Nocturia in Spanish patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH)

ABSTRACT

Objective: This study aimed to assess the prevalence of nocturia and its impact on quality of life (QoL) in Spanish patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH).

Research design and methods: This was a Spanish, multicentre, cross-sectional study. Outpatients aged 60 years and over with LUTS/BPH, a prostate size ≥ 25?g, untreated for LUTS/BPH and responding to the International Prostate Symptom Score (I-PSS) were included. Nocturia was defined as ≥ 2 nocturnal voids/night. The Spanish version of the Nocturia-specific Quality of Life (N-QoL) questionnaire assessed the impact of nocturia on QoL, with a low score indicating a poor QoL due to nocturia.

Results: A total of 502 patients were included; mean age 68.1 ± 5.7 years, mean I-PSS 14.9 ± 7.1, mean prostate size 50.9 ± 20?g. The overall prevalence of nocturia was 83.1% (95% confidence interval [CI]: 79.8–86.4). Patients with nocturia had a lower score on the overall N-QoL questionnaire and the sleep/energy and bother/concern domains than those without nocturia (?p < 0.001); 42.9% of patients with nocturia stated that they had a good-very good QoL compared to 90.6% in those without nocturia (?p < 0.001).

Conclusion: This study shows a high prevalence of nocturia in Spanish LUTS/BPH patients. Nocturia negatively impacts on the QoL of LUTS/BPH patients, which is reflected in worse sleep, reduced energy levels and increased bother and concern. Therefore adequate treatment of this symptom is necessary.     

高龄二孩再产妇下尿路症状的临床因素分析

目的　探讨高龄二孩产妇产后1年内下尿路症状发生的临床因素。方法　对2018年4月至2019年4月就诊于惠州市第二妇幼保健院的643例高龄二孩再产妇进行问卷调查,年龄（36.64±1.71）岁,采用logistic回归分析产后1年下尿路症状发生与临床各种因素的相关性。结果　在产后3个月,妊娠期下尿路病史、经常咳嗽便秘、年龄3个变量是储尿期下尿路症状的危险因素（OR=9.968、13.276、1.844）;在产后6个月,妊娠期下尿路病史、女性年龄是储尿期下尿路症状发生的危险因素（OR=2.228、2.254）;在产后9个月,胎儿体质量、女性年龄、会阴侧切顺产是储尿期下尿路症状发生的危险因素（OR=3.006、1.723、3.098）;在产后12个月,民族、胎儿体质量、女性年龄、会阴侧切顺产是储尿期下尿路症状发生的危险因素（OR=8.402、2.603、1.829、2.444）。剖宫产是避免高龄二孩产妇产后1年发生储尿期、排尿后症状发生的保护因素。结论　相对于会阴侧切、普通顺产分娩,剖宫产是避免高龄二孩再产妇产后1年内出现下尿路症状的显著保护因素,而女性年龄的增长和会阴侧切则明显增加高龄二孩再产妇产后1年内储尿期下尿路症状的发病风险。     

Managing lower urinary tract symptoms in men

Over one-quarter of men aged 40 years or over in the UK have lower urinary tract symptoms. These symptoms, which may seriously disrupt day-to-day activity, include frequency, urgency, hesitancy, reduced flow, dribbling, nocturia, incontinence and incomplete emptying of the bladder. Here, we review non-surgical measures that may help men with such symptoms.     

Combination therapy with omega-3 fatty acids plus tamsulocin and finasteride in the treatment of men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH)

Purpose

Inflammation and Cyclooxygenase-2 (COX-2) as a part of it are common in BPH specimens and may play a role in the pathogenesis of the disease through cytokines that promote cell growth or lead to smooth muscle contraction. The aim of this study is to analyze whether combination therapy with omega-3 fatty acids, which have anti-inflammatory and COX-2 inhibitory effects, and tamsulocin plus finasteride offers an advantage compared to tamsulocin plus finasteride therapy in patients with BPH.

Materials and methods

This is a single-center blinded clinical trial. One hundred consecutive men between 50 and 70 years of age and no other comorbidities with LUTS and BPH were entered into the study and were randomized to receive omega-3 fatty acids 300 mg three times a day with meals plus tamsulocin 0.4 mg at bed time and finasteride 5 mg/day (study group) versus tamsulocin 0.4 mg at bed time and finasteride 5 mg/day (control group) for 6 months. The efficacy and safety of treatments were assessed at baseline and at month one, three and six.

Results

In our population, both treatments (groups study and control) produced statistically significant improvements in IPSS, Q _max, Q _ave and prostate volume from baseline during follow-up (p < 0.05). We found that study group showed higher improvement in IPSS (p = 0.007), Q _max (p = 0.011) and Q _ave (p = 0.004) at the 1 month interval. These higher improvements last at month three and six (p < 0.05). Prostate volume in the study group also showed more improvement at month six (p = 0.000). Adverse effects were the same in both groups during the study.

Conclusion

It can be concluded that association of omega-3 fatty acids with tamsulocin and finasteride may produce better clinical results.

     

Interrelation of erectile dysfunction and lower urinary tract symptoms

The association between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) has garnered attention as investigators have hypothesized a common pathophysiology to explain the assertion that they are causally linked. This relationship between LUTS and ED has received increased attention because both diseases are highly prevalent, frequently co-associate in the same aging male group, and significantly influence the overall quality of life. A causal association between LUTS and ED cannot be established on the basis of the ever-increasing number of epidemiological studies. Attempting to explain a causal relationship between ED and LUTS requires the use of Hill's criterion, which is used by many epidemiologists to separate causal from non-causal explanations. A review of the epidemiological evidence reveals a strong degree of association, internal consistency and dose response effects between ED and LUTS. The temporal relationships between the two remain unknown because of the strong cross-sectional flavor of the epidemiological studies. The issue of an "alternate explanation" to describe the LUTS-ED association appears to be accounted for in that several large studies have provided convincing multiple regression analyses in which the ED-LUTS relationship remains significant. Biologic plausibility is an important issue if the link between ED and LUTS is to have credence. There are four leading theories of how these diseases interrelate. These explanations have a variable amount of supporting data. These include: 1) autonomic hyperactivity effects on LUTS, prostate growth and ED; 2) nitric oxide synthase/nitric oxide levels decreased or altered in the prostate and penile smooth muscle; 3) prostate and penile ischemia; and 4) increased Rho-kinase activation/ endothelin activity. LUTS and sexual dysfunction are highly prevalent in aging men. Both conditions are also significant contributors to overall quality of life. New data has emerged to indicate potential links in epidemiological, physiologic, pathophysiologic and treatment aspects of these two diseases. Using Hill's causality method to separate causal from non-causal explanations linking ED with LUTS, it appears that most epidemiological components are fulfilled.     

女性下尿路症状的影像尿动力学评价

目的探讨女性下尿路症状患者的影像尿动力学异常表现及临床意义。方法选择38例门诊主诉持续下尿路症状就诊的女性患者，采用15％泛影葡胺溶液为膀胱灌注液。根据膀胱测压、压力-流率、盆底肌电图以及X线影像等对患者下尿路症状进行诊断，并比较尿动力学正常和异常患者的I-PSS评分。结果38例中影像尿动力学异常23例，占60．5％，其中感觉性尿急迫6例，不稳定膀胱（DI）5例，假性逼尿肌一括约肌协同障碍（PDS）4例，PDS＋DI2例，尿道外口狭窄2例，DI＋急迫尿失禁、低顺应性膀胱、膀胱颈后唇增生以及近端尿道憩室各1例。结论影像尿动力学检查不仅可以了解女性下尿路症状患者的下尿路功能和形态变化，且有助于不同病变类型的诊断和治疗。     

Pharmacotherapeutic management of lower urinary tract symptoms in Multiple Sclerosis patients

ABSTRACT

Introduction

Multiple Sclerosis (MS) manifests with a plethora of signs and symptoms affecting brain structures and spinal pathways. The multitude of lesions in MS patients makes difficult to establish the relative role of each of them to lower urinary tract symptoms (LUTS). Generally, the subcortical white-matter lesions result in detrusor overactivity, whilst lesions of the spinal cord result in the combined occurrence of detrusor overactivity and detrusor-sphincter dyssynergia (DSD). It has been estimated that 80–90% of patients with MS will suffer from some form of LUTS over the course of the disease. Among LUTS, the most reported is detrusor overactivity which includes urinary urgency, frequent urination, nocturia, and urge urinary incontinence.     

Current pharmacological treatment options for male lower urinary tract symptoms

Introduction: Benign prostatic hyperplasia (BPH) is a highly prevalent disease in the aging male and significantly impairs quality of life. Men with BPH present with lower urinary tract symptoms (LUTS), which include storage and voiding disorders. Medical therapy is the first option in patients with mild to moderate symptoms.

Areas covered: α₁-adrenoceptor antagonists, 5α-reductase inhibitors or the combination of both have been considered gold standard for pharmacological treatment over the last decade in this patient cohort. Recently, a variety of novel substances have been tested which include Phosphodiesterase Typ 5 inhibitors (PDE5i), anti-cholinergic agents and β-3-agonists. This article highlights the key studies with regard to each drug class and discusses current pharmacotherapy and possible future treatment options.

Expert opinion: In patients with small prostates, α₁-adrenoceptor antagonists represent the gold standard in the medical treatment of mild LUTS. For men with large prostate glands and mild to moderate LUTS, recent data support the combination of α₁-adrenoceptor antagonists and 5α-reductase inhibitors. PDE5i may be useful in men with LUTS and concomitant erectile dysfunction, while anti-cholinergics have been shown to be beneficial in patients with predominant storage disorders. Future studies have to elucidate the role of β-3-agonists in men with BPH and LUTS.     

深圳某社区青年女性下尿路症状的问卷调查研究

目的:分析青年女性人群下尿路症状(LUTS)的发病率和相关影响因素.方法:对广东省深圳市某社区青年女性人群进行随机抽样问卷调查[问卷设计参考女性下尿路症状国际尿失禁标准问卷(ICIQ-FLUT)、国际前列腺状问卷(IPSS)布里斯托女性下尿路症状(BFLUTS)问卷及生活质量(QoL)等],根据具体情况进行调整.问卷由被调查者独立填写.结果:调查共发出问卷1 500份,回收有效问卷1 387份.储尿症状总患病率为91.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P＜0.01),与年龄和分娩方式有关;排尿症状总患病率为65.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P＜0.01),与生育情况、分娩方式以及文化水平有关.受调查者以刺激症状和梗阻症状的生活质量进行评分,分别为(2.87±1.32)分和(2.23±1.05)分;刺激症状和梗阻症状与生活质量评分的关联系数分别为0.51和0.23.结论:青年女性人群中的LUTS患病率很高,且不同程度影响青年女性的生活质量.     

深圳某社区青年女性下尿路症状的问卷调查研究

目的:分析青年女性人群下尿路症状(LUTS)的发病率和相关影响因素。方法:对广东省深圳市某社区青年女性人群进行随机抽样问卷调查〔问卷设计参考女性下尿路症状国际尿失禁标准问卷(ICIQ-FLUT)、国际前列腺状问卷(IPSS)布里斯托女性下尿路症状(BFLUTS)问卷及生活质量(QoL)等〕,根据具体情况进行调整。问卷由被调查者独立填写。结果:调查共发出问卷1 500份,回收有效问卷1 387份。储尿症状总患病率为91.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P<0.01),与年龄和分娩方式有关;排尿症状总患病率为65.2%,随年龄的增加,总储尿症状患病率呈增高趋势(P<0.01),与生育情况、分娩方式以及文化水平有关。受调查者以刺激症状和梗阻症状的生活质量进行评分,分别为(2.87±1.32)分和(2.23±1.05)分;刺激症状和梗阻症状与生活质量评分的关联系数分别为0.51和0.23。结论:青年女性人群中的LUTS患病率很高,且不同程度影响青年女性的生活质量。     

Treatment of erectile dysfunction and lower urinary tract symptoms by phosphodiesterase inhibitors

To date, it is widely accepted that several disorders of the male and female urogenital tract, such as erectile dysfunction, bladder overactivity, urinary stone disease, the benign prostatic syndrome, as well as symptoms of female sexual arousal and orgasmic dysfunctions, can be therapeutically approached by influencing the function of the smooth musculature of the respective organs. To achieve a pronounced drug effect without significant adverse events, a certain degree of tissue selectivity is mandatory. Selective intervention in intracellular pathways regulating smooth muscle tone has become the most promising strategy to modulate tissue and organ function. Since the concept of taking a pill to relieve symptoms of lower urinary tract dysfunction is now widely accepted following the successes of phosphodiesterase 5 (PDE5) inhibitor treatment of erectile dysfunction, the treatment of urological diseases has focused on orally available drugs acting via influencing intracellular signaling pathways, thereby combining a high response rate with the advantage of an on-demand intake. Specifically, the use of isoenzyme-selective PDE inhibitors offers great opportunities in the medical treatment of various genitourinary diseases. These agents are regarded to be safe and to be efficacious, i.e., having a fast onset of drug action and an improved effect-to-side-effect ratio. As experience with this class of compounds and their use in urology is rapidly growing, basic and clinical research in this field will most likely expand the pharmacological armamentarium of innovative treatment options in the next few years. The purpose of this review is to summarize current, as well as potential, upcoming indications for the use of PDE inhibitors in the pharmacotherapy of male erectile dysfunction and lower urinary tract symptoms.     

Anticholinergic therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia

Lower urinary tract symptoms (LUTS) are commonly associated with benign prostatic hyperplasia (BPH). The LUTS-BPH complex consists of both voiding and storage symptoms that may overlap with overactive bladder symptoms. Drug therapy for men with LUTS may include alpha1-antagonists, 5-alpha-reductase inhibitors, combination therapy, and over-the-counter phytotherapy. Anticholinergic agents are effective in relieving overactive bladder symptoms in patients without bladder outlet obstruction. However, anticholinergic therapy has historically been contraindicated in patients with LUTS associated with BPH because of concerns for developing acute urinary retention. To assess the safety and efficacy of anticholinergic therapies for LUTS associated with BPH, a MEDLINE search and a bibliographic search of the English-language literature were conducted. Two nonrandomized, open-label studies; two randomized trials that assessed anticholinergic therapy alone; and eight trials that assessed anticholinergic therapy in combination with an alpha1-antagonist were identified. Trials were of short duration (6-12 wks) and included only men with low postvoid residual volumes at baseline. Small nonsignificant changes were seen in objective measures of urinary function. Several trials demonstrated an increase in postvoid residual with anticholinergic therapy, which was statistically significant in two trials. Despite the increase in postvoid residual, rates of acute urinary retention were low and the drugs were well tolerated. Of the five trials that used a validated symptom scoring scale, two demonstrated subjective improvement in urinary function. Men with symptomatic overactive bladder and BPH who are not adequately relieved with alpha1-antagonists may benefit from the addition of an anticholinergic agent. Before starting therapy, however, a postvoid residual volume should be measured to measure to rule out baseline urinary retention.     

Phosphodiesterase (PDE) inhibitors in the treatment of lower urinary tract dysfunction

Several disorders of the human upper and lower urinary tract, such as urinary stone disease, lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and detrusor overactivity, can be therapeutically addressed by influencing the function of the smooth musculature of the ureter, prostate or urinary bladder, respectively. In order to ensure a drug effect without significant adverse events, a certain degree of tissue selectivity is mandatory. The treatment of said conditions aims to focus on orally available drugs acting via intracellular signalling pathways. Specifically, the cyclic nucleotide monophosphate cyclic GMP represents an important mediator in the control of the outflow region (bladder, urethra). The use of phosphodiesterase (PDE) inhibitors, such as sildenafil, tadalafil, vardenafil, avanafil or udenafil, known to restrain the degradation of the second messenger cyclic GMP, offers great opportunities in the treatment of lower urinary tract dysfunction. PDE inhibitors are regarded as efficacious, have a rapid onset of action and favourable effect-to-side-effect ratio. The role of PDE5 inhibitors in the treatment of BPH/LUTS and the overactive bladder has already been addressed in randomized, double-blind, placebo-controlled trials, as well as preliminary open-label studies enrolling either several hundreds or only 20 patients. The purpose of this review is to focus on the potential use and clinical significance of PDE inhibitors in the treatment of storage and voiding dysfunctions of the lower urinary tract. The strategy of modulating the activity of PDE isoenzymes might represent a novel approach in patients with lower urinary tract dysfunction (LUTD).     

伐地那非治疗前列腺增生症所致下尿路症状的疗效

目的 观察伐地那非治疗良性前列腺增生症(BPH)所致下尿路症状(LUTS)的临床疗效.方法 国际前列腺症状评分(IPSS)≥12的BPH患者62例随机分为两组,每组31例.治疗组,口服伐地那非10 mg,每日两次;对照组服用安慰剂,疗程8周.比较治疗前后IPSS总分、最大尿流率(Qmax)、残余尿量(PVR),并行生活质量(QoL)和勃起功能评估.结果 与对照组比较,治疗8周后,治疗组IPSS值明显下降,国际勃起功能评分5(IIEF-5)明显增加,QoL明显改善(P<0.05).结论 伐地那非治疗BPH所致LUTS安全、有效.     

西地那非治疗良性前列腺增生症所致下尿路症状的疗效

目的 观察西地那非治疗前列腺增生症（BPH）所致下尿路症状（LUTS）的临床疗效及安全性.方法 将经导入期后符合本试验研究的90例BPH所致LUTS并伴有勃起功能障碍（ED）的患者完全随机分成治疗组45例、对照组45例.治疗组口服西地那非100 mg/次,1次/d;对照组服用外型相同的安慰剂1片/次,1次/d,2组均用药8周.观察2组患者IPSS、最大尿流率（Qmax）、残余尿量等的改变,对LUTS进行评估;采用国际勃起功能评分（IIEF-5）对勃起功能进行评估,采用生活质量（QoL）评分评价BPH患者生活质量.结果 2组各有3例患者失访,末获任何评估结果,故实际试验患者数为84例.治疗8周后,对照组各项指标及治疗组的Qmax、残余尿量均有所改善,但差异无统计学意义（P＞0.05）;治疗组治疗后与治疗前比较IPSS、IIEF-5、QoL评分均明显改善（13.3分比17.5分,23.2分比15.2分,2.0分比4.9分,P＜0.05）.试验中,不良反应发生率治疗组为3例（7.1%）,对照组为2例（4.7%）,治疗组患者对西地那非耐受良好,不良反应轻微.结论 西地那非对治疗BPH所致LUTS有效、安全,尤其对BPH伴发ED患者具有较好的疗效.     

Neuropeptides in lower urinary tract function

Numerous neuropeptide/receptor systems including vasoactive intestinal polypeptide, pituitary adenylate cyclase-activating polypeptide, calcitonin gene-related peptide, substance P, neurokinin A, bradykinin, and endothelin-1 are expressed in the lower urinary tract (LUT) in both neural and nonneural (e.g., urothelium) components. LUT neuropeptide immunoreactivity is present in afferent and autonomic efferent neurons innervating the bladder and urethra and in the urothelium of the urinary bladder. Neuropeptides have tissue-specific distributions and functions in the LUT and exhibit neuroplastic changes in expression and function with LUT dysfunction following neural injury, inflammation, and disease. LUT dysfunction with abnormal voiding, including urinary urgency, increased voiding frequency, nocturia, urinary incontinence, and pain, may reflect a change in the balance of neuropeptides in bladder reflex pathways. LUT neuropeptide/receptor systems may represent potential targets for therapeutic intervention.     

尿流动力学检查在男性下尿路症状诊治中的临床应用

目的 评价尿流动力学检查在男性下尿路症状（LUTS）临床诊治中的作用.方法 采用Laborie尿流动力学分析仪对385例合并下尿路症状的男性患者进行检查,检测其各项尿流动力学指标,参考国际尿控学会（ICS）标准判断其膀胱尿道功能并进行分型,并根据其分型进行针对性治疗.结果 尿流动力学检查结果发现,385例男性LUTS患者中,膀胱出口梗阻（BOO） 283例,其中合并膀胱过度活动（OAB） 96例,合并逼尿肌无力38例;单纯OAB 64例;神经原性膀胱25例,尿流动力学检查正常13例.根据其尿流动力学检查结果分别进行治疗,有效率93％,疗效满意.结论 尿流动力学检查对于男性LUTS患者的诊断、治疗具有重要意义.     

军人家属及部分女兵下尿路症状调查分析和防治

目的 调查军人家属及女兵的下尿路症状发病情况。方法在某部及其下属的3个团的家属及部分女兵进行体检的同时进行问卷调查。采用布里斯托女性下尿路症状调查问卷，问卷由被调查者独立填写，个别不能独立完成问卷的被调查者，由调查员对其进行解释，再由其完成。结果 91人完整回答了问卷，其中尿频、尿急、膀胱疼痛、夜尿、压力性尿失禁、排尿时需要用力、捧尿延迟、排尿中断、排尿力量发生变化和感觉总是不能完全排空膀胱的患病率分别是：9．9％、58．2％、37．4％、24．2％、34．1％、22％、28．6％、31．9％、16．5％和53．8％。夜尿对生活质量影响最大。结论 军人家属及部分女兵中下尿路症状很常见，48岁以上家属基本都存在这种或那种下尿路症状。