Videourodynamic analysis in men with lower urinary tract symptoms: Correlation between age and prostate size with lower urinary tract dysfunction

ObjectivesLower urinary tract symptoms (LUTS) are highly prevalent in aging men. In this study we examined the relationship between age, total prostate volume (TPV), and videourodynamic study findings.MethodsWe retrospectively analyzed a total of 971 men ≥ 40 years of age referred to us for investigation of LUTS. We analyzed the distribution of the different videourodynamic study diagnoses in male LUTS by correlating their age and prostate size.ResultsThe most common diagnosis in the bladder outlet obstruction (BOO) group differed significantly by age and poor relaxation of the external sphincter (PRES) in those aged < 50 years; bladder neck dysfunction in those aged 50–69 years, and benign prostatic obstruction in those ≥ 60 years. Detrusor overactivity was the most common diagnosis in all ages in the bladder dysfunction group, and the cases of hyperactivity with impaired contractility (DHIC) increased with age. In patients < 50 years of age, PRES was the most common diagnosis in the BOO group in both those with small prostates (total prostate volume ≤ 40 mL) and large prostates (total prostate volume > 40 mL). In patients aged 50–69 years, the most common diagnosis in those with BOO and a small prostate was bladder neck dysfunction, and that in those with BOO and a large prostate was benign prostatic obstruction. Similar results were observed in patients aged ≥ 70 years. In all age groups, the majority of patients with detrusor overactivity, hypersensitive bladder, detrusor underactivity, and DHIC had a small prostate.ConclusionIn male LUTS, the diagnoses in the BOO group differed by age and prostate volume. In young patients with BOO, the leading diagnosis was PRES, and the contribution of prostate volume to BOO increased with age. As age increased, the bladder function became more complex with an increased percentage of patients with DHIC. Both bladder outlet and bladder functions were affected by age.     

Association between lower urinary tract symptoms and sexual dysfunction in Taiwanese men

The study investigated the association between lower urinary tract symptoms (LUTS) and sexual dysfunction in ageing men. It was a cross-sectional study in an unselected consecutive sample of 398 men aged >40 years attending a urology clinic. LUTS and sexual function were assessed by validated symptom scales, including the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 (IIEF-5). Clinically the severity of total and obstructive IPSS showed no significant correlation with age, but irritative IPSS is statistically correlated with age (P < 0.05). The prevalence of moderate to severe ED (IIEF-5 < 12) was significantly associated with LUTS severity (P < 0.05) and the severity of IIEF-5 correlated significantly with age (P < 0.01). A consistent inverse correlation was found between IIEF-5 and IPSS severity across the age groups, with the strongest effect within aged 60 to 69 years (r = −0.286, P < 0.01). The irritative IPSS showed a significant correlation with IIEF-5 severity across all age groups. These results reveal a significant correlation between LUTS and the severity of ED, especially on the irritative domain.     

他汀类药物的使用与良性前列腺增生和下尿路症状相关性的临床研究

目的:探讨服用他汀类药物是否可延缓良性前列腺增生(BPH)和下尿路症状的临床进展。方法:选择2003年1月至2008年12月于我院体检中心体检的50~69岁男性作为研究对象,制定纳入标准,随访5年,通过比较IPSS评分、最大尿流率(Qmax)和前列腺体积(PV)探讨他汀类药物的使用与前列腺增生和下尿路症状临床进展的相关性。结果:总共有653例男性纳入本研究,其中他汀类药物使用组(1组)283例,他汀类药物未使用组(2组)370例,两组入选时的年龄、IPSS评分、Qmax和PV差异均无显著性(P0.05),随访过程中因出现明显的排尿困难各剔除24例(1组)和35例(2组)。5年随访过程中1组和2组的IPSS评分都逐渐升高,但1组升高程度明显低于2组(P0.01),1组和2组的Qmax都逐渐下降,但1组下降程度明显低于2组(P0.01);1组[PV5年分别为(22.60±4.99)、(25.80±5.20)、(27.92±5.05)、(29.11±5.24)、(29.97±5.26)ml]和2组[5年分别为(24.30±4.98)、(28.50±5.14)、(32.84±4.77)、(36.99±4.78)、(40.90±4.78)ml]的PV都逐渐增大,但1组增大程度明显小于2组(P0.01)。结论:使用他汀类药物可明显延缓BPH和下尿路症状的临床进展,且长时间服用疗效更显著。     

Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia

Study Type – Aetiology (case series)
Level of Evidence 4

OBJECTIVES

To investigate a possible association between the severity of lower urinary tract symptoms (LUTS) and the serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia (BPH) that underwent surgery for severe benign prostatic obstruction.

PATIENTS AND METHODS

In all, 127 selected men with symptomatic BPH attending our urology clinic were recruited. The clinical conditions of BPH were assessed by digital rectal examination, serum prostate‐specific antigen (PSA) determination, International Prostate Symptom Score (IPSS), transrectal ultrasonography and maximum urinary flow rate (Q_max) value at uroflussimetry. Before surgery, we measured the serum concentrations of total testosterone (TT) and free testosterone (FT), oestradiol, prolactin, luteinizing hormone and follicle‐stimulating hormone. We excluded men with endocrine diseases, those with prostate disease who were receiving antiandrogen therapy and those with psychological diseases. The relationships between the IPSS score and serum sex hormone levels were determined.

RESULTS

The final study population consisted of 122 men (mean age of 70.66 years), as five were excluded (three due to incomplete evaluation and two who were diagnosed with prostate cancer). On statistical analysis, the total IPSS was significantly associated with age (r= 0.405, P < 0.001) and TT (r= 0.298, P= 0.020) but not with FT or the serum levels of the other sex hormones. The serum levels of testosterone and IPSS did not correlate with prostate volume and Q_max. PSA level and age correlated with prostate volume (r= 0.394, P < 0.001; r = 0.374, P < 0.001, respectively). We distinguished two subgroups of patients: the first group of 40 men with an IPSS of <19 and the second group of 82 with an IPSS of >19, and we evaluated the median levels of TT in each group. There was an increased risk of LUTS in men with a greater serum concentration of TT (P= 0.042), although the mean TT level was in the normal range.

CONCLUSIONS

In the present study, the severity of LUTS was associated with age and serum levels of TT but only age correlated with the measures of BPH, especially prostate volume. The potential effects of testosterone on LUTS may well be indirect. Additional large studies are needed to confirm these preliminary results.     

Assessment of lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) encompass a range of symptoms commonly experienced by both men and women, and encountered by a wide range of healthcare practitioners (HCPs). This review summarizes the basic terminology and assessment that HCPs should be aware of, regardless of their professional discipline. Apart from emphasizing the need for standardization in terminology, there is a need to avoid misleading terms that suggest a causative mechanism until the mechanism has been identified by investigation. HCPs should also avoid arbitrary thresholds for judging severity of symptoms. The use of algorithms from evidence-based guidelines limits variation in management and avoids unnecessary investigations. However, a tailored approach is useful in understanding the underlying pathophysiology in individual patients. As symptoms are unreliable in predicting the underlying mechanism, a useful approach is to try and develop a urodynamic diagnosis mindful of the normal physiology of the lower urinary tract as the practitioner works through the symptoms, signs and appropriate urodynamic investigations, and use such investigations in a logical manner tailored to the individual to either support or refute assumptions and arrive at a working diagnosis.     

Assessment of lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) encompass a range of symptoms commonly experienced by both men and women, and encountered by a wide range of healthcare practitioners (HCPs). This review summarizes the basic terminology and assessment that HCPs should be aware of, regardless of their professional discipline. Apart from emphasizing the need for standardization in terminology, there is a need to avoid misleading terms that suggest a causative mechanism until the mechanism has been identified by investigation. HCPs should also avoid arbitrary thresholds for judging severity of symptoms. The use of algorithms from evidence-based guidelines limits variation in management and avoids unnecessary investigations. However, a tailored approach is useful in understanding the underlying pathophysiology in individual patients. As symptoms are unreliable in predicting the underlying mechanism, a useful approach is to try and develop a urodynamic diagnosis mindful of the normal physiology of the lower urinary tract as the practitioner works through the symptoms, signs and appropriate urodynamic investigations, and use such investigations in a logical manner tailored to the individual to either support or refute assumptions and arrive at a working diagnosis.     

Factors correlated with prostate volume in middle-aged men with bothersome lower urinary tract symptoms

ObjectiveThe aim of this study was to investigate the predictive factors of prostate volume (PV) by analyzing potential predictors in a population of middle-aged men with bothersome lower urinary tract symptoms (LUTS) and use a prediction model for PV estimation to compare with digital rectal examination (DRE) alone.Materials and methodsPatients between the ages of 40 years and 64 years who underwent transrectal prostate ultrasound as part of a self-paid medical check-up were enrolled. Participant demographics, medical history, and voiding symptoms were assessed by the International Prostate Symptoms Score (IPSS) questionnaire. A multiple linear regression with stepwise selection was used to analyze the correlations between PV and all potential predictors.ResultsTwo hundred and twenty-eight men with bothersome LUTS (IPSS > 7) were enrolled as study participants at a mean age of 56.4 years. Patients with PV > 25 mL were significantly older and had higher serum prostate-specific antigen (PSA) levels and scores for total IPSS, storage, urgency items, and nocturia items. DRE, serum PSA, age, and urgency score were independent predictors for PV, especially for men with PV > 25 mL, for which the standardized regression equation was PV = 0.74 × (DRE estimation) + 0.10 × (age) + 0.12 × (serum PSA) + 0.079 × (urgency score) (adjusted R² = 0.80).ConclusionIn the current study, we confirmed that serum PSA, age, and urgency score are significant predictors of PV. The prediction model including DRE, PSA, age, and urgency score was a better method to estimate PV than DRE alone, especially for men with a larger prostate (PV > 25 mL).     

女性护士无尿意排尿行为与下尿路症状的关系

目的探讨女性护士的无尿意排尿行为现状,分析其与下尿路症状的关系。方法采用方便抽样的方法,调查江苏省2家医院578名女性在职护士。使用无尿意排尿行为量表和中文版国际尿失禁咨询委员会女性下尿路症状量表调查女性护士的无尿意排尿行为和下尿路症状情况。采用Pearson相关分析和多元线性回归分析女性护士无尿意排尿行为与下尿路症状的关系。结果女性护士无尿意排尿量表平均得分为(9.17±3.67)分,45.67%的护士在离开家之前没有尿意也会排尿,有61.24%的护士在临睡前没有尿意也会排尿;多元线性回归显示,无尿意排尿行为是储尿期症状(β=0.214,P0.01)和排尿期症状(β=0.181,P0.01)的影响因素。结论女性护士群体中存在频繁的无尿意排尿行为,且对行为的认知程度不高。无尿意排尿行为与下尿路症状中储尿期症状和排尿期症状的发生有关,应制定针对护士无尿意排尿行为的相关措施来预防女性护士下尿路症状的发生。     

The relationship between premature ejaculation and anogenital distance

Premature ejaculation is a common male sexual disease in andrology practice. The goal of essay is to investigate the relation of anogenital distance that predicts prenatal testosterone exposure with premature ejaculation. Between January and May 2019, 150 men were participated in the study. The patients were evaluated with anamnesis and physical examination; age, smoking, alcohol consumption, intravaginal ejaculation latency time, body mass index, premature ejaculation diagnostic tool, distance from anal point to scrotum and distance from anal point to penis were recorded. According to premature ejaculation diagnostic tool score, the patients were classified as premature ejaculation group (score ≥11) and control group (score <11). The mean of the male age was 30.73 ± 4.40 years. The mean intravaginal ejaculation latency time score was 3.42 ± 2.71 min. Two groups were compared using the distance from anal point to scrotum distance from anal point to penis. In the premature ejaculation group, the distances were found lower (77.46 ± 2.31 and 54.78 ± 2.56 mm) than the control group (81.32 ± 3.11 and 58.16 ± 3.48 mm). There were statistical differences between two groups (p < .001). It was concluded that it is likely to have a negative relationship between anogenital distance and premature ejaculation diagnostic tool score.     

The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial

Objective

The ongoing REDUCE trial is a 4-yr, phase 3, placebo-controlled study to determine if daily dutasteride 0.5 mg reduces the risk of biopsy detectable prostate cancer. Prostate biopsies performed in all men prior to entry were centrally reviewed, thus allowing an examination of the relationship between inflammatory changes and lower urinary tract symptoms (LUTS).

Methods

Eligible men were aged 50–75 yr, with serum prostate-specific antigen ≥2.5 ng/ml and ≤10 ng/ml (50–60 yr), or ≥3.0 ng/ml and ≤10 ng/ml (>60 yr) and an International Prostate Symptom Score (IPSS) < 25 (or <20 if already on alpha-blocker therapy). Acute prostatitis was an exclusion criterion. For a given individual, inflammation was assessed across all cores and the amount of inflammation scored as none (0), mild (1), moderate (2), or marked (3). LUTS was assessed with the use of the IPSS. The relationship between inflammation scores (averaged over all cores) and total IPSS; grouped IPSS (0–3, 4–7, 8–11, 12–15, 16–19, ≥20); and irritative, obstructive, and nocturia subscores was determined by Spearman rank correlations. The relative contribution of inflammation, age, and body mass index was then examined with the use of linear regression analyses.

Results

Data were available for 8224 men. Statistically significant but relatively weak correlations were found between average and maximum chronic inflammation and IPSS variables (correlation coefficients, 0.057 and 0.036, respectively; p < 0.001 for total IPSS). Both age and average chronic inflammation were significant in the linear regression after adjustment for other covariates; for both variables, more severe inflammation was associated with higher IPSS scores.

Conclusions

In the REDUCE population, there is evidence of a relationship between the degree of LUTS and the degree of chronic inflammation. Study entry criteria that selected older men and decreased enrolment of men with a greater degree of inflammation and LUTS may have limited the strength of this relationship. The impact of baseline prostate inflammation on progression of LUTS and/or associated complications will be determined during 4-yr longitudinal follow-up.     

男性顽固性下尿路症状的病因探讨

目的探讨男性顽固性下尿路症状的病因。方法疑似慢性前列腺炎患者11例,年龄（51．3±14．3）岁,病程（3．0±1．6）年。主要临床表现为尿频尿急和膀胱充盈时疼痛。评估方法为尿及前列腺液常规和细菌学检查、细胞学检查、IVU等,临床常规评估均正常时,进一步行麻醉下水扩张和膀胱随机活检。结果11例患者中随机活检为慢性炎症者9例,其中1例麻醉下水扩张阴性;采用间质性膀胱炎的诊断性治疗即口服阿米替林及膀胱灌注RTX联合治疗（6例）,单纯口服阿米替林治疗（1例）,膀胱灌注透明质酸钠（1例）和骶神经电刺激神经调节治疗（1例）;其24 h排尿次数、平均排尿量、O’leary-Sant间质性膀胱炎症状及问题指数、膀胱区疼痛评分及生活质量评分均得到明显改善,另2例患者麻醉下水扩张阴性,但膀胱随机活检显示为广泛原位癌,并行膀胱尿道全长切除及尿流改道术,术后患者膀胱疼痛症状消失。结论疑似慢性前列腺炎经抗生素治疗无效的顽固性男性下尿路症状应考虑间质性膀胱炎的可能性,也应警惕膀胱癌的存在。     

下尿路症状男性人群勃起功能调查

目的:了解下尿路症状(LUTS)男性人群的勃起功能障碍(ED)患病情况,探讨LUTS与ED之间的相关性。方法:2011年11月~2012年8月,抽取1 000例40~80岁、有固定性伴侣的男性人群,采用国际前列腺症状评分(IPSS)及国际勃起功能指数(IIEF-5)评估LUTS和ED的严重程度,单因素Logistic回归分析LUTS与ED的相关性。结果:40~80岁男性人群的LUTS患病率为42.81%(426/995),ED患病率为76.18%(758/995)。其中426例有LUTS症状患者的ED患病率为82.16%(350/426),569例无LUTS症状的ED患病率为71.70%(408/569)。随着LUTS严重程度的增高,ED的患病率明显升高。Logistic回归分析显示,年龄、LUTS严重程度与ED的关联存在统计学显著意义(P0.01)。结论:LUTS患者存在很高的ED发生率。年龄越大,LUTS症状愈严重者患ED的风险更高。     

Caffeine ingestion and lower urinary tract symptoms in healthy volunteers

AIMS: To assess lower urinary tract symptoms (LUTS) after caffeine ingestion in healthy volunteers. MATERIALS AND METHODS: We conducted a randomized, double-blind, placebo-controlled trial utilizing healthy adult volunteers without urinary tract disease. Caffeine dosage was based on patient weight (equivalent to a 70 kg person taking 200 mg of caffeine twice a day). After a 24-hr washout period, subjects ingested tablets (placebo and drug were identical in appearance) twice a day for 3 days. All participants completed volume-frequency diaries and a post-study symptom questionnaire. Statistical analysis was performed using SAS (version 8.2). Differences voiding frequency and volume were assessed by Wilcoxon rank sum test. The designated level of statistical significance was P < 0.05. RESULTS: During the first day on study medications, patients taking caffeine versus placebo voided a mean of 7.8 versus 6.4 times in a 24-hr period, respectively, P = 0.05. The mean total urine production was 2,004 ml (caffeine) versus 1,643 ml (placebo), P = 0.06, while total fluid ingested was similar (2,246 ml-caffeine, 2,102 ml-placebo, P = 0.46). For the remaining 2 days there was no significant difference between the two arms. The post-study questionnaire revealed no differences in symptom perception between the two groups. CONCLUSIONS: In healthy volunteers caffeine appears to produce an initial diuresis, but does not appear to have other significant or sustaining effects on lower urinary symptoms in this 4-day model.     

Influence of hypertension on lower urinary tract symptoms in benign prostatic hyperplasia

AIM: To clarify the influence of hypertension on lower urinary tract symptoms (LUTS) we examined the relationship between blood pressure, LUTS, and the effect of terazosin on LUTS in patients with benign prostatic hyperplasia (BPH). METHODS: The subjects were patients who had LUTS and BPH. They were treated with terazosin (1 mg, twice-a-day) for 12 weeks. Calculation of the International Prostate Symptom Score (IPSS), measurement of blood pressure, and uroflowmetry were performed before and after 12 weeks of therapy. Patients were divided into a normotensive (NT) group and a hypertensive (HT) group at the time of first examination. RESULTS: The IPSS for urinary frequency and nocturia in BPH-HT patients (n = 21; mean age, 71 years) were significantly higher than those in the BPH-NT patients (n = 21; mean age, 69 years) before the administration of terazosin. The total IPSS the BPH-HT patients was also significantly higher than that of the BPH-NT patients. There were no differences of uroflowmetric parameters between the two groups. After 12 weeks of therapy, systolic and diastolic blood pressure decreased in the BPH-HT patients, but not in the BPH-NT patients. However, the systolic pressure of the BPH-HT patients was still significantly higher than that of the BPH-NT patients. The score for each IPSS parameter decreased in both groups, but the difference of the score between the two groups increased. CONCLUSION: Hypertension may worsen LUTS and may decrease the improvement of symptoms by terazosin.     

Correlation between lower urinary tract symptoms and urethral function in benign prostatic hyperplasia

AIM: To examine the potential correlation between urethral function and lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). METHODS: Thirty-one patients with clinical BPH, who were confirmed to have benign prostatic enlargement (BPE) of 20 ml or more, were enrolled into the study. A mark-sheet questionnaire was used for obtaining the LUTS history. Multichannel pressure-flow urodynamic studies were performed and external urethral sphincter pressure (PEUS), intravesical pressure (PVES), and bladder neck pressure (PBN) were recorded both at maximum cystometric capacity and during voiding with 5-microtip transducers, for the purpose of detecting BPE-specific urodynamic findings at different levels within the urethra. RESULTS: There was a positive correlation between hesitancy and detrusor bladder neck dyssynergia (DBND) (P = 0.0011) and between incomplete emptying and low PBN at maximum cystometric capacity (P = 0.0425). The hesitancy proved to have no correlation with bladder neck opening time (TBNO). CONCLUSION: Urodynamic evaluation of urethral function was beneficial for attributing LUTS to clinical BPH. Among various parameters, DBND was the most specific to clinical BPH, suggesting it to be a situation where a steep rise in PBN or prostatic urethral pressure remains greater than the increasing PVES, resulting in sustained difficulty in opening the bladder neck and subsequently the subjective sensation of hesitancy.     

他达拉非治疗继发于良性前列腺增生下尿路症状的研究进展

他达拉非作为新一代的选择性磷酸二酯酶-5抑制剂(PDE5Is)为男性勃起功能障碍(ED)的治疗带来了全新的理念。继发于男性良性前列腺增生症(BPH)的下尿路症状(LUTS)由于其病因的复杂性,治疗效果受到多因素的影响,使得传统的临床治疗方法不可避免地存在各种难以预测的并发症。目前日益受到关注的他达拉非每日一次口服方案(OAD)治疗ED的新方案在临床研究中表现出了对继发于BPH的LUTS的显著的疗效,在治疗的早期,国际前列腺症状评分(IPSS)就得以显著改善。还有研究表明在同时存在ED和LUTS症状的BPH患者中,他达拉非也显著有效。本文旨在回顾PDE5Is对BPH相关症状治疗的相关研究进展,综述他达拉非治疗继发于BPH的LUTS的有效性和安全性证据。