Benign prostatic hyperplasia (BPH) and prostatitis: prevalence of painful ejaculation in men with clinical BPH

OBJECTIVES: To determine the prevalence and importance of pain/discomfort on ejaculation (prostatitis-like symptom) in men with lower urinary tract symptoms (LUTS) diagnosed with clinical benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Baseline data from 5096 men reporting LUTS suggestive of BPH, and enrolled in the ALF-ONE study by general practitioners and urologists in Europe, Asia, Latin America, the Middle East and Canada, were analysed to determine the prevalence and significance of pain/discomfort on ejaculation. All the men were asked to complete the International Prostate Symptom Score (IPSS) questionnaire, the bother score (IPSS question 8), and the Danish Prostate Symptom Score sexual-function questionnaire (DAN-PSSsex) which assesses three symptoms (rigidity of erection, amount of ejaculate and pain/discomfort on ejaculation) and their bothersomeness. RESULTS: There were 3700 sexually active men who had an evaluable answer to the DAN-PSSsex question related to pain/discomfort on ejaculation. Of these, 688 (18.6%) reported pain/discomfort on ejaculation and 609 (88%) considered it was a problem. Patients with painful ejaculation had more severe LUTS and reported greater bother (P < 0.001). Of men with painful ejaculation, 72% reported erectile dysfunction, of whom 91% considered it a problem, and 75% reported reduced ejaculation, of whom 81% considered it a problem. By contrast, of men with no ejaculatory discomfort, 57% reported erectile dysfunction, of whom 79% considered it a problem, and 56% reported reduced ejaculation, of whom 57% considered it a problem. A history of urinary tract infection was reported by 12% of men in the ejaculatory pain group, compared with 7% in the LUTS-only group, while 5% of men in the ejaculatory pain group reported macroscopic haematuria, compared to 3% in the LUTS-only group. Men with ejaculatory pain were slightly younger, but there were no significant differences in duration of LUTS, history of acute urinary retention, prostate-specific antigen concentrations or maximum urinary flow rate compared to the LUTS-only group. CONCLUSIONS: Of sexually active men with LUTS suggestive of BPH, approximately 20% complain of specific prostatitis-like symptoms of pain/discomfort on ejaculation, and these men clearly differ from those who present with LUTS only. For most the symptom is a significant bother. Men with BPH and painful ejaculation have more severe LUTS and reported greater bother, and had a higher prevalence of erectile dysfunction and reduced ejaculation, than men with LUTS only. Evaluation and treatment strategies should address this population of men with symptoms suggestive of both prostatitis and BPH.     

Evaluation of Quality of Life and Quality of Sleep in Clinical Practice

Nocturia has been recognised as one of the most bothersome storage symptoms in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). It has a negative impact on quality of sleep (QoS), which might result in daytime fatigue, decreased energy/vitality, insomnia, and increased incidence of infection, and may ultimately negatively affect the patient's quality of life (QoL). However, the evaluation of a patient with LUTS/BPH and assessment of benefits of new medical and surgical LUTS/BPH treatments are mainly focused on voiding symptoms or flow rate. The impact of storage symptoms, in particular nocturia, on the patient's QoS and QoL is often underestimated. Commonly used instruments to measure the severity of nocturia and its impact on QoS and QoL are not specific and lack sensitivity. Potential new instruments that evaluate the consequences of nocturia on QoL are nocturia-specific questionnaires such as the Nocturia QoL (N-QoL) questionnaire. Furthermore, the assessment of “Hours of Undisturbed Sleep” (HUS) seems a useful method to evaluate the impact of nocturia on QoS. These new tools should be incorporated in clinical practice and may give better insights into the effects of LUTS/BPH treatments on the patient's QoS, energy/vitality, and overall QoL.     

Prevalence,Severity, and Symptom Bother of Lower Urinary Tract Symptoms among Men in the EPIC Study: Impact of Overactive Bladder

Background

Lower urinary tract symptoms (LUTS) are prevalent among men.

Objective

To describe the prevalence, severity, and symptom bother of LUTS in all men and men with overactive bladder (OAB) symptoms in the EPIC study.

Design, setting, and participants

A secondary analysis of data from EPIC, a multinational population-based survey of 19 165 adults, was performed. Current International Continence Society definitions were used for individual LUTS and OAB; OAB cases were defined as men reporting urgency.

Measurements

Participants were asked about the presence of individual LUTS and associated symptom bother. LUTS severity was measured using the International Prostate Symptom Score (IPSS).

Results and limitations

There was substantial overlap of storage, voiding, and postmicturition symptoms among all men (n = 7210) and in men with OAB symptoms (n = 502); men with OAB symptoms were more likely to experience multiple LUTS subtypes. Among both populations, nocturia was the most commonly reported symptom, except for urgency (the hallmark symptom) among men with OAB symptoms; terminal dribble and sensation of incomplete emptying were the most common voiding and postmicturition symptoms. The prevalence of all LUTS increased with age among the general population; only storage LUTS increased with age among men with OAB symptoms. Number of LUTS and mean IPSS increased with age in both populations but were higher among men with OAB symptoms at all ages; the proportion reporting moderate–severe LUTS was higher than the general population (30% vs 6%). The proportion of men with OAB symptoms reporting symptom bother increased with urgency severity and severity and number of LUTS. LUTS severity may have been underestimated by the IPSS, which does not assess incontinence.

Conclusions

Men with LUTS commonly experience coexisting storage, voiding, and postmicturition symptoms, emphasizing the need for comprehensive urologic assessments. Men with OAB symptoms reported more LUTS and greater severity than the general population. Symptom bother was related to number of LUTS and urgency severity.     

LUTS and Sleep Disorders: Emerging Risk Factor

Lower urinary tract symptoms (LUTS) are commonly associated with benign prostatic hyperplasia (BPH) and represent significant bother among aging men. Bothersome LUTS secondary to BPH, including nocturia, significantly impact men??s general health-related quality of life (QoL) as do sleep disturbances. However, very few studies have examined the relationship between the severity of BPH-related urinary symptoms and sleep disturbances. This review analyzes the recent studies that report the association between the bother and severity of LUTS secondary to BPH and the severity of sleep disturbance. In addition, we address the relationship between treating LUTS and the influence that it has on treating the sleep disorders.     

Diversity of urinary symptoms in patients tentatively diagnosed with benign prostatic hyperplasia referred to a urologic clinic in Norway

OBJECTIVE: Lower urinary tract symptoms (LUTS) has become the preferred term used to classify the urinary symptoms of elderly men. This term places more emphasis on clinical appearance rather than being restricted to the functional pathophysiology. The objective of this study was to investigate this new concept in a group of patients who had been tentatively diagnosed with benign prostatic hyperplasia (BPH). The range of urinary symptoms, incontinence, sexual function and impact on daily living were registered. MATERIAL AND METHODS: Data from a group of 480 men awaiting urologic assessment were collected by questionnaire shortly after referral from their general practitioner between 1997 and 2000. The questionnaires used were the International Prostate Symptom Score (IPSS), the Symptom Problem Index, the International Continence Society-BPH, the Sandvik Incontinence Severity Index and the BPH-specific Interference with Activities. RESULTS: The mean age of the subjects was 67.0 years. As assessed by the IPSS, 15%, 54% and 31% of the men had mild, moderate and severe symptoms, respectively. Men who gave positive answers to questions regarding the frequency, amount and type of leakage were considered to have urinary incontinence (UI), which was found in 37% of cases. The majority of men had mild or moderate UI. Influence on daily living varied with the severity of symptoms. However, no significant differences in influence on daily living were found between groups with different degrees of severity of incontinence as all groups reported a relatively high impact. CONCLUSIONS: Our results show that UI is fairly common, very bothersome and socially embarrassing in male LUTS patients waiting for urologic evaluation. Although UI is not typically associated with BPH and is not regarded as a crucial component of LUTS, this study indicates that more emphasis should be placed on UI in the terminology of LUTS. UI may also act as an indicator of a need for healthcare.     

Web-based research of lower urinary tract symptoms that affect quality of life in elderly Japanese men: analysis using a structural equation model

OBJECTIVE: To investigate the distribution of lower urinary tract symptoms (LUTS) in elderly Japanese men, to clarify which variables contributed to medical care-seeking behaviour, and to construct a structural-equation model (SEM) to explain overall quality of life (QoL). SUBJECTS AND METHODS: A dataset was obtained from 662 Japanese men aged 50-79 years who participated in the programme by accessing a website via the Internet between 10.30 hours on 19 February 2003 and 10.30 hours on 24 February 2003. The participants were queried about their International Prostate Symptom Score (IPSS), bother, QoL index and medical care-seeking behaviour. RESULTS: Of the 662 participants, 314 reported intending to seek medical care for LUTS (intention group); the remaining 348 answered that they did not intend to see a doctor (no-intention group). The characteristic of weak stream had the strongest correlation with the QoL index, not only in the intention (r = 0.58) but also in the no-intention group (r = 0.48). Among several SEMs proposed, one that included a latent variable termed 'QoL sensitivity' was the most appropriate to explain overall QoL. In this model it was assumed that 'QoL sensitivity' was affected by other latent variables, termed the 'voiding symptom factors' and 'storage symptom factors', and affected the degree of bother related to each symptom. CONCLUSION: In Japanese men, voiding symptoms, especially weak stream, contributed to overall QoL for medical care-seeking behaviour. Differences in 'QoL sensitivity' among men may be one of the reasons why symptomatic severity is not always correlated with symptom-related bother.     

A Cross-Sectional,Population-Based,Multinational Study of the Prevalence of Overactive Bladder and Lower Urinary Tract Symptoms: Results from the EPIC Study

The EPIC study was the first large-scale, multinational, population-based, cross-sectional survey to estimate the prevalence of lower urinary tract symptoms (LUTS) using current (2002) International Continence Society (ICS) definitions, with a focus on LUTS subtypes, overactive bladder (OAB), and urinary incontinence (UI). This study was conducted between April and December 2005 using randomly selected men and women ≥18 yr of age living in Canada, Germany, Italy, Sweden, and the United Kingdom. The results of the EPIC study are fairly consistent with the literature, showing that LUTS are highly prevalent; 64.3% of the 19,165 respondents reported experiencing at least one LUTS. Storage LUTS were considerably more prevalent than were voiding and postmicturition LUTS in both men and women. The prevalence of OAB was comparable in men (10.8%) and women (12.8%) and increased with age in both sexes. Nocturia was the most prevalent symptom in both men (48.6%) and women (54.5%). UI was more prevalent among women (13.1%) than men (5.4%). Among women, stress UI and other UI were the most prevalent types of UI; among men, other UI and urgency UI were most prevalent. Rates of physician-diagnosed depression were significantly higher in respondents with OAB, with or without UI, than in respondents without OAB. Further analyses of EPIC data will be available soon and should yield information about OAB regarding bother and impact on quality of life; risk factors and comorbidities; coping and health care-seeking behaviours; and impact on sexuality, mental health, and work productivity.     

Impact of LUTS using bother index in DAN-PSS-1 questionnaire

OBJECTIVES: To quantify the bothersomeness of urinary symptoms in males with lower urinary tract symptoms (LUTS). METHODS: A population-based postal survey of urinary symptoms among 2837 men aged 55, 65, or 75 years was conducted. The response rate was 75%, and data of both symptom and bother questions were eligible for 1803-2046 men, depending on the question. Bothersomeness of each urinary symptom was measured with a bother index (BI) as a ratio of the number of men with a bother score higher than a symptom score to that with a bother score lower than a symptom score. The BI was compared with the relative risk (RR), the prevalence of men with bother to those with symptom. RESULTS: Urgency (46%) and postmicturition dribble (42%) were the most common symptoms. Any type of incontinence was considered highly bothersome (BI: 1.79-3.70). In light of the BI, most voiding and postmicturition symptoms except weak stream (BI: 1.14) were well tolerated. The variation of the BI (0.06-3.70) was substantially larger than that of RR (0.53-0.89) of the urinary symptoms. CONCLUSIONS: Bothersomeness of a symptom is an independent contribution in the assessment of LUTS. The BI may be a useful indicator of bothersomeness of urinary symptoms. The greater variation of the BI than that of RR indicates that the BI provides information on LUTS that cannot be described by prevalence or prevalence ratio only.     

A randomised, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

INTRODUCTION: Benign prostatic hyperplasia (BPH) is associated with bothersome lower urinary tract symptoms (LUTS) and reduced patient quality of life (QoL). Phosphodiesterase (type) 5 (PDE5) inhibitors such as vardenafil are commonly used for the treatment of erectile dysfunction (ED), but have also been shown to improve the symptoms of BPH. This randomised, double-blind, placebo-controlled study investigated the effects of vardenafil on LUTS and QoL in men with BPH/LUTS, with or without concomitant ED. METHODS: Men aged 45-64 yr with BPH/LUTS and an International Prostate Symptom Score (IPSS) > or =12 were randomised to receive either 10mg vardenafil or placebo twice daily. LUTS were assessed with the use of two primary efficacy parameters, IPSS score and maximum urinary flow rate (Qmax), as well as postvoid residual (PVR) urine volume; ED was measured with the use of the erectile function (EF) domain score of the International Index of Erectile Function (IIEF-EF); and QoL was assessed with the Urolifetrade mark QoL-9 questionnaire. RESULTS: After 8 wk of treatment, there was a significant improvement in the IPSS total score in the vardenafil group compared with placebo (-5.9 and -3.6, respectively; p=0.0013). Nominally significant improvements in irritative and obstructive IPSS subscores (p=0.0017 and p=0.0081, respectively), EF (p=0.0001), and Urolife QoL-9 (p<0.0001) were also associated with vardenafil treatment. Qmax and PVR urine volume did not change significantly with treatment, although baseline values were already considered close to normal. Vardenafil was generally well tolerated, with most adverse events considered mild or moderate in severity. CONCLUSIONS: Vardenafil treatment significantly improved LUTS, EF, and QoL in men with BPH/LUTS. Vardenafil may be considered a promising treatment option for men with symptoms secondary to BPH.     

Understanding the elements of overactive bladder: questions raised by the EPIC study

OBJECTIVES

To compare the prevalence of frequency and nocturia and the bother they impose in a population‐based sample of men and women using current International Continence Society (ICS) definitions of lower urinary tract symptoms (LUTS) and commonly used alternative definitions of these LUTS to emphasize the importance of standardizing the definitions when evaluating overactive bladder (OAB) syndrome; we also describe the spectrum of LUTS and bother they impose in this population with OAB.

SUBJECTS AND METHODS

Several validated disease‐specific measures were used in a population‐based, cross‐sectional telephone survey of adults aged ≥18 years in five countries. The population with OAB was defined as those participants who answered ‘yes’ to questions about urgency or urgency urinary incontinence according to ICS standards. The prevalence of daytime frequency and nocturia within the OAB population was examined using two different criteria for each symptom. Frequency was defined using the current ICS definition (i.e. subject’s perception of whether they urinated too often during the day) or more than eight daytime voids. Nocturia was defined according to the ICS definition of having to wake once or more per night to void and using the threshold of waking twice or more per night to urinate. Urinary symptom bother within the OAB population was compared using the different criteria for frequency and nocturia.

RESULTS

In all, 1434 participants (502 men and 932 women) were classified as having OAB; 31% of men and 25% of women with OAB had daytime frequency consistent with the ICS definition. The ICS‐defined frequency identified a population with a varied distribution of reported daytime voiding frequencies; most respondents reported frequencies below the threshold of nine daytime voids. The ICS‐defined daytime frequency was reported as bothersome by more than half of the OAB population (46% of men, 66% of women). Of the OAB population, ≈75% reported one or more nocturia episodes per night, and ≈40% reported two or more per night. The proportion of the OAB population that was bothered by nocturia increased markedly as the number of nocturia episodes increased. Among those with OAB, the most prevalent combination of OAB symptoms was urgency and nocturia. More than half of those with OAB reported urgency combined with three or more other LUTS (including voiding and postmicturition symptoms), and the number of LUTS reported increased with age. The proportion of the population reporting symptom bother increased as the number of reported LUTS in that population increased.

CONCLUSIONS

The ICS definitions for daytime frequency as ‘the subject’s perception of urinating too often’ and for nocturia as ‘one or more episodes per night’ adequately described bladder symptoms within the OAB population when assessed by the level of symptom bother. Urgency was uncommon in isolation and did not alone impose as high a level of bother as when combined with other LUTS. In this population, the most predominant manifestation of OAB was a combination of urgency with one or more other OAB symptoms. Symptom bother became more common as the number of symptoms reported increased. LUTS other than the defining symptoms of OAB were also highly prevalent within the OAB population.     

Association of lower urinary tract symptoms with sexual dysfunction: a cross‐cultural study between Japanese and American men with localized prostate cancer

OBJECTIVE

To assess the association of lower urinary tract symptoms (LUTS) with sexual function, and estimate the correlates of LUTS among Japanese and American men with localized prostate cancer.

PATIENTS AND METHODS

In all, 343 Japanese men and 307 American men with prostate cancer were enrolled in the study. Sexual function and sexual bother were measured separately with the University of California‐Los Angeles Prostate Cancer Index and obstructive/irritative voiding symptoms were measured with the American Urological Association Symptom Index (AUA SI).

RESULTS

Japanese men had worse sexual function scores than the American men before treatment, whereas no differences were reported between Japanese and American men in sexual bother scores. Japanese and American men also did not differ meaningfully in AUA SI. However, those with moderate to severe LUTS reported significantly worse sexual bother scores than those with mild symptoms in both Japanese and American men (P = 0.004 and <0.001, respectively). The Japanese men were more likely to have LUTS than were American men (odds ratio 1.60, P = 0.029). Age and sexual function were highly associated with LUTS (odds ratio 1.35, P = 0.027; and 0.652, P = 0.001, respectively). The comorbidity count was independently associated with worse urinary symptoms (odds ratio 1.23, P = 0.015).

CONCLUSIONS

We posit that cultural differences in the meaning or salience of sexual functioning, and the interpretation of the questionnaire in quality‐of‐life surveys, might explain the different profiles in the association of LUTS with sexual activity in Japanese and American men with localized prostate cancer.     

The relation of lower urinary tract symptoms with life-style factors and objective measures of benign prostatic enlargement and obstruction: an Italian survey

OBJECTIVES: The association between the severity of LUTS and prostate volume, prostate-related variables and general life-style factors was investigated in a large number of patients with persistent LUTS suggestive of BPH (LUTS/BPH). METHODS: Patients with LUTS/BPH aged between 50 and 80 years, were enrolled in this Italian, multicentre, observational study. The total, storage and voiding I-PSS and I-PSS-QoL index were collected, prostate volume and urodynamic variables measured. Multiple logistic regression equations were used to obtain the odds ratio (and 95% confidence interval) of moderate plus severe I-PSS (>7) versus mild I-PSS (< or =7, reference category), with allowance for age stratification, whenever indicated. RESULTS: In total, 802 patients were evaluated. The strongest association was found between the total I-PSS and the QoL. There was a slightly increased risk to suffer from more severe LUTS with increasing age. A significant increase risk of developing storage symptoms was found in older patient cohorts. Decrease of Q(max) values, increase of Abrams-Griffith number, serum PSA levels and prostate volume as judged by digital rectal examination were significantly associated to a higher risk of developing LUTS. No association was found between symptom severity and prostate volume or post-voiding residual, estimated by ultrasound. CONCLUSIONS: No significant association between severity of LUTS and life-style factors was observed. An increased risk of developing LUTS was found in patients with lower maximum flow rate and in those with higher PSA values. The association between LUTS and prostate volume remains questionable.     

Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth

OBJECTIVE: To assess the severity of both stress urinary incontinence (SUI) and overactive bladder (OAB) symptoms during and after the first pregnancy, using a self-reported health-related quality-of-life questionnaire, and to assess the effect of pregnancy and childbirth on bothersome lower urinary tract symptoms (LUTS) persisting at 1 year after the first childbirth. PATIENTS AND METHODS: In a prospective cohort study, 344 women completed four self-reported questionnaires. Urogenital symptoms were assessed with the Urogenital Distress Inventory (UDI), assessing if a urogenital symptom is present and the amount of bother it causes, measured on a 4-point Likert scale, i.e. 'not at all', 'slightly', 'moderately' and 'greatly bothered'. Bothersome LUTS were defined as reporting moderate or great bother from the symptom, and as not bothersome if it was absent or present with none or only a slight degree of self-reported bother. In the analysis we used three of the five subscales from the UDI; UI, OAB and obstructive voiding, where each subscale has a range of 0 (no symptom) to 100 (all symptoms present with the highest degree of bother). RESULTS: Of the 344 women, 83 (24.2%) reported having a moderate to greatly bothersome frequency symptom at 36 weeks of gestation. After childbirth there was a statistically significant decline in the prevalence of bothersome frequency to 38 (9.6%) women (P < 0.001). Bothersome SUI was present in 53 (15.4%) women at 36 weeks of gestation, and in 36 (10.5%) at 1 year after childbirth. Fifty-eight (16.9%) women reported having moderate to greatly bothersome urge UI (UUI) and at 1 year after childbirth, 51 (14.8%) were still bothered by it. After univariate and multivariate analysis, the predictive factors for the presence of bothersome SUI were greater maternal age (32.5 vs 30.3 years old at delivery) and the presence of bothersome SUI at 12 weeks of gestation. Bothersome UUI was significantly associated with a lower educational level (odds ratio 0.08, 95% confidence interval 0.02-0.36). Women after a Caesarean delivery had more bothersome UUI and women after a spontaneous vaginal delivery developed more bothersome SUI (neither statistically significant, possibly because there were too few samples). During pregnancy, all UDI subscale scores increased significantly and after childbirth all scores decreased significantly vs 36 weeks of gestation. However, the score on the UI subscale remained significantly higher at 1 year after birth than at 12 weeks of gestation, whereas the scores on the OAB and obstructive voiding subscales were lower at 1 year after birth than at 12 weeks of gestation. Nevertheless, the scores for UI and obstructive voiding were low, indicating little bother. CONCLUSION: Most women are not bothered by their LUTS after their first delivery. As the prevalence of bothersome symptoms was highest at 36 weeks of gestation, they are probably part of a normal pregnancy. However, OAB symptoms can be perceived as bothersome. Physiotherapy and bladder training can be offered to women with bothersome LUTS. Bothersome SUI in early pregnancy and a greater maternal age were predictive of bothersome SUI at 1 year after first childbirth. A Caesarean delivery seemed to be protective for bothersome SUI at 1 year after birth, but bothersome UUI was more prevalent after a Caesarean than a vaginal delivery. More research with a larger sample is needed to allow definite statements about the effect of the mode of delivery and bothersome UI symptoms.     

Quality of life in women with stress urinary incontinence

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity. Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional support from the National Institute of Child Health and Human Development and the Office of Research on Women’s Health, National Institutes of Health.     

Gender and Age Differences in the Perception of Bother and Health Care Seeking for Lower Urinary Tract Symptoms: Results from the Hospitalised and Outpatients’ Profile and Expectations Study

Background

Few comparisons have been made of health care seeking behaviour for lower urinary tract symptoms (LUTS) between men and women, as well as trends across age groups.

Objective

To investigate the bother from LUTS and effect on health care seeking in both men and women of different age groups and in comparison between the two genders.

Design, setting, and participants

A representative cross section of each of 13 clinics of a general academic hospital, with equal numbers of subjects recruited in each of six design cells that were defined by age (18–40, 41–60, 61–80 yr) and gender.

Intervention

A 2-h in-person interview, conducted by a trained psychologist/interviewer in a clinic office.

Measurements

Severity of LUTS was measured by the International Prostate Symptom Score (IPSS). Treatment seeking was measured by a single item. A bother question was modified to assess overall bother. Impact on quality of life (QoL) was measured by the IPSS QoL question.

Results and limitations

The final study sample comprised 415 patients. More women than men reported the presence of LUTS (85.5% vs 75.2%; p = 0.01). LUTS were more bothersome in women (25.4% of women vs 17.6% of men with bother “some” or “a lot”; p = 0.02). Severity of LUTS increased with age in both genders (men: p < 0.001; women: p = 0.03). Bother from LUTS increased as severity of symptoms increased in both genders (p < 0.001) but was associated with age only in men (p < 0.001). QoL showed similar results as bother. Although men and women had equal prevalence of treatment seeking (27.9% vs 23.7%; p = 0.40), men, but not women, were more likely to seek treatment as age (p < 0.01) and severity of LUTS (p < 0.001) increased. In multivariate logistic regressions, only bother from LUTS was associated with treatment seeking in women, compared with bother, age, and the presence of voiding symptoms in men.

Conclusions

In our hospital-based sample, differences in LUTS frequency, bother, and health care seeking profiles between men and women suggest a different perception and response to LUTS between the two genders.     

The medical management of lower urinary tract symptoms and benign prostatic hyperplasia

Prostatism is a widely used term assigned to the symptom complex of older men with voiding dysfunction. The cause of the syndrome has routinely been ascribed to an enlarged prostate. More recent thinking recognizes that many men with such symptoms do not, in fact, have prostate enlargement or benign prostatic hyperplasia (BPH) and that such symptoms are not a surrogate for BPH. Such recognition is essential if cost effective medical management of lower urinary tract symptoms (LUTS) is to be achieved. Prostate volume has emerged as a key factor in the selection of medical therapy of LUTS and BPH not only regarding symptom relief but also to the newer concept of the prevention of disease progression and the avoidance of future adverse events in those men with true BPH. In the United States, medical management is now first line therapy for LUTS. The proper selection of therapy based on the patient's individual pathophysiologic characteristics is now made possible by many new recent studies within the medical literature.     

Effect of diabetes mellitus on lower urinary tract symptoms and dysfunction in patients with benign prostatic hyperplasia

This article reviews the recent literature on men with diabetes mellitus (DM) and concomitant lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Diabetes is reported to be associated with greater BPH symptom severity. Men with non-insulin-dependent diabetes had the highest median annual prostate growth rate compared with those who had other metabolic disease. Urodynamic evaluations in the reviewed studies were absent. Extensive diagnostic evaluations with urodynamics in our outpatient department revealed that patients with LUTS suggestive of BPH and with concomitant DM hardly differed from those without DM.     

The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study

OBJECTIVES

To examine the effect overactive bladder (OAB) and other lower urinary tract symptoms (LUTS) on health‐related quality of life (HRQoL) in a population sample, as OAB often occurs in conjunction with many other LUTS.

SUBJECTS AND METHODS

A nested case‐control analysis was performed on men and women with (cases) and without (controls) OAB, from the EPIC study. OAB was assessed using 2002 International Continence Society definitions. Based on their responses to questions about LUTS, cases were classified into five groups; continent OAB, OAB with incontinence, OAB + postmicturition, OAB + voiding, and OAB + postmicturition + voiding. Both cases and controls were asked questions about symptom bother (OAB‐q), generic QoL (EQ‐5D), work productivity (Work Productivity and Activity Impairment, WPAI), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sexual satisfaction, and erectile dysfunction (men only) using the Massachusetts Male Aging Study. Cases answered additional condition‐specific questions HRQoL (OAB‐q short form), Patient Perception of Bladder Condition and work productivity related to a specific health problem (WPAI‐SHP). General linear models were used to evaluate group differences.

RESULTS

Of the EPIC participants, 1434 identified OAB cases were matched by age, gender and country, with 1434 participants designated as controls. Cases and controls were primarily Caucasian (96.2% and 96.7%, respectively), and most (65%) were female; the mean age was 53.8 and 53.7 years, respectively. Comorbid conditions differed significantly by case/control status, with cases reporting significantly greater rates of chronic constipation, asthma, diabetes, high blood pressure, bladder or prostate cancer, neurological conditions and depression. There were significant differences between the cases and controls in all reported LUTS. The OAB + postmicturition + voiding group reported significantly greater symptom bother, worse HRQoL, higher rates of depression and decreased enjoyment of sexual activity, than the other subgroups.

CONCLUSION

OAB has a substantial, multidimensional impact on patients; OAB with additional LUTS has a greater impact. The diagnosis and treatment of OAB should be considered in conjunction with other LUTS, to maximize treatment options and optimize patient outcomes.     

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).     

Lower urinary tract symptoms and related help-seeking behaviour in South Asian men living in the UK

OBJECTIVE: To describe the pattern and prevalence of lower urinary tract symptoms (LUTS) and related help-seeking behaviour in men of South Asian origin living in the UK, and to compare this to the white population. SUBJECTS AND METHODS: Data were obtained as part of the Leicestershire MRC Incontinence Study. Community-dwelling men aged >40 years were sent a postal questionnaire addressing urinary symptoms, bother and help-seeking. Prevalence rates of self-reported LUTS were compared on the basis of the Office of Population Censuses and Surveys ethnic classifications. Logistic regression was used to estimate the relative risk of symptoms between groups. Data from 7810 men were included in the analysis. RESULTS: In all, 409 (5.3%) of the population sample described themselves as Asian; 36.5% of these men described at least one significant LUTS, vs 29.0% of white men. The overall prevalence rates for all storage symptoms were significantly higher in Asian men. Straining to void was the only voiding symptom to show a difference in prevalence between the groups. However, when controlling for age, Asian men were at greater risk for all symptoms except a weak urinary stream. Reported levels of bother and felt need were the same in both population groups, but actual help-seeking was significantly less in the Asian group. Only 25.0% of Asian men had actively sought help, compared to 53.1% of white men. CONCLUSION: South Asian men in the UK have a higher risk of experiencing LUTS than white men from the same population. This increase in risk is greatest for storage symptoms. Although levels of bother are the same, South Asian men are less likely to seek help for their symptoms.