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Kim DH, Lee KS, Koo KC, Chung BH, Yoo JW. Comprehensive Analysis of Individual Anatomical Structures for Micturition Symptoms and Maximum Flow Rate in Men With Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms. Int Neurourol J 2023; 27:146-154. [PMID: 37401026 DOI: 10.5213/inj.2346046.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/30/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE Individual anatomical structural variations, including intravesical prostatic protrusion (IPP), prostatic urethral angle (PUA), prostatic urethral length, or prostatic apex shape, were correlated with micturition symptoms. We aimed to investigate the effects of these variables on micturition symptoms in men with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). METHODS This observational study was based on data from 263 men with the first visit to health promotion center and without BPH/LUTS treatment between March 2020 and September 2022. A multivariate analysis was performed to determine the variables affecting total international prostate symptom score, maximum flow rate (Qmax), and voiding efficacy (postvoid residual volume to total bladder volume ratio). RESULTS Of 263 patients, decreasing PUA increases the severity of international prostate symptoms score (mild, 141.9°; moderate, 136.0°; severe, 131.2°; P<0.015). A multivariate analysis reported that the total international prostate symptom score was correlated with age (P=0.002), PUA (P=0.007), and Qmax (P=0.008). Qmax was negatively associated with IPP (P=0.002). In subanalysis for large prostate volume (≥30 mL, n=81), international prostate symptom score was correlated with PUA (P=0.013), Qmax was correlated with prostatic apex shape (P=0.017), and length of proximal prostatic urethra (P=0.007). IPP was not identified as a significant factor. For small prostate volume (<30 mL, n=182), age (P=0.011) and prostate volume (P=0.004) are correlated with increasing Qmax. CONCLUSION This study presented that individual anatomical structure variations influenced the micturition symptoms according to prostate volume. To identify the major resistant factors in men with BPH/LUTS, further studies are required to investigate which components played a role in major resistant factors for micturition symptoms.
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Affiliation(s)
- Dae Ho Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Suk Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyo Chul Koo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Woo Yoo
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
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Chen YZ, Peng L, Zhang C, Xu S, Luo DY. Bladder Sonomorphological Tests in Diagnosing Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis. Urol Int 2021; 107:327-335. [PMID: 34903702 DOI: 10.1159/000519102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/02/2021] [Indexed: 02/05/2023]
Abstract
AIMS We aimed to investigate the accuracy of bladder sonomorphological parameters including detrusor wall thickness (DWT) and ultrasound-estimated bladder weight (UEBW) for diagnosing bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms (LUTS). METHODS A comprehensive search was conducted through databases including PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, China Knowledge Network (CNKI), China Biomedical Literature Database, Wanfang Database, the Chongqing VIP Chinese Science, and Technology Periodical Database (VIP) to select studies assessing the diagnostic accuracy of DWT and UEBW to diagnose BOO in adults with LUTS. Databases were searched from inception to 2020 without restriction. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), and measures of accuracy were calculated using random-effects model. RESULTS The initial search included 84 publications, of which 78 publications were screened, and 16 studies with 1,847 patients finally contained diagnostic data. The results from 10 out of 16 studies assessing DWT showed a pooled sensitivity (SSY) of 0.68 (95% CI, 0.56-0.78) and specificity (SPY) of 0.91 (95% CI, 0.82-0.96) with I2 values of 93%, while 6 studies evaluating UEBW were analyzed with a SSY of 0.88 (95% CI, 0.78-0.93) and SPY of 0.81 (95% CI, 0.67-0.90) with I2 values of 83%. CONCLUSIONS DWT shows high SPY, and UEBW performs high SSY of diagnosing BOO. Further well-designed studies are needed to evaluate the utilization of DWT and UEBW for the diagnosis of BOO.
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Affiliation(s)
- Yuan-Zhuo Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chi Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuai Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - De-Yi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Wadie BS. How correlated is BOO with different objective parameters commonly used in evaluation of BPH: a prospective study. Int Urol Nephrol 2020; 53:635-640. [PMID: 33175306 DOI: 10.1007/s11255-020-02707-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The use of non-intubated uroflowmetry, PVR, prostate volume, and I-PSS are the most commonly used tools for the evaluation of patients with BPH. In this prospective study, we elucidated the correlation between BOO as rated by pressure-flow study in men with LUTS attributed to BPH and those parameters. METHODS Over a period of 2 years 460 men above the age of 45 years old (mean age 60.46 ± 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, prostate-specific antigen, and transrectal ultrasound were done. The urodynamic evaluation included uroflowmetry, filling cystometry, and voiding cystometry with the plotting of pressure-flow study according to Lin-PURR (Schäfer's nomogram). The correlation coefficient was calculated between these variables. RESULTS The correlation of other objective parameters with total score was not much better. The Spearman's correlation coefficient were - 0.09, 0.07 and - 0.1 for prostate weight, post voiding residual urine and maximum free flow rate respectively. Correlations between Schäfer's grade and Qmax, PVR and prostate volume were found to be weak to fair correlation (r values were - 0.4, 0.18, and 0.39 respectively). CONCLUSION Objective non-invasive parameters most commonly used in the evaluation of men with LUTS attributed to BPH have limited correlation with obstruction, as diagnosed by pressure flow nomogram.
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Affiliation(s)
- Bassem S Wadie
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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The role of prostatic apex shape in voiding symptoms and urine flow: an exploratory and confirmatory study. World J Urol 2019; 38:1275-1282. [PMID: 31456018 DOI: 10.1007/s00345-019-02925-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Lower urinary tract symptoms in men have previously been attributed to obstruction from an enlarged prostate. However, several factors in addition to prostate volume have been identified as impacting urine flow. Prostatic apex shape is one factor that has not been evaluated. This study evaluates the relationship between prostatic apex shape and voiding symptoms and urine flow. METHODS A retrospective, exploratory data review was conducted for 806 healthy men who underwent routine transrectal ultrasonography at our hospital, and data for 329 patients with uroflowmetric measurements were reviewed for the confirmatory study. Patients were categorized into four groups according to the prostatic apex shape on midsagittal ultrasonography. The association between prostatic apex shape and voiding symptoms was investigated. International Prostate Symptom Score (IPSS) and uroflowmetry were measured, and the associations between IPSS, uroflowmetry, and prostatic apex shape were analyzed. RESULTS Patients in group 4 (356/806, 44.2%), whose prostatic apex did not overlap the membranous urethra anteriorly or posteriorly, had a significantly lower incidence of moderate and severe lower urinary tract symptoms compared to other groups. There was a significant relationship between prostatic apex shape and total International Prostate Symptom Score. Patients in group 3, whose prostatic apex overlapped posteriorly with the membranous urethra, had lower maximum flow rates on uroflowmetry. There were significant correlations between the maximum flow rate and independent factors including age, intravesicle prostatic protrusion, and prostatic apex shape. CONCLUSIONS Prostatic apex shape is an independent risk factor for voiding symptom severity and low maximum flow rate.
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Topazio L, Perugia C, De Nunzio C, Gaziev G, Iacovelli V, Bianchi D, Vespasiani G, Finazzi Agrò E. Intravescical prostatic protrusion is a predictor of alpha blockers response: results from an observational study. BMC Urol 2018; 18:6. [PMID: 29394926 PMCID: PMC5797399 DOI: 10.1186/s12894-018-0320-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the efficacy of tamsulosin in patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) with intravesical prostatic protrusion (IPP). Ultrasound measurement of the IPP has been previously described as an effective instrument for the evaluation of benign prostatic obstruction (BPO) and could help in clarifying the role of alpha-blockers in patients with (BPE). METHODS Patients with BPE and LUTS were enrolled in this observational study. Intravesical prostatic protrusion was graded as grade 1 (< 5 ml), 2 (5 < IPP < 10 ml) and 3 (> 10 ml). Patients were treated with tamsulosin for twelve weeks. Evaluation was performed before and at the end of treatment by means of International Prostate Symptom Score (IPSS) and uroflowmetry. Patients were considered responders if a reduction of IPSS > 3 points was reported. RESULTS One hundred forty-two patients were enrolled. Twelve patients were excluded because of incomplete data. Fifty patients showed an IPP grade 1 (group A), 52 a grade 2 (group B) and 28 a grade 3 (group C). Treatment success was obtained in 82%, 38,5% and 7,1% of patients respectively; these differences (group A vs B-C and group B vs C) were highly significant. The odd ratio to obtain a treatment success was of 59 and 8.1 in group A and group B respectively, in comparison to group C. After a multivariate regression, the relationship between IPP grade and treatment success remained significant. Improvement of uroflowmetry parameters has been reported in all the groups especially in patients with a low grade IPP (p value = 0,016 group A vs group B; p value = 0,005 group A vs group C). Prostate volume seems not to influence this relationship. CONCLUSIONS Intravesical prostatic protrusion has found to be significantly and inversely correlated with treatment success in patients with LUTS and BPE under alpha-blockers therapy. Alpha blockers odd ratio of success is 59 times higher in patients with a low grade IPP in comparison to patients with a high grade.
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Affiliation(s)
- L Topazio
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy.
| | - C Perugia
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy
| | - C De Nunzio
- Department of Urology, Sant'Andrea Hospital, University "La Sapienza", Rome, Italy
| | - G Gaziev
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy
| | - V Iacovelli
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy
| | - D Bianchi
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy
| | - G Vespasiani
- Department of Experimental Medicine and Surgery, University "Tor Vergata", Rome, Italy
| | - E Finazzi Agrò
- Department of Experimental Medicine and Surgery, University "Tor Vergata", Rome, Italy
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Ahmed AF, Bedewi M. Can Bladder and Prostate Sonomorphology Be Used for Detecting Bladder Outlet Obstruction in Patients With Symptomatic Benign Prostatic Hyperplasia? Urology 2016; 98:126-131. [PMID: 27591808 DOI: 10.1016/j.urology.2016.08.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/21/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the accuracy of the bladder and prostate sonomorphologic parameters for the diagnosis of bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). PATIENTS AND METHODS First-visit men, aged ≥ 50 years, with LUTS/BPH were prospectively enrolled. Added to the initial basic evaluation, all patients underwent pelvic ultrasonography and pressure flow study. The pressure flow study was used as a reference standard for BOO, and according to its results, patients were divided into BOO and non-BOO groups. The sonomorphologic findings were compared between both groups, and the diagnostic accuracy of the significant parameters was determined. RESULTS In total, 157 patients were included. Of these, 48 (30.57%) had BOO and 109 (69.43%) did not. Bladder wall thickness (BWT), ultrasound estimated bladder weight (UEBW), and intravesical prostatic protrusion (IPP) were the sonomorphologic parameters that differed significantly between both groups (P < .001). By receiver operating characteristic curve analysis, the optimal cutoff values distinguishing patients with BOO were BWT of 3.7 mm (area under the curve [AUC]: 0.940), UEBW of 31.5 g (AUC: 0.835), and IPP of 10.9 mm (AUC: 0.874). The sensitivity, specificity, and accuracy of BWT, UEBW, and IPP were 95.00%, 90.91%, and 93.55%; 75.44, 57.97%, and 65.62%; and 87.90%, 76.43%, and 82.17%, respectively. CONCLUSION BWT, UEBW, and IPP measurements can be used to detect BOO in LUTS/BPH patients. The simple estimation of these sonomorphologic parameters by suprapubic approach makes these measurements potentially suitable methods to judge BOO noninvasively during the routine clinical evaluation of BPH.
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Affiliation(s)
- Abul-Fotouh Ahmed
- Department of Urology, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia; Department of Urology, Al-Azhar University, Cairo, Egypt.
| | - Mohamed Bedewi
- Department of Diagnostic Radiology, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Hickling DR, Sun TT, Wu XR. Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection. Microbiol Spectr 2015; 3:10.1128/microbiolspec.UTI-0016-2012. [PMID: 26350322 PMCID: PMC4566164 DOI: 10.1128/microbiolspec.uti-0016-2012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Indexed: 02/07/2023] Open
Abstract
The urinary tract exits to a body surface area that is densely populated by a wide range of microbes. Yet, under most normal circumstances, it is typically considered sterile, i.e., devoid of microbes, a stark contrast to the gastrointestinal and upper respiratory tracts where many commensal and pathogenic microbes call home. Not surprisingly, infection of the urinary tract over a healthy person's lifetime is relatively infrequent, occurring once or twice or not at all for most people. For those who do experience an initial infection, the great majority (70% to 80%) thankfully do not go on to suffer from multiple episodes. This is a far cry from the upper respiratory tract infections, which can afflict an otherwise healthy individual countless times. The fact that urinary tract infections are hard to elicit in experimental animals except with inoculum 3-5 orders of magnitude greater than the colony counts that define an acute urinary infection in humans (105 cfu/ml), also speaks to the robustness of the urinary tract defense. How can the urinary tract be so effective in fending off harmful microbes despite its orifice in a close vicinity to that of the microbe-laden gastrointestinal tract? While a complete picture is still evolving, the general consensus is that the anatomical and physiological integrity of the urinary tract is of paramount importance in maintaining a healthy urinary tract. When this integrity is breached, however, the urinary tract can be at a heightened risk or even recurrent episodes of microbial infections. In fact, recurrent urinary tract infections are a significant cause of morbidity and time lost from work and a major challenge to manage clinically. Additionally, infections of the upper urinary tract often require hospitalization and prolonged antibiotic therapy. In this chapter, we provide an overview of the basic anatomy and physiology of the urinary tract with an emphasis on their specific roles in host defense. We also highlight the important structural and functional abnormalities that predispose the urinary tract to microbial infections.
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Affiliation(s)
- Duane R Hickling
- Division of Urology, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Tung-Tien Sun
- Departments of Cell Biology, Biochemistry and Molecular Pharmacology, Departments of Dermatology and Urology, New York University School of Medicine, New York, NY, 10016
| | - Xue-Ru Wu
- Departments of Urology and Pathology, New York University School of Medicine, New York, NY, 10016
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8
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Pelvic ultrasound evaluation for benign prostatic hyperplasia: prediction of obstruction. Curr Urol Rep 2014; 15:403. [PMID: 24658830 DOI: 10.1007/s11934-014-0403-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Global improvements in water quality, management of infectious diseases, and other medical therapeutics have resulted in a growing population of healthy aging men. One obligate anatomic consequence of aging for these men is the development of benign prostatic hyperplasia (BPH) with secondary bladder outlet obstruction. Although the voiding symptoms associated with the change in bladder health over time predominantly impact the quality of a man's daily experience, there are also significant medical consequences of BPH that require intervention. It is a challenge to distinguish men who are at risk for these medical consequences from the much larger population of older men with voiding symptoms (lower urinary tract symptoms, LUTS). A variety of national guidelines have been developed to establish a diagnostic paradigm for meeting this challenge, but all suffer from inadequate sensitivity for the early identification of men at risk for permanent bladder injury. It is likely that the application of a thorough pelvic ultrasound designed to identify the pertinent anatomic aspects of both the bladder and prostate will improve the sensitivity of these diagnostic paradigms, with subsequent improvement in the outcomes for men with BPH/LUTS.
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Reis RB, Rodrigues Neto AA, Reis LO, Machado RD, Kaplan S. Correlation between the presence of inguinal hernia and the intensity of lower urinary tract symptoms. Acta Cir Bras 2012; 26 Suppl 2:125-8. [PMID: 22030828 DOI: 10.1590/s0102-86502011000800023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To verify the correlation between the presence of IH and the intensity of LUTS related to BPH quantified through the International Prostate Symptom Score (IPSS). METHODS We prospectively selected 52 patients over the age of 55 years; Patients were divided into 2 groups. Group 1: composed of 32 patients with IH; Group 2 (control group): composed of 20 patients with no clinical evidence of IH. All patients were assessed using the IPSS, uroflowmetry (Qmax), post-void residual urine volume (PVR) and prostate volume (PV). RESULTS Groups 1 and 2 presented no difference in PV (p>0.05) and uroflowmetry (Qmax) (p>0.05). There was a statistical significant difference between the PVR mean values between groups 1 and 2. The presence of IH correlated with a higher IPSS score (r=0.38 p<0.05) despite the fact the no difference was detected between the incidence of patients with mild, moderate and severe LUTS in groups 1 and 2. CONCLUSION Patients with IH present higher IPSS. The role of IPSS as a marker to predict the development of clinical IH still to be determined.
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Abstract
Benign prostatic obstruction (BPO) affects an increasing number of men with age. It can cause troublesome lower urinary tract symptoms, can have a negative impact on quality of life, and may be associated with significant morbidity. Currently available medication and surgical treatments are limited by adverse events, invasiveness, and patient compliance. This has driven research into the pathogenesis of benign prostatic hyperplasia and led to the development of novel pharmacological agents and minimally invasive therapeutic interventions. This review highlights emerging treatment options for BPO.
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Affiliation(s)
- Brian A Parsons
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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McLaren ID, Jerde TJ, Bushman W. Role of interleukins, IGF and stem cells in BPH. Differentiation 2011; 82:237-43. [PMID: 21864972 DOI: 10.1016/j.diff.2011.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/09/2011] [Accepted: 06/14/2011] [Indexed: 12/22/2022]
Abstract
The condition known as benign prostatic hyperplasia may be defined as a benign enlargement of the prostate gland resulting from a proliferation of both benign epithelial and stromal elements. It might also be defined clinically as a constellation of lower urinary tract symptoms (LUTSs) in aging men. The purpose of this review is to consider the ways in which inflammatory cytokines belonging to the interleukin family, members of the IFG family, and stem cells may contribute to the development and progression of BPH-LUTS. This might occur in three mechanisms: One, interleukin signaling, IFG signaling and stem cells may contribute to reactivation of developmental growth mechanisms in the adult prostate leading to tissue growth. Two, given that epidemiologic studies indicate an increased incidence of BPH-LUTS in association with obesity and diabetes, IFG signaling may provide the mechanistic basis for the effect of diabetes and obesity on prostate growth. Three, expression of interleukins in association with inflammation in the prostate may induce sensitization of afferent fibers innervating the prostate and result in increased sensitivity to pain and noxious sensations in the prostate and bladder and heightened sensitivity to bladder filling.
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Affiliation(s)
- Ian D McLaren
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Bushman W. Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin North Am 2010; 36:403-15, v. [PMID: 19942041 DOI: 10.1016/j.ucl.2009.07.003] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Historically, benign prostatic hyperplasia (BPH) has been a major focus of urologic practice and surgery. But a simplistic causal relationship among prostatic enlargement, progressive obstruction, lower urinary tract symptoms, retention, and complications of retention has been challenged by recognition of the incomplete overlap of prostatic enlargement with symptoms and obstruction. The result has been a greater focus on symptoms than prostatic enlargement and a shift from surgery to medical treatment. Therefore, the question can be asked whether BPH per se, the glandular enlargement as it contributes to bladder dysfunction, or hyperplastic enlargement as a biomarker for generalized lower urinary tract dysfunction are concerns. This article addresses these issues.
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Affiliation(s)
- Wade Bushman
- Department of Urology, University of Wisconsin Medical School, K6-562 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Lewicky-Gaupp C, Wei JT, Delancey JOL, Fenner DE, McGuire EJ, Morgan DM. The association of Incontinence Symptom Index scores with urethral function and support. Am J Obstet Gynecol 2008; 199:680.e1-5. [PMID: 18976736 DOI: 10.1016/j.ajog.2008.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/12/2008] [Accepted: 07/11/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to establish categories of symptom severity based on Incontinence Symptom Index (ISI) scores and to show how these categories are associated with urethral function and support. STUDY DESIGN Women with stress incontinence (n = 97) and asymptomatic controls (n = 98) completed the ISI. Asymptomatic women's scores were between 0 and 6; this range was designated as absent/mild (n = 104). The median score for symptomatic women was 16; scores from 7 to 16 (n = 50) were designated as moderate, and scores of 17 or greater (n = 40) were designated as severe. RESULTS Urethral function differed in women with mild, moderate, and severe scores: Valsalva leak point pressure (162.3 vs 123.5 vs 101.9 cm H(2)O; P = .001), cough leak point pressure (202.0 vs 163.0 vs 134.3 cm H(2)O; P = .001), and maximum urethral closure pressure (69.1 vs 44.1 vs 35.3 cm H(2)O; P = .001). Loss of urethrovesical support (point Aa: -1.0 vs -0.6 vs -0.5 cm; P = .004) was found in women with moderate and severe symptoms, compared with those with mild symptoms. CONCLUSION Categories of symptom severity assessed by the ISI are associated with urethral function and support.
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Affiliation(s)
- Christina Lewicky-Gaupp
- Pelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, MI, USA
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MacDiarmid SA, Peters KM, Chen A, Armstrong RB, Orman C, Aquilina JW, Nitti VW. Efficacy and safety of extended-release oxybutynin in combination with tamsulosin for treatment of lower urinary tract symptoms in men: randomized, double-blind, placebo-controlled study. Mayo Clin Proc 2008; 83:1002-10. [PMID: 18775200 DOI: 10.4065/83.9.1002] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and tolerability of extended-release oxybutynin in combination with the alpha1-blocker tamsulosin in reducing lower urinary tract symptoms in men. PATIENTS AND METHODS In this multicenter, double-blind trial performed between March 29, 2004, and June 22, 2005, 420 men aged 45 years or older with a total International Prostate Symptom Score (IPSS) of 13 or more and IPSS for storage of 8 or more were randomized to receive tamsulosin (0.4 mg/d) with either extended-release oxybutynin (10 mg/d) or placebo for 12 weeks. Eligibility requirements included a maximum flow rate of 8 mL/s or more with voided volume of 125 mL or more and a postvoid residual volume of 150 mL or less on 2 occasions. Postvoid residual volume and peak flow rates at weeks 4, 8, and 12 were measured. The primary end point was change from baseline in total IPSS after 12 weeks of treatment. Secondary outcomes included change in IPSSs for storage and quality of life. RESULTS Tamsulosin combined with extended-release oxybutynin resulted in significantly greater improvement in total IPSS compared with tamsulosin and placebo after 8 (P=.03) and 12 (P=.006) weeks of treatment, and improved IPSS for storage and quality of life at all assessment points (P<.01). The incidence of postvoid residual volume higher than 300 mL was 2.9% (6/209) in patients receiving combination therapy compared with 0.5% (1/209) in patients receiving tamsulosin alone (P=.12). Occurrence of peak flow rates below 5 mL/s was 3.8% (8/209) for combination therapy and 5.7% (12/209) for tamsulosin alone (P=.49). CONCLUSION In men with substantial storage symptoms, combination therapy with tamsulosin and extended-release oxybutynin demonstrated greater efficacy than and comparable safety and tolerability to tamsulosin monotherapy.
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Seftel AD, Miner MM, Kloner RA, Althof SE. Office Evaluation of Male Sexual Dysfunction. Urol Clin North Am 2007; 34:463-82, v. [DOI: 10.1016/j.ucl.2007.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hamann MF, Wild C, Seif C, Hautmann S, Jünemann KP, Braun PM. Funktionelle Ergebnisse nach Laservaporisation der Prostata mit dem KTP-Laser. Urologe A 2007; 46:521-4, 526-7. [PMID: 17372716 DOI: 10.1007/s00120-007-1311-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treatment for bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH) impairs the quality of life. The potassium tintanyl phosphate (KTP) vaporisation of the prostate offers promising modalities in treatment of BOO. We prospectively determined the impact of KTP-lasertherapy on voiding function, quality of life and sexual function. PATIENTS AND METHODS So far a total of n=123 patients complaining of symptomatic BPH were treated with an 80 watt Laser. N= 40 of them agreed to participate in the study and were evaluated prospectively. Preoperative pressure-flow-studies verified significant bladder outlet obstruction in all cases. Disease specific quality of life and sexual function were assessed using the International Prostate Symptom Score (IPSS) and International Inventory of Erectile Function (IIEF). Three months after treatment follow-up video-urodynamics were carried out to determine changements in pressure flow and bladder function. RESULTS All patients showed significant improvement after a hospital stay of 4,9 days. The maximum flow rate increased from 9,1 ml/sec preoperatively to 20,2 ml/sec and the amount of residual urine decreased from 98 ml preoperatively to 17 ml immediately after removal of the catheter. Urodynamics after the follow up period showed that the maximum urinary flow improved from 9.7 ml/s preoperatively to 17,6 ml/s and the volume of residual urine decreased from a median of 127.5 ml preoperatively to 45 ml postoperatively. The IPSS and IIEF decreased from a median of 20,4 preoperatively to 8,16 and from a median of 14 preoperatively to 12,7 respectively. The pressure-flow study verified the desobstruction and showed a decline in detrusor pressure at maximum flow from 76,66 cm H2O to 33,79 cm H2O. The urethral opening pressure sank from 75.86 cm H2O preoperatively to 37,51 cm H2O postoperatively. CONCLUSION The potassium tintanyl phosphate (KTP) vaporisation of the prostate is a promising new method in the treatment of benign prostatic hyperplasia as shown by the data. Beside its low perioperative and postoperative morbidity due to a high hemostatic property it offers a good tissue debulking effect.
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Affiliation(s)
- M F Hamann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105 Kiel.
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17
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Qiu Y, DU C, Shen X. Transurethral resection in women with lower urinary tract symptoms. Int J Urol 2005; 11:1097-103. [PMID: 15663682 DOI: 10.1111/j.1442-2042.2004.00962.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the preliminary safety, efficacy and complications of transurethral resection (TUR) in the management of women with lower urinary tract symptoms. METHODS One hundred and eight women (mean age, 57.6 years) with moderate to severe lower urinary tract symptoms underwent TUR between September 1998 and December 2002. At preoperative baseline, 6 months and 24 months postoperatively, all patients underwent clinical evaluations including the standardized American Urological Association symptom score, peak urine flow, postvoid residual urine volume and quality-of-life assessments. Operative time, catheter time, hospital stay and incidence of side-effects were also recorded. RESULTS The total mean operative time was 19.25 +/- 6.70 min. The mean catheter time was 26.2 +/- 12.8 h and the mean hospital stay was 2.08 +/- 0.84 days. No patient needed a blood transfusion or experienced hyponatremia. The total storage and voiding symptom scores and quality of life score had improved significantly 6 months after the surgical procedure (P < 0.01). There were little changes in peak flow rate and residual urine volume. Complications of the procedure included urinary tract infections (n = 4) and stress incontinence (n = 3). Two patients later underwent bladder neck suspension procedure. CONCLUSIONS In this preliminary study, there was significant clinical improvement maintained at all follow-up intervals and the results were not comparable to TUR of the prostate in men with clinical benign prostatic hyperplasia. The risks associated with TUR in women, especially of stress incontinence, are significant. A multicenter clinical trial is currently underway to determine the long-term efficacy and safety of TUR in women.
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Affiliation(s)
- Yiqing Qiu
- Department of Urology, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
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18
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Abstract
Urinary symptoms are prevalent in the geriatric population.Symptoms, however, often are misleading. Urodynamic evaluation can help target specific treatments of specific disorders. In this article, the fundamentals of urodynamics are described. In addition,urodynamic findings in common geriatric conditions, such as Parkinson's disease, cerebral vascular accidents, benign prostatic hypertrophy, and incontinence, are discussed.
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Affiliation(s)
- Kimberly C Berni
- Division of Urology, Saint Louis University, 3635 Vista Avenue, St. Louis, MO 63110, USA.
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19
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Liu CC, Wang CJ, Huang SP, Chou YH, Wu WJ, Huang CH. Relationships Between American Urological Association Symptom Index, Prostate Volume, and Disease-Specific Quality of Life Question in Patients with Benign Prostatic Hyperplasia. Kaohsiung J Med Sci 2004; 20:273-8. [PMID: 15253468 DOI: 10.1016/s1607-551x(09)70118-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The American Urological Association (AUA) symptom index is both valid and reliable in identifying the need to treat patients with benign prostatic hyperplasia (BPH) and in monitoring their response to therapy. We evaluated the relationships between AUA symptom index, disease-specific quality of life question, and prostate volume in patients with BPH. A total of 100 patients who came to Kaohsiung Medical University Hospital, Taiwan, for help due to lower urinary tract symptoms (LUTS) and who were diagnosed with BPH between October 2002 and June 2003 were included in the study. All patients were evaluated using transrectal ultrasonography, AUA symptom index, and disease-specific quality of life question. The disease-specific quality of life question showed good correlation with AUA symptom score (r = 0.815, p < 0.01), but weak correlation with prostate volume (r = 0.225, p < 0.05) and age (r = 0.274, p < 0.05). Prostate volume had weak correlation with AUA symptom score (r = 0.251, p < 0.05) and age (r = 0.472, p < 0.01), but good correlation with prostate specific antigen (r = 0.638, p < 0.01). In addition to AUA symptom index, we suggest using the disease-specific quality of life question to evaluate the influence on quality of life and response to treatment in clinical practice. Moreover, we should assess the impact of BPH symptoms rather than the increase in prostate volume during the management of BPH.
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Affiliation(s)
- Chia-Chu Liu
- Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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Yano M, Kitahara S, Yasuda K, Yamanishi T, Nakai H, Yanagisawa R, Morozumi M, Homma Y. A pilot study evaluating a new questionnaire for prostatic symptom scoring, the SPSS, and its sensitivity as constructed to objective measures of outflow obstruction. Int J Urol 2004; 11:288-94. [PMID: 15147544 DOI: 10.1111/j.1442-2042.2004.00796.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the extent to which our newly developed questionnaire, the Saitama Prostate Symptom Score (SPSS), for prostatic symptom scoring reflects objective findings in benign prostatic hyperplasia (clinical BPH) and to compare it with the International Prostate Symptom Score (IPSS) with regard to diagnostic sensitivity in clinical BPH. METHODS In this study, both the SPSS and the IPSS were self-administered by patients. Free uroflowmetry, a pressure-flow study and the measurement of prostatic volume were carried out. RESULTS There was no significant correlation between the results of the IPSS questionnaire and the urethral obstruction grade estimated by Schaefer or Abrams-Griffiths nomograms. The total score of the SPSS was correlated with these nomograms (P = 0.0487 and P = 0.0413, respectively). There was no significant correlation between the results of the IPSS questionnaire and the total volume or transition zone volume of the prostate, whereas the total score of the SPSS correlated with the total volume of the gland and transition zone volume (P = 0.0044 and P= 0.0051, respectively). CONCLUSION This study revealed the SPSS to correlate with objective findings satisfactorily. However, there are still several aspects of the SPSS which need to be improved upon, and the questionnaire should be studied in larger numbers of patients suffering from lower urinary tract symptoms.
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Affiliation(s)
- Masataka Yano
- Department of Urology, Dokkyo University School of Medicine, Koshigaya Hospital, Koshigaya City, Japan
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21
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Scarpero HM, Fiske J, Xue X, Nitti VW. American Urological Association Symptom Index for lower urinary tract symptoms in women: correlation with degree of bother and impact on quality of life. Urology 2003; 61:1118-22. [PMID: 12809877 DOI: 10.1016/s0090-4295(03)00037-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine first whether the American Urological Association Symptom Index (AUASI) correlates with the degree of bother caused by lower urinary tract symptoms (LUTS) in women and whether the association varies with a woman's age and continent status; and second, whether the AUASI and degree of bother caused by symptoms correlate with a woman's quality of life (QOL) and whether the association varies with a woman's age and continent status. LUTS occur in women and may produce significant bother and affect their QOL. The AUASI has been used to evaluate LUTS in female patients; however, its correlation with the degree of bother and QOL has not been clearly established in women. METHODS The charts of 1232 women who completed the AUASI, as well as the Symptom Problem Index and global QOL question, were reviewed. Spearman's rank order correlation was computed to assess the correlation between the AUASI and Symptom Problem Index. It was also computed after stratifying the women's age and continence status (continent versus incontinent). A linear regression model was applied, with the AUASI and Symptom Problem Index as the response variables and QOL as the continuous explanatory variable. RESULTS The mean age was 54.6 years. Six hundred women (49%) were incontinent. Spearman's rank order showed a strong correlation between symptoms and problems caused by symptoms (0.858, P <0.0001). The correlation existed throughout various age groups and was independent of coexisting incontinence. The symptoms correlated with QOL in a similar pattern. CONCLUSIONS The AUASI accurately described LUTS in women and, as with men, is a good indicator of the degree of bother and affect on QOL.
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Affiliation(s)
- Harriette M Scarpero
- Department of Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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22
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FILLING AND VOIDING SYMPTOMS IN THE AMERICAN UROLOGICAL ASSOCIATION SYMPTOM INDEX: THE VALUE OF THEIR DISTINCTION IN A VETERANS AFFAIRS RANDOMIZED TRIAL OF MEDICAL THERAPY IN MEN WITH A CLINICAL DIAGNOSIS OF BENIGN PROSTATIC HYPERPLASIA. J Urol 2000. [DOI: 10.1097/00005392-200011000-00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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BARRY MICHAELJ, WILLIFORD WILLIAMO, FOWLER FLOYDJ, JONES KARENM, LEPOR HERBERT. FILLING AND VOIDING SYMPTOMS IN THE AMERICAN UROLOGICAL ASSOCIATION SYMPTOM INDEX: THE VALUE OF THEIR DISTINCTION IN A VETERANS AFFAIRS RANDOMIZED TRIAL OF MEDICAL THERAPY IN MEN WITH A CLINICAL DIAGNOSIS OF BENIGN PROSTATIC HYPERPLASIA. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67028-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- MICHAEL J. BARRY
- From the Medical Practices Evaluation Center, Massachusetts General Hospital and Center for Survey Research, University of Massachusetts-Boston, Boston, Massachusetts, Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, and Veterans Affairs Medical Center and New York University Medical Center, New York, New York
| | - WILLIAM O. WILLIFORD
- From the Medical Practices Evaluation Center, Massachusetts General Hospital and Center for Survey Research, University of Massachusetts-Boston, Boston, Massachusetts, Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, and Veterans Affairs Medical Center and New York University Medical Center, New York, New York
| | - FLOYD J. FOWLER
- From the Medical Practices Evaluation Center, Massachusetts General Hospital and Center for Survey Research, University of Massachusetts-Boston, Boston, Massachusetts, Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, and Veterans Affairs Medical Center and New York University Medical Center, New York, New York
| | - KAREN M. JONES
- From the Medical Practices Evaluation Center, Massachusetts General Hospital and Center for Survey Research, University of Massachusetts-Boston, Boston, Massachusetts, Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, and Veterans Affairs Medical Center and New York University Medical Center, New York, New York
| | - HERBERT LEPOR
- From the Medical Practices Evaluation Center, Massachusetts General Hospital and Center for Survey Research, University of Massachusetts-Boston, Boston, Massachusetts, Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, and Veterans Affairs Medical Center and New York University Medical Center, New York, New York
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24
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STEELE GRAEMES, SULLIVAN MARYROSEP, SLEEP DARRYLJ, YALLA SUBBARAOV. COMBINATION OF SYMPTOM SCORE, FLOW RATE AND PROSTATE VOLUME FOR PREDICTING BLADDER OUTFLOW OBSTRUCTION IN MEN WITH LOWER URINARY TRACT SYMPTOMS. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67356-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- GRAEME S. STEELE
- From the Divisions of Urology, Brigham and Women’s Hospital, Boston and West Roxbury Veterans Affairs Medical Center, West Roxbury, Massachusetts
| | - MARYROSE P. SULLIVAN
- From the Divisions of Urology, Brigham and Women’s Hospital, Boston and West Roxbury Veterans Affairs Medical Center, West Roxbury, Massachusetts
| | - DARRYL J. SLEEP
- From the Divisions of Urology, Brigham and Women’s Hospital, Boston and West Roxbury Veterans Affairs Medical Center, West Roxbury, Massachusetts
| | - SUBBARAO V. YALLA
- From the Divisions of Urology, Brigham and Women’s Hospital, Boston and West Roxbury Veterans Affairs Medical Center, West Roxbury, Massachusetts
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25
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COMBINATION OF SYMPTOM SCORE, FLOW RATE AND PROSTATE VOLUME FOR PREDICTING BLADDER OUTFLOW OBSTRUCTION IN MEN WITH LOWER URINARY TRACT SYMPTOMS. J Urol 2000. [DOI: 10.1097/00005392-200008000-00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Pannek J, Berges RR, Haupt G, Senge T. Value of the Danish Prostate Symptom Score compared to the AUA symptom score and pressure/flow studies in the preoperative evaluation of men with symptomatic benign prostatic hyperplasia. Neurourol Urodyn 2000; 17:9-18. [PMID: 9453687 DOI: 10.1002/(sici)1520-6777(1998)17:1<9::aid-nau3>3.0.co;2-h] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Danish Prostate Symptom Score (DAN-PSS) is a new questionnaire for the assessment of lower tract urinary symptoms (LUTS), which claims to be able to predict bladder outlet obstruction. We evaluated the ability of the DAN-PSS to assess LUTS, to predict obstruction, and to predict treatment outcome in men with symptomatic uncomplicated BPH. Twenty-five consecutive men with symptomatic uncomplicated BPH filled in the AUA symptom score and the DAN-PSS and underwent uroflowmetry and pressure-flow studies prior to transurethral prostatic resection (TURP). Patients were reevaluated 4 days and 8 months after surgery. AUA score and DAN-PSS both assessed LUTS and were sensitive to symptom changes after therapy. Compared to pressure/flow studies, neither score correlated with bladder outlet obstruction. Peak urinary flow, however, correlated significantly with obstruction. None of the diagnostic tools used was able to improve patient selection for surgical treatment. The DAN-PSS is a valid and sensitive questionnaire for the assessment of LUTS. It is not able, however, to predict bladder outlet obstruction. In men with uncomplicated BPH, urodynamic evaluation of bladder outlet obstruction did not improve the subjective outcome of TURP.
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Affiliation(s)
- J Pannek
- Department of Urology, Ruhr-Universität Bochum, Herne, Germany
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27
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Höfner K, Tubaro A, de la Rosette JJ, Carter SS. Analysis of outcome after thermotherapy using different classifications of bladder outlet obstruction. Neurourol Urodyn 2000; 17:109-20. [PMID: 9514143 DOI: 10.1002/(sici)1520-6777(1998)17:2<109::aid-nau4>3.0.co;2-h] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The urodynamic profiles of 97 patients with benign prostatic hyperplasia undergoing low-energy transurethral microwave thermotherapy (TUMT) for lower urinary tract symptoms were analysed using the Abrams/Griffiths nomogram, the urethral resistance algorithm, the linPURR, Schäfer nomogram, and the CHESS classification. A significant clinical response was seen for the whole group, as shown by changes in symptom score, free flow rate, and residual urine. The best symptomatic response was identified in patients in whom obstruction was present, whatever the classification used. Only the two-dimensional CHESS classification was found to predict a group of patients with a better response in both symptoms and objective variables. Obviously, a better response from TUMT can only be predicted by a classification system that identifies the independent variables of footpoint and slope of the PURR. The CHESS classification was the only one of those studied that satisfactorily identified these two parameters and could be used as a system of case selection for this minimally invasive treatment.
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Affiliation(s)
- K Höfner
- Department of Urology, Hannover Medical School, Germany
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28
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MORPHOLOGICAL AND MORPHOMETRIC ANALYSIS OF HUMAN DETRUSOR MITOCHONDRIA WITH URODYNAMIC CORRELATION AFTER PARTIAL BLADDER OUTLET OBSTRUCTION. J Urol 2000. [DOI: 10.1097/00005392-200001000-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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LU SHINGHWA, WEI YAUHUEI, CHANG LUKES, LIN ALEXT, CHEN KUANGKUO, YANG ANHANG. MORPHOLOGICAL AND MORPHOMETRIC ANALYSIS OF HUMAN DETRUSOR MITOCHONDRIA WITH URODYNAMIC CORRELATION AFTER PARTIAL BLADDER OUTLET OBSTRUCTION. J Urol 2000. [DOI: 10.1016/s0022-5347(05)68011-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- SHING-HWA LU
- From the Divisions of Urology (Department of Surgery) and Ultrastructural and Molecular Pathology (Department of Pathology), Veterans General Hospital-Taipei Institute of Clinical Medicine, School of Medicine and Department of Biochemistry and Center for Cellular and Molecular Biology, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - YAU-HUEI WEI
- From the Divisions of Urology (Department of Surgery) and Ultrastructural and Molecular Pathology (Department of Pathology), Veterans General Hospital-Taipei Institute of Clinical Medicine, School of Medicine and Department of Biochemistry and Center for Cellular and Molecular Biology, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - LUKE S. CHANG
- From the Divisions of Urology (Department of Surgery) and Ultrastructural and Molecular Pathology (Department of Pathology), Veterans General Hospital-Taipei Institute of Clinical Medicine, School of Medicine and Department of Biochemistry and Center for Cellular and Molecular Biology, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - ALEX T.L. LIN
- From the Divisions of Urology (Department of Surgery) and Ultrastructural and Molecular Pathology (Department of Pathology), Veterans General Hospital-Taipei Institute of Clinical Medicine, School of Medicine and Department of Biochemistry and Center for Cellular and Molecular Biology, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - KUANG-KUO CHEN
- From the Divisions of Urology (Department of Surgery) and Ultrastructural and Molecular Pathology (Department of Pathology), Veterans General Hospital-Taipei Institute of Clinical Medicine, School of Medicine and Department of Biochemistry and Center for Cellular and Molecular Biology, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - AN-HANG YANG
- From the Divisions of Urology (Department of Surgery) and Ultrastructural and Molecular Pathology (Department of Pathology), Veterans General Hospital-Taipei Institute of Clinical Medicine, School of Medicine and Department of Biochemistry and Center for Cellular and Molecular Biology, National Yang-Ming University, Taipei, Taiwan, Republic of China
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30
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Ameda K, Sullivan MP, Bae RJ, Yalla SV. Urodynamic characterization of nonobstructive voiding dysfunction in symptomatic elderly men. J Urol 1999; 162:142-6. [PMID: 10379758 DOI: 10.1097/00005392-199907000-00035] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The pathogenesis of lower urinary tract symptoms in men without bladder outlet obstruction has not been well characterized. Therefore, we defined the urodynamic abnormalities associated with symptomatic nonobstructive voiding dysfunction, and determined the relationship between age and type of dysfunction. MATERIALS AND METHODS Video urodynamic studies of symptomatic men without outlet obstruction were examined. The criterion for a normal bladder outlet was a pressure gradient across the prostatic urethra of 5 cm. water or less in the absence of distal stricture. A maximum isometric contraction pressure less than 60 cm. water was regarded as impaired detrusor contractility. Detrusor instability was defined as involuntary detrusor contractions during filling or the inability to suppress a detrusor contraction after initiation of flow. Patients were categorized into 4 groups based on the urodynamic findings. RESULTS Of 193 men (mean age 69.6+/-10.5 years) 40.9% had detrusor instability (group 1), 31.1% had impaired contractility (group 2), 10.8% had detrusor instability and impaired contractility (group 3), and 17.1% were urodynamically normal (group 4). Average patient age was significantly lower in group 4 than all other groups. Bladder capacity was lowest in group 1, and group 3 had the lowest voiding efficiency. Maximum flow rate, bladder compliance and symptom scores were not different among the 4 groups. The prevalence of detrusor instability with and without impaired contractility increased, while the proportion of patients without urodynamic abnormalities decreased with age. Bladder contractility did not correlate with age. CONCLUSIONS The nonobstructed patient population comprises several groups that are functionally distinct while symptomatically similar. Thus, treatment of nonobstructed cases based on symptoms may lead to inappropriate pharmacological therapy and unsuccessful clinical outcomes.
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Affiliation(s)
- K Ameda
- Division of Urology, Surgical Service, Brockton and West Roxbury Veterans Affairs Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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31
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Frankel SJ, Donovan JL, Peters TI, Abrams P, Dabhoiwala NF, Osawa D, Lin AT. Sexual dysfunction in men with lower urinary tract symptoms. J Clin Epidemiol 1998; 51:677-85. [PMID: 9743316 DOI: 10.1016/s0895-4356(98)00044-4] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The conventional view that sexual function is not adversely affected by lower urinary tract symptoms (LUTS), assumed to be caused by enlargement secondary to benign prostatic hyperplasia (BPH), was investigated in this study of 423 men aged 40 years and over in a community population in the UK and 1271 urology clinic attenders aged 45 years and over in 12 countries, using the ICSmale and ICSsex questionnaires. Sexual dysfunction was found to be common: in the community, age standardized prevalences of reduced rigidity of erections were 53%, reduced ejaculation 47%, and pain on ejaculation 5%; in clinic men, age standardized prevalences of reduced rigidity of erections were 60%, reduced ejaculation 62%, and pain on ejaculation 17%. Sex lives were reported to be spoiled by LUTS in 8% of community men and 46% in the clinic. There were negative trends for age in the extent to which clinic men were bothered by these symptoms, although older men were still very concerned. Significantly raised odds ratios of sexual dysfunction were found in those with LUTS, especially storage symptoms associated with incontinence. Urinary flow rates were not associated with sexual symptoms. Sexual dysfunction is, therefore, strongly associated with LUTS, is a matter of concern to the men affected, and should be taken into account when managing patients with LUTS.
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Affiliation(s)
- S J Frankel
- Department of Social Medicine, University of Bristol, United Kingdom.
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32
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AMEDA KANAME, STEELE GRAEMES, SULLIVAN MARYROSEP, STEMBER DORON, YALLA SUBBARAOV. DETRUSOR CONTRACTION DURATION AS A URODYNAMIC PARAMETER OF BLADDER OUTLET OBSTRUCTION FOR EVALUATING MEN WITH LOWER URINARY TRACT SYMPTOMS. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62930-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- KANAME AMEDA
- Division of Urology, Surgical Service, Brockton/West Roxbury Department of Veterans Affairs Medical Center, Harvard Medical School, Boston, Massachusetts
| | - GRAEME S. STEELE
- Division of Urology, Surgical Service, Brockton/West Roxbury Department of Veterans Affairs Medical Center, Harvard Medical School, Boston, Massachusetts
| | - MARYROSE P. SULLIVAN
- Division of Urology, Surgical Service, Brockton/West Roxbury Department of Veterans Affairs Medical Center, Harvard Medical School, Boston, Massachusetts
| | - DORON STEMBER
- Division of Urology, Surgical Service, Brockton/West Roxbury Department of Veterans Affairs Medical Center, Harvard Medical School, Boston, Massachusetts
| | - SUBBARAO V. YALLA
- Division of Urology, Surgical Service, Brockton/West Roxbury Department of Veterans Affairs Medical Center, Harvard Medical School, Boston, Massachusetts
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33
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DETRUSOR CONTRACTION DURATION AS A URODYNAMIC PARAMETER OF BLADDER OUTLET OBSTRUCTION FOR EVALUATING MEN WITH LOWER URINARY TRACT SYMPTOMS. J Urol 1998. [DOI: 10.1097/00005392-199808000-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Elbadawi A. Voiding dysfunction in benign prostatic hyperplasia: trends, controversies and recent revelations. I. Symptoms and urodynamics. Urology 1998; 51:62-72. [PMID: 9610560 DOI: 10.1016/s0090-4295(98)00070-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A Elbadawi
- State University of New York, Health Science Center, Department of Pathology, Syracuse 13210, USA
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Elbadawi A. Voiding dysfunction in benign prostatic hyperplasia: trends, controversies and recent revelations. II. Pathology and pathophysiology. Urology 1998; 51:73-82. [PMID: 9610561 DOI: 10.1016/s0090-4295(98)00069-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A Elbadawi
- State University of New York, Health Science Center, Department of Pathology, Syracuse 13210, USA
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Lepor H. The pathophysiology of lower urinary tract symptoms in the ageing male population. BRITISH JOURNAL OF UROLOGY 1998; 81 Suppl 1:29-33. [PMID: 9589015 DOI: 10.1046/j.1464-410x.1998.0810s1029.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- H Lepor
- Department of Urology, New York University Medical Center, NY, USA
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Madersbacher S, Pycha A, Schatzl G, Mian C, Klingler CH, Marberger M. The aging lower urinary tract: a comparative urodynamic study of men and women. Urology 1998; 51:206-12. [PMID: 9495699 DOI: 10.1016/s0090-4295(97)00616-x] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The fact that aging women report similar voiding symptoms as age-matched men prompted us to compare age-related changes of urodynamic parameters in both sexes. METHODS Four hundred thirty-six patients (253 men and 183 women) 40 years of age or older underwent the following investigations: free uroflowmetry, measurement of postvoid residual volume, and full urodynamic testing, including a pressure-flow study (pQs). Additional investigations were a urethral pressure profile in women and quantification of prostate volume by transrectal ultrasonography in men. All men were referred for lower urinary tract symptoms suspicious of bladder outflow obstruction and women predominantly for urinary incontinence. Patients with previous surgery of the lower urinary tract (prostate, bladder, urethra) and those taking medication with a major effect on voiding function (alpha-receptor blockers, 5 alpha-reductase inhibitors, anticholinergic agents) were excluded. RESULTS The mean +/- standard deviation (SD) age in the female (f) population (n = 183) was 59 +/- 16 years (range 40 to 93), in the male population (m) (n = 253) 67 +/- 9 years (range 40 to 90). In both sexes, we observed a statistically significant increase of postvoid residual volume (f: P = 0.0001; m: P = 0.02) and a decrease of peak flow rate (f: P = 0.019; m: P = 0.014), average flow rate (f: P = 0.007; m: P = 0.04), voided volume (f: P = 0.007; m: P = 0.002), and bladder capacity determined by urodynamics (f: P = 0.003; m: P = 0.0004) with progressing age. In both sexes, there were no age-related changes (P >0.05), demonstrable for maximum detrusor pressure and detrusor pressure at peak flow rate. In women, there was a significant decrease of functional urethral length (P = 0.012) and maximum urethral closing pressure (P = 0.0001) with higher age; in men, the prostate volume increased significantly with age (P = 0.0001). With respect to detrusor instability, we observed an increase in men from 23.4% (40 to 60 years) to 46.7% (more than 80 years) (P = 0.004), whereas in women no significant age-related changes were present (P >0.05). CONCLUSIONS These data show that age-associated urodynamic changes in both sexes are comparable for a number of parameters. They provide an explanation for the fact that aging women report comparable voiding symptoms as men and suggest a primary, non-sex-specific aging process of the urinary bladder.
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Ichiyanagi O, Ishigooka M, Hashimoto T, Hayani S, Suzuki Y, Nakada T. The American Urological Association Symptom Index: early postoperative evaluation of irritative and obstructive symptoms due to benign prostatic hyperplasia. Int Urol Nephrol 1997; 29:441-7. [PMID: 9406002 DOI: 10.1007/bf02551111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In order to evaluate the acute effects of two different treatments on changes in the American Urological Association symptom score, we divided 23 men with benign prostatic hyperplasia into 2 groups. Group 1 (n = 16) and group 2 (n = 7) were treated with transurethral resection of the prostate and visual laser ablation of the prostate, respectively. Twice before and about 1 week after surgery, patients completed the AUA symptom questionnaire and underwent urodynamic evaluation. The symptom indexes were subcategorized as obstructive and irritative symptoms. All symptom scores were identical in groups 1 and 2 preoperatively. Postoperatively, significant improvement was found in obstructive scores, the total score, maximum and average flow rates only in group 1. This outcome is probably the reflection of an essential dissmilarity in both therapies. Clinically, the obstructive subscore appears reactive to changes in obstruction and seems meaningful in follow-up even in the early postoperative days.
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Affiliation(s)
- O Ichiyanagi
- Department of Urology, School of Medicine, Yamagata University, Japan
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Voiding Dysfunction Following Transurethral Resection of the Prostate: Symptoms and Urodynamic Findings. J Urol 1997. [DOI: 10.1016/s0022-5347(01)65214-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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41
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Significant Correlation of the American Urological Association Symptom Score and a Novel Urodynamic Parameter. J Urol 1996. [DOI: 10.1097/00005392-199611000-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gerber GS. The role of urodynamic study in the evaluation and management of men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology 1996; 48:668-75. [PMID: 8911507 DOI: 10.1016/s0090-4295(96)00249-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G S Gerber
- Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois, USA
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Kaplan SA, Reis RB. Significant Correlation of the American Urological Association Symptom Score and a Novel Urodynamic Parameter: Detrusor Contraction Duration. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65479-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Steven A. Kaplan
- Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Rodolfo B. Reis
- Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York
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45
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Madersbacher S, Klingler HC, Schatzl G, Stulnig T, Schmidbauer CP, Marberger M. Age Related Urodynamic Changes in Patients with Benign Prostatic Hyperplasia. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65478-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Stephan Madersbacher
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
| | - H. Christoph Klingler
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
| | - Georg Schatzl
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
| | - Thomas Stulnig
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
| | | | - Michael Marberger
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
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Editorial. J Urol 1996. [DOI: 10.1097/00005392-199609000-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jonas U, Höfner K. Symptom scores, watchful waiting and prostate specific antigen levels in benign prostatic hyperplasia. J Urol 1996; 156:1040-1. [PMID: 8709303 DOI: 10.1016/s0022-5347(01)65695-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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48
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The American Urological Association Symptom Score in the Evaluation of Men With Lower Urinary Tract Symptoms. J Urol 1996. [DOI: 10.1097/00005392-199606000-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The American Urological Association Symptom Score in the Evaluation of Men With Lower Urinary Tract Symptoms: at 2 years of followup, does it work? J Urol 1996. [DOI: 10.1016/s0022-5347(01)66064-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sirls LT, Kirkemo AK, Jay J. Lack of correlation of the American Urological Association Symptom 7 Index with urodynamic bladder outlet obstruction. Neurourol Urodyn 1996; 15:447-56; discussion 457. [PMID: 8857613 DOI: 10.1002/(sici)1520-6777(1996)15:5<447::aid-nau2>3.0.co;2-f] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The objective of this study is to assess whether subjective information from the American Urological Association (AUA) Symptom 7 Index correlates with or predicts objective urodynamic parameters of bladder outlet obstruction. Seventy-five men, mean age 67 years (range 42-85 years), were referred for evaluation of "prostatism." Evaluation consisted of the AUA Symptom 7 Index, noninvasive uroflow, post-void residual (PVR) urine measurement, and pressure-flow analysis. Men were categorized as "obstructed," "equivocal," or "unobstructed" according to pressure-flow nomogram of Abrams and Griffiths. The total AUA 7 score, and all individual components, were compared with all invasive urodynamic parameters, and to the pressure-flow categories of obstructed, equivocal, or unobstructed. The AUA index severity categories (mild 0-7, moderate 8-19, and severe > or = 20) were compared to the urodynamic pressure flow categories. Thirty-three men had severe symptoms, and 42 had moderate or mild symptoms. Forty men were urodynamically obstructed, and 35 men were equivocal or unobstructed. There was no correlation of any AUA index parameter (total symptom score, obstructive or irritative score component, or any individual question) with any noninvasive urodynamic parameter. The sensitivity and specificity of the AUA index for urodynamic obstruction was 42.5% and 54.3% respectively. Multivariable logistic regression analysis was used to determine whether clinical data easily obtained in the office setting (age, PVR, noninvasive maximum and average flow rates) could predict urodynamic obstruction when combined with any component of the AUA index. Only age was found to be a significant predictor of obstruction status (P = 0.026). Subjective information from the AUA Symptom 7 Index does not correlate with objective data assessing bladder outlet obstruction. Though the AUA index is a valid clinical tool, it should not be used to gauge the presence or severity of bladder outlet obstruction.
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Affiliation(s)
- L T Sirls
- Department of Urology, Henry Ford Hospital, Detroit, Michigan 48202, USA
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