1
|
Qin Z, Guo J, Chen H, Wu J. Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A GRADE-assessed Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 46:55-67. [PMID: 36506258 PMCID: PMC9732484 DOI: 10.1016/j.euros.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
Context Acupuncture is a promising therapy for relieving symptoms in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), which affects 9-16% of adult men worldwide. Objective This study aims to explore the efficacy and safety of acupuncture for CP/CPPS. Evidence acquisition Nine electronic databases were searched. Only randomized controlled trials were included. Two reviewers extracted data and assessed the risk of bias of trials using the revised Cochrane risk-of-bias (RoB 2.0) tool. Stata 17.0 was used to analyze the data. Evidence synthesis Twelve trials were included. The results of a meta-analysis showed that acupuncture had larger effect sizes (standardized mean difference [SMD] = -1.20, confidence interval or CI [-1.69, -0.71], acupuncture compared with sham acupuncture; SMD = -1.01, CI [-1.63, -0.38], acupuncture compared with medication; SMD = -0.91, CI [-1.29, -0.54], acupuncture plus medication compared with medication) in reducing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score. In decreasing NIH-CPSI pain domain score, acupuncture also led to larger effect sizes (SMD = -0.94, CI [-1.18, -0.70], acupuncture compared with sham acupuncture; SMD = -1.04, CI [-1.29, -0.79], acupuncture compared with medication; SMD = -0.85, CI [-1.23, -0.48], acupuncture plus medication compared with medication), whereas the effect sizes in the reduction of NIH-CPSI urinary domain and quality of life domain scores were medium. Compared with sham acupuncture and medication, acupuncture appears to be more effective in improving the global response rate. Results from four trials indicated that acupuncture was better than sham acupuncture in decreasing the International Prostate Symptom Score. No serious adverse effects were found in the acupuncture treatment. Conclusions Current evidence supports acupuncture as an effective treatment for CP/CPPS-induced symptoms, particularly in relieving pain. Comprehensive acupuncture treatment according to individual symptoms should be considered in future clinical practice and trials for CP/CPPS. Patient summary In this study, we further verified the efficacy of acupuncture in patients with chronic prostatitis/chronic pelvic pain syndrome, especially in reducing pain.
Collapse
Affiliation(s)
- Zongshi Qin
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jianbo Guo
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Haiyong Chen
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Corresponding authors. Guang’anmen Hospital, China Academy of Chinese Medical Science, 5 Beixian’ge Street, Xicheng, Beijing, China. Tel.: +86 010 88001413 (J. Wu); School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, China. Tel.: +852 39176413 (H. Chen).
| | - Jiani Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Corresponding authors. Guang’anmen Hospital, China Academy of Chinese Medical Science, 5 Beixian’ge Street, Xicheng, Beijing, China. Tel.: +86 010 88001413 (J. Wu); School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, China. Tel.: +852 39176413 (H. Chen).
| |
Collapse
|
2
|
Yao MW, Green JSA. How international is the International Prostate Symptom Score? A literature review of validated translations of the IPSS, the most widely used self-administered patient questionnaire for male lower urinary tract symptoms. Low Urin Tract Symptoms 2021; 14:92-101. [PMID: 34734477 DOI: 10.1111/luts.12415] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The International Prostate Symptom Score (IPSS) approaches its 30th anniversary. This ubiquitous clinical assessment tool is a standard in the assessment and research of lower urinary tract symptoms in men. The authors explore its history, development, and subsequent dissemination through validated translations across the world. An estimated global coverage is calculated and mapped according to language population. METHODS Embase and Medline literature searches were performed, with further hand searches of grey literature and online resources. Twenty-two abstracts and journal articles validating language translations of the IPSS were reviewed in full and tabulated. Language population data were gathered from an official database and mapped. RESULTS The IPSS is available in 53 languages. Twenty-seven languages have statistically or clinically validated translations for use in male patients. This corresponds to a conservative estimate of global population coverage of approximately 2.3 billion men, or 60% of the worldwide male population. Translation methodology involves forward and back translation. Statistical validation is performed with control patients. Cronbach's alpha is used for internal consistency, and Spearman's coefficient (p) or Pearson's coefficient (r) for test-retest reliability. Issues such as the emergence of altered versions deviating from original validated translations and translation difficulties due to cultural differences are observed. Further translational work is needed to validate versions of the IPSS in languages of the developing world. CONCLUSIONS The IPSS is the most prevalent patient-administered questionnaire used in urology across the world. There is no other clinical tool seen to have similar coverage. This paper aims to provide a roadmap for future clinical tools to acquire a similar level of translation and dissemination.
Collapse
Affiliation(s)
- Mark W Yao
- Department of Urology, Kent And Canterbury Hospital, East Kent University NHS Foundation Trust, Canterbury, UK
| | - James S A Green
- Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
3
|
Omran A, Leca BM, Oštarijaš E, Graham N, Da Silva AS, Zaïr ZM, Miras AD, le Roux CW, Vincent RP, Cardozo L, Dimitriadis GK. Metabolic syndrome is associated with prostate enlargement: a systematic review, meta-analysis, and meta-regression on patients with lower urinary tract symptom factors. Ther Adv Endocrinol Metab 2021; 12:20420188211066210. [PMID: 34900218 PMCID: PMC8664322 DOI: 10.1177/20420188211066210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is defined by at least three of the following five criteria: blood pressure ⩾130/85 mmHg, fasting blood glucose ⩾5.6 mmol/l, triglycerides concentration ⩾1.7 mmol/l, waist circumference ⩾102 cm (for men), and high-density lipoprotein cholesterol concentration <1.03 mmol/l (for men). MetS has been associated with worse lower urinary tract symptoms (LUTS) and higher International Prostate Symptom questionnaire scores. MATERIALS AND METHODS MEDLINE, Cochrane, ClinicalTrials.gov, and SCOPUS were critically appraised for all peer-reviewed manuscripts that suitably fulfilled our protocol's inclusion criteria established a priori. Meta-analytical and meta-regression calculations were performed in R using the Sidik-Jonkman and Hartung-Knapp random effects model and predefined covariates. RESULTS A total of 70 studies (n = 90,206) were included in qualitative synthesis. From these, 60 studies focused on MetS and LUTS: 44 reported positive correlations, 5 reported negative correlations, 11 reported no association, and 10 studies focused on MetS and total prostate volume (TPV). MetS positively correlated with moderate LUTS [odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.35-1.80], severe LUTS (OR = 2.35, 95% CI = 1.82-3.03), overactive bladder (OAB; OR = 3.2, 95% CI = 1.6-5.8), and nocturia severity (OR = 2.509, 95% CI = 1.571-4.007) at multivariate analysis. A total of 30 studies (n = 22,206) were included in meta-analysis; MetS was significantly associated with higher TPV (mean differences = 4.4450 ml, 95% CI = 2.0177-6.8723), but no significant predictive factors for effect sizes were discovered. CONCLUSION Our meta-analysis demonstrates a significant association between the aggravating effects of MetS, which commonly coexists with obesity and benign prostate enlargement.
Collapse
Affiliation(s)
| | | | - Eduard Oštarijaš
- Institute for Translational Medicine, University of Pecs Medical School, Pecs, Hungary
| | - Natasha Graham
- Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital, London, UK
| | - Ana Sofia Da Silva
- Department of Urogynaecology, King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Alexander D. Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Carel W. le Roux
- Diabetes Complication Research Centre, School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Royce P. Vincent
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King’s College London, London, UKDepartment of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King’s College Hospital NHS Foundation Trust, London, UK
| | | |
Collapse
|
4
|
Booth L, Skelton DA, Hagen S, Booth J. Identifying the most reliable and valid bladder health screening tool: a systematic review. Disabil Rehabil 2019; 42:2451-2470. [PMID: 30696291 DOI: 10.1080/09638288.2018.1561953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose: Lower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement. This systematic review aimed to identify the most valid and reliable brief screening tool for these symptoms or bladder problems, to incorporate into a health promotion programme for older adults to facilitate discussion about self-management.Method: Review eligibility criteria included studies published between 1990 and November 2018, reporting the validity, reliability and/or acceptability of bladder health screening tools. Six electronic databases were searched.Results: Twenty-two studies were included. Three screening tools met the criteria: International Prostate Symptom Score (IPSS); International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form; Bladder Control Self-Assessment Questionnaire (B-SAQ). Test-retest reliability for total scores of the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form was acceptable. All three questionnaires showed evidence of acceptable levels of internal consistency and of convergent validity.Conclusion: Having favourable psychometric scores compared to the B-SAQ and for ease of use and trustworthiness of a simple questionnaire, the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form met the criteria for recommendation for raising awareness and bladder health promoting interventions to reduce associated disability.Implications for RehabilitationLower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement.Lower urinary tract symptoms can be prevented or improved through self-management strategies.Help-seeking levels for lower urinary tract symptoms is low but could be improved through continence promotion interventions.The International Prostate Symptom Score and the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form are bladder health screening questionnaires which would be appropriate to use as part of a continence promotion intervention to help prompt discussions and raise awareness and subsequently improve symptoms and associated disability.
Collapse
Affiliation(s)
- Lorna Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Joanne Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
5
|
The International Prostate Symptom Score (IPSS) Is an Inadequate Tool to Screen for Urethral Stricture Recurrence After Anterior Urethroplasty. Urology 2016; 95:197-201. [PMID: 27109599 DOI: 10.1016/j.urology.2016.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To validate the use of the International Prostate Symptom Score (IPSS) as a stand-alone tool to detect urethral stricture recurrence following urethroplasty. MATERIALS AND METHODS This study included 393 men who had undergone anterior urethroplasty and were enrolled in a multi-institutional outcomes study. Data analyzed included pre- and post-operative answers to the IPSS in addition to findings from a same- day cystoscopy. IPSS from men found to have cystoscopic recurrence were then compared to scores from those with successful repairs, and receiver operating characteristic curves were plotted to illustrate the predictive ability of these questions to screen for cystoscopic recurrence. RESULTS Mean postoperative scores were lower (fewer symptoms) in successful repairs; IPSS improved from preoperative values regardless of recurrence. Successful repairs had significantly better degree of improvement in question #5 (assessing weak stream) compared to recurrences. Receiver operating characteristic curves demonstrated the highest area under the curve for the IPSS quality of life question (0.66) that alone outperformed the complete IPSS questionnaire (0.56). CONCLUSION The IPSS had inadequate sensitivity and specificity to be used as a stand-alone screening tool for stricture recurrence in this large cohort of men, highlighting the need to continue development of a disease-specific, validated patient-reported outcome measure.
Collapse
|
6
|
Raleigh DR, Chang AJ, Tomlin B, Cunha JA, Braunstein SE, Shinohara K, Gottschalk AR, Roach M, Hsu IC. Patient- and treatment-specific predictors of genitourinary function after high-dose-rate monotherapy for favorable prostate cancer. Brachytherapy 2015. [DOI: 10.1016/j.brachy.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Rush S, Alibhai SMH, Xu L, Xu W, Louis AS, Matthew AG, Nesbitt M, Finelli A, Fleshner NE, Hamilton RJ, Kulkarni G, Zlotta A, Jewett MAS, Trachtenberg J. Health-related quality of life in robotic versus open radical prostatectomy. Can Urol Assoc J 2015. [PMID: 26225166 DOI: 10.5489/cuaj.2618] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It is unclear whether health-related quality of life (HRQoL) outcomes are superior in robot-assisted radical prostatectomy (RARP) compared to open prostatectomy (ORP). METHODS We retrospectively analyzed records from men who received ORP or RARP at our institution between January 2009 and December 2012. Patients completed a demographics questionnaire and the Patient-Oriented Prostate Utility Scale (PORPUS), a validated disease-specific HRQoL instrument prior to surgery and every 3 months up to 15 months after surgery. RESULTS In total, 974 men met the inclusion criteria (643 ORP and 331 RARP patients). At baseline, RARP patients were significantly younger (p < 0.001), had lower body mass index (BMI) (p < 0.001), lower preoperative prostate-specific antigen (PSA) (p < 0.001), fewer comorbidities (p < 0.004), and higher baseline PORPUS scores (p = 0.024). On follow-up, unadjusted PORPUS scores were significantly higher in the RARP group at each point. On multivariable analysis adjusting for age, ORP versus RARP procedure, Gleason score, BMI, first PSA, comorbidity, ethnicity, and baseline PORPUS scores, PORPUS score was higher for the RARP group at 3 months (p = 0.038) and 9 months (p = 0.037), but not at 6, 12, and 15 months (p = 0.014). No difference met pre-defined thresholds of clinical significant. CONCLUSIONS Though unadjusted HRQoL outcomes appeared improved with RARP compared to ORP differences, adjusted differences were seen at only 2 of 5 postoperative time points, and did not meet pre-defined thresholds of clinical significance. Further randomized trials are needed to assess whether one treatment option provides consistently better HRQoL outcomes.
Collapse
Affiliation(s)
- Stacy Rush
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network and the Department of Medicine, University of Toronto, Toronto, ON
| | - Lizhen Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - Alyssa S Louis
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - Andrew G Matthew
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON; ; Department of Surgical Oncology and Psychosocial Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery and Psychiatry, University of Toronto, Toronto, ON
| | - Michael Nesbitt
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - Antonio Finelli
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - Neil E Fleshner
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - Robert J Hamilton
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - Girish Kulkarni
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - Alexandre Zlotta
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - Michael A S Jewett
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| | - John Trachtenberg
- Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON
| |
Collapse
|
8
|
Hedelin H, Jonsson K, Lundh D. Pain associated with the chronic pelvic pain syndrome is strongly related to the ambient temperature. ACTA ACUST UNITED AC 2012; 46:279-83. [DOI: 10.3109/00365599.2012.669404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hans Hedelin
- Department of Research and Development, Skaraborgs Sjukhus, and School of Communication and Informatics, University of Skövde,
Skövde, Sweden
| | - Karin Jonsson
- Department of Research and Development, Skaraborgs Sjukhus, and School of Communication and Informatics, University of Skövde,
Skövde, Sweden
| | - Dan Lundh
- Department of Research and Development, Skaraborgs Sjukhus, and School of Communication and Informatics, University of Skövde,
Skövde, Sweden
| |
Collapse
|
9
|
Park KK, Lee SH, Kim YJ, Choi YD, Mah SY. Association between urinary hesitancy symptoms and uroflowmetry measured urinary hesitancy time in men with lower urinary tract symptoms. Neurourol Urodyn 2011; 30:578-82. [PMID: 21351126 DOI: 10.1002/nau.21001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 07/27/2010] [Indexed: 11/06/2022]
Abstract
AIMS In patients with urinary hesitancy, the standard time of urinary hesitancy has not been established. Accordingly, we have analyzed the association between urinary hesitancy and various uroflowmetric finding in the present study. METHODS Between April 2009 and September 2009, 163 consecutive male subjects with lower urinary tract symptoms (LUTS) were prospectively enrolled. Individuals with a taking any medications known to affect bladder function were excluded. To measure time to voiding (T2V), 1 ml of water was poured into the uroflowmeter funnel of immediately after the subjects pulled down their undergarments. This step was employed to compensate for the intrinsic disadvantage of the uroflowmeter, which works at the beginning of urination. After urination is completed, subjects were asked whether they experienced any urinary hesitancy at that time. Subjects also completed an IPSS questionnaire. RESULTS Mean patient age was 60.1 years, and 81 of a total of 163 patients reported experiencing urinary hesitancy. The optimal cut-off value for T2V was found to be 11.5 sec among individuals with voiding volumes greater than 150 ml (AUC = 0.919). A correlation was also found between the score of question #6 on the IPSS questionnaire and the presence of urinary hesitancy during urology clinic visits (r = 0.26, P < 0.01). CONCLUSIONS In men with LUTS, T2V is an effective uroflometric parameter to demonstrate urinary hesitancy. Accordingly, we contend that 11.5 sec of hesitancy is an optimal cut-off time to distinguish the presence of urinary hesitancy in voided volume of greater than 150 ml.
Collapse
Affiliation(s)
- Kyung Kgi Park
- Department of Urology, Yonsei University Health System, Urological Science Institute, Seoul, Korea
| | | | | | | | | |
Collapse
|
10
|
Watanabe T, Maruyama S, Maruyama Y, Kageyama S, Shinbo H, Otsuka A, Ozono S. Seasonal changes in symptom score and uroflowmetry in patients with lower urinary tract symptoms. ACTA ACUST UNITED AC 2009; 41:521-6. [PMID: 17853015 DOI: 10.1080/00365590701485921] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether subjective or objective seasonal changes occur in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS A total of 31 patients with LUTS were observed for >5 years. Their International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), voided volume (VV) a nd post-void residual (PVR) we re measured every month. RESULTS Total IPSS, QOL, VV or PVR did not show any seasonal changes between the three seasons: summer (hot season: June to September); winter (cold season: December to March); and spring and fall (comfortable season: April, May, October and November). Furthermore, when the IPSS was examined by dividing it into storage symptoms (frequency, urgency and nocturia) and voiding symptoms (incomplete emptying, intermittency, weak stream and straining), no significant seasonal changes were detected. Only Qmax showed a significant seasonal change, being higher in both the cold season (median 10.4 ml/s) and the comfortable season (median 10.1 ml/s) than in the hot season (median 9.4 ml/s). CONCLUSIONS It has generally been thought that LUTS worsen in winter. Our results indicate that the IPSS and the QOL score remain nearly constant if they are determined regularly over an extended period of time. Qmax may however be influenced by seasonal changes in temperature.
Collapse
|
11
|
Keyes M, Miller S, Moravan V, Pickles T, Liu M, Spadinger I, Lapointe V, Morris WJ. Urinary symptom flare in 712 125I prostate brachytherapy patients: long-term follow-up. Int J Radiat Oncol Biol Phys 2009; 75:649-55. [PMID: 19211199 DOI: 10.1016/j.ijrobp.2008.11.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 11/25/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the late transient worsening of urinary symptoms ("urinary symptom flare") in 712 consecutive prostate brachytherapy patients, associated predictive factors, association with rectal and urinary toxicity, and the development of erectile dysfunction. METHODS AND MATERIALS Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). International Prostate Symptom Score (IPSS), Radiation Therapy Oncology Group (RTOG) toxicity, and erectile function data were prospectively collected. Flare was defined as an increase in IPSS of > or =5 and of > or =8 points greater than the post-treatment nadir. The relationships between the occurrence of flare and the patient, tumor, and treatment characteristics were examined. The Cox proportional hazards method was used to test individual variables and the multivariate models. RESULTS The incidence of flare was 52% and 30% using the flare definition of an IPSS of > or =5 and > or =8 points greater than the postimplant nadir, respectively. Of the patients with symptoms, 65% had resolution of their symptoms within 6 months and 91% within 1 year. Flares most commonly occurred 16-24 months after implantation. On multivariate analysis, a greater baseline IPSS and greater maximal postimplant IPSS were the predictors of flare, regardless of the flare definition used. Androgen suppression was a predictor for fewer flares (IPSS > or =5). Diabetes and prostate edema predicted for more frequent flares (IPSS >/=8). Patients with flare had a greater incidence of RTOG Grade 3 urinary toxicity and RTOG Grade 2 or greater rectal toxicity. No association was found between erectile dysfunction and the occurrence of flare. CONCLUSION Urinary symptom flare is a common, transient phenomenon after prostate brachytherapy. A greater baseline IPSS and maximal postimplant IPSS were the strongest predictive factors. Flare was associated with a greater incidence of late RTOG Grade 3 urinary toxicity and greater rate of late RTOG Grade 2 or greater rectal toxicity.
Collapse
Affiliation(s)
- Mira Keyes
- Department of Surgery, University of British Columbia, Provincial Prostate Brachytherapy Program, British Columbia Cancer Agency, 600 W. 10th Avenue, Vancouver, BC, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Perrin P, Némoz C, Paparel P, Ruffion A. Comparaison de l’IPSS et de l’ICS male SF dans le bilan initial des troubles urinaires. Prog Urol 2008; 18:519-26. [DOI: 10.1016/j.purol.2008.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 03/29/2008] [Indexed: 10/22/2022]
|
13
|
Crook J, Fleshner N, Roberts C, Pond G. Long-term urinary sequelae following 125iodine prostate brachytherapy. J Urol 2007; 179:141-5; discussion 146. [PMID: 17997424 DOI: 10.1016/j.juro.2007.08.136] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Indexed: 11/27/2022]
Abstract
PURPOSE We describe long-term urinary function in men treated with 125iodine brachytherapy without supplemental beam irradiation. MATERIALS AND METHODS A total of 484 men with favorable risk prostate cancer received 125I prostate brachytherapy with a followup ranging from 12 to 93 months (median 41). Prior hormonal therapy (2 to 6 months) was used in 14% of patients to reduce prostate size. Urinary function was assessed before implant by the International Prostate Symptom Score and a voiding study, and in followup by International Prostate Symptom Score. Urinary retention and catheterization, urgency and urge incontinence, persistently increased International Prostate Symptom Score, stricture, and the need for surgical intervention are reported. RESULTS Beyond 1 year 73.3% of men had no significant urinary sequelae. A flare in the International Prostate Symptom Score to greater than 15 and at least 5 points above baseline occurred in 23%, lasting a median of 3 months. Symptoms of retention requiring catheterization or surgical intervention were seen in 3.4% (1.7% stricture, 0.4% transurethral resection of the prostate, 2.7% catheter). Of the 13 men requiring catheterization at any time after 1 year, 5 (1% of total) remain dependent on clean intermittent catheterization. Median duration of catheter use for those with resolution is 4.5 months. Moderate to severe urinary urgency occurred in 6.4% of patients but it was unresponsive to anticholinergics in only 0.8%. CONCLUSIONS In this group 27% of men experienced late urinary morbidity following 125I prostate brachytherapy. Rates may vary according to technique and selection factors. The majority responded well to medical or surgical intervention, with 0.8% persistent urgency, and 1% catheter dependence.
Collapse
Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
14
|
Yap TL, Cromwell DA, Brown C, van der Meulen J, Emberton M. The Relationship between Objective Frequency–Volume Chart Data and the I-PSS in Men with Lower Urinary Tract Symptoms. Eur Urol 2007; 52:811-8. [PMID: 17276583 DOI: 10.1016/j.eururo.2007.01.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Accepted: 01/04/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The International Prostate Symptom Score (I-PSS) is considered a benchmark in defining the severity of lower urinary tract symptoms (LUTS). However, its relationship with variables of the frequency-volume (FV) chart, an objective measure of LUTS, is not well understood. We analyzed this relationship between the I-PSS and FV chart variables in men with LUTS. METHODS Patients referred for the investigation of uncomplicated LUTS completed an I-PSS and a 3-d FV chart. Correlation coefficients were used to describe the relationship between total I-PSS and its components with the FV variables. The distributions of FV variable scores within the categories of I-PSS severity were also examined. The effect of patient's quality of life score on I-PSS and FV variables was analyzed using regression. RESULTS A total of 104 patients completed both the I-PSS and FV chart. The association between FV variables and I-PSS scores was generally weak, with 24-h frequency being the strongest (r = 0.43) and with considerable overlap within each severity category. There was weak association between the I-PSS for nocturia and urgency and their FV counterparts. The number of self-reported nocturnal voids tended to be overestimated. These discrepancies were partly explained by the patient's quality of life rating, which reduced the level of variation between I-PSS score and FV variables and accounted for some of the overestimation. CONCLUSION Weak associations were found between the self-rated I-PSS scores and FV measures of voiding, suggesting that the accurate assessment of LUTS requires self-reported measures of symptoms and objective measures of voiding behaviour. Significant differences between the two types of data might be explained by perceived quality of life.
Collapse
Affiliation(s)
- Tet L Yap
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
| | | | | | | | | |
Collapse
|
15
|
Abstract
Instruments designed to assess the severity of lower urinary tract symptoms have become a routine component of the diagnostic evaluation of men with benign prostatic hyperplasia (BPH). Several validated tools have been developed to this end, including the International Prostate Symptom Score, which is used most commonly today. Despite attempts to correlate symptom score severity with commonly measured objective parameters of BPH, no clear relationships have been found. The reason for this is likely multifactorial and suggests a complex relationship among subjective and objective variables. However, symptom scores show a good correlation with the patient's perception of quality of life and degree of bother. This is critical because the decision to treat should be largely based on these subjective variables. Moreover, symptom scores have been shown to represent a meaningful endpoint in assessing treatment response in clinical studies.
Collapse
Affiliation(s)
- A Christopher Stage
- Division of Urology, University of Texas Health Sciences Center, Houston, TX 77030, USA
| | | |
Collapse
|
16
|
Naderi N, Mochtar CA, de la Rosette JJMCH. Real life practice in the management of benign prostatic hyperplasia. Curr Opin Urol 2004; 14:41-4. [PMID: 15091049 DOI: 10.1097/00042307-200401000-00009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To review the current diagnostic and treatment options of lower urinary tract symptom due to benign prostatic hyperplasia and to put data from real life practice into perspective. RECENT FINDINGS The overall incidence rate of lower urinary tract symptom/benign prostatic hyperplasia was found at 15 per 1000 man-years (95% CI 14.8-16.1). The incidence increases with age from 3/1000 man-years at 45-49 years to 38/1000 man-years at 75-79 years. Recent diagnostic studies include the use of PSA to estimate prostate volume and its predictive value for the long-term risk of prostate enlargement. Variability of the International Prostate Symptom Score when filled at home and in the hospital is discussed. The first-line treatment option remains medical therapy. The most prescribed alpha-blockers are terazosin, alfuzosin, and tamsulosin, which are comparable in efficacy. The efficacy of finasteride is also confirmed, especially for enlarged prostates with the possibility of volume reduction up to 30%. Interventional therapy begins when there is evidence of moderate to severe symptoms. Long term results put transurethral microwave thermotherapy in advantage over other minimally invasive modalities. Surgical treatment remains the procedure with the best results. Open prostatectomy is still indicated for severely enlarged prostates. Transurethral resection for medium-sized prostates and bladder-neck incision for small prostates also remain the best option. SUMMARY Real life practice studies in the last few years have broadened our insight into the application of different diagnostic and treatment modalities. Since results from randomized controlled trials can not always be extrapolated to daily urological practice, real life practice studies made data available to complement data from randomized controlled trials.
Collapse
Affiliation(s)
- Nader Naderi
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands0
| | | | | |
Collapse
|