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Costa Silva A, Pina-Vaz T, Morgado A, Martins-Silva C, Antunes-Lopes T, Alturas Silva J. Prevalence of non-neurogenic male lower urinary tract symptoms after kidney transplantation. BJU Int 2024. [PMID: 38520403 DOI: 10.1111/bju.16347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
OBJECTIVE This review investigates the prevalence of male non-neurogenic lower urinary tract symptoms (LUTS) after renal transplant, as kidney transplantation is a transformative intervention for patients with end-stage renal disease significantly enhancing quality of life that might be diminished by LUTS. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A systematic search in the PubMed and Scopus databases was performed using specific terms. Inclusion criteria considered male kidney transplant recipients, analysing outcomes in English-language studies. Discrepancies were resolved by consultation. RESULTS Among 18 studies involving 29 086 recipients, the prevalence of non-neurogenic LUTS ranged from 5.8% to 33.0%. Studies predominantly used the International Prostate Symptom Score for evaluation. Surgical interventions, mostly for benign prostatic obstruction, ranged from 2.5% to 20.0%. Voiding and post-micturition symptoms were under-represented. CONCLUSION This review found varied non-neurogenic LUTS prevalence and characteristics in male kidney transplant recipients, emphasising the need for standardised assessments, prospective studies, and improved understanding of LUTS mechanisms. Enhanced knowledge can guide interventions, additionally benefiting recipient quality of life.
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Affiliation(s)
- Alberto Costa Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Teresa Pina-Vaz
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Afonso Morgado
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carlos Martins-Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago Antunes-Lopes
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Alturas Silva
- Urology Department, University Hospital Center of São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Filomena GB, Gentile BC, Albanesi L, Bellavia F, D'Ascenzo R, Vermiglio M, Ghahhari J, Riolo S, Lombardo R, Giulianelli R. Long-Term Outcomes Following Bipolar Transurethral Plasma Enucleation of the Prostate: 10-Year Follow-Up. J Endourol 2023; 37:811-816. [PMID: 37218445 DOI: 10.1089/end.2022.0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background and Purpose: The aim of our study is to assess the long-term outcomes and safety of bipolar transurethral plasma enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) in a single-center cohort study. Our focus is to evaluate the impact on outcomes after 10 years of follow-up (FUP) in terms of recurrence, LUTS, and patients' quality of life after B-TUEP in prostates between 30 and 80 cc. Materials and Methods: Between May 2010 and December 2011, all consecutive patients with benign prostatic hyperplasia undergoing B-TUEP were prospectively enrolled in our study. Data on patients' history, physical examination, prostate volumes, erectile function, prostate-specific antigen levels, International Prostate Symptoms Score (IPSS), and uroflowmetry were collected at 0, 1, 3, 6, 12, 24, 36, 60, and 120 months. Early and long-term complications were recorded. Results: A total of 50 consecutive patients underwent B-TUEP in our facility, all performed by a single surgeon (R.G.). Twelve patients were excluded during the 10 years. No patients had persistent bladder outlet obstruction (BOO) requiring reoperation. In terms of results, the improvement in IPSS was sustained throughout 5 years, and the mean difference from baseline at 5 years was 17 points, with similar results at 10 years. Erectile function was also slightly improved after surgery and maintained for the next 5 years, with a slight age-related decrease at 10 years. Furthermore, the improvements in maximum urine flow rate (Qmax) were maintained at 5 years, with a mean improvement of 16 mL/s, while at 10 years, it settled on a mean improvement from baseline of 12 mL/s. Conclusions: In our 10 years' experience, B-TUEP is a safe and highly effective technique for relieving BOO, with excellent outcomes and no recurrence at 10 years of FUP. Further multicenter studies should confirm our results.
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Affiliation(s)
- Giovanni Battista Filomena
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, "Università Cattolica del Sacro Cuore," Rome, Italy
| | | | | | - Fabrizio Bellavia
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, "Università Cattolica del Sacro Cuore," Rome, Italy
| | | | | | | | - Sara Riolo
- Department of Urology, Sant'Andrea Hospital, "La Sapienza" University, Roma, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, "La Sapienza" University, Roma, Italy
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Dawson BC. Assessment and management of lower urinary tract symptoms in men. Nurs Stand 2023; 38:e11996. [PMID: 36970750 DOI: 10.7748/ns.2023.e11996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 06/18/2023]
Abstract
Lower urinary tract symptoms (LUTS) is a broad term that covers a range of urinary issues, which are often categorised as storage and voiding symptoms. Storage symptoms include increased frequency, nocturia, urgency and urge incontinence, while voiding symptoms include hesitancy, suboptimal flow, dribbling and incomplete emptying. In men, the most common causes of LUTS are benign prostatic hyperplasia (prostate enlargement) and overactive bladder. This article provides an overview of the anatomy of the prostate and outlines the assessment process for men presenting with LUTS. It also explains the recommended lifestyle modifications, medicines and surgical interventions available to male patients who are experiencing these symptoms.
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Elsakka H, Ibrahim A, Khogeer A, Elatreisy A, Elabbady R, Shalkamy O, Khan A, Sadri I, AlShammari A, Khalifa A, Carrier S, Aube-Peterkin M. Evaluation of urodynamic pattern in short and long-standing diabetic patients. Arch Ital Urol Androl 2023; 95:11072. [PMID: 36924376 DOI: 10.4081/aiua.2023.11072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 03/14/2023] Open
Abstract
PURPOSE To address the pattern of urodynamic findings in diabetic patients with lower urinary tract symptoms (LUTS), comparing short-standing and long-standing type 2 diabetes mellitus (T2DM). METHODS A prospective study was conducted on 50 patients presenting with LUTS and a concurrent diagnosis of T2DM, between February 2016 and May 2018. Patients were classified and evaluated according to the duration of diabetes into two groups: short-standing DM (< 15 years, n = 31), and long-standing DM (≥ 15 years, n = 19) groups. The impact of LUTS and quality of life were assessed in female patients using ICIQ-FLUTS and male patients using ICIQ-MLUTS. RESULTS A total of 50 patients were included in the study. The mean duration of T2DM was 10 ± 0.7 years. The mean age was 56.3 ± 1.2 years, and the mean HbA1c was 7.5 ± 1.2%. Urodynamic evaluation detected significantly higher detrusor overactivity (DO) and increased bladder sensation with the short-standing DM group (35.5 vs. 15.8%, p = 0.01 and 32.3 vs. 5.3%, p = 0.01, respectively). Comparatively, weak, or absent detrusor contractility were more frequent in patients with long-standing DM (52% and 26% respectively p = 0.01). As expected, overflow incontinence and straining during voiding were significantly higher in the long-standing DM group (p = 0.04 and p = 0.03, respectively). Surprisingly, there was no significant correlation between patients presenting with urgency in their voiding diary (subjective) and urodynamic detection of DO (p = 0.07). CONCLUSIONS There are different patterns in urodynamic characterizations of T2DM. Patients with short-standing DM present more commonly with storage symptoms and detrusor overactivity on urodynamics. Contrastingly, patients with long-standing DM present more frequently with voiding symptoms and detrusor underactivity on urodynamics. Thus, screening for an underactive bladder is advisable in patients with long-standing T2DM.
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Affiliation(s)
- Haytham Elsakka
- Urology Department, East Lancashire Hospitals NHS trust, Balckburn, Lancashire.
| | - Ahmed Ibrahim
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
| | - Abdulghani Khogeer
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC; Department of Surgery, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Adel Elatreisy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Rawan Elabbady
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
| | - Osama Shalkamy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Ayesha Khan
- Urology Department, East Lancashire Hospitals NHS trust, Balckburn, Lancashire.
| | - Iman Sadri
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
| | - Ahmad AlShammari
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
| | - Ahmad Khalifa
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
| | - Serge Carrier
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
| | - Melanie Aube-Peterkin
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
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Guzelsoy M, Erkan A, Ozturk M, Zengin S, Coban S, Turkoglu AR, Koc A. Comparison of three questionnaire forms used in the diagnosis of lower urinary tract symptoms: A prospective study. Prostate Int 2022; 10:218-223. [PMID: 36570650 PMCID: PMC9747591 DOI: 10.1016/j.prnil.2022.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose Questionnaire forms (QFs) are used in the evaluation of all patients presenting with lower urinary tract symptoms (LUTSs). Our study aims to investigate the compatibility of the three QFs with each other and to investigate the relationship between education level and complete completion of these forms. Materials and methods A total of 224 patients between February 2018 and February 2019 were included. The patients were divided into 3 groups as primary, intermediate, and advanced according to their education level and the patients who gave incomplete answers to the questions were determined. Results The mean age of the patients was 61.0 ± 7.57(45-85), International Prostate Symptom Score (IPSS) value was 16.2 ± 8.3(1-35), the international incontinence form-male lower urinary tract symptoms (ICIQ-MLUTS) value was 16.5 ± 7.9(0-38), the visual prostate symptom score (VPSS) value was 9.9 ± 3.0(3-16). There was a significant correlation between the three QFs (P < 0.05). The correlation between IPSS and ICIQ-MLUTS was strong (r = 0.745). The incomplete response rate was 32.1% (n = 72) in ICIQ-MLUTS, 16.5% (n = 37) in VPSS, and 10.7% (n = 24) in IPSS (P < 0.05). The incomplete response rate was not affected by education. The rate of patients who could be questioned with ICIQ-MLUTS but not with the other two QFs varied between 12.9% and 85.2%, depending on the symptoms. Conclusions Each QF has its advantages and disadvantages. The strong correlation between IPSS and ICIQ-MLUTS found in our study indicates that these tools can be used interchangeably in daily clinical practice. ICIQ-MLUTS can evaluate symptoms that are not present in other QFs. In the evaluation of illiterate patients, VPSS should be used without any alternative.
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Affiliation(s)
- Muhammet Guzelsoy
- Corresponding author. Department of Urology, Bursa Yuksek Ihtisas Education and Research Hospital, University of Health Sciences, Mimar Sinan Mah, Emniyet Cad, Polis Okulu karsisi No:35, 16310 Yildirim, Bursa, Turkey.
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Renoncourt T, Saint F, Bennis Y, Mondet L, Bloch F. Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons. J Am Med Dir Assoc 2022; 23:992-997. [PMID: 34653381 DOI: 10.1016/j.jamda.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven. DESIGN This was a descriptive study of drug prescriptions in a geriatric academic center. SETTING AND PARTICIPANTS We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital. METHODS We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. RESULTS A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P = .026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P = .005) or arrhythmia (P = .028), and experienced more falls in their history (P = .043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P = .039, 95% confidence interval 1.08-10.2). CONCLUSIONS AND IMPLICATIONS In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls.
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Affiliation(s)
- Thomas Renoncourt
- Department of Geriatric Medicine, CHU Amiens-Picardie, Amiens, France.
| | - Fabien Saint
- Department of Urology and Transplantation, CHU Amiens-Picardie, Amiens, France; EPROAD Laboratory EA 4669, Picardie Jules Verne University, Amiens, France
| | - Youssef Bennis
- Department of Pharmacology, CHU Amiens-Picardie, Amiens, France
| | - Lisa Mondet
- Department of Pharmacology, CHU Amiens-Picardie, Amiens, France
| | - Frédéric Bloch
- Department of Geriatric Medicine, CHU Amiens-Picardie, Amiens, France
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Guo J, Tang R. Efficacy and tolerability of doxazosin gastro-intestinal therapeutic system versus tamsulosin in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26955. [PMID: 34414962 PMCID: PMC8376339 DOI: 10.1097/md.0000000000026955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Alpha1-adrenoceptor antagonists (α1-blockers) are first-line drugs for the treatment of lower urinary tract symptoms associated with benign prostate hyperplasia (BPH). Doxazosin gastrointestinal therapeutic system (GITS) and tamsulosin belong to the 2 most frequently prescribed α1-blockers. This systematic review and meta-analysis was performed to compare the efficacy and tolerability of these 2 α1-blockers. METHODS A systematic review of published randomized controlled trials in English or Chinese language was performed using the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and Vip databases. After data extraction and quality assessment, the meta-analysis was performed to compare clinical parameters (International Prostate Symptom Score [IPSS] total [IPSS-T], storage [IPSS-S], voiding [IPSS-V], maximum urine flow [Qmax], and postvoid residual) and adverse events (AEs) that changed after first drug intake. RESULTS After the screening, 8 eligible randomized controlled trials with 1316 patients were identified. Doxazosin-GITS showed a significantly higher efficacy compared with tamsulosin (IPSS-T P < .001, IPSS-S P < .001, and IPSS-V P < .001). There were no significant differences between the 2 drugs for changes in Qmax (P = .477) or postvoid residual (P = .739). The overall AEs were significantly lower in the doxazosin-GITS group (risk ratio: 0.77; 95% CI: 0.54-1.08; P = .036). However, dizziness (P = .387), headache (P = .745), asthenia (P = .693), postural hypotension (P = .114), and retrograde ejaculation (P = .187) were similar between the 2 groups. CONCLUSIONS This meta-analysis indicates that doxazosin-GITS has significantly higher efficacy and lower AEs than tamsulosin in patients with lower urinary tract symptoms/benign prostate hyperplasia.
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Affiliation(s)
- Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong Tang
- Viatris Pharmaceuticals Co., Ltd, Shanghai, China
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Salvador Hidalgo D, Bernardello Ureta M, Sbriglio M, García Gámez A, Sampere Moragas J, Areal Calama J, Ágreda Castañeda F. Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery. Actas Urol Esp 2021; 45:481-485. [PMID: 34326030 DOI: 10.1016/j.acuroe.2021.06.008] [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: 12/08/2020] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Benign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment. MATERIAL AND METHODS Retrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure. RESULTS A total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90 mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100 mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%). CONCLUSION PAE is a safe and effective treatment for patients with permanent urinary catheterization who are ineligible for surgical treatment.
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Affiliation(s)
| | | | - M Sbriglio
- Servicio de Urología, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - A García Gámez
- Servicio de Radiología Intervencionista, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J Sampere Moragas
- Servicio de Radiología Intervencionista, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J Areal Calama
- Servicio de Urología, Hospital Germans Trias i Pujol, Barcelona, Spain
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López-Ramos H, Latorre C, Patiño G, Arenas J. Guía de manejo Hiperplasia Prostática Benigna (SCU 2021). Rev Urol 2021. [DOI: 10.1055/s-0041-1731669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hugo López-Ramos
- Profesor y Jefe del Programa de Urología. Pontificia Universidad Javeriana. Hospital Universitario San Ignacio. Bogotá, Colombia
| | | | - Germán Patiño
- Urólogo. Unidad de Urología Reconstructiva. Hospital Universitario San Ignacio. Bogotí, Colombia
| | - Juliana Arenas
- Departamento de Urologia. Pontificia Universidad Javeriana. Hospital Universitario San Ignacio. Bogotá, Colombia
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Song G, Wang M, Chen B, Long G, Li H, Li R, Liu Z, Wei C, Wang T, Wang S, Liu J, Zhang Y, Liu X. Lower Urinary Tract Symptoms and Sexual Dysfunction in Male: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:653510. [PMID: 34124091 PMCID: PMC8193225 DOI: 10.3389/fmed.2021.653510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/10/2021] [Indexed: 01/10/2023] Open
Abstract
Background: An association between lower urinary tract symptoms (LUTS) and risk of sexual dysfunction in male remains controversial in recent decades. Materials and Methods: PubMed and Web of Science were searched up to October 28, 2020, for articles reporting the prevalence of sexual dysfunction in men with LUTS. The main outcomes were results from sexual dysfunction assessments. Pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) were calculated. The quality assessment of the included studies was performed by using The Newcastle-Ottawa Scale (NOS) or JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Results: A total of 24 full-manuscript papers met the inclusion criteria. The pooled OR for 21 studies suggested that patients with severer LUTS had a higher risk of sexual dysfunction (OR = 3.31, 95% CI: 2.43 to 4.49, p < 0.001, I 2 = 90%). A significant decrease in scores of assessment tools for sexual dysfunction was observed in the patients with higher severity of LUTS compared with those patients with lower severity (WMD = -5.49, 95%CI: -7.25 to -3.27, P < 0.001, I 2 = 96%). Similar outcomes were also found in subgroup analyses. In a detailed analysis of specific sexual function domains, the severity of LUTS was associated with erectile dysfunction, intercourse satisfaction, and overall satisfaction, except for sexual desire. Conclusion: The study demonstrates an association between exposure of lower urinary tract symptoms and risk of sexual dysfunction in male. Assessment of sexual function is necessary for patients with lower urinary tract symptoms. Systematic Review Registration: http://www.crd.york.ac.uk/prospero, identifier: CRD42020208747.
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Affiliation(s)
- Guoda Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Wang
- Department of Emergency and Intensive Care Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingliang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Wei
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatric, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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D'Agostino D, Colicchia M, Corsi P, Romagnoli D, Del Rosso A, Modonutti D, Busetto GM, Ferro M, Schiavina R, Molinaroli E, Artibani W, Porreca A. The combination of waterjet ablation (Aquabeam ®) and holmium laser power for treatment of symptomatic benign prostatic hyperplasia: early functional results. Cent European J Urol 2021; 74:222-228. [PMID: 34336242 PMCID: PMC8318024 DOI: 10.5173/ceju.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to assess the short-term functional outcomes and the efficacy of hemostasis performed with holmium laser performed following prostatic hydroablation with the Aquabeam® system. Material and methods Between June 2019 and July 2020, 53 consecutive patients underwent Aquabeam® with our modified hemostasis approach with holmium laser. The following standard preoperative assessments were retrospectively recorded: prostate volume; International Prostate Symptom Score (IPSS) and Quality of Life (IPSS-QoL); uroflowmetry including Qmax and post void residual volume (PVR). Results Fifty-three patients consecutively underwent aquablation and holmium laser hemostasis. Median age at surgery, median prostate-specific antigen (PSA) and median prostate volume were 62 years (IQR: 57-66), 2.95 ng/ml (IQR: 1.6-4.8) and 55 ml (IQR: 43-65), respectively.Median operative time was 60 minutes (IQR: 40-80). Median catheterization time and length of hospital stay were 2 days (IQR: 1-3) for both parameters. The median hemoglobin decrease between the preoperative values and those assessed on the second day was equal to 1.25 g/dl (IQR: 0.7-1.85).Continence rate was 100% at catheter removal. Thirty-six patients (72%) reported anterograde ejaculation preservation. IPSS (6, 3-21) and Qmax (19, 9-26) changed dramatically between baseline and 3 months follow-up. Conclusions The combination of Aquabeam® and holmium laser energy for hemostasis is a safe, reproducible technique to relieve moderate lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) while preserving ejaculation in younger and sexually active individuals. The short-term results showed a lower rate of complications; the encouraging functional results confirm that this can be a valid surgical approach for treatment of BPH.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Michele Colicchia
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Alessandro Del Rosso
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Daniele Modonutti
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | | | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Riccardo Schiavina
- Department of Urology, Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Enrico Molinaroli
- Department of Urology, Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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12
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Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery. Actas Urol Esp 2021. [PMID: 33992446 DOI: 10.1016/j.acuro.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Benign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment. MATERIAL AND METHODS Retrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure. RESULTS A total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%). CONCLUSION PAE is a safe and effective treatment for patients with permanent urinary catheterization who are ineligible for surgical treatment.
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13
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Kristensen MH, Elfeki H, Sinimäki S, Laurberg S, Emmertsen KJ. Urinary dysfunction after colorectal cancer treatment and impact on quality of life-a national cross-sectional study in males. Colorectal Dis 2021; 23:394-404. [PMID: 33524243 DOI: 10.1111/codi.15554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/08/2020] [Accepted: 01/23/2021] [Indexed: 01/10/2023]
Abstract
AIM Despite advances in the treatment of colorectal cancer, postoperative urogenital dysfunction is still a problem although its exact extent remains unclear. The aim of this study was to identify the prevalence and patterns of urinary dysfunction in men following treatment for colorectal cancer and the impact of urinary dysfunction on quality of life. METHOD A retrospective national Danish cross-sectional study was performed in patients treated for colorectal cancer between 2001 and 2014. Patients answered questionnaires on urinary function and quality of life including the International Consultation on Incontinence Modular Questionnaire-Male Lower Urinary Tract Symptoms measuring voiding and incontinence. Results were analysed based on data on demographics and treatment-related factors obtained from the Danish Colorectal Cancer Group database. RESULTS A total of 5710 patients responded to the questionnaire (response rate 52.8%). In both crude analysis and after adjusting for patient-related factors (age, time since surgery and American Society of Anesthesiologists score), both voiding (P < 0.0001) and incontinence scores (P < 0.0001) were significantly higher after rectal cancer than after colon cancer. In the rectal cancer group, abdominoperineal excision was found to be a significant risk factor for both voiding (P < 0.0001) and incontinence (P = 0.011), while radiotherapy only impaired continence (P = 0.014). Significant correlations between high voiding and incontinence scores and impaired quality of life were found in both groups. CONCLUSION We found a high prevalence of urinary dysfunction following treatment for colorectal cancer, especially in the rectal cancer group. Abdominoperineal excision was the most significant risk factor for both voiding and incontinence. Urinary dysfunction significantly impairs patients' quality of life.
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Affiliation(s)
| | - Hossam Elfeki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Saija Sinimäki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Katrine J Emmertsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Randers Regional Hospital, Randers, Denmark
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14
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Koupparis A, Mehmi A, Rava M, Kearley S, Aning J, Rowe E, Richardson S. Cycling and men’s health: A worldwide survey in association the Global Cycling Network. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820915389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This study aimed to examine the association between cycling and men’s health issues, including prostate cancer (CaP), erectile dysfunction (ED), chronic pelvic pain syndrome (CPPS) and lower urinary tract symptoms (LUTs). Methods: Information regarding CaP, ED, CPPS and LUTs were collected from 8074 male cyclists via a unique online men’s health and cycling video produced in conjunction with the Global Cycling Network (GCN) using validated questionnaires. Logistic regression analyses were used to evaluate any relationship between cycling and men’s health issues, including the effect of risk factors. Results: The GCN video received 619,105 views, and completed data were collected on 8074 male cyclists. Of these, 0.57% had a diagnosis of CaP, 14.5% described ED, 8.82 reported symptoms of CPPS and 12.5% reported LUTs. All reported symptoms were mild, and no correlation was found between cycling and CaP or ED on statistical analyses. Conclusions: This is the largest worldwide cross-section observational study on the association between cycling and men’s health. It demonstrates no negative association between cycling and CaP, ED, CPPS or LUTs. Level of evidence: Not applicable for this multicentre audit.
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15
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Giampaoli M, Bianchi L, D'agostino D, Corsi P, Romagnoli D, Mineo Bianchi F, Del Rosso A, Schiavina R, Brunocilla E, Artibani W, Porreca A. Can preoperative multiparametric MRI avoid unnecessary prostate biopsies before holmium laser enucleation of the prostate? Preliminary results of a multicentric cohort of patients. MINERVA UROL NEFROL 2019; 71:524-530. [PMID: 31166103 DOI: 10.23736/s0393-2249.19.03463-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) is a surgical technique that allows to safely and effectively treat bladder outlet obstruction due to benign prostate enlargement and retrieve an adequate surgical specimen. We investigated the role of multiparametric magnetic resonance imaging of the prostate (mpMRI) as a tool to exclude incidental prostate cancer (iPCa) and to compare mpMRI alone with a contextual transrectal ultrasound guided biopsy (TRUS-GB). METHODS Retrospective multicentric evaluation of 244 patients underwent to HoLEP with a suspicion of prostate cancer (PCa) due to raised PSA and/or abnormal digital rectal examination (DRE) and a negative mpMRI (PI-RADS score <3), was performed. Of these, 118 patients had only a negative mpMRI (MRI group) while 126 had a negative mpMRI and a contextual preoperative negative TRUS-GB (MRI + TRUS-GB group). Comparison between the two groups, univariate and multivariate analysis were conducted in order to identify any predictive factors of iPCa. RESULTS Median age, PSA, prostate volume and PSA density were 64.0 years (IQR: 58.0-69.0), 6.10 ng/mL (IQR: 4.76-9.65), 86.0 cc (IQR: 65.0-115.0), 50.0 cc (IQR: 37.5-80.0) and 0.08 ng/mL/cc (IQR: 0.06-0.10), respectively. In surgical specimen, iPCa was detected in 21 cases (8.8%). No statistically differences between MRI and MRI + TRUS-GB group were found in terms of iPCa (7.6% and 8.5%, respectively), pathological T stage and ISUP Grade Group. A contextual TRUS-GB added to mpMRI did not correlate to iPCa either at uni- and multivariate analysis while a significant correlation of a PSA density >0.15 ng/mL/cc was found only at univariate analysis. CONCLUSIONS Including a mpMRI in clinical evaluation of patients eligible to HoLEP with a preoperative PCa suspicion leads to low the rates of iPCa and might avoid unnecessary TRUS-GB.
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Affiliation(s)
- Marco Giampaoli
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy -
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Paolo Corsi
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Daniele Romagnoli
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | | | | | | | | | - Walter Artibani
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
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16
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Porreca A, Giampaoli M, Bianchi L, D'Agostino D, Romagnoli D, Bianchi FM, Rosso AD, Corsi P, Schiavina R, Artibani W, Brunocilla E. Preoperative multiparametric prostate magnetic resonance imaging: a safe clinical practice to reduce incidental prostate cancer in Holmium laser enucleation of the prostate. Cent European J Urol 2019; 72:106-112. [PMID: 31482016 PMCID: PMC6715077 DOI: 10.5173/ceju.2019.1943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/20/2019] [Accepted: 04/21/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Purpose of the study was to investigate the correlation of a preoperative multiparametric magnetic resonance imaging of the prostate (mpMRI) in patients with a suspicion of prostate cancer and eligible for Holmium Laser Enucleation of the Prostate (HoLEP). Material and methods Data of 228 patients who had undergone HoLEP was selected and retrospectively analyzed from a multicentric database. All patients presented with a raised serum PSA and/or an abnormal digital rectal examination (DRE). Prostate cancer (PCa) was excluded either with a negative mpMRI (group ‘NEGATIVE MRI’ n = 113) or a standard biopsy (group ‘NO MRI’ n = 115). Preoperative characteristic surgical and histological outcomes were confronted. A univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa). Results Both groups presented with no statistical differences in preoperative characteristics besides previous acute urinary retention rates and post-voided residual volume, found to be higher (27.8% vs. 14.2% and median 120cc vs. 80cc) in NO MRI and NEGATIVE MRI respectively. No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate. Statistically lower rate of iPCa (p = 0.03) was detected in the NEGATIVE MRI group (6.2%) in comparison with NO MRI group (14.8%). In multivariate logistic regression only presence of a preoperative negative mpMRI correlated (p = 0.04) as an independent predictive factor (OR 2.63; 95% CI: 1.02–6.75). Conclusions A negative mpMRI might be a useful tool to be included in a novel preoperative assessment to patients eligible for HoLEP with a suspicion of PCa in order to avoid an incidental PCa.
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Affiliation(s)
- Angelo Porreca
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Marco Giampaoli
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Lorenzo Bianchi
- University of Bologna, Department of Urology, Bologna, Italy
| | | | | | | | | | - Paolo Corsi
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | | | - Walter Artibani
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
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Huang W, Wang Q, Chen J, Wu P. Development and validation of the International Consultation on Incontinence Modular Questionnaire for Male Lower Urinary Tract Symptoms (ICIQ‐MLUTS) and the ICIQ‐MLUTS Long Form in Chinese population. Low Urin Tract Symptoms 2019; 11:189-194. [PMID: 30945458 DOI: 10.1111/luts.12260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/29/2019] [Accepted: 02/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Weina Huang
- Department of Urology, Nanfang HospitalSouthern Medical University Guangzhou China
| | - Qiang Wang
- Department of UrologyZhongshan First People's Hospital Zhongshan China
| | - Jiawei Chen
- Department of Urology, Nanfang HospitalSouthern Medical University Guangzhou China
| | - Peng Wu
- Department of Urology, Nanfang HospitalSouthern Medical University Guangzhou China
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18
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Nnabugwu II, Ugwumba FO, Udeh EI, Anyimba SK, Okolie LT. The relationship between prevalence and severity of lower urinary tract symptoms (LUTS), and body mass index and mid-abdominal circumference in men in a resource-poor community in Southeast Nigeria: a cross-sectional survey. BMC Urol 2019; 19:15. [PMID: 30791899 PMCID: PMC6385379 DOI: 10.1186/s12894-019-0444-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Abstract
Background There is paucity of information on the community-based prevalence and severity of lower urinary tract symptoms (LUTS) in men who are 40 years and older in the southeast region of Nigeria. This study seeks to determine the community-based prevalence of LUTS and the relationship between LUTS, and body mass index (BMI) and mid-abdominal circumference (MAC) in men. Methods An interviewer-administered, questionnaire-based survey. Three of nine settlement clusters were randomly selected while systematic random sampling of 1 in 3 eligible subjects was used to select participants. Analysis was done using SPSS® version 20. Results One thousand three hundred and nineteen duly completed questionnaires were analyzed. The respondents are within ages 40-92 years with mean age 54.2 ± 10.2 years, mean BMI 25.97 ± 4.18Kg/m2 and mean MAC 89.80 ± 12.43 cm. Overall prevalence of LUTS is 20.2%. Nocturia at a prevalence of 19.2% is the most prevalent lower urinary tract symptom and also the earliest to manifest. LUTS prevalence and severity increases with increasing age. About 9.6% report moderate LUTS while 2.3% report severe LUTS. Storage LUTS are reported more frequently than voiding LUTS. LUTS did not vary significantly with BMI, MAC or Wealth-Index. Conclusion LUTS prevalence and severity vary with age, but not with BMI, MAC or Wealth-Index.
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Affiliation(s)
- Ikenna I Nnabugwu
- Department of Surgery, College of Medicine, University of Nigeria Ituku-Ozalla, KM 20 Enugu-PortHarcourt Highway, Enugu, PMB 01129, Nigeria. .,Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Nigeria.
| | - Fredrick O Ugwumba
- Department of Surgery, College of Medicine, University of Nigeria Ituku-Ozalla, KM 20 Enugu-PortHarcourt Highway, Enugu, PMB 01129, Nigeria
| | - Emeka I Udeh
- Department of Surgery, College of Medicine, University of Nigeria Ituku-Ozalla, KM 20 Enugu-PortHarcourt Highway, Enugu, PMB 01129, Nigeria
| | - Solomon K Anyimba
- Department of Surgery, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria
| | - Louis T Okolie
- Department of Surgery, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria
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19
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De Nunzio C, Presicce F, Lombardo R, Trucchi A, Bellangino M, Tubaro A, Moja E. Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients' care - a systematic review. BMC Urol 2018; 18:62. [PMID: 29940928 PMCID: PMC6019782 DOI: 10.1186/s12894-018-0376-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/17/2018] [Indexed: 11/24/2022] Open
Abstract
Background Even though evidence based medicine, guidelines and algorithms still represent the pillars of the management of chronic diseases (i.e: hypertension, diabetes mellitus), a patient centred approach has been recently proposed as a successful strategy, in particular to improve drug adherence. Aim of the present review is to evaluate the unmet needs in LUTS/BPH management and the possible impact of a patient centered approach in this setting. Methods A National Center for Biotechnology Information (NCBI) PubMed search for relevant articles published from January 2000 until December 2016 was performed by combining the following MESH terms: patients centred medicine, patient centered care, person centered care, patient centered outcomes, value based care, shared decision making, male, Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, treatment. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). All studies reporting on patient centred approach, shared decision making and evidence-based medicine were included in the review. All original article, reviews, letters, congress abstracts, and editorials comments were included in the review. Studies reporting single case reports, experimental studies on animal models and studies not in English were not included in the review. Results Overall 751 abstracts were reviewed, out of them 87 full texts were analysed resulting in 36 papers included. The evidence summarised in this systematic review confirmed how a patient centred visit may improve patient’s adherence to medication. Although a patient centred model has been rarely used in urology, management of Low Urinary Tract Symptoms (LUTS) and Benign Prostatic Obstruction (BPO) may represent the perfect ground to experiment and improve this approach. Notwithstanding all the innovations in LUTS/BPO medical treatment, the real life picture is far from ideal. Conclusions Recent evidence shows a dramatical low drug adherence and satisfaction to medical treatment in LUTS/BPH patients. A patient centred approach may improve drug adherence and some unmet needs in this area, potentially reducing complications and costs. However further well designed studies are needed to confirm this data.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy.
| | - Fabrizio Presicce
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Alberto Trucchi
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Mariangela Bellangino
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Egidio Moja
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy.,CURA Centre, University of Milan, Milan, Italy
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20
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Gacci M, Sebastianelli A, Spatafora P, Corona G, Serni S, De Ridder D, Gravas S, Abrams P. Best practice in the management of storage symptoms in male lower urinary tract symptoms: a review of the evidence base. Ther Adv Urol 2017; 10:79-92. [PMID: 29434675 DOI: 10.1177/1756287217742837] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/16/2017] [Indexed: 01/28/2023] Open
Abstract
Storage lower urinary tract symptoms (LUTS) are characterized by an altered bladder sensation, increased daytime frequency, nocturia, urgency and urgency incontinence. Some evidence underlines the role of metabolic factors, pelvic ischemia, prostatic chronic inflammation and associated comorbidities in the pathophysiology of storage LUTS. A detailed evaluation of the severity of storage LUTS, and the concomitance of these symptoms with voiding and postmicturition symptoms, is mandatory for improving the diagnosis and personalizing treatment. A detailed medical history with comorbidities and associated risk factors, a physical examination, a comprehensive analysis of all the features of LUTS, including their impact on quality of life, and a frequency-volume chart (FVC) or bladder diary, are recommended for men with storage LUTS. Several drugs are available for the treatment of LUTS secondary to benign prostatic obstruction (BPO). Alpha-blockers (α-blockers), 5-α-reductase inhibitors and phosphodiesterase type 5 inhibitors are commonly used to manage storage LUTS occurring with voiding symptoms associated with BPO. Muscarinic receptor antagonists and Beta 3-agonists (β3-agonists) alone, or in combination with α-blockers, represent the gold standard of treatment in men with predominant storage LUTS. There is no specific recommendation regarding the best treatment options for storage LUTS after prostatic surgery.
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Affiliation(s)
- Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, AOUC, University of Florence, Largo Brambilla 3 - 50134 Florence
| | - Arcangelo Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Sergio Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Dirk De Ridder
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Stavros Gravas
- Department of Urology, University of Thessaly, Larissa, Greece
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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21
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Denys MA, Decalf V, Kumps C, Petrovic M, Goessaert AS, Everaert K. Pathophysiology of nocturnal lower urinary tract symptoms in older patients with urinary incontinence. Int J Urol 2017; 24:808-815. [DOI: 10.1111/iju.13431] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Veerle Decalf
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Candy Kumps
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Mirko Petrovic
- Department of Geriatrics; Ghent University Hospital; Ghent Belgium
| | | | - Karel Everaert
- Department of Urology; Ghent University Hospital; Ghent Belgium
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22
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Analysis of the Prevalence and Factors Associated with Nocturia in Adult Korean Men. Sci Rep 2017; 7:41714. [PMID: 28139743 PMCID: PMC5282484 DOI: 10.1038/srep41714] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/23/2016] [Indexed: 12/27/2022] Open
Abstract
This study investigated the prevalence of and factors associated with nocturia in Korean men. A total of 92,626 participants aged between 19 and 103 years from the 2011 Korean Community Health Survey (KCHS) were enrolled. Simple and multiple logistic regression analyses with complex sampling investigated participants’ personal health and socioeconomic and disease factors. The prevalence of nocturia ≥1 time and ≥2 times/night was 41.8% and 17.6%, respectively, and nocturia increased with age (1.44 [1.39–1.50] for each 10-year increase, P < 0.001). Lower income levels (lowest, 1.27 [1.19–1.36]; low-middle, 1.13 [1.07–1.19]; upper-middle, 1.00 [0.95–1.06], P = 0.022) and higher levels of stress (severe, 1.38 [1.23–1.55]; moderate, 1.23 [1.16–1.31]; some, 1.11 [1.05–1.16]) exhibited dose-dependent relationships with nocturia (≥1 time; P < 0.001). Low education level (1.27 [1.20–1.36]), long sleep duration (1.33 [1.18–1.50]), and type of occupation showed significant associations with nocturia (≥1 time; P < 0.001). Underweight (1.19 [1.05–1.34]), hypertension (1.09 [1.03–1.15]), diabetes mellitus (1.32 [1.23–1.41]), hyperlipidaemia (1.28 [1.20–1.35]), and cerebral stroke (1.63 [1.40–1.89]) were significantly related to nocturia (≥1 time; P < 0.001). Married men were less likely to experience nocturia ≥2 times per night (0.72 [0.64–0.82], P < 0.001).
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23
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Assessment and management of male lower urinary tract symptoms (LUTS). Int J Surg 2016; 25:164-71. [DOI: 10.1016/j.ijsu.2015.11.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/07/2015] [Accepted: 11/21/2015] [Indexed: 11/19/2022]
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Hur KJ, Lee KW, Kim SJ, Kim KS, Bae WJ, Cho HJ, Hong SH, Lee JY, Hwang TK, Kim SW. Changes in Nocturia and Lower Urinary Tract Symptoms after Radical Prostatectomy. World J Mens Health 2015; 33:194-201. [PMID: 26770940 PMCID: PMC4709436 DOI: 10.5534/wjmh.2015.33.3.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/03/2015] [Accepted: 10/06/2015] [Indexed: 11/15/2022] Open
Abstract
Purpose The goal of this study was to evaluate changes in nocturia and other lower urinary tract symptoms (LUTS) after laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP). Materials and Methods We reviewed the medical records of 96 patients who underwent LRP or RALP for clinically localized prostate cancer and completed the International Prostate Symptom Score (IPSS) questionnaire, which provided a basis for assessing their symptoms. We also evaluated maximal flow rate and post-void residual urine volume over a follow-up period of at least 24 months. We divided the patients into three groups according to postoperative changes in the frequency of nocturia. Results Voiding symptoms significantly improved over the course of 24 months in patients who underwent LRP or RALP. However, most patients showed persistent or increased nocturia after LRP or RALP. Moreover, more than one third of the patients (33/96) presented with exacerbated nocturia (1.0±0.9 episodes of preoperative nocturia vs. 3.0±1.3 episodes of postoperative nocturia). Multiple regression analysis showed that preoperative IPSS storage sub-score had negative association with the nocturia after radical prostatectomy (p=0.005). However, patients' age, body mass index, preoperative prostate specific antigen, Gleason score, T-stage, and prostate volume had no association. Conclusions The present study showed that nocturia was influenced by a range of factors, including other storage LUTS and the relief of bladder outlet obstruction after radical prostatectomy. Moreover, the preoperative storage symptoms are regarded as an important factor which influences the changes of nocturia after radical prostatectomy.
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Affiliation(s)
- Kyung Jae Hur
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Won Lee
- Department of Urology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Jin Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Sup Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woong Jin Bae
- Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuck Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Kon Hwang
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.; Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kasivisvanathan V, Emberton M. Evidence based management of male lower urinary tract symptoms: A contemporary update. Int J Surg 2015; 25:162-3. [PMID: 26654900 DOI: 10.1016/j.ijsu.2015.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 11/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Veeru Kasivisvanathan
- Division of Surgery and Interventional Sciences, University College London, UK; Department of Urology, University College London Hospitals Trust, London, UK.
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, UK; Department of Urology, University College London Hospitals Trust, London, UK; NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK
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Goessaert AS, Everaert K, Hoebeke P, Vande Walle J. Pharmacokinetics and Pharmacodynamics of the Oral Disintegrating Tablet of Desmopressin in Adults with Nocturnal Polyuria: A Pilot Study. Adv Ther 2015; 32:799-808. [PMID: 26412224 DOI: 10.1007/s12325-015-0247-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The higher sensitivity to desmopressin (dDAVP) found in women and older patients with nocturnal polyuria (NP) has partially been unraveled, leading to adaptation of the dosage based on gender. However, besides age and gender, other factors might play a role in differences in sensitivity and side effects. The aim of this study is to design a pharmacokinetic/pharmacodynamic (PD) assay to identify appropriate treatment for different groups of patients, primarily dependent on differences in age and gender. METHODS This interventional pilot study was carried out in Ghent University Hospital, Belgium, between 2011 and 2013. Patients with NP were subjected to a water load test (15 mL/kg), as well as an administration of 120 µg dDAVP oral disintegrating tablet (ODT) followed by blood analysis to determine plasma dDAVP levels and urine analysis for diuresis rate, osmolality, free water clearance and sodium clearance. RESULTS Six female and six male patients were included (range 30-89 years old; mean age 69 years; SD 18). Three groups based on plasma dDAVP levels were found: (1) high (only women), (2) intermediate (only men) and (3) low plasma levels. For the nighttime samples (3-12 h after intake) men presented with significantly higher variation in PD response, whereas 12-15 h after dDAVP ODT intake women presented with a less predictable outcome, although all patients but one (female) have a prolonged PD effect. CONCLUSION This study suggests the need for individualized dose titration rather than fixed dose regimens in NP patients with bothersome symptoms. Gender, body weight and results of nocturnal free water and sodium clearance need to be taken into account for more accurate individualized treatment to result in high response rates and low side effects.
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