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Tarcan T, Hashim H, Malde S, Sinha S, Sahai A, Acar O, Selai C, Agro EF, Abrams P, Wein A. Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI-RS 2023. Neurourol Urodyn 2024. [PMID: 38477358 DOI: 10.1002/nau.25435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
AIMS Lower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome. METHODS A think tank of ICI-RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS. RESULTS Our think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity. CONCLUSION Future research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust & King's College London, London, UK
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - Arun Sahai
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Omer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- College of Medicine, Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Caroline Selai
- University College London - Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery/UCLH NHS Foundation Trust, London, UK
| | - Enrico Finazzi Agro
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Molecular Regulation of Concomitant Lower Urinary Tract Symptoms and Erectile Dysfunction in Pelvic Ischemia. Int J Mol Sci 2022; 23:ijms232415988. [PMID: 36555629 PMCID: PMC9782153 DOI: 10.3390/ijms232415988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Aging correlates with greater incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in the male population where the pathophysiological link remains elusive. The incidence of LUTS and ED correlates with the prevalence of vascular risk factors, implying potential role of arterial disorders in concomitant development of the two conditions. Human studies have revealed lower bladder and prostate blood flow in patients with LUTS suggesting that the severity of LUTS and ED correlates with the severity of vascular disorders. A close link between increased prostatic vascular resistance and greater incidence of LUTS and ED has been documented. Experimental models of atherosclerosis-induced chronic pelvic ischemia (CPI) showed increased contractile reactivity of prostatic and bladder tissues, impairment of penile erectile tissue relaxation, and simultaneous development of detrusor overactivity and ED. In the bladder, short-term ischemia caused overactive contractions while prolonged ischemia provoked degenerative responses and led to underactivity. CPI compromised structural integrity of the bladder, prostatic, and penile erectile tissues. Downstream molecular mechanisms appear to involve cellular stress and survival signaling, receptor modifications, upregulation of cytokines, and impairment of the nitric oxide pathway in cavernosal tissue. These observations may suggest pelvic ischemia as an important contributing factor in LUTS-associated ED. The aim of this narrative review is to discuss the current evidence on CPI as a possible etiologic mechanism underlying LUTS-associated ED.
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Letkiewicz S, Pilis K, Ślęzak A, Pilis A, Pilis W, Żychowska M, Langfort J. Eight Days of Water-Only Fasting Promotes Favorable Changes in the Functioning of the Urogenital System of Middle-Aged Healthy Men. Nutrients 2020; 13:nu13010113. [PMID: 33396948 PMCID: PMC7824351 DOI: 10.3390/nu13010113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to determine whether, after 8 days of water-only fasting, there are changes in the efficiency of the lower urinary tract, the concentration of sex hormones, and the symptoms of prostate diseases in a group of middle-aged men (n = 14). For this purpose, before and after 8 days of water-only fasting (subjects drank ad libitum moderately mineralized water), and the following somatic and blood concentration measurements were made: total prostate specific antigen (PSA-T), free prostate specific antigen (PSA-F), follicle stimulating hormone (FSH), luteotropic hormone (LH), prolactin (Pr), total testosterone (T-T), free testosterone (T-F), dehydroepiandrosterone (DHEA), sex hormone globulin binding (SHGB), total cholesterol (Ch-T), β-hydroxybutyrate (β-HB). In addition, prostate volume (PV), volume of each testis (TV), total volume of both testes (TTV), maximal urinary flow rate (Qmax), and International Prostate Symptom Score (IPSS) values were determined. The results showed that after 8 days of water-only fasting, Qmax and IPSS improved but PV and TTV decreased significantly. There was also a decrease in blood levels of PSA-T, FSH, P, T-T, T-F, and DHEA, but SHGB concentration increased significantly. These results indicate that 8 days of water-only fasting improved lower urinary tract functions without negative health effects.
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Affiliation(s)
- Sławomir Letkiewicz
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
- Urological and Andrological Clinic “Urogen”, 42-600 Tarnowskie Góry, Poland
| | - Karol Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
- Correspondence: ; Tel.: +48-34-365-5983 or +48-508-204-403
| | - Andrzej Ślęzak
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Anna Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Wiesław Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Małgorzata Żychowska
- Faculty of Physical Education, Department of Sport, Kazimierz Wielki University in Bydgoszcz, 85-091 Bydgoszcz, Poland;
| | - Józef Langfort
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
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Truschel ST, Clayton DR, Beckel JM, Yabes JG, Yao Y, Wolf-Johnston A, Birder LA, Apodaca G. Age-related endolysosome dysfunction in the rat urothelium. PLoS One 2018; 13:e0198817. [PMID: 29883476 PMCID: PMC5993304 DOI: 10.1371/journal.pone.0198817] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/27/2018] [Indexed: 12/24/2022] Open
Abstract
Lysosomal dysfunction is associated with a number of age-related pathologies that affect all organ systems. While much research has focused on neurodegenerative diseases and aging-induced changes in neurons, much less is known about the impact that aging has on lower urinary tract function. Our studies explored age-dependent changes in the content of endo-lysosomal organelles (i.e., multivesicular bodies, lysosomes, and the product of their fusion, endolysosomes) and age-induced effects on lysosomal degradation in the urothelium, the epithelial tissue that lines the inner surface of the bladder, ureters, and renal pelvis. When examined by transmission electron microscopy, the urothelium from young adult rats (~3 months), mature adult rats (~12 months), and aged rats (~26 months old) demonstrated a progressive age-related accumulation of aberrantly large endolysosomes (up to 7μm in diameter) that contained undigested content, likely indicating impaired degradation. Stereological analysis confirmed that aged endolysosomes occupied approximately 300% more volume than their younger counterparts while no age-related change was observed in multivesicular bodies or lysosomes. Consistent with diminished endolysosomal degradation, we observed that cathepsin B activity was significantly decreased in aged versus young urothelial cell lysates as well as in live cells. Further, the endolysosomal pH of aged urothelium was higher than that of young adult (pH 6.0 vs pH 4.6). Our results indicate that there is a progressive decline in urothelial endolysosomal function during aging. How this contributes to bladder dysfunction in the elderly is discussed.
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Affiliation(s)
- Steven T. Truschel
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Dennis R. Clayton
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Jonathan M. Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Jonathan G. Yabes
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Yi Yao
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Amanda Wolf-Johnston
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Lori A. Birder
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Gerard Apodaca
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
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Madersbacher S. Re: Functional Outcomes After Transurethral Resection of the Prostate in Nursing Home Residents. Eur Urol 2017; 71:989. [PMID: 28153447 DOI: 10.1016/j.eururo.2017.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
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Abstract
Underactive bladder (UAB) is a very common condition leading to disabling lower urinary tract symptoms. There has been an increasing interest in this condition as there is no effective treatment currently available. UAB has been described in many ways, but there is no agreed upon consensus on its terminology. The prevalence of UAB may be underestimated. This review focuses on the terminology, pathophysiology, common causes, its treatment, and future areas of research.
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Affiliation(s)
- Himanshu Aggarwal
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, J8 122, Dallas, TX, 75390-9110, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, J8 122, Dallas, TX, 75390-9110, USA.
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Sun F, Crisóstomo V, Báez-Díaz C, Sánchez FM. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications. Cardiovasc Intervent Radiol 2015; 39:1-7. [PMID: 26581418 DOI: 10.1007/s00270-015-1233-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.
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Affiliation(s)
- Fei Sun
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Verónica Crisóstomo
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Claudia Báez-Díaz
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
| | - Francisco M Sánchez
- Jesús Usón Minimally Invasive Surgery Centre, Carretera N-521, km. 41.8, 10071, Cáceres, Spain.
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Skarecky D, Gordon A, Babaian KN, Dhaliwal H, Morales B, Ahlering TE. Analysis of Improved Urinary Peak Flow Rates After Robot-Assisted Radical Prostatectomy. J Endourol 2015; 29:1152-8. [DOI: 10.1089/end.2015.0353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Douglas Skarecky
- Department of Urology, University of California, Irvine, Medical Center, Orange, California
| | - Adam Gordon
- Department of Urology, University of California, Irvine, Medical Center, Orange, California
| | - Kara N. Babaian
- Department of Urology, University of California, Irvine, Medical Center, Orange, California
| | - Harleen Dhaliwal
- Department of Urology, University of California, Irvine, Medical Center, Orange, California
| | - Blanca Morales
- Department of Urology, University of California, Irvine, Medical Center, Orange, California
| | - Thomas E. Ahlering
- Department of Urology, University of California, Irvine, Medical Center, Orange, California
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Beltrame F, Ferreira FT, Lorenzetti F, Dambros M, Bisogni S, Dambros M. Bladder function in obstructed men - does age matter? Aging Male 2015; 18:143-8. [PMID: 26000866 DOI: 10.3109/13685538.2015.1025377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The high prevalence of diseases and disabilities in the elderly will therefore impose major future challenges for governments, particularly in social security, health system and social care. METHODS Nine hundred and seventy-one men, 40 years or older referred for low urinary tract symptoms (LUTS) evaluation who underwent full urodynamic investigation, were reviewed. Urodynamic parameters were obtained, such as Uroflowmetry, those of Filling Cystometry and those of pressure flow study (PFS). RESULTS Mean age was of 66.1 years old. Most the patients included in the analysis were categorized as Schafer score 2-4. Correlation analysis of uroflowmetry parameters revealed statistically significant decrease in voided volume (p = 0.013), Qmax (p = 0.023) with aging. Cystometric parameters revealed significant age-related decrease in bladder capacity (p < 0.001) and bladder compliance (p = 0.004). PFS revealed significant decrease in voiding efficiency (p = 0.029), voided volume (p < 0.001), Qave (p = 0.008) and Qmax (p = 0.048) with progressing age. Age subgroup analyses showed significant differences in voiding efficiency (KW, p = 0.032), voided volume (KW, p < 0.001) and Qave (KW, p = 0.036). CONCLUSIONS Age-related changes in voiding function might not be a result of impaired detrusor contractility or increased outflow obstruction, intrinsic causes must be suspected. Changes in the storage function of the bladder represent specific pathophysiological mechanisms influenced by aging.
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Affiliation(s)
| | | | - Fabio Lorenzetti
- c Division of Geriatric Urology, Escola Paulista de Medicina , Federal University of São Paulo , São Paulo , Brazil
| | - Mara Dambros
- d Faculty of Medicine , São Leopoldo Mandic , Campinas, São Paulo , Brazil , and
| | - Sergio Bisogni
- d Faculty of Medicine , São Leopoldo Mandic , Campinas, São Paulo , Brazil , and
| | - Miriam Dambros
- e Hospital Municipal Dr. Mario Gatti , Campinas , Brazil
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Osman NI, Chapple CR. Contemporary concepts in the aetiopathogenesis of detrusor underactivity. Nat Rev Urol 2014; 11:639-48. [PMID: 25330789 DOI: 10.1038/nrurol.2014.286] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Detrusor underactivity (DUA) is a poorly understood, yet common, bladder dysfunction, referred to as underactive bladder, which is observed in both men and women undergoing urodynamic studies. Despite its prevalence, no effective therapeutic approaches exist for DUA. Exactly how the contractile function of the detrusor muscle changes with ageing is unclear. Data from physiological studies in animal and human bladders are contradictory, as are the results of the limited number of clinical studies assessing changes in urodynamic parameters with ageing. The prevalence of DUA in different patient groups suggests that multiple aetiologies are involved in DUA pathogenesis. Traditional concepts focused on either efferent innervation or myogenic dysfunction. By contrast, contemporary views emphasize the importance of the neural control mechanisms, particularly the afferent system, which can fail to potentiate detrusor contraction, leading to premature termination of the voiding reflex. In conclusion, the contemporary understanding of the aetiology and pathophysiology of DUA is limited. Further elucidation of the underlying mechanisms is needed to enable the development of new and effective treatment approaches.
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Affiliation(s)
- Nadir I Osman
- Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK
| | - Christopher R Chapple
- Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK
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Yee CH, Li JKM, Lam HC, Chan ESY, Hou SSM, Ng CF. The prevalence of lower urinary tract symptoms in a Chinese population, and the correlation with uroflowmetry and disease perception. Int Urol Nephrol 2013; 46:703-10. [PMID: 24136186 DOI: 10.1007/s11255-013-0586-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/05/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the prevalence of lower urinary tract symptoms (LUTS) in a population of Chinese men, and its correlation with uroflowmetry and disease perception. MATERIALS AND METHODS Male volunteers above 40-year old were recruited in the community. Assessment with International Prostatic Symptom Score (IPSS), uroflowmetry, and a quiz on prostatic disease knowledge with 12 true-false-type questions were performed. Correlation of IPSS with uroflowmetry results and prostatic disease knowledge was analyzed. RESULTS A total of 319 men were recruited for the study, with a mean age of 62 ± 8 years. About 69.3 % of them had moderate-to-severe symptoms on IPSS. A statistically significant correlation was found between IPSS and Q max (r = -0.260, p < 0.001), IPSS and quality of life (r = -0.172, p = 0.002), and IPSS and post-void residuals (r = 0.223, p < 0.001). About 53.0 % of subjects had less than 4 correct answers for the 12 true-false questions. Negative correlation was noted between the number of correct answers and IPSS (r = -0.185, p = 0001). In other words, for the better knowledge on prostatic diseases, the lower IPSS was found. CONCLUSIONS In a cohort of community-dwelling Chinese men, a significant portion of the population had moderate-to-severe LUTS. While uroflowmetry parameters were found to correlate with IPSS, the degree of knowledge on prostatic diseases also shared a statistically significant correlation with IPSS. This has an implication on the role of urological health education in the future.
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Affiliation(s)
- Chi-Hang Yee
- Division of Urology, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong,
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12
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Abstract
Lower urinary tract symptoms (LUTS) may be a sign of aging rather than a consequence of benign prostatic enlargement (BPE) or benign prostatic obstruction (BPO). Medical or invasive treatments should address the bothersome symptoms and the quality of life of patients. Alpha blockers and 5-alpha reductase inhibitors are most frequently used in benign prostatic hyperplasia (BPH) medical treatments, whereas Transurethral Resection of the Prostate (TURP) remains the "gold standard" for surgical treatments. Several minimal invasive treatments are emerging with promising outcomes.
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Reis RB, Rodrigues Neto AA, Reis LO, Machado RD, Kaplan S. Correlation between the presence of inguinal hernia and the intensity of lower urinary tract symptoms. Acta Cir Bras 2012; 26 Suppl 2:125-8. [PMID: 22030828 DOI: 10.1590/s0102-86502011000800023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To verify the correlation between the presence of IH and the intensity of LUTS related to BPH quantified through the International Prostate Symptom Score (IPSS). METHODS We prospectively selected 52 patients over the age of 55 years; Patients were divided into 2 groups. Group 1: composed of 32 patients with IH; Group 2 (control group): composed of 20 patients with no clinical evidence of IH. All patients were assessed using the IPSS, uroflowmetry (Qmax), post-void residual urine volume (PVR) and prostate volume (PV). RESULTS Groups 1 and 2 presented no difference in PV (p>0.05) and uroflowmetry (Qmax) (p>0.05). There was a statistical significant difference between the PVR mean values between groups 1 and 2. The presence of IH correlated with a higher IPSS score (r=0.38 p<0.05) despite the fact the no difference was detected between the incidence of patients with mild, moderate and severe LUTS in groups 1 and 2. CONCLUSION Patients with IH present higher IPSS. The role of IPSS as a marker to predict the development of clinical IH still to be determined.
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Abdul-Rahman A, Al-Hayek S, Belal M. Urodynamic studies in the evaluation of the older man with lower urinary tract symptoms: when, which ones, and what to do with the results. Ther Adv Urol 2011; 2:187-94. [PMID: 21789074 DOI: 10.1177/1756287210385924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in older men. Most urinary dysfunctions in the elderly are multifactorial in origin and associated with a broad spectrum of mental and physical conditions. In this population, it is essential to have a comprehensive assessment of the lower urinary tract, functional impairments and concurrent medical diseases. A holistic and individualized approach to management is important. Urodynamic studies (UDS) are objective tests which provide a major contribution to our understanding of the pathophysiology of lower urinary tract symptoms (LUTS). Urodynamic findings in older men may include common diagnoses such as bladder outlet obstruction and urinary incontinence. However, coexisting conditions such as detrusor overactivity and impaired detrusor contractility are common in older men. The identification of these conditions is necessary to appropriately counsel patients regarding treatment options. Simple urodynamic tests should be used whenever possible such as uroflowmetry and residual volume estimation. However, in complicated cases more invasive tests such as pressure flow studies are important to help choose the best treatment.
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Affiliation(s)
- Ahmad Abdul-Rahman
- Clinical Research Fellow, Registrar in Neuro-Urology, Spinal Injuries Centre, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK
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Homma Y, Gotoh M, Yokoyama O, Masumori N, Kawauchi A, Yamanishi T, Ishizuka O, Seki N, Kamoto T, Nagai A, Ozono S. JUA clinical guidelines for benign prostatic hyperplasia. Int J Urol 2011. [DOI: 10.1111/j.1442-2042.2011.02861.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Azadzoi KM, Chen BG, Radisavljevic ZM, Siroky MB. Molecular reactions and ultrastructural damage in the chronically ischemic bladder. J Urol 2011; 186:2115-22. [PMID: 21944111 DOI: 10.1016/j.juro.2011.06.047] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Clinical and basic research data suggest that pelvic ischemia may contribute to bladder overactivity. We characterized the molecular and ultrastructural reactions of the chronically ischemic bladder. MATERIALS AND METHOD A model of pelvic ischemia was developed by creating iliohypogastric/pudendal arterial atherosclerosis in rabbits. At 12 weeks conscious urinary frequency was examined, bladder blood flow was recorded and cystometrograms were done using general anesthesia. Bladder tissue was processed for molecular and ultrastructural analysis using quantitative real-time polymerase chain reaction, Western blot and transmission electron microscopy. RESULTS Conscious urinary frequency and the frequency of spontaneous bladder contractions significantly increased in animals with pelvic ischemia. Bladder ischemia up-regulated the gene and protein expression of hypoxia inducible factor-1α, transforming growth factor-β and nerve growth factor B. Vascular endothelial growth factor gene expression also increased but protein levels were unchanged. Transmission electron microscopy of ischemic bladder samples showed swollen mitochondria with degraded granules, thickened epithelium, deformed muscle fascicles, collagen deposition and impaired microvasculature with thickened intima and disrupted endothelial cell junctions. Degenerating axonal and Schwann cell profiles, and myelin sheath splitting around axons and Schwann cells were evident in ischemic bladders. CONCLUSIONS Interrupting pelvic blood flow resulted in an ischemic overactive bladder and significant increase in conscious urinary frequency. Molecular responses involving hypoxia inducible factor, transforming growth factor-β, vascular endothelial growth factor and nerve growth factor were associated with mitochondrial injury, fibrosis, microvasculature damage and neurodegeneration. Ischemia may have a key role in bladder overactivity and lower urinary tract symptoms.
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Affiliation(s)
- Kazem M Azadzoi
- Department of Pathology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
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Azadzoi KM, Yalla SV, Siroky MB. Human bladder smooth muscle cell damage in disturbed oxygen tension. Urology 2011; 78:967.e9-15. [PMID: 21872910 DOI: 10.1016/j.urology.2011.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/10/2011] [Accepted: 06/14/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize human bladder smooth muscle cell reactions to disturbed oxygen tension. Clinical studies have shown a close correlation between bladder ischemia and lower urinary tract symptoms in elderly patients. MATERIALS AND METHODS Confluent cultured human bladder smooth muscle cells were incubated under normoxia, continuous hypoxia, and oxidative stress (hypoxia/reoxygenation) conditions using a computerized oxycycler system. After 48 hours, cell samples were collected and processed for fluorometric assessment of oxidative injury, enzyme immunoassay of antioxidant capacity, and transmission electron microscopy. RESULTS Lipid peroxidation was found in cell hypoxia and oxidative stress, whereas protein oxidation was evident in oxidative stress only. Cell antioxidant capacity decreased in oxidative stress but remained unchanged in hypoxia. Oxidative products were present in cell oxidative stress only, whereas nitrosative products increased in both hypoxia and oxidative stress conditions. Forty-eight hours of hypoxia and oxidative stress had no effect on cell senescence. Thickened deformed cell membrane, swollen mitochondria, and enlarged endoplasmic reticulum (ER) were found in cell hypoxia. Partially lost cell membrane with increased caveolae, swollen mitochondria with degraded cristae, splintered ER, and increased lysosomes were evident in cell oxidative stress. CONCLUSION Human bladder smooth muscle cells are highly reactive to nonconforming oxygen tension. Reactions to hypoxia are consistent with cell survival signaling to cope with lack of oxygen. Changes in oxidative stress indicate extensive damage and deterioration of the subcellular elements. Hypoxic and oxidative damage may be an important mechanism of smooth muscle degeneration in bladder conditions with disturbed oxygen tension.
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Affiliation(s)
- Kazem M Azadzoi
- Department of Urology, Boston University School of Medicine, Boston, MA, USA.
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Zhang XJ, Chen GZ, Ke M, Han H, Lu ZW, Wang TJ, Sun FH, Yu HY. A study on Astragalus mongholicus heterosaccharides affecting contractions of isolated bladder detrusor strips. Carbohydr Polym 2011. [DOI: 10.1016/j.carbpol.2011.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Choi EY, Jeong J, Kang DI, Johnson K, Ercolani M, Jang T, Lee DH, Kim WJ, Kim IY. Impact of robot-assisted radical prostatectomy on health-related quality of life in patients with lower urinary tract symptoms. Int J Urol 2011; 18:297-303. [DOI: 10.1111/j.1442-2042.2011.02730.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Preventive Effects of Vitamin E Against Oxidative Damage in Aged Diabetic Rat Bladders. Urology 2011; 77:508.e10-4. [DOI: 10.1016/j.urology.2010.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 07/29/2010] [Accepted: 08/14/2010] [Indexed: 11/18/2022]
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Han JH, Lee MY, Lee SY, Chang IH, Kim HJ, Kim W, Myung SC. Effect of low concentrations of hydrogen peroxide on the contractile responses of rat detrusor smooth muscle strips. Eur J Pharmacol 2010; 638:115-20. [DOI: 10.1016/j.ejphar.2010.02.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 02/07/2010] [Accepted: 02/24/2010] [Indexed: 11/24/2022]
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Roosen A, Blake-James BT, Wood D, Fry CH. Clinical and experimental aspects of Adreno-muscarinic synergy in the bladder base and prostate. Neurourol Urodyn 2010; 28:938-43. [PMID: 19618452 DOI: 10.1002/nau.20742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent clinical trials have shown that combination therapy using an alpha-receptor antagonist and an antimuscarinic is more effective than either agent alone in improving quality of life and objective urodynamic variables in men with bladder outflow obstruction. There appear to be no negative effects on bladder function. The mode of action of this combination is unknown but presumed to be an antimuscarinic reduction in detrusor overactivity and the alpha-receptor antagonist reduced outflow tract resistance. We have shown with in vitro experiments that in smooth muscles influencing outflow tract resistance (prostate, trigone) there is a profound contractile synergy between adrenergic and muscarinic pathways. We propose the hypothesis that both arms of the combination therapy reduce contractile tone of the outflow tract and that their simultaneous attenuation has a disproportionately large effect on outflow tract resistance. Our data from trigone muscle suggest that adrenergic and muscarinic receptor activation increase the intracellular [Ca(2+)] but the adrenergic pathway also operates through Ca(2+)-sensitisation of the contractile apparatus, primarily through a PKC-dependent pathway.
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Bushman W. Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin North Am 2010; 36:403-15, v. [PMID: 19942041 DOI: 10.1016/j.ucl.2009.07.003] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Historically, benign prostatic hyperplasia (BPH) has been a major focus of urologic practice and surgery. But a simplistic causal relationship among prostatic enlargement, progressive obstruction, lower urinary tract symptoms, retention, and complications of retention has been challenged by recognition of the incomplete overlap of prostatic enlargement with symptoms and obstruction. The result has been a greater focus on symptoms than prostatic enlargement and a shift from surgery to medical treatment. Therefore, the question can be asked whether BPH per se, the glandular enlargement as it contributes to bladder dysfunction, or hyperplastic enlargement as a biomarker for generalized lower urinary tract dysfunction are concerns. This article addresses these issues.
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Affiliation(s)
- Wade Bushman
- Department of Urology, University of Wisconsin Medical School, K6-562 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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Homma Y, Araki I, Igawa Y, Ozono S, Gotoh M, Yamanishi T, Yokoyama O, Yoshida M. Clinical guideline for male lower urinary tract symptoms. Int J Urol 2009; 16:775-90. [PMID: 19811547 DOI: 10.1111/j.1442-2042.2009.02369.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Mohanty NK, Kumar A, Jain M, Prakash S, Arora RP. Efficacy and Safety of an Alpha-Blocker With and Without Anticholinergic Agent in the Management of Lower Urinary Tract Symptoms With Detrusor Overactivity. ACTA ACUST UNITED AC 2009. [DOI: 10.3834/uij.1944-5784.2009.12.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Age and Bladder Outlet Obstruction Are Independently Associated with Detrusor Overactivity in Patients with Benign Prostatic Hyperplasia. Eur Urol 2008; 54:419-26. [DOI: 10.1016/j.eururo.2008.02.017] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 02/13/2008] [Indexed: 11/17/2022]
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Ruszat R, Wyler SF, Seitz M, Lehmann K, Abe C, Bonkat G, Reich O, Gasser TC, Bachmann A. Comparison of potassium-titanyl-phosphate laser vaporization of the prostate and transurethral resection of the prostate: update of a prospective non-randomized two-centre study. BJU Int 2008; 102:1432-8; discussion 1438-9. [PMID: 18671785 DOI: 10.1111/j.1464-410x.2008.07905.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the intermediate-term clinical efficacy and the rate of complications in 80 W photoselective vaporization of the prostate (PVP) with the potassium-titanyl-phosphate laser (Greenlight, (AMS, Minnetonka, MN, USA) compared with transurethral resection of the prostate (TURP) in a prospective non-randomised two-centre study. PATIENTS AND METHODS From December 2003 to August 2006, 396 patients (PVP 269, TURP 127) with lower urinary tract symptoms secondary to benign prostatic hyperplasia were included in the study. There was a significant difference in mean age (72 years for PVP vs 68 for TURP, P = 0.001). Patients were therefore stratified in age categories (<70, 70-80, >80 years) and compared for perioperative variables, functional outcome and complications, with a follow-up of up to 24 months. RESULTS The mean prostate size was greater (overall, 62 vs 48 mL, P < 0.001) and mean operative duration longer (overall 72 vs 53 min; P = 0.001) for PVP in all age categories. The rate of intraoperative bleeding (3% vs 11%), blood transfusions (0% vs 5.5%) and capsule perforations (0.4% vs 6.3%), and early postoperative clot retention (0.4% vs 3.9%) was significantly lower for PVP. Hospitalization time was significantly shorter in the PVP group for patients aged <70 years (3.0 vs 4.7 days) and 70-80 years (4.0 vs 5.0 days; P = 0.001). The improvement of peak urinary flow rate was higher after TURP for any age category. The International Prostate Symptom Score and postvoid residual volume during the follow-up showed no significant difference. After 12 months the overall prostate size reduction was 63% (-30 mL) after TURP and 44% (-27 mL) after PVP. The rate of repeat TURP/PVP was higher in the PVP group (6.7% vs 3.9%, not significant) within the follow-up of up to 2 years. The incidence of urethral and bladder neck strictures was comparable. CONCLUSIONS PVP was more favourable in terms of perioperative safety. Although patients assigned for PVP were older and had larger prostates, PVP resulted in a similar functional outcome. Further follow-up is needed to draw final conclusions about the long-term efficacy of PVP.
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Affiliation(s)
- Robin Ruszat
- Department of Urology, University Hospital Basel, Basel, Switzerland.
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Madersbacher S, Marszalek M, Lackner J, Berger P, Schatzl G. The Long-Term Outcome of Medical Therapy for BPH. Eur Urol 2007; 51:1522-33. [PMID: 17416456 DOI: 10.1016/j.eururo.2007.03.034] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 03/17/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The lack of cure with medical therapy implies life-long treatment emphasising the need for a thorough understanding of the long-term outcome. We review the natural history, markers for progression, placebo effect, efficacy, pharmacoeconomic aspects, and preventive measures. METHODS Literature review with particular reference to long-term controlled studies using plant extracts, alpha1-blockers, 5alpha-reductase inhibitors (5-ARIs), and combination therapy. RESULTS There is a long-lasting (>or=12 mo) placebo response of symptoms (20% decrease) and maximum flow rate (10% rise). The five long-term controlled trials of plant extracts are inconclusive and therefore their role in contemporary medical management is still controversial. The alpha1-blockers provide fast amelioration of symptoms yet have no relevant impact on the risk of acute urinary retention or surgery. Combination therapy should be reserved for moderately or severely symptomatic patients with a high risk of progression; in the majority of patients the alpha1-blocker can be safely stopped after 6-12 mo. The preventive use of 5-ARIs in men with no or mild symptoms at risk of progression is scientifically sound yet not generally accepted mainly for economic reasons. CONCLUSIONS A sharp contrast exists between the duration of the longest controlled trial (4.5 yr) and the situation in real life with treatment periods up to one or two decades of life. Real-life and registry data will be the only source of this important information in the future.
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Affiliation(s)
- Stephan Madersbacher
- Department of Urology, Danube Hospital, and Medical University of Vienna, Austria.
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Kumar SM. Rapid Communication: Holmium Laser Ablation of Large Prostate Glands: An Endourologic Alternative to Open Prostatectomy. J Endourol 2007; 21:659-62. [PMID: 17638566 DOI: 10.1089/end.2006.0283] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of holmium laser ablation of the prostate (HoLAP) to treat patients with large glands who would otherwise be recommended for open prostatectomy. PATIENTS AND METHODS A series of 17 patients aged 54 to 79 years (mean 68.2 years) with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) (n = 14) or prostate carcinoma (n = 3) and a transurethral ultrasonography-assessed prostate volume of >80 cc were treated with a 100 W holmium laser. The endpoint of treatment was complete vaporization of obstructing prostate tissue down to the capsular fibers with an adequate prostate cavity. RESULTS The mean laser time was 77 minutes (range 43-203 minutes), the catheter time 2.12 days (range 1-5 days), and the length of stay 1.34 days (range 1-3 days). None of the patients required continuous bladder irrigation. Prostate volume decreased from 121.82 +/- 42.10 cc to 54.58 +/- 20.65 cc (55%; P < 0.01). The American Urological Association Symptom Score decreased from 20.41 +/- 5.35 to 5.70 +/- 2.20 (70%; P < 0.01). The peak urinary flow rate (Q(max)) increased from 6.92 +/- 5.71 to 15.06 +/- 7.57 (217%; P < 0.01). Serum sodium changed from 138.53 +/- 2.50 mEq/L to 138.00 +/- 3.29 mEq/L (P = 0.4). Hemoglobin changed from 14.4 +/- 1.15 g/dL to 13.58 +/- 1.29 g/dL (-5%). No patient had postoperative stress incontinence. CONCLUSION The HoLAP technique is effective in the treatment of patients with LUTS secondary to BPH and for some patients with prostate carcinoma. Because of the excellent hemostatic properties of the holmium laser wavelength, large glands can be vaporized safely with minimal morbidity and a short hospital stay. The clinical advantages over open prostatectomy include clinically insignificant perioperative blood loss, no stress incontinence, short duration of catheterization, and no skin incision.
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Taylor J, Harrison SCW, Assassa RP, McGrother CW. The Pattern and Progression of Lower Urinary Tract Symptoms after Transurethral Prostatectomy Compared with Those Seen in the General Population. Eur Urol 2007; 51:1023-9; discussion 1029-30. [PMID: 17081677 DOI: 10.1016/j.eururo.2006.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 10/05/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Men undergoing transurethral prostatectomy (TURP) often have some level of residual symptoms after this operation. Reliance on symptom scores to assess outcomes means there is relatively little information on the exact pattern of such symptoms. The aim of this study was to describe the pattern, progression, and associated bother of lower urinary tract symptoms after TURP. METHODS Detailed information on urinary symptoms, prostatectomy status, and associated bother was obtained from a randomly selected sample of community-dwelling men by using a postal questionnaire. Rates of individual urinary symptoms in the postprostatectomy population were calculated, and compared with those in the background population and those in secondary care. RESULTS Of 7640 men who responded, 422 had undergone prostatectomy. Symptom levels remained significantly higher in the postoperative group than the background population, with 19.4% experiencing four or more symptoms on a weekly basis. The pattern of symptoms was similar to that seen in the general population. Men in the post-TURP group experienced greater levels of bother when symptom level (odds ratio: 2.69; 95%CI, 1.80-4.01) was controlled. Both symptom and bother, however, were significantly lower than those in people referred for secondary care treatment of their symptoms. CONCLUSIONS Men with a previous prostatectomy still report high levels of urinary symptoms and appear to experience greater levels of bother from these symptoms than men in the general population.
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Affiliation(s)
- Joby Taylor
- Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, United Kingdom.
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31
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Itoh H, Kojima M, Okihara K, Ukimura O, Ushijima S, Kawauchi A, Miki T. Significant relationship of time-dependent uroflowmetric parameters to lower urinary tract symptoms as measured by the International Prostate Symptom Score. Int J Urol 2006; 13:1058-65. [PMID: 16903930 DOI: 10.1111/j.1442-2042.2006.01496.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aim of the present paper is to elucidate the possible involvement of time-dependent parameters as obtained by uroflowmetry in the manifestation of lower urinary tract symptoms (LUTS) in elderly patients. METHODS Using simple and multiple regression analyses, the correlation of the International Prostate Symptom Score (IPSS) with objective parameters including age, postvoid residual, uroflowmetry and transrectal ultrasonic measurements of the prostate was analyzed in 206 male patients (average age of 68.0 +/- 7.4 years) who visited our outpatient clinic complaining of LUTS. RESULTS In the 206 patients, the mean maximum flow rate was 12.2 mL/s (13.7 mL/s in mild, 11.9 mL/s in moderate, and 11.2 mL/s in severe IPSS total score) and average flow rate was 4.4 mL/s (5.4 mL/s in mild, 4.3 mL/s in moderate, and 3.5 mL/s in severe IPSS total score). Simple regression analyses demonstrated that age, voiding time, and average and maximum flow rates correlate significantly with symptom scores. In particular, relatively strong relationships were found between average flow rate and scores of intermittency, weak stream and total and voiding symptoms scores. Serum prostate specific antigen level, postvoid residual and prostatic ultrasonic measurements did not show a significant correlation with symptom scores. Multiple regression analyses revealed age and average flow rate to be independent determinants for symptom scores. These results suggest that the time-dependent function in micturition interferes in the manifestation of LUTS in elderly men who have borderline or pathologic maximum flow rate. When evaluating uro flowmetry in elderly male patients with LUTS, attention should be paid to time-dependent parameters such as voiding time and average flow rate.
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Affiliation(s)
- Hideaki Itoh
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Rule AD, Jacobson DJ, McGree ME, Girman CJ, Lieber MM, Jacobsen SJ. LONGITUDINAL CHANGES IN POST-VOID RESIDUAL AND VOIDED VOLUME AMONG COMMUNITY DWELLING MEN. J Urol 2005; 174:1317-21; discussion 1321-2; author reply 1322. [PMID: 16145411 DOI: 10.1097/01.ju.0000173922.29275.54] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We describe the natural history of post-void residual (PVR) and voided volume (VV) in men. MATERIALS AND METHODS A random sample of community dwelling men (529 men 40 to 79 years old) were followed with a sonographic PVR and VV every 2 years for up to 12 years (median 5 examinations). Men were censored at the time of treatment for a prostate condition. RESULTS The median annual change (slope) for PVR was 2.2% (p=0.03) and for VV was -2.1% (p <0.0001). There was considerable variability in PVR slopes (25th percentile -11%, 75th percentile 18%). A rapid increase in PVR slope (greater than 80th percentile) was more likely in men with a baseline American Urological Association Symptom Index greater than 7 (age adjusted odds ratio [OR]1.6, 95% CI 1.0 to 2.5). There was less variability in VV slopes (25th percentile -8.0%, 75th percentile 3.1%). A rapid decrease in VV slope (less than 20th percentile) was more likely in men with baseline age 70 to 79 years than 40 to 49 years (OR 3.9, 95% CI 2.1 to 7.2) and in men with a baseline PVR greater than 50 ml (age adjusted OR 2.1, 95% CI 1.2 to 3.6). CONCLUSIONS Although it is highly variable, there is progressive bladder dysfunction in community dwelling men as they age. In addition, signs and symptoms attributed to benign prostatic hyperplasia were modest predictors of the development of bladder dysfunction. A baseline increased PVR predicted a rapid decrease in VV, consistent with a bladder outlet obstruction contributing to the development of detrusor overactivity and decreased bladder compliance.
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Affiliation(s)
- Andrew D Rule
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Affiliation(s)
- Stephan Madersbacher
- Department of Urology and Ludwig Boltzmann Institute for Urological Oncology, Donauspital, Langobardenstrasse 122, A-1220 Vienna, Austria.
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Aikawa K, Leggett RE, Levin RM. Effect of Age on Hydrogen Peroxide Mediated Contraction Damage in the Male Rat Bladder. J Urol 2003; 170:2082-5. [PMID: 14532858 DOI: 10.1097/01.ju.0000081461.73156.48] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Recent studies introduced the concept that reactive oxygen species (ROS) may be a major factor in the progressive deterioration of bladder function induced by benign prostatic hyperplasia in men and following partial outlet obstruction in animals. We determined whether bladder contraction sensitivity to ROS changes with aging. Using H2O2 to simulate ROS damage we compared the sensitivity of the contractile responses of bladder smooth muscle isolated from young and elderly rats to H2O2. MATERIALS AND METHODS Male 3-month-old (young) and 12-month-old (elderly) Sprague-Dawley rats were used for this study with 24 per group. Each rat was anesthetized and the bladder was excised. Two longitudinal strips were cut from the bladder body. Each strip was placed in individual 15 ml baths containing oxygenated Tyrode's solution at 37C. Each strip was stimulated at 32 Hz for 20 seconds with pulses 1 millisecond in duration at 80 V. After electrical field stimulation (EFS) the response to 20 microM carbachol and 120 mM KCl was determined. The bath solution was then exchanged for H2O2 solutions of 6 different concentrations including 0%, 0.0625%, 0.125%, 0.25%, 0.5% and 1.0%. After 1 hour of exposure to H2O2 the tissues were washed free of H2O2, and the response to EFS, carbachol and KCl were measured again. At the end of the experiment the strips were weighed and frozen at -70C for malondialdehyde analysis. RESULTS The magnitude of the contractile responses of the young and elderly rats to all forms of stimulation were equal. Hydrogen peroxide caused a dose dependent decrease in the contractile responses of bladder strips to all forms of stimulation. Contractile responses to carbachol and KCl were more sensitive to H2O2 than to EFS. Contractile responses of bladder strips isolated from elderly rats were significantly more sensitive to H2O2 damage than strips isolated from young rats. Malondialdehyde generation of bladder strips isolated from elderly rats was significantly greater than those from young rats. CONCLUSIONS It is suggested that aging increases the sensitivity of detrusor contraction to oxidative damage.
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Affiliation(s)
- Ken Aikawa
- Division of Basic and Pharmaceutical Sciences, Albany College of Pharmacy, 106 New Scotland Avenue, Albany, NY 12208, USA
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Vesely S, Knutson T, Fall M, Damber JE, Dahlstrand C. Clinical diagnosis of bladder outlet obstruction in men with lower urinary tract symptoms: reliability of commonly measured parameters and the role of idiopathic detrusor overactivity. Neurourol Urodyn 2003; 22:301-5. [PMID: 12808704 DOI: 10.1002/nau.10128] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS There is no generally accepted consensus how to evaluate patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO). We have tried to determine whether the most frequently used objective variables as prostate volume, IPS-score, maximum flow rate, residual urine volume, functional bladder capacity, and pressure-flow study are reliable for diagnosis of BOO and we investigated the influence of idiopathic detrusor overactivity (IDO) on this condition. METHODS A total of 153 men with LUTS and suspected BOO were systematically examined with routine investigation including digital rectal examination, transrectal ultrasound (TRUS), post-void residual urine volume measurement, uroflowmetry, and pressure-flow study. All patients completed IPS-score. Patients were divided into groups based on Schäfer's grade of obstruction and incidence of IDO and clinical and urodynamical variables were compared. RESULTS At baseline, 45.8% of the patients were urodynamically moderately obstructed and 37.9% were found to be severely obstructed. The grade of obstruction did not correlate with age. Prostate volume, post-void residual volume (PVR), and maximum flow rate correlated significantly with the degree of obstruction. The mean IPS-score remained almost unchanged throughout all obstruction groups. The incidence of IDO was 40.5% and increased from 16% in the minor obstruction group to 38.6% and 53.4% in the moderate and severe obstruction group, respectively. The patients with IDO were older, had larger prostates and were more obstructed. There was no impact of IDO on symptomatology of BOO. CONCLUSIONS These data indicate that IPS-score does not achieve sufficient diagnostic accuracy and its role in the assessment of BOO is limited. The grade of obstruction is more related to prostate volume, PVR, and maximum flow rate. BOO and IDO seem to be related and have numerous mutual interactions.
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Affiliation(s)
- Stepan Vesely
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Azadzoi KM, Babayan RK, Kozlowski R, Siroky MB. Chronic ischemia increases prostatic smooth muscle contraction in the rabbit. J Urol 2003; 170:659-63. [PMID: 12853851 DOI: 10.1097/01.ju.0000064923.29954.7e] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We studied the effect of chronic ischemia on prostatic smooth muscle contraction in the rabbit. MATERIALS AND METHODS New Zealand male rabbits weighing 3 to 3.5 kg were assigned to 2 groups. Group 1 (10 rabbits) underwent balloon endothelial injury of the iliac arteries and received a 0.5% cholesterol diet for 4 weeks and then a regular diet for 8 weeks. Control group 2 (10 rabbits) received a regular diet. After 12 weeks the animals were anesthetized. Iliac artery and prostate blood flow was recorded. Prostate tissues were prepared for isometric tension measurement, enzyme immunoassay to determine cyclic guanosine monophosphate (cGMP) release and histological examination. RESULTS In group 1 atherosclerosis as well as a significant decrease in iliac artery and prostate blood flow were observed. Ischemia significantly increased prostatic tissue contraction, decreased cGMP release and led to capsular and stromal thickening, and epithelial atrophy. The alpha1-adrenoceptor blocker doxazosin and the phosphodiesterase-5 inhibitor sildenafil citrate significantly decreased the contraction of control and ischemic tissues. Doxazosin was more effective in decreasing contractions when it was combined with sildenafil or the nitric oxide (NO) precursor L-arginine. In contrast, doxazosin was less effective when it was combined with the NO synthase inhibitor N omega-nitro-L-arginine or with the guanylate cyclase inhibitor methylene blue. Doxazosin significantly increased cGMP release in control tissues but not in ischemic tissues. Sildenafil significantly increased cGMP release in control and ischemic tissues. CONCLUSIONS Ischemia increased prostatic smooth muscle contraction and led to marked structural damage. Stimulators of NO synthesis and cGMP production enhanced the efficacy of doxazosin in decreasing prostatic tissue contraction. Sildenafil decreased contractility and increased cGMP release. Increased smooth muscle tone and structural changes in the ischemic prostate may suggest a role for prostate ischemia in resistance to urinary flow independent of prostate size.
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Affiliation(s)
- Kazem M Azadzoi
- Department of Urology, Boston University School of Medicine, Massachusetts 02130, USA
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Clemens JQ. The role of urodynamics in the diagnosis and treatment of benign prostatic hyperplasia. Curr Urol Rep 2003; 4:269-75. [PMID: 12882717 DOI: 10.1007/s11934-003-0083-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Quentin Clemens
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 11-715, Chicago, IL 60611, USA.
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Athanasopoulos A, Gyftopoulos K, Giannitsas K, Fisfis J, Perimenis P, Barbalias G. Combination treatment with an alpha-blocker plus an anticholinergic for bladder outlet obstruction: a prospective, randomized, controlled study. J Urol 2003; 169:2253-6. [PMID: 12771763 DOI: 10.1097/01.ju.0000067541.73285.eb] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluate the effect of tolterodine combined with tamsulosin on quality of life in patients with bladder outlet obstruction and concomitant detrusor instability. MATERIALS AND METHODS The study included 50 consecutive patients with urodynamically proven mild or moderate bladder outlet obstruction and concomitant detrusor instability. All patients were initially treated with 0.4 mg. tamsulosin orally once a day. A week later the patients were randomly allocated into group 1-25 who continued treatment with tamsulosin only and, group 2-25 who also received 2 mg. tolterodine orally twice daily. Reevaluation with a quality of life questionnaire and urodynamic study was performed after 3 months. RESULTS Two patients from group 2 stopped tolterodine while 1 patient from each group stopped tamsulosin because of hypotension. Analysis revealed statistically significant improvement in quality of life scores only in group 2 patients (mean score 525.0 and 628.4 before and after treatment, respectively, 2-sided t test p = 0.0003). A significant difference was noted in both groups after treatment for maximum flow rate and volume at first contraction. Additionally, in group 2, a statistically significant difference was observed for maximum detrusor pressure and maximum unstable contraction pressure after treatment. CONCLUSIONS Combination treatment with an alpha-blocker (tamsulosin) plus an anticholinergic (tolterodine) improves quality of life in patients with bladder outlet obstruction and concomitant detrusor instability. Interestingly, no acute urinary retention was observed and tolterodine did not affect the quality of urine flow or residual urine volume. The proposed combination appears to be an effective and relatively safe treatment option in patients with bladder outlet obstruction and detrusor instability.
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Affiliation(s)
- A Athanasopoulos
- Department of Urology, University of Patras, School of Medicine, Patras, Greece
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Hakenberg OW, Pinnock CB, Marshall VR. Preoperative urodynamic and symptom evaluation of patients undergoing transurethral prostatectomy: analysis of variables relevant for outcome. BJU Int 2003; 91:375-9. [PMID: 12603418 DOI: 10.1046/j.1464-410x.2003.04078.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the value of preoperative symptom score assessment and pressure-flow measurement in men undergoing transurethral prostatectomy (TURP). PATIENTS AND METHODS In a prospective study, 95 men (mean age 74.3 years) scheduled for TURP because of their lower urinary tract symptoms, flow rates and urinary residual volumes were assessed using the self-administered International Prostate Symptom Score (IPSS) and urodynamic pressure-flow studies. At 3 months after TURP the patients were reassessed with a flow rate measurement and the IPSS. The baseline IPSS and urodynamic values were analysed with respect to the endpoints of the study, flow rate and IPSS after TURP, and the improvements thereof, respectively. RESULTS There were significant improvements in mean IPSS (- 10.87 points) and peak flow rate (+ 7.06 mL/s) 3 months after TURP. Classifying the patients into subgroups with distinctly different initial values for IPSS, flow rate, residual urine volume and degree of obstruction (as expressed by Abrams-Griffiths number) showed that the flow rate and degree of obstruction influenced the improvement in flow rate but not in symptoms after TURP. Symptom improvement was only related to the initial level of symptoms. In a multivariate analysis, only age was an independent predictor of the outcome variables of flow rate and symptoms. CONCLUSIONS Clinical decision-making remains a valid instrument for selecting patients for TURP. Both the IPSS and pressure-flow assessment are useful to exclude patients who are unlikely to benefit from TURP. Age is an important predictor of the improvement in symptoms and flow rates after TURP for the lower urinary tract symptom complex associated with benign prostatic enlargement.
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Affiliation(s)
- O W Hakenberg
- Department of Urology, University Hospital Dresden, Gemany
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Dmochowski RR, Staskin D. Overactive bladder in men: special considerations for evaluation and management. Urology 2002; 60:56-62; discussion 62-3. [PMID: 12493356 DOI: 10.1016/s0090-4295(02)01797-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lower urinary tract symptoms (LUTS) in men may arise from a variety of underlying causes, including benign prostatic hyperplasia. LUTS may have a significant component of storage symptoms (urgency, frequency, urge incontinence) at presentation; however, the absence of overactive bladder (OAB) symptoms does not necessarily imply pure outlet obstruction nor does their presence indicate the lack thereof. Symptomatic correlates to urodynamic findings are high when considering isolated OAB symptoms. However, mixed presentations or more overtly obstructive scenarios have less correlation with baseline symptom appraisal instruments. The ideal approach for diagnosis and management is predicated on a graded approach, with more invasive evaluation withheld for those men in whom presumptive therapy fails or who present with associated complex symptoms and in whom a higher level of intervention is being considered. The increasing incidence of LUTS with age implies a partial detrusor contribution, which must be considered in the overall management schema.
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Affiliation(s)
- Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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KOZLOWSKI ROBERT, KERSHEN RICHARDT, SIROKY MIKEB, KRANE ROBERTJ, AZADZOI KAZEMM. CHRONIC ISCHEMIA ALTERS PROSTATE STRUCTURE AND REACTIVITY IN RABBITS. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66595-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- ROBERT KOZLOWSKI
- From the Departments of Urology and Pathology, Boston University School of Medicine and Department of Urology, Boston Veterans Affairs Medical Center, Boston, Massachusetts
| | - RICHARD T. KERSHEN
- From the Departments of Urology and Pathology, Boston University School of Medicine and Department of Urology, Boston Veterans Affairs Medical Center, Boston, Massachusetts
| | - MIKE B. SIROKY
- From the Departments of Urology and Pathology, Boston University School of Medicine and Department of Urology, Boston Veterans Affairs Medical Center, Boston, Massachusetts
| | - ROBERT J. KRANE
- From the Departments of Urology and Pathology, Boston University School of Medicine and Department of Urology, Boston Veterans Affairs Medical Center, Boston, Massachusetts
| | - KAZEM M. AZADZOI
- From the Departments of Urology and Pathology, Boston University School of Medicine and Department of Urology, Boston Veterans Affairs Medical Center, Boston, Massachusetts
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Rodrigues P, Lucon AM, Freire GC, Arap S. Urodynamic pressure flow studies can predict the clinical outcome after transurethral prostatic resection. J Urol 2001; 165:499-502. [PMID: 11176404 DOI: 10.1097/00005392-200102000-00033] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluate whether urodynamic evaluation can determine preoperatively the clinical prognosis of patients treated with transurethral prostatic resection as measured by urinary symptom score and quality of life index. MATERIALS AND METHODS A total of 253 patients who previously elected transurethral prostatic resection based on clinical symptoms completed the American Urological Association symptom score and quality of life index, and underwent urodynamic evaluation before and after operation. The patients were divided into 7 groups in accordance with detrusor pressure at maximum urinary flow rate. The preoperative and postoperative symptom score and quality of life index were analyzed in each group. RESULTS Of the patients 42% were not obstructed and could not be distinguished from those who were obstructed preoperatively based on total urinary symptoms (p = 0.95) or subjective impression measured by the quality of life index (p = 0.96). The entire obstructed group demonstrated marked improvement compared to the nonobstructed group (p = 0.018). Analysis of severity also revealed a clear relationship with clinical outcome and subjective satisfaction with obstruction grade, that is the more severely obstructed cases had greater clinical benefit compared to those with little or no obstruction. Furthermore, the nonobstructed subjects did not show any clinical or subjective improvement after transurethral prostatic resection (p = 0.24). CONCLUSIONS Urodynamic studies provide great predictive value of clinical improvement after prostatic relief but they also properly predict the poor clinical results in nonobstructed patients.
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Affiliation(s)
- P Rodrigues
- Department of Urology, Hospital das Clínicas of Univesity of São Paulo, São Paulo, Brazil
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Madersbacher S, Pycha A, Klingler CH, Schatzl G, Marberger M. The International Prostate Symptom score in both sexes: a urodynamics-based comparison. Neurourol Urodyn 2000; 18:173-82. [PMID: 10338437 DOI: 10.1002/(sici)1520-6777(1999)18:3<173::aid-nau3>3.0.co;2-m] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of our study was to determine the urodynamic basis for the observation that aging women report comparable benign prostatic hyperplasia (BPH) symptom scores as age-matched men. Sixty-seven women (mean age, 60.4 +/- 1.5 years; mean +/- standard error of the mean) and 70 age-matched men (mean age, 63.7 +/- 0.9 years; P > 0.05) entered this prospective study. Men were referred for the diagnostic workup of lower urinary tract symptoms (LUTS) due to BPH and women predominantly for urinary incontinence. All patients completed the International Prostate Symptom score (IPSS) with quality-of-life assessment and underwent a detailed clinical and urodynamic evaluation including a multichannel pressure-flow study. Results of the IPSS, quality-of-life assessment, and irritative and obstructive component of the IPSS were correlated with urodynamic findings and the respective data were compared in both sexes. The mean IPSS was 15.7 for men and 13.0 for women (P = 0.02), quality-of-life score was higher in women (4.2 vs. 3.4; P = 0.0008). The irritative score was significantly higher in women (8.7 vs. 6.8; P = 0.003). Incidence of detrusor instability (DI), however, was higher in men (women, 38.1%; men, 48.6%; P = 0.015) and bladder capacity was higher in women (425 vs. 333 ml; P = 0.0001). There was no correlation between incidence and degree of DI with the irritative score in both sexes. The obstructive score was significantly higher in men (8.8 vs. 4.4; P = 0.0001). Ninety-one percent (64/70) of men had urodynamically documented bladder outlet obstruction (BOO), whereas this was the case in only 9% (6/67) of women. In parallel to the irritative score, we could not identify a correlation between the degree of urodynamically proven BOO and the obstructive score in both sexes. This urodynamics-based comparison fails to give an explanation for the observation that aging women report similar BPH scores as men. These data suggest that other mechanisms, such as changes in diurnal urine production, structural alterations of the aging detrusor, endocrine disturbances affecting lower urinary tract function, and subtle urodynamic changes are responsible.
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Madersbacher S, Pycha A, Klingler CH, Mian C, Djavan B, Stulnig T, Marberger M. Interrelationships of bladder compliance with age, detrusor instability, and obstruction in elderly men with lower urinary tract symptoms. Neurourol Urodyn 2000; 18:3-15. [PMID: 10090122 DOI: 10.1002/(sici)1520-6777(1999)18:1<3::aid-nau2>3.0.co;2-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Data on the interrelationships of bladder compliance (BC), detrusor instability (DI), and bladder outflow obstruction (BOO) in elderly men with lower urinary tract symptoms (LUTS) are scarce and were therefore assessed in this study. Principle inclusion criteria for this study were men aged > or = 50 years suffering from LUTS as defined by an International Prostate Symptoms Score (IPSS) of > or = 7 and a peak flow rate (Qmax) of < or = 15 ml/sec. Patients with previous surgery of the bladder, prostate, or urethra as well as a pathological neurourological status were excluded from this study. The following parameters were studied in all patients: IPSS, prostate volume calculated by transrectal ultrasonography, free uroflow study, post-void residual volume determined by transurethral catheterization, and a multichannel pressure flow study (pQS). A group of 170 men were included in the analysis. The mean BC in the overall group was 32 +/- 2 ml/cm H2O (mean +/- standard error of the mean [SEM]; range, 4-100 ml/cm H2O). In 36.5% of patients, BC was significantly reduced (< or = 20 ml/cm H2O), and in a further 37.1%, it ranged from 20 to 40 ml/cm H2O. BC decreased statistically significantly (p < 0.05) in patients with advanced age, lower Qmax, higher voiding pressures, and larger prostates. In men with DI (n = 61), mean BC was significantly lower (22 +/- 3 ml/cm H2O) compared to those without (37 +/- 3 ml/cm H2O; p = 0.001; n = 109). Patients with severe BOO as defined by a linear passive urethral resistance relationship of > or = 3 (n = 109), had a significantly lower BC (23 +/- 2 ml/cm H2O) compared to those without or minimal obstruction only (39 +/- 3 ml/cm H2O; p = 0.0002; n = 61). Stepwise logistic regression analysis revealed that DI, a low bladder capacity, and a high maximum detrusor pressure were independent predictors of markedly reduced BC (< 20 ml/cm H2O). BC is decreased in elderly men with high voiding pressures, BOO, and DI. The mechanism leading to the reduction of BC under these circumstances is largely unknown and could result from cytostructural alterations of the detrusor and changes in detrusor innervation.
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MICHEL MARTINC, MEHLBURGER LUDWIG, SCHUMACHER HELMUT, BRESSEL HANSULRICH, GOEPEL MARK. EFFECT OF DIABETES ON LOWER URINARY TRACT SYMPTOMS IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67529-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- MARTIN C. MICHEL
- From the Departments of Medicine and Urology, University of Essen, Essen, Boehringer Ingelheim, Ingelheim and Yamanouchi Pharma, Heidelberg, Germany
| | - LUDWIG MEHLBURGER
- From the Departments of Medicine and Urology, University of Essen, Essen, Boehringer Ingelheim, Ingelheim and Yamanouchi Pharma, Heidelberg, Germany
| | - HELMUT SCHUMACHER
- From the Departments of Medicine and Urology, University of Essen, Essen, Boehringer Ingelheim, Ingelheim and Yamanouchi Pharma, Heidelberg, Germany
| | - HANS-ULRICH BRESSEL
- From the Departments of Medicine and Urology, University of Essen, Essen, Boehringer Ingelheim, Ingelheim and Yamanouchi Pharma, Heidelberg, Germany
| | - MARK GOEPEL
- From the Departments of Medicine and Urology, University of Essen, Essen, Boehringer Ingelheim, Ingelheim and Yamanouchi Pharma, Heidelberg, Germany
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Thomas AW, Abrams P. Lower urinary tract symptoms, benign prostatic obstruction and the overactive bladder. BJU Int 2000; 85 Suppl 3:57-68; discussion 70-1. [PMID: 11954200 DOI: 10.1111/j.1464-410x.2000.tb16953.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lower urinary tract symptoms (LUTS), benign prostatic obstruction (BPO), and the overactive bladder have increasing prevalence with age in both men and women (with the obvious exception). The question is, are they interrelated or independently related to age? The specific issue is whether BPO causes the overactive bladder. There are two pieces of evidence that might appear to suggest such a cause and effect. First, the overactive bladder is more common in men than in women of the same age, although physiologically, men are 5-10 years older at the same biological age. Second, the overactive bladder resolves in two-thirds of individuals after surgical interventions such as transurethral prostatectomy. The symptoms suggestive of an overactive bladder are the most troublesome, even though they may not be the most prevalent. Long-term follow-up studies with repeated urodynamic investigations have shown that the incidence of the overactive bladder and its attendant symptoms increases despite there being no deterioration in outlet obstruction over follow-up periods of 10 and 20 years. These data, and others, indicate that the situation is not as straightforward as some believe. The statement that 'the overactive bladder is secondary to BPO' cannot be made, as there are too many unanswered questions and pieces of the puzzle that do not fit. The overactive bladder is undoubtedly associated with BPO, and it leads to the most troublesome LUTS in older men. Epidemiological research, coupled with urodynamic evaluation, may provide further evidence. We also need better and more relevant models (e.g. ageing animals), together with further histological and other biological data before the waters become crystal clear.
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Affiliation(s)
- A W Thomas
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Azadzoi KM, Tarcan T, Siroky MB, Krane RJ. Atherosclerosis-induced chronic ischemia causes bladder fibrosis and non-compliance in the rabbit. J Urol 1999. [PMID: 10210430 DOI: 10.1016/s0022-5347(05)68995-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE The overall goal was to determine whether chronic ischemia and hypercholesterolemia interfere with bladder function and structure. The roles of atherosclerosis-induced chronic ischemia and hypercholesterolemia in bladder fibrosis and non-compliance were studied in the rabbit. The relationship between ischemia-induced changes in the expression of transforming growth factor-beta1 (TGF-beta1) and basic fibroblast growth factor (bFGF) and the severity of bladder fibrosis was also investigated. MATERIALS AND METHODS Male New Zealand White rabbits were divided into chronic bladder ischemia (CBI, n = 11), hypercholesterolemia (Hch, n = 8) and control (n = 8) groups. The CBI group underwent balloon endothelial injury of the iliac arteries and received a 0.5% cholesterol diet. The Hch group received a 0.5% cholesterol diet alone. The control group was placed on a regular diet. After 16 weeks, iliac artery and bladder wall blood flow measurements, cystometrograms (CMG) and aorto-iliac arteriograms were obtained in all animals. Iliac arteries and bladder tissues were processed for histological staining and computer-assisted histomorphometric image analysis. The expressions of TGF-beta1 and bFGF in bladder tissue were determined by immunohistochemical staining utilizing monoclonal antibodies. RESULTS At 16 weeks, arteriography and histology showed significant diffuse atherosclerotic occlusive disease of the aorto-iliac arteries in the CBI group. Iliac artery and bladder wall blood flows were significantly decreased in the CBI group compared with the Hch and control groups. Atherosclerosis-induced CBI shifted the volume-pressure curve to the left and caused severe bladder fibrosis. Hypercholesterolemia also caused fibrosis and non-compliance but to a much lesser extent compared with those caused by CBI. In histomorphometry, the percentage of detrusor smooth muscle was moderately decreased in the Hch group and severely decreased in the CBI group compared with the control group. In immunohistochemical stains of bladder tissues, bFGF expression was similar in the three groups of animals. TGF-beta1 expression was significantly greater in bladder tissues from the CBI group compared with the Hch and control groups. CONCLUSIONS Our studies show that atherosclerosis-induced chronic ischemia increases TGF-beta1 expression in the bladder leading to fibrosis, smooth muscle atrophy and non-compliance. Hypercholesterolemia also interferes with bladder structure and compliance but to a significantly lesser extent compared with CBI. Our studies suggest that arterial insufficiency and hypercholesterolemia, common aging-associated disorders, may play important roles in the pathophysiology of voiding dysfunction in the elderly.
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Affiliation(s)
- K M Azadzoi
- Department of Urology, Boston University School of Medicine, Boston VA Medical Center, Massachusetts 02130, USA
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