Videourodynamics identifies the causes of young men with lower urinary tract symptoms and low uroflow

OBJECTIVES: Using videourodynamics (VUDS) we prospectively investigated the etiologies of lower urinary tract symptoms (LUTS) and low uroflow in young men and correlated the results with clinical symptoms and noninvasive exams. METHODS: From 1999 to 2001, 90 men 18-50 years old with LUTS and low uroflow were enrolled. Patients with active urinary tract infection, congenital urogenital diseases, neurological diseases, diabetes mellitus or urinary tract malignancy were excluded. Evaluation included International Prostate Symptom Score (I-PSS), renosonography, transrectal ultrasonography of prostate and VUDS. The clinical parameters were compared in the different diagnostic groups of patients classified by VUDS. RESULTS: Mean patient age was 37.5+/-7.8 years and mean symptom duration was 28.3+/-21.3 months. Mean total I-PSS was 19.8, voiding 11.1 and storage 8.7. VUDS showed dysfunctional voiding in 39 (43%), primary bladder neck obstruction in 37 (41%), impaired detrusor contractility in 9 (10%) and benign prostatic obstruction in 5 (6%). Patients with impaired detrusor contractility had higher symptoms scores and poorer quality of life than those in the other diagnostic groups. Mean age and size of prostate in patients with benign prostatic obstruction were greater than those in the remaining groups. The remaining clinical symptoms or noninvasive tests could not predict a specific urodynamic diagnosis. CONCLUSIONS: VUDS is recommended to make an accurate diagnosis in young men with LUTS and low uroflow because few clinical symptoms or noninvasive tests were helpful in this regard.     

Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior

IntroductionOur aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department.MethodsRetrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings.ResultsSeven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 patients. Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal.ConclusionsMost of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications.     

Lower urinary tract dysfunctions in patients with spinal cord tumors

AIMS: The objective of this study was to elucidate the incidence and pathophysiology of lower urinary tract dysfunctions (LUTS) in patients with spinal cord tumors. METHODS: Urinary questionnaire and urodynamic studies were done in 76 patients with spinal cord tumors. RESULTS: The patients included 56 with cervical-thoracic (C1 to T11) and 20 with lumbosacral tumors. The lumbosacral tumors consisted of 12 epiconus/conus medullaris (below T11) and 8 cauda equina tumors. These tumors were further subdivided into intramedullary, intradural extramedullary, and dumbbell-type. More than 83% of the patients had urinary symptoms. Patients with cervical-thoracic tumors commonly had voiding symptoms (75%). Detrusor hyperreflexia (39%), and detrusor areflexia on voiding (21%) were the main urodynamic features. Patients with epiconus/conus medullaris tumors commonly had voiding symptoms as well (58%), but decreased urge to void (50%), detrusor-sphincter dyssynergia (42%), and detrusor areflexia on voiding (32%) were the main features. Patients with cauda equina tumors commonly had storage symptoms (88%), of which sensory urgency was most common (63%). Severe LUTS occurred in the epiconus/conus medullaris tumors and in the intramedullary tumors. These dysfunctions tended to appear late and rarely appeared as the initial symptom in the course of the disease. There was no significant relationship between neurologic abnormalities and LUTS. Urodynamics showed that spinal cord tumors cause a variety of LUTS, depending on the location and the type of the tumor. CONCLUSION: Spinal cord tumors are commonly accompanied by LUTS. Clinical and urodynamic evaluation is crucial to diagnosis and management since there is little relationship between symptoms and findings.     

The role of invasive and non-invasive urodynamics in male voiding lower urinary tract symptoms

Introduction

Troublesome voiding lower urinary tract symptoms (LUTS) are a common problem in men, particularly with ageing. Implicitly, management of voiding LUTS can be guided by accurate determination of underlying mechanisms, distinguishing men with voiding symptoms caused by outlet obstruction from those with reduced bladder contractility.

Methods

A PubMed search of the published literature on invasive and non-invasive methods used to assess lower urinary tract function was carried out.

Results

A multitude of methods have been applied to assess LUTS. Multichannel pressure flow studies (PFS) are the standard for diagnosing bladder outlet obstruction and underlying mechanisms of LUTS, though their invasive nature can be difficult to tolerate, and improved prediction of treatment outcome is disputed. Uroflowmetry and post void residual measurement are insufficient to make a definitive diagnosis. Ultrasound-derived measurements of bladder wall thickness and estimated bladder weight offer a potential non-invasive alternative to PFS, but their diagnostic parameters are still under evaluation. Non-invasive methods that measure isovolumetric bladder pressure by interrupting the urinary stream can reproducibly measure pressure and urinary flow, but are unable to determine the effects of abdominal straining during voiding and give no insight into urine storage symptoms. Doppler ultrasound during urethral flow is informative, but it is an expensive approach whose clinical utility has yet to be established.

Conclusion

A variety of non-invasive urodynamic and non-urodynamic techniques have been used to evaluate LUTS and some show great promise. However, there is as yet, insufficient evidence to justify replacement of invasive voiding cystometry by these investigational approaches.     

Prevalence of overactive bladder, urinary incontinence, and lower urinary tract symptoms: results of Korean EPIC study

Objective

Despite growing interest in overactive bladder (OAB), urinary incontinence (UI), and lower urinary tract symptoms (LUTS), there is no epidemiologic study on the prevalence in general population of Korea. This survey was aimed at estimating the prevalence of OAB, UI, and other LUTS among Korean men and women.

Methods

Population-based cross-sectional telephone survey was conducted between May and September 2006 using questionnaire regarding demographics and the prevalence. A geographically stratified random sample of men and women aged????18?years were selected. Current International Continence Society definitions were used for individual LUTS and OAB.

Results

Of a total of 9,067 individuals contacted, 2,000 (888 men, 1,112 women) agreed to participate. Overall prevalence of LUTS was 61.4% (53.7% of men, 68.9% of women) and the prevalence increased with age. Storage LUTS was more prevalent than voiding or post-micturition LUTS in both men (storage; 44.6%, voiding; 28.5%, post-micturition; 15.9%) and women (storage; 64.4%, voiding; 25.9%, post-micturition; 13.9%). Nocturia was the most frequently reported symptom (36.6% of men, 48.2% of women). Overall prevalence of OAB was 12.2% (10.0% of men, 14.3% of women). UI was reported by 2.9% of men and 28.4% of women. The most prevalent type was other UI in men and stress urinary incontinence in women.

Conclusions

Lower urinary tract symptoms and OAB are prevalent among Korean men and women and the prevalence increases with age. Storage LUTS is more prevalent than voiding or post-micturition LUTS and nocturia is the most common symptom.     

Clinical guidelines for male lower urinary tract symptoms associated with non-neurogenic overactive bladder

The purpose of this guideline is to direct urologists and patients regarding how to identify overactive bladder (OAB) in male patients with lower urinary tract symptoms (LUTS) and to make an accurate diagnosis and establish treatment goals to improve the patients' quality of life (QoL). LUTS are commonly divided into storage, voiding, and postmicturition symptoms, and are highly prevalent in elderly men. LUTS can result from a complex interplay of pathophysiologic features that can include bladder dysfunction and bladder outlet dysfunction such as benign prostatic obstruction (BPO) or poor relaxation of the urethral sphincter. Diagnosis of OAB in male LUTS leads to accurate diagnosis of pure OAB and bladder outlet-related OAB, and appropriate treatment in men with residual storage symptoms after treatment for LUTS.     

Urodynamic characterization of lower urinary tract symptoms in men less than 40 years of age

Purpose

Lower urinary tract symptoms (LUTS) in young men are becoming a more recognized urologic issue that can arise from many causes, each with their own management strategy. The purpose of this study was to determine the rates and types of voiding dysfunction causing LUTS in men under 40 years.

Methods

Videourodynamic studies (VUDS) of 87 men 40 years of age or less with LUTS for greater than 6 months, performed between July 2004 and June 2012 at Weill Cornell Medical College, were retrospectively analyzed. Patients with culture-proven bacterial prostatitis, symptoms for less than 6 months, a history of neurologic disease, or previous urological surgery affecting voiding function were excluded from the analysis.

Results

The mean age of the patients was 31.84 ± 5.78. There were 37 patients that presented with more than one urinary symptom (42.5 %). The most frequent complaints included: urinary frequency (N = 42, 48.28 %), difficulty with urination (N = 41, 47.13 %), and urinary urgency (N = 21, 24.14 %). The most common urodynamic abnormality was bladder outlet obstruction (BOO) (N = 37, 42.53 %), dysfunctional voiding (N = 25, 28.74 %), detrusor underactivity (N = 10, 11.49 %), and detrusor overactivity (N = 7, 8.05 %). There were no differences seen in AUA symptom and quality of life scores across diagnosis groups.

Conclusions

Lower urinary tract symptoms can present in younger men with a variety of types of voiding dysfunction. This study uses VUDS to show that the most common types of voiding dysfunction in this population with chronic LUTS are BOO followed by dysfunctional voiding.     

Lower Urinary Tract Dysfunction in Children

Up to 10% of school-age children suffer from recurrent urinary tract infections (UTIs) and/or urinary incontinence. Lower urinary tract problems are, together with asthma, the most important chronic disease of the pediatric age group. Diagnosis must discriminate among those children with functional voiding problems, those with neuropathic bladders, and those with anatomic anomalies who may need surgery. In boys with overactive bladder (OAB) and incontinence, urethral obstruction must be evaluated as the possible cause. Functional incontinence with lower urinary tract symptoms (LUTS) is very common in girls and can be accompanied by UTI. In girls with dysfunctional voiding or underactive bladder, other anomalies need to be excluded because, for many of these girls, LUTS can be a chronic condition that requires lifelong attention to voiding behavior.     

A case of urethral stricture diagnosed by transrectal ultrasonography (TRUS) at voiding

Subcapsral prostatectomy was performed in a 75-year-old male, with the diagnosis of benign prostatic hyperplasia. Total prostate volume was 105 ml by transrectal ultrasonography (TRUS) and the excised prostate weighed in 90 g. After the surgery, he recovered from urinary disturbance once, but, he again complained of severe dysuria 12 days after the surgery. With the aim of non-invasive examination, we performed TRUS at voiding. Urethral stricture was definitely diagnosed using TRUS during micturition. Thus voiding TRUS was very effective in diagnosing urethral stricture.     

The reliability of the frequency-volume chart in assessing lower urinary tract symptoms

OBJECTIVE: To assess the test-retest reliability of a 1-day frequency-volume chart (FVC) in men with lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: Men with uncomplicated LUTS presenting to a urology clinic were asked to complete FVCs on three consecutive days. Standard measures of voiding frequency and volume were derived using International Continence Society definitions. Test-retest reliability of 1-day voiding behaviour was evaluated with an intraclass correlation coefficient (ICC). We also derived 95% confidence intervals (CI) for each measure, thereby indicating the precision of the measurements produced by a 1-day chart. RESULTS: Of 140 patients with LUTS enrolled, 96 patients (69%) completed three 1-day FVCs. The frequency and volume measures typically had ICCs of 0.7-0.8; the "number of urgent voids" had the highest ICC. Nocturnal frequency and nocturnal volume were less reliable, with ICCs of 0.59 and 0.60, respectively. However, the 95% CIs around patient measurements tended to be wide. For 24-h voiding frequency, the true value for a patient might be up to +/- three voids away from the observed value for 95% of patients. CONCLUSION: The measures of voiding behaviour derived from 1-day FVCs had sufficient test-retest reliability to differentiate between high and low levels of voiding symptoms. However, individual measurements could be imprecise, suggesting that, in men with LUTS, a 1-day FVC cannot be used for diagnosis, or monitoring changes in symptom scores after treatment.     

Comparison of Voiding Disturbances in Patients with LUTS and BPH at Home and by Episodic Checks at an Outpatient Clinic

To clarify the presence of voiding disturbances in patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH), measurements of the capacity at normal desire to void (CNDV), residual urine volume (RUV) and RUV rate at home and in a hospital were done.It has been found that (1) RUV and RUV rate in patients with BPH were markedly greater than that in the normal group and LUTS patients staying at home. Moreover, there was no difference in RUV and RUV rate between the normal group and the LUTS patients. (2) RUV and RUV rate in patients with LUTS and BPH decreased more markedly without changing CNDV when the patients stayed at home than when they underwent episodic checks in a hospital.In conclusion, frequent checks of LUTS and BPH in patients in their domestic environment can probably be utilized for management or determination of treatment.     

Vesicoureteral reflux in male and female neonates as detected by voiding ultrasonography

BACKGROUND: Vesicoureteral reflux (VUR) is assumed to be congenital, and its early diagnosis is desired in order to prevent acquired renal damage. However, the incidence of VUR in neonates remains to be revealed. METHODS: Two thousand newborn babies (1048 boys and 952 girls) underwent voiding ultrasonography (an ultrasound examination of urinary tract during provoked voiding). Those who showed transient renal pelvic dilation during voiding, who had small kidneys, or who subsequently developed urinary infection underwent voiding cystourethrography. RESULTS: Transient renal pelvic dilation was observed in 16 babies (0.8%), including one boy with small kidneys. Among the rest of the babies, one boy had a small kidney, and nine babies subsequently developed urinary infection. Voiding cystourethrography revealed VUR in 24 ureters of 16 children (11 boys and 5 girls). Dimercaptosuccinate renoscintigraphy confirmed small kidneys, with generally reduced tracer uptake in a total of three boys, all having VUR. Voiding ultrasonography detected transient renal pelvic dilation in 17 (71%) of the 24 kidneys with VUR and, strikingly, 16 of the 17 (94%) kidneys with high-grade VUR (grade III or more). CONCLUSION: This study effectively detected VUR in 0.8% of the neonates (mostly of high grades and predominantly in males) and voiding ultrasonography showed a decided usefulness for the detection of VUR. The male preponderance of VUR in neonates was considered to be due to the occurrence of congenitally small kidneys, with reflux found exclusively in males and easier ultrasound detection of VUR in male neonates because the majority of diagnoses are reported to be high grades of VUR.     

Prevalence and factors associated with uncomplicated storage and voiding lower urinary tract symptoms in community-dwelling Australian men

Purpose

To determine the prevalence of, and associated risk factors for, voiding and storage lower urinary tract symptoms (LUTS) in a population-based sample of Australian men.

Methods

Data were collected from 1,103 men randomly selected, community-dwelling men, as part of the Florey Adelaide Male Ageing Study, after exclusion of men with prostate or bladder cancer or prior surgery to either organ. The presence of LUTS was assessed using the International Prostate Symptom Score. Urine flow was measured via flow meter. Demographic, clinical, and bio-psychosocial data were collected by questionnaire.

Results

The prevalence of total, storage, and voiding LUTS was 18.1, 28.0 and 12.6%, respectively. The most common storage symptoms were frequency (12.3%), nocturia (9.9%) and urgency (8.1%), and voiding symptoms were weak stream (8.5%), intermittency (5.4%), incomplete emptying (5.1%) and straining (2.4%). There were linear associations between storage LUTS and increased abdominal fat mass, plasma glucose and low HDL cholesterol (components of the metabolic syndrome), obstructive sleep apnoea (OSA) risk, and retirement. Voiding symptoms were associated with a previous diagnosis of benign prostatic enlargement (BPH), mean peak urine flow, total energy intake, elevated risk of OSA, erectile dysfunction, physician-diagnosed thyroid dysfunction and higher household income.

Conclusions

The close association of storage LUTS with the metabolic syndrome, and of both storage and voiding LUTS with OSA, suggest that these conditions should be considered in men presenting with LUTS.     

Effect of tension-free vaginal tape and TVT-obturator on lower urinary tract symptoms other than stress urinary incontinence

Variable effects on lower urinary tract symptoms (LUTS) other than stress urinary incontinence (SUI) have been reported after tension-free vaginal tape (TVT). We measured the effect of TVT on LUTS using the American Urological Association Symptom Index (AUASI). Patients undergoing TVT completed the AUASI pre- and post-operatively. Total scores (TS), storage scores (SS), and voiding scores (VS) were compared overall and among patients with SUI vs mixed urinary incontinence (MUI) and those who underwent TVT vs TVT-obturator (TVT-O). The mean change in TS and SS was −3.6 and −3.0. Mean reductions in TS and SS were significant in all patient subsets with no change in VS. There was no significant difference in the mean changes in TS between patients with SUI vs MUI or those undergoing TVT vs TVT-O. LUTS are improved after TVT in most patients. In general, voiding symptoms were not adversely affected.     

Investigation of dysfunctional voiding in children with urgency frequency syndrome and urinary incontinence

PURPOSES: Dysfunctional voiding may result in lower urinary tract symptoms (LUTS) in children and is associated with urinary tract infection and vesicoureteral reflux (VUR). This study analyzed the videourodynamic investigations in children with urgency frequency syndrome and/or urinary incontinence. METHODS: Forty children, 1-13 years old, with urgency frequency syndrome and/or incontinence were investigated to determine their LUTS or for the assessment of VUR. Videourodynamic study was performed in all patients and the results were analyzed with clinical characteristics and underlying pathophysiology. RESULTS: Dysfunctional voiding was present in 75.7% of the children with detrusor overactivity, in 73.3% of the children with VUR, in 63% of the children with urinary incontinence, in 77% of the children with episodic urinary tract infection, and in all of the children with diurnal enuresis. Compared to children without dysfunctional voiding, the voiding pressure was significantly higher in children with dysfunctional voiding (with VUR, 61.1 +/- 29.8 vs. 24.8 +/- 15.8 cm H(2)O, p = 0.004; without VUR, 53.4 +/- 24.1 vs. 24.8 +/- 15.8 cm H(2)O, p = 0.010). Biofeedback pelvic floor muscle training and treatment with antimuscarinic agent effectively decreased detrusor pressure, increased bladder capacity and maximum flow rate, and reduced the grade of VUR in 5 children who had post-treatment urodynamic studies. CONCLUSIONS: This study has shown that dysfunctional voiding is highly prevalent in children with symptoms of urgency frequency and incontinence. Biofeedback pelvic floor muscle training is effective in treatment of dysfunctional voiding in children.     

Neurogenic Voiding Dysfunctions (NVD)

Neurogenic lower urinary tract dysfunction continues to represent a diagnostic and therapeutic challenge. Many different conditions affecting the vesicourethral system have their origins in the nervous system, and it is important to recognise that lower urinary tract symptoms (LUTS) may sometimes be one of the first signs of neurological disorders such as multiple sclerosis (MS). A sound urodynamic investigation forms the basis for both the diagnosis and the therapy of neurogenic voiding dysfunction, the treatment of which is usually symptomatic.     

逼尿肌活动低下在下尿路症状中的临床特征及诊疗策略分析

目的:探讨逼尿肌活动低下(DU)在下尿路症状(LUTS)患者中的流行病学现状、临床特征及诊疗策略。方法:回顾性分析了我院1 019例排除神经源性膀胱及解剖结构异常的LUTS患者的尿流动力学检查结果及随访资料,探讨DU在LUTS中的流行病学及临床诊治特点,并对106例DU患者治疗前后行尿流动力学检查,结合文献进行临床分析。结果:在就诊患者中,储尿期症状最为多见,在男性患者中,排尿期症状稍多于储尿期症状,而女性患者储尿期症状明显多于排尿期症状。男性患者中膀胱出口梗阻(BOO)的患者为57.9%,而女性患者中压力性尿失禁(SUI)患者达到了43.3%。27.4%男性及23.2%女性诊断为DU,男性及女性患病率差异无统计学意义。DU患者与非DU患者的临床表现无明显差异,均以LUTS为主要表现。DU可能合并有逼尿肌过度活动或BOO。DU随着年龄的增加,患病率逐渐增加。106例DU患者经治疗后行尿动力学检查发现逼尿肌收缩力有一定提高,治疗前后逼尿肌肌力差异有统计学意义。结论:DU是LUTS患者的常见病因,并有可能同时合并有逼尿肌过度活动或BOO。目前针对DU患者的治疗有一定效果。     

Extended-release tolterodine with or without tamsulosin in men with lower urinary tract symptoms and overactive bladder: effects on urinary symptoms assessed by the International Prostate Symptom Score

OBJECTIVE

To evaluate the efficacy of tolterodine extended‐release (ER) plus tamsulosin on lower urinary tract symptoms (LUTS) as assessed by changes in the International Prostate Symptom Score (IPSS) in men who met symptom entry criteria for both overactive bladder (OAB) and benign prostatic hyperplasia (BPH) trials.

PATIENTS AND METHODS

Men aged ≥40 years with an IPSS of ≥12 and diary‐documented OAB symptoms (≥8 voids/24 h and ≥3 urgency episodes/24 h, with or without urgency urinary incontinence) who reported at least moderate problems related to their bladder condition were randomized to receive placebo, tolterodine ER (4 mg), tamsulosin (0.4 mg), or tolterodine ER (4 mg) + tamsulosin (0.4 mg) once daily for 12 weeks. Patients completed the IPSS at baseline and at 1, 6 and 12 weeks.

RESULTS

Patients receiving tolterodine ER + tamsulosin had significantly greater improvements than those taking placebo on IPSS storage subscale scores and scores for all three individual storage items included on the IPSS (urinary frequency, urgency, and nocturnal micturitions) by 12 weeks. Storage subscale and urgency scores were significantly improved vs placebo at 1 and 6 weeks, whereas frequency scores were significantly improved at 6 weeks. Changes in IPSS storage subscale and individual storage item scores in the tolterodine ER and tamsulosin monotherapy groups were not significantly different from placebo at most time points. IPSS voiding subscale scores and scores for three of four individual voiding items (sensation of incomplete emptying, intermittency, and weak stream) were significantly improved by 12 weeks for patients receiving tamsulosin monotherapy vs placebo. Voiding subscale and intermittency scores were significantly improved vs placebo at 1 week; weak stream scores were significantly improved at 1 and 6 weeks. The IPSS voiding subscale and individual voiding item scores in the tolterodine ER + tamsulosin and tolterodine ER groups were not significantly different from placebo at most time points.

CONCLUSIONS

In this distinct clinical research population of men who met traditional symptom entry criteria for both OAB and BPH trials, tolterodine ER + tamsulosin was significantly more effective than placebo in treating storage LUTS, including OAB symptoms. Tamsulosin monotherapy produced significant improvements in voiding LUTS.     

Storage (irritative) and voiding (obstructive) symptoms as predictors of benign prostatic hyperplasia progression and related outcomes

OBJECTIVES: To assess the utility of voiding and filling symptom subscores in predicting features of benign prostatic hyperplasia (BPH) progression, including acute urinary retention (AUR) and prostate surgery. METHODS: The Proscar Long-term Efficacy and Safety Study (PLESS) was a 4-year study designed to evaluate the effects of finasteride versus placebo in men with lower urinary tract symptoms (LUTS), clinical evidence of BPH, and no evidence of prostate cancer. A self-administered questionnaire was employed to quantify LUTS at baseline. Receiver operating characteristics (ROC) curves were used to assess baseline characteristics from patients treated with placebo as predictors of outcomes. The characteristics assessed included the overall symptom score (Quasi-AUA SI), separate voiding and filling subscores, prostate volume (PV) and serum prostate-specific antigen (PSA) levels. RESULTS: PV and PSA were superior to the symptom scores at predicting episodes of spontaneous AUR and all types of AUR. The Quasi-AUA SI and the filling and voiding subscores were effective at predicting progression to surgery; however, PSA was more effective at predicting this outcome. To better evaluate symptoms as predictors of surgery, patients who experienced a preceding episode of AUR were excluded from the surgery analysis. In the absence of preceding AUR, the best predictors of future surgery were the Quasi-AUA SI and the filling subscore. CONCLUSIONS: Among men with LUTS, clinical BPH and no history of AUR, the overall symptom score and storage subscore are useful parameters to aid clinicians in identifying patients at risk for future prostate surgery. PV and PSA were the best predictors of AUR, while PSA was the best predictor of prostate surgery (for all indications).     

Prevalence and risk factors of lower urinary tract symptoms in Fuzhou Chinese women

AIMS: To evaluate the prevalence and associated risk factors of lower urinary tract symptoms (LUTS). METHODS: We randomly sampled 6066 women (3.0% of registered female residents aged 20 years and older in Fuzhou) and mailed Bristol Female Lower Urinary Tract Symptoms questionnaire to women for self-completion. 4684 (77.2%) women with evaluable data were included in this study. RESULTS: The prevalence of LUTS, voiding symptoms, storage symptoms was 39.7%, 13.4%, 37.3%, respectively. Among voiding symptoms, the prevalence of hesitancy, slow stream, intermittence, straining, terminal dribble, splitting was 6.8%, 5.5%, 4.8%, 4.5%, 4.1%, 3.5%, respectively. Among storage symptoms, stress incontinence, urge incontinence, urgency, frequency, nocturia, enuresis was 16.6%, 10.0%, 10.2%, 16.4%, 9.9%, 3.9%, respectively. A multiple logistic regression analysis showed menopause, parity > 2, constipation, fetal birthweight, and episiotomy were common potential risk factors for LUTS, voiding and storage symptoms. Higher BMI increased the occurrence of LUTS and storage symptoms, while cesarean delivery and labor protected against the development of storage symptoms. CONCLUSIONS: The prevalence of LUTS in Chinese women is lower than that of most reports in Occidental women. The prevalence of LUTS increases with age.