patients treated from 1986 to 2010. We analyzed demographics, underlying diagnosis and treatment data to assess risk factors for hemorrhagic cystitis. We also correlated disease severity scores with clinical predisposing factors, and performed univariate and multivariate analyses to examine associations between risk factors and outcomes. Results: Hemorrhagic cystitis was observed in 97 of 6,119 children (1.6%), most of whom (75%) had severity scores of II or III. Mean AE SD age was 12.2 AE 6.3 years for patients with hemorrhagic cystitis and 10.5 AE 7 years for patients without hemorrhagic cystitis (p ¼ 0.017). On univariate analysis increased risk of hemorrhagic cystitis was significantly associated with age greater than 5 years, male gender, cyclophosphamide or busulfan chemotherapy, bone marrow or peripheral blood stem cell transplantation, pelvic radiotherapy and underlying diagnoses of rhabdomyosarcoma, acute leukemia and aplastic anemia. On multivariate analysis age greater than 5 years, allogeneic bone marrow or peripheral blood stem cell transplantation and pelvic radiotherapy were significantly associated with increased risk of hemorrhagic cystitis. Older age, late onset hemorrhagic cystitis, positive urine culture for BK virus and bone marrow or peripheral blood stem cell transplantation were associated with greater disease severity. Patients with higher severity scores more frequently experienced bladder perforation, hydronephrosis, overall hemorrhagic cystitis complications, and increased creatinine and blood urea nitrogen levels during followup. Conclusions: Older age, previous bone marrow or peripheral blood stem cell transplantation and BK virus in the urine are risk factors for hemorrhagic cystitis and are associated with a higher severity score. Higher severity scores are associated with increased rates of genitourinary complications and renal impairment.

Objectives: Lower urinary tract symptoms (LUTS), which are often caused by benign prostatic hypertrophy (BPH), and sexual dysfunction are common in older men, with an overall prevalence of >50% in men aged !50 years. Men with LUTS have been reported to experience sexual dysfunction, including ejaculatory loss, painful ejaculation, and erectile dysfunction. This study was conducted to investigate the relationship between LUTS and sexual problems in aging men. Methods: A large-scale, multinational survey was conducted in the US and six European countries to systematically investigate the relationship between LUTS and sexual dysfunction in older men. Detailed questionnaires were mailed to a national representative sample of men aged 50 to 80 years in each country. Selection was made on the basis of age, occupation, geographic region, and population density. LUTS and sexual function were assessed by validated symptom scales, including the International Prostate Symptom Score, the Danish Prostatic Symptom Score, and the International Index of Erectile Function. Subjects also completed a health and demographics questionnaire. Results: A total of 34,800 surveys were mailed out, 14,254 were completed and returned, and 12,815 were deemed evaluable and included in the analysis. Results were consistent from one country to another. Although 90% of the men had LUTS, only 19% had sought medical help for urinary problems and only 11% were medically treated. Sexual activity was reported by 83% of the sample, with 71% reporting at least one episode of sexual activity during the previous 4 weeks. Sexual disorders and their bothersomeness were strongly related to both age and severity of LUTS. The relationship between sexual problems and LUTS is independent of comorbidities such as diabetes, hypertension, cardiac disease, and hypercholesterolemia. Conclusions: Sexual activity is common in a majority of men over age 50 and is an important component of overall quality of life. The presence and severity of LUTS are independent risk factors for sexual dysfunction in older men. These results highlight the clinical importance of evaluating LUTS in patients with sexual dysfunction, and the need to consider sexual issues in the management of patients with benign prostatic hypertrophy. #

Resumen Context: Benign Prostatic Hyperplasia (BPH) is a common disease that course with Lower Urinary Tract Symptoms (LUTS), mainly in over 50 years-old men. Commonly indicated drugs such as alpha adrenergicblockers are life-treatment with some adverse reactions. Center for Drug Research and Development produce a microencapsulated lipophilic extract of pumpkin seed oil (Calprost) with anti-androgenic, antiinflammatory, antioxidant, antiproliferative and diuretic properties. Aims: To evaluate the effect and safety of Calprost in patients with BPH and LUTS. Methods: A multicenter, randomized, controlled, open exploratory clinical trial was conducted. Two experimental groups, study group (Calprost, 140 mg daily) (n=81), and control group (terazosin, 2 mg daily) (n=50) were conformed. All the patients were treated during three months. Efficacy was evaluated through International Prostate Symptoms Score (IPSS), residual bladder volume and prostate volume. Results: Most of the included p...

Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple) extended prostate biopsies are a regularly encountered problem in urological practice. Even now, patients are seen with no objective explanation of this persistent elevated and/or rising PSA. So far, many strategic proposals have been elaborated and published to deal with this specific population including the use of different PSA derivates; applying different biopsy schemes—strategies—biopsy target imaging; diagnostic use of prostate cancer genes; and many more. In this review, we propose a new algorithm in which an urodynamic evaluation should be included since bladder outlet obstruction (BOO) can be expected. Once BOO is confirmed, a transurethral resection of the prostate (TURP) can be offered to these patients. This procedure will result in subjective and biochemical improvement and allows extensive histological examination. Current literature was reviewed with regard to this specific population. This research was performed using the commercially available Medline online search tools and applying the following search terms: “diagnostic TURP”; “elevated PSA”; and “prostate biopsy”. Furthermore, subsequent reference search was executed on retrieved articles.

The use of dietary supplements for treating a wide range of health conditions has grown rapidly in the United States. In the field of men&#39;s health, the most common dietary supplement used is an extract of the berry of the saw palmetto plant, with which men commonly self-medicate in order to treat lower urinary tract symptoms. Throughout the past two decades, substantial literature has emerged examining the biologic and clinical effects of saw palmetto extracts. Several lines of evidence suggest that saw palmetto may exert physiologic effects consistent with a beneficial clinical effect on the mechanisms of benign prostatic hyperplasia. Although most clinical studies tend to suggest a modest efficacy benefit of saw palmetto, more recent studies are less consistent and the precise clinical value of saw palmetto for treating lower urinary tract symptoms remains undefined. Overall, there appear to be few safety concerns with short-term use of this herbal medicine, although large-sca...

Over the past decade, the use of quality of life (QOL) questionnaires in the evaluation of pelvic organ prolapse (POP) has become a standard part of most clinical studies. Investigators have attempted to correlate QOL scores with objective findings and treatment efficacy and as outcome measures in comparing different treatment modalities. Many of the QOL questionnaires are available in short forms, making them easier to adapt to clinical settings. This article includes an overview of several validated QOL questionnaires and their application in studies whose results provide useful guidelines for health care professionals who diagnose and manage women with POP.

To compare the incidence of early postpartum voiding dysfunction (PPVD) in primiparae women delivered vaginally (VD) to those delivered by elective Caesarean section (CS). Methods: A prospective study of primiparae in early postpartum period, were grouped into: VD group and CS group. Following the first 24 h from delivery, patients had uroflowmetry and post-void residual urine (PVR) volume measurement. Results: Two hundred and fifty six primiparae women recruited; 204 (81%) had VD and 48 (19%) had primary elective CS. Forty-two women in the VD group (20.2%) diagnosed with PPVD compared to only four (8.3%) in the CS group (P = 0.05). Within VD group, women who had vaginal tear (86.4% vs. 44%, P < 0.001) or epidural analgesia (33.3% vs. 18.1%, P < 0.05) experienced higher incidence of PPVD. Conclusion: Women who had normal VD are at higher risk of transient PPVD than those delivered by CS during their early postpartum period.

Objective: To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). Materials and Methods: In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80mL, serum PSA < 4ng/mL, IPSS ≥ 20, Q max ≤ 10mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Q max were assessed preoperatively and 3 months after procedure in all cases. Results: Both groups were similar in patient age, prostate volume, preoperative IPSS and Q max . The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Q max . But the TUVP group had significantly lower IPSS and higher Q max than TURP group. Conclusions: Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better perioperative and postoperative outcomes, superior hemostasis and higher efficacy.

Paruresis manifests in an inability to urinate in public restrooms followed by a considerable avoidance behavior. According to DSM-IV TR this disorder is classified as social phobia. A sample of N = 226 subjects completed different questionnaires concerning paruresis, social phobic symptoms, lower urinary tract symptoms and depressive symptoms. These individuals were divided into four groups: no symptoms, suffering primarily from paruresis, non-generalized social phobia and generalized social phobia. The paruretic group differs significantly in all symptom variables from both the non-generalized and the generalized social phobia groups. Regression analysis separated by groups shows that the interference with everyday life can be mainly explained by paruretic symptoms (in the paruretic group) or by social anxiety and depressive symptoms, respectively (in the social phobic groups). These results question the classification of paruresis as simply being a form of social phobia. #

Background: Lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH) negatively impact the psychological well-being of patients and may relate to the emergence of anxiety and depression. Objective: The present study aimed to investigate the prevalence of anxiety and depression among patients with LUTS/BPH as well as to determine their correlations. Method: A cross-sectional study was conducted from July to October 2019 on 153 LUTS/BPH patients under surgical outpatient follow-ups at Hospital Universiti Sains Malaysia (USM). A set of self-administered questionnaires comprising the sociodemographic profile, International Prostate Symptoms Score (IPSS), and Hospital Anxiety and Depression Scale (HADS) were used. Data were analysed using measures of frequency for the prevalence of anxiety and depression in LUTS/BPH and correlation analysis to study the relationship between them. Result: The study reported the prevalence of depression and anxiety at 27.5% and 15.0% respectively among patients with LUTS/BPH. There was positive correlation between severity of depression (r = 0.426, p-value < 0.001) and anxiety (r = 0.367, p-value < 0.001) with severity of LUTS/BPH. Conclusion: Depression and anxiety are prevalence among patients with LUTS/BPH in Hospital USM. There is also a positive correlation between the severity of depression and anxiety with severity of LUTS/BPH. Comorbidity of these conditions should draw the attention of both psychiatrists and urologists as well as enhance interdisciplinary treatment approach to improve the patient's psychological well-being.

To determine whether subjects engaged in horseback riding are more likely to be affected by sexual dysfunction and lower urinary tract symptoms than those engaged in sports with less perineal impact.Surveys evaluating the presence of and the risk factors for sexual dysfunction and urinary symptoms were distributed among members of equestrian clubs, swimming clubs, and individual horseback riders and swimmers. About 327 surveys were distributed by hand at horse shows and swimming pools. A total of 2000 surveys were sent by direct mail to random members of 1 national equestrian organization and 1 national swimming organization. We also evaluated bicycle habits as a possible confounding factor.There was no significant association between horseback riding and lower urinary tract symptoms (P = .1759) and sexual dysfunction (P = .1793) in males. The same applies to the association of horseback riding and lower urinary tract symptoms (P = .5036) and sexual dysfunction (P > .05) in females, although there was a trend toward a protective association between horseback riding and stress incontinence (P = .0567). Years of bicycling (P = .04) and hardness of the bicycle seat (P = .02) were associated with an increased prevalence for lower urinary tract symptoms in women.Regular participation in horseback riding is not significantly associated with increased prevalence of lower urinary tract symptoms or sexual dysfunction, although it may be associated with decreased prevalence of stress urinary incontinence. Bicycle riding may be associated with higher prevalence of lower urinary tract symptoms in women.

Objective: Lower urinary tract symptoms are common among older women. The Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire was designed to assess a wide range of symptoms, including incontinence, and impact on sexual function and quality of life. This paper describes development and validation of a scored form BFLUTS questionnaire. Study design: Baseline and 6-month follow-up data from a randomized trial compared tensionfree vaginal tape with colposuspension for 344 women with urodynamically proven stress incontinence. Problematic and responsive items were identified and subjected to factor analysis to develop a scoring system. Results: Three domains were identified to assess symptoms: incontinence (5 items); voiding (3 items); and filling (4 items); with additional subscales for sexual function (2 items) and quality of life (5 items). All scales have simple additive scores. Conclusion: A scored form of the BFLUTS questionnaire is now available and should be useful in research and clinical practice in urology and gynecology.

Background: Laser vaporisation of the prostate has had a considerable impact in recent years. In an attempt to achieve tissue vaporisation with bipolar highfrequency generators, plasma vaporisation was recently introduced. Objective: To provide the first clinical information on bipolar plasma vaporisation of the prostate for patients with lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO). Design, setting, and participants: Thirty patients were included in this prospective bicentre study. Intervention: All patients underwent bipolar plasma vaporisation with a novel electrode (Olympus Winter & Ibe GmbH, Hamburg, Germany). Measurements: International Prostate Symptom Score (IPSS), bother score, maximum flow rate (Q max ), and postvoid residual were evaluated at baseline and at the time of discharge as well as at 1, 3, and 6 mo after the intervention. Results and limitations: Mean preoperative prostate volume was 59 AE 32 ml (range: 30-170), and mean operating time was 61 AE 26 min (range: 20-140). Besides one reoperation (conventional transurethral prostatectomy) due to persistent obstruction, no major complication occurred intra-or postoperatively and no blood transfusion was required. Catheterisation time averaged . Transient mild to moderate dysuria was noted in four patients (13%). At 1, 3, and 6 mo, Q max increased from 6.6 AE 2.7 ml/s preoperative to 17.3 AE 4.7 ml/s ( p < 0.01), 18.5 AE 4.6 ml/s ( p < 0.01), and 18.1 AE 5.0 ml/s ( p < 0.01), respectively. The IPSS decreased from 20.8 AE 3.6 to 10.4 AE 3.5 ( p < 0.01), 8.2 AE 2.9 ( p < 0.01), and 8.1 AE 3.1 ( p < 0.01), respectively. These data represent a small nonrandomised study cohort with limited follow-up. Conclusions: Our initial experience indicates that bipolar plasma vaporisation might be a safe and effective treatment option for patients with LUTS due to BOO. To define the potential role of this novel technique, randomised trials with longer follow-up are mandatory.

The multisystem nature of female chronic pelvic pain (CPP) makes this condition a challenge for physical therapists and other health care providers to manage. This article uses a case scenario to illustrate commonly reported somatic, visceral, and neurologic symptoms and their associated health and participation impact in a female with CPP. Differential diagnosis of pain generators requires an in-depth understanding of possible anatomic and physiologic contributors to this disorder. This article provides a detailed discussion of the relevant clinical anatomy with specific attention to complex interrelationships between anatomic structures potentially leading to the patient's pain. In addition, it describes the physical therapy management specific to this case, including examination, differential diagnosis, and progression of interventions. Clin. Anat. 26:77-88, 2013. V V C 2012 Wiley Periodicals, Inc.

Introduction /Aim: Serenoa repens (SR) and Pygeum Africanun (PA) exhibit marked anti-inflammatory, anti-androgenic and anti-proliferative effects. For this reason, they have been subject of research as potential treatment of benign prostatic hypertrophy (BPH). The aim of this study is to present current knowledge on the topic.
Methods: A non-systematic search was performed in electronic libraries for clinical trials, experimental studies and systematic reviews on the topic using the terms: “prostate”, “benign prostatic hypertrophy”, “lower urinary tract symptoms” combined
with the key words: “phytotherapy”, “Saw palmetto”, “Serenoa repens”, “Serenoa serrulata”, “Pygeum Africanum”, “Prunus africana” in various combinations. Results: A sufficient number of studies of the efficacy of SR for the treatment of LUTS and BPH exists. Most of them examine the role of saw palmetto as add-on to other agents and less as monotherapy. Few similar studies for PA have been published up to date. Αlmost all examine its role as monotherapy. According to our research, there is no clear evidence of clinical superiority of phytotherapy over conventional treatment however a potent synergistic effect was shown. SR seems to be more efficient than
PA though non produce some of the therapeutic effects of PA. Conclusions: Combination of SR and PA with other medications can offer significant improvements of urinary status while having a favourable safety profile and for this reason may be considered a viable therapy for treating LUTS in certain groups of patients.

HRQL = health-related quality of life ICIQ-SF = International Consultation on Incontinence Questionnaires Short Form IPSS = International Prostate Symptom Score LUTS = lower urinary tract symptoms MFR = maximal flow rate OAB-Q = overactive bladder questionnaire POP = pelvic organ prolapse POP-Q = pelvic organ prolapse quantification PVR = postvoid residual QOL = quality of life SUI = stress urinary incontinence TOT = transobturator tape TVM = tension-free vaginal mesh Correspondence: Satoru

Erectile dysfunction (ED) has multifactor pathogenesis, with neurological, vascular, endocrinological and psychogenic components described. However, about 50-85% of ED population report the presence of one or more comorbidities i.e. hypertension, diabetes, cardiovascular disease, dyslipidemia which all impair endothelial function and, erection is a basically vascular event that necessitates an intact endothelium to occur. Hence, ED may be mostly considered as the clinical manifestation of a disease affecting penile circulation as a part of a generalized vascular disorder due to atherosclerosis. Orally active drugs, i.e. phosphodiesterase type-5 inhibitors (PDE5-i), are a group of on-demand drugs licensed for ED treatment and appear to offer advantages over past therapies in terms of ease of administration and cost, and they are now widely advocated as first-line therapy. The recent discovery that chronic not on-demand administration of these drugs may improve erectile and endothelial response in men previously unresponding to on-demand regimes, opens a new scenario in the treatment of men with ED and comorbidities. Finally, the recent approval of PDE5-i sildenafil for the treatment of pulmonary arterial hypertension represents the new challenge for these class of drugs. Aim of this article will be to provide an update on the pathophysiology of ED and how to use of different available PDE5-i in approaching sexual dysfunctional men, pointing out on their characteristic of efficacy and safety and different indications in special subpopulations.

Objectives: Benign prostatic hyperplasia (BPH) commonly affects men above 40 years old. The progression of BPH is often accompanied with lower urinary tract symptoms (LUTS) that can significantly affect the quality of life of the patients. Serenoa repens (saw palmetto) is a popular herbal remedy indicated for LUTS/BPH. We reviewed the current research on the efficacy of S. repens on LUTS/BPH as a monotherapy as well as combination therapies. Design: Non-systematic searches were performed in PubMed for human studies and systematic reviews on the topic. Results: The latest evidence, based largely on the Cochrane review, suggests that S. repens is not superior to placebo in treating LUTS/BPH as a monotherapy, even at double and triple doses. Initial clinical trials on treatment of LUTS/BPH using S. repens with lycopene and selenium, as well as S. repens with Urtica Dioica, have shown positive results. S. repens is safe in its application. However, there is a high level of heterogeneity in the quality of S. repens products. We suggest that strong placebo effect, potentially influenced by positive patients' expectation on S. repens, shapes both the clinical practice outcomes and the findings of clinical trials. Hitherto, the totality of evidence continues to suggest that S. repens is a prudent therapeutic option as part of the naturopathic treatment for LUTS/BPH. Conclusions: The totality of evidence includes favorable patients' response from clinical experience, impact of placebo effect, early positive studies, subjective nature of symptom reporting, pharmacological properties of S. repens, and potential synergistic effects when combined with other therapies.

This study evaluated the clinical and urodynamic findings before and after tension-free bladder neck sling (TBS) procedure with Prolene tape. We enrolled 32 women who underwent TBS for genuine stress incontinence without intrinsic sphincter deficiency or severe uterovaginal prolapse. All subjects received 1-h pad test, Q-tip test, multichannel urodynamic testing, introital ultrasonography, and the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 1 year after surgery. Of the 32 subjects 27 were cured of stress incontinence, two improved, and three failed. The incidence of irritative symptoms and incomplete bladder emptying were significantly lower after surgery. The mean urethral straining angle showed a significant decrease from 73.8° preoperatively to 30.1° postoperatively. At rest the postsurgical position of the bladder neck (BN) was localized more cranially. During straining both ventral and caudal mobility of the BN decreased significantly following TBS, causing a more cranial and dorsal position of the BN. Urodynamic parameters including functional urethral length, maximal urethral closure pressure, and pressure transmission ratio showed significant increases after surgery. TBS could decrease the hypermobility of the BN and restore the BN support to prevent urinary leakage during straining, instead of urethral obstruction. The subjective and objective cure rate of stress incontinence is 84%, similar to those results reported after retropubic urethropexy and tension-free vaginal tape procedure. It is also worth emphasizing that no postoperative urinary retention occurred, although the limited number of cases makes it hard to confirm the significance of findings over the retention rate of tension-free vaginal tape.

BD ϭ bladder diary CRF ϭ case report form FLW ϭ uroflowmetry ICI ϭ International Consultation on Incontinence ICIQ ϭ ICI Questionnaire ICIQ-CLUTS ϭ ICIQ-Pediatric LUTS LUTS ϭ lower urinary tract symptoms PCA ϭ principal component analysis PVR ϭ post-void residual urine SRCC ϭ Spearman's correlation coefficient Study received institutional review board approval.

The purpose of the present study was to validate the Mandarin version of the International Prostate Symptom Score (Mand-IPSS) in a Malaysian population. Methods: The validity and reliability were studied in patients with lower urinary tract symptoms (LUTS; benign prostatic hyperplasia [BPH] group) and without LUTS (control group). Test-retest methodology was used to assess the reliability while Cronbach alpha was used to assess the internal consistency. Sensitivity to change was used to express the effect size index in the preintervention versus post-intervention score in patients with LUTS who underwent transurethral resection of the prostate. Results: For the control group and BPH group, the internal consistency was excellent and a high degree of internal consistency was observed for all seven items (Cronbach a= 0.86-0.98 and 0.90-0.98, respectively). Test-retest correlation coefficients for all items were highly significant. Intraclass correlation coefficient (ICC) was high for the control (ICC = 0.93-0.99) and BPH group (ICC = 0.91-0.99). The sensitivity and specificity showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significance between baseline and post-treatment scores was observed across all seven items in the BPH group but not in the control group. Conclusions: The Mand-IPSS is a suitable, reliable, valid and sensitive instrument to measure clinical change in the Malaysian population.

Resumen Context: Benign Prostatic Hyperplasia (BPH) is a common disease that course with Lower Urinary Tract Symptoms (LUTS), mainly in over 50 years-old men. Commonly indicated drugs such as alpha adrenergic-blockers are life-treatment with some adverse reactions. Center for Drug Research and Development produce a microencapsulated lipophilic extract of pumpkin seed oil (Calprost ®) with anti-androgenic, anti-inflammatory, antioxidant, antiproliferative and diuretic properties. Aims: To evaluate the effect and safety of Calprost ® in patients with BPH and LUTS. Methods: A multicenter, randomized, controlled, open exploratory clinical trial was conducted. Two experimental groups, study group (Calprost ® , 140 mg daily) (n=81), and control group (terazosin, 2 mg daily) (n=50) were conformed. All the patients were treated during three months. Efficacy was evaluated through International Prostate Symptoms Score (IPSS), residual bladder volume and prostate volume. Results: Most of the included patients (74.0%) were white skin color and their mean age was 66 yrs. Fifteen patients, nine of them from terazosin group, withdraw the trial voluntarily. A significant reduction in the overall IPSS scale was obtained for both groups. Nevertheless, some obstructive (intermittency, straining) and irritative (frequency, urgency) urinary symptoms decreased more markedly in the Calprost ® group being milder. Median residual and prostatic volumes decreased significantly (p=0.048 and p=0.002, respectively) only into the Calprost ® group. Most of the adverse events were recorded in the terazosin group (79.4%), where postural hypotension prevailed. Conclusions: The natural product Calprost ® was probed as a successful treatment of patients with BPH/LUTS, being also well-tolerated.

Objectives. A high prevalence of significant bladder outlet obstruction has been reported among men diagnosed as having "chronic prostatitis." To evaluate the possibility that case selection may determine this high prevalence, we compared findings in patients referred directly to our Urodynamic Unit with that of patients evaluated in our Prostatitis Clinic. Methods. The videourodynamics records of 201 men aged 18 to 50 years who presented to the Urodynamic Unit with any lower tract symptoms (irritative and/or obstructive with or without pain) were compared with the findings in 123 Prostatitis Clinic patients. The latter were evaluated for obstruction with flow rates and, if abnormal, by retrograde urethrograms and videourodynamics. Results. Only 37 (18%) of 201 patients referred to the Urodynamic Unit had pain as a significant symptom and might have been diagnosed as having chronic prostatitis. Of these 37 patients, 4 (11%) had definite obstruction, 6 (16%) were equivocal, 6 (16%) were hypocontractile, 1 (3%) had pseudodyssynergia, and 7 (19%) had normal findings. The remainder had abnormalities of bladder filling (hypersensitivity in 11 [30%] and detrusor instability in 2 [5%]). Fewer of the 123 patients with prostatitis had obstruction (definite in 2 [1.6%] and equivocal in 1 [0.8%]) (P ϭ 0.03), 2 (1.6%) had hypocontractile detrusors, and 2 had urethral strictures. Conclusions. Patients referred to the Urodynamic Unit with lower urinary tract symptoms and pain rarely have bladder outlet obstruction. However, they are significantly more likely to have bladder outlet obstruction than patients referred to the Prostatitis Clinic who can be screened for obstruction by history, flow rate, postvoid residual, and retrograde urethrogram. UROLOGY 52: 417-421, 1998.

Context: Detrusor underactivity (DU) is a common cause of lower urinary tract symptoms (LUTS) in both men and women, yet is poorly understood and underresearched. Objective: To review the current terminology, definitions, and diagnostic criteria in use, along with the epidemiology and aetiology of DU, as a basis for building a consensus on the standardisation of current concepts. Evidence acquisition: The Medline and Embase databases were searched for original articles and reviews in the English language pertaining to DU. Search terms included underactive bladder, detrusor underactivity, impaired detrusor contractility, acontractile detrusor, detrusor failure, detrusor areflexia, raised PVR [postvoid residual], and urinary retention. Selected studies were assessed for content relating to DU. Evidence synthesis: A wide range of terminology is applied in contemporary usage. The only term defined by the standardisation document of the International Continence Society (ICS) in 2002 was the urodynamic term detrusor underactivity along with detrusor acontractility. The ICS definition provides a framework, considering the urodynamic abnormality of contraction and how this affects voiding; however, this is necessarily limited. DU is present in 9-48% of men and 12-45% of older women undergoing urodynamic evaluation for non-neurogenic LUTS. Multiple aetiologies are implicated, affecting myogenic function and neural control mechanisms, as well as the efferent and afferent innervations. Diagnostic criteria are based on urodynamic approximations relating to bladder contractility such as maximum flow rate and detrusor pressure at maximum flow. Other estimates rely on mathematical formulas to calculate isovolumetric contractility indexes or urodynamic ''stop tests.'' Most methods have major disadvantages or are as yet poorly validated. Contraction strength is only one aspect of bladder voiding function. The others are the speed and persistence of the contraction. Conclusions: The term detrusor underactivity and its associated symptoms and signs remain surrounded by ambiguity and confusion with a lack of accepted terminology, definition, and diagnostic methods and criteria. There is a need to reach a consensus on these aspects to allow standardisation of the literature and the development of optimal management approaches.

Background: The first Italian national guidelines were developed by the Italian Association of Urologists and published in 2007. Since then, a number of new drugs or classes of drugs have emerged for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH), new data have emerged on medical therapy (monotherapies and combination therapies), new surgical techniques have come into practice, and our understanding of disease pathogenesis has increased. Consequently, a new update of the guidelines has become necessary. Methods: A structured literature review was conducted to identify relevant papers published between 1 August 2006 and 12 December 2010. Publications before or after this timeframe were considered only if they were recognised as important milestones in the field or if the literature search did not identify publications within this timeframe. The quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation framework.

The term lower urinary tract symptoms (LUTS) encompasses a range of urinary symptoms, including storage symptoms (e.g. overactive bladder [OAB]) as well as voiding and post-micturition symptoms. Although treatment of male LUTS tends to focus on voiding symptoms, patients typically find storage symptoms the most bothersome. The core storage symptom is urgency, which drives the other main storage symptoms of increased daytime frequency, nocturia and incontinence. Although several validated questionnaires have been widely used to study urgency, few measure the two important storage parameters, urgency and frequency, in a single assessment. The total urgency and frequency score (TUFS) is a new validated tool that captures both variables and is derived from the Patient Perception of Intensity of Urgency Scale, which has been validated in patients with OAB and LUTS. The TUFS was first validated in OAB in the phase IIa BLOSSOM study, which was designed to assess the efficacy and safety of mirabegron, a β3-adrenoceptor agonist, in 260 patients. The responsiveness of the TUFS to treatment has been confirmed in a further three large-scale randomized controlled trials of solifenacin in patients with OAB or LUTS. Changes in TUFS from baseline to end of treatment were consistent with changes in micturition diary variables in all four studies. Furthermore, the TUFS was significantly correlated with several health-related quality-of-life variables in the phase III NEPTUNE study. Thus, the TUFS appears to be useful for assessing improvements in major storage symptoms (urgency and frequency) in clinical trials.

To evaluate published evidence on nocturia in men and derive expert recommendations. The International Consultations on Urological Diseases-Société Internationale d&#39;Urologie convened a Consultation of experts on male lower urinary tract symptoms. The Consultation assigned standardized levels of evidence and grades of recommendation to various studies of nocturia epidemiology, pathophysiology, assessment, and treatment. Evidence review and consensus recommendations were made in the areas of epidemiology, pathophysiology, assessment, and treatment. The review presents a condensed summary of the International Consultations on Urological Diseases-Société Internationale d&#39;Urologie evaluation of nocturia, which offers contemporaneous expert consensus on this topic, with an assessment algorithm emphasizing the potential contribution of systemic conditions to the symptom.

Background: The PDE5 inhibitor tadalafil is under investigation for the treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Several clinical studies of tadalafil and other PDE5 inhibitors have reported significant symptom reduction but limited urinary flow rate improvement. This manuscript reviews the published literature describing the pathophysiology of male LUTS, with an emphasis on mechanisms that may be modulated or improved by phosphodiesterase type 5 (PDE5) inhibition. Methods: Literature (through March 2010) was obtained via Medline searches and from the individual reviewers files. Articles were selected for review based on describing in vitro, preclinical, or clinical studies of pathological processes contributing to LUTS, or possible effects of PDE5 inhibition in the lower urinary tract. Results: Major mechanisms contributing to LUTS include: reduced nitric oxide/cyclic guanosine monophosphate signaling; increased RhoA kinase pathway activity; autonomic overactivity; increased bladder afferent activity; and pelvic ischemia. Tadalafil and other PDE5 inhibitors have demonstrated beneficial effects on smooth muscle relaxation, smooth muscle and endothelial cell proliferation, nerve activity, and tissue perfusion that may impact LUTS in men. Conclusions: The pathophysiology of male LUTS is complex and not completely understood. LUTS may occur independently of BPH or secondary to BPH but in both cases involve obstructive or irritative mechanisms with substantial pathophysiological overlap. While the precise mechanism remains unclear, inhibition of PDE5 seems to have an effect on several pathways that may impact LUTS. Neurourol. Urodynam.

a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Keywords: Benign prostatic hyperplasia Bladder Lower urinary tract symptoms Male Pathophysiology Pharmacotherapy Prostate Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

Epidemiological studies have demonstrated rates of incontinence and enuresis as high as 20% in school-age children. This cross-sectional study aimed to investigate the prevalence of lower urinary tract (LUT) symptoms in 739 children aged 6-12 years enrolled in three government schools with different socioeconomic levels in Minas Gerais, Brazil. Symptoms of LUT were evaluated using a modified version of the Dysfunction Voiding Scoring System in which the cutoff point considered as an indicator of LUT dysfunction is >6 for girls and >9 for boys. Children with a score indicative of symptoms received an educational booklet on the functioning of the LUT and were sent for clinical evaluation. LUT dysfunction symptoms were detected in 161 (21.8%) children. Symptoms were most frequent in girls (p<0.001), children aged 6-8 (p< 0.028), and attended the school with the lowest social level (p<0.001). Intestinal constipation was the most prevalent finding (30.7%), independent of LUT score. The most common urinary symptoms in children with an elevated score were diurnal urinary incontinence (30.7%), holding maneuvers (19.1%), and urinary urgency (13.7%). Stress factors were associated in 28.4% of children. Our findings suggest that LUT symptoms must be investigated carefully at routine pediatric visits.

Objective: While the lipido-sterolic extract of Serenoa repens (LSESr)ÐPermixon 1 Ðhas been shown to have an equivalent ef®cacy to ®nasteride in patients with benign prostatic hyperplasia (BPH), to date, there has been no valid comparison of phytotherapy with a-blockers. The aim of this study was to assess the equivalent ef®cacy of Permixon and tamsulosin. Methods: Eight hundred and eleven men with symptomatic BPH (I-PSS ! 10) were recruited in 11 European countries for a 12-month, double-blind randomized trial. After a 4-week run-in period, 704 patients were randomly assigned to either tamsulosin 0.4 mg/day (N 354) or Permixon 320 mg/day (N 350). I-PSS, QoL and Q max were evaluated at baseline and periodically for 1 year. Prostate volume and serum prostate-speci®c antigen (PSA) were measured at selection and at endpoint. The endpoint analysis was performed on the per-protocol population of 542 patients (tamsulosin: N 273; Permixon: N 269). Results: At 12 months, I-PSS decreased by 4.4 in each group and no differences were observed in either irritative or obstructive symptom improvements. The increase in Q max was similar in both treatment groups (1.8 ml/s Permixon, 1.9 ml/s tamsulosin). PSA remained stable while prostate volume decreased slightly in the Permixon-treated patients. The two compounds were well tolerated, however, ejaculation disorders occurred more frequently in the tamsulosin group. Conclusion: This study demonstrates that Permixon and tamsulosin are equivalent in the medical treatment of lower urinary tract symptoms in men with BPH, during and up to 12 months of therapy. #

Context: A new formulation of tamsulosin for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) has been developed. This formulation uses the proprietary oral controlled absorption system (OCAS 1 ) technology which has the potential to better control the release during passage of the gastrointestinal tract including the colon and which may be devoid of a food effect. This study describes the characteristics of the tamsulosin OCAS formulation with respect to single and multiple dose human pharmacokinetics (PK). Methods: The single dose PK of three tamsulosin OCAS 0.4 mg formulations (S2, S3 and S4) in comparison with tamsulosin modified release (MR) 0.4 mg capsules were analysed in 12 young healthy volunteers in a 4-way crossover study to allow selection of a candidate for further development.

Benign prostatic hyperplasia (BPH) is the noncancerous proliferation of the prostate gland associated with benign prostatic obstruction and lower urinary tract symptoms (LUTS) such as frequency, hesitancy, urgency, etc. Its prevalence increases with age affecting around 70% by the age of 70 years. High activity of 5␣-reductase enzyme in humans results in excessive dihydrotestosterone levels in peripheral tissues and hence suppression of androgen action by 5␣-reductase inhibitors is a logical treatment for BPH as they inhibit the conversion of testosterone to dihydrotestosterone. Finasteride (13) was the first steroidal 5␣reductase inhibitor approved by U.S. Food and Drug Administration (USFDA). In human it decreases the prostatic DHT level by 70-90% and reduces the prostatic size. Dutasteride (27) another related analogue has been approved in 2002. Unlike Finasteride, Dutasteride is a competitive inhibitor of both 5␣-reductase type I and type II isozymes, reduced DHT levels >90% following 1 year of oral administration. A number of classes of non-steroidal inhibitors of 5␣-reductase have also been synthesized generally by removing one or more rings from the azasteroidal structure or by an early non-steroidal lead (ONO-3805) (261). In this review all categories of inhibitors of 5␣-reductase have been covered.