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Clinicopathological features and short outcomes of oliguric acute tubular injury. J Crit Care 2022; 71:154076. [PMID: 35716651 DOI: 10.1016/j.jcrc.2022.154076] [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: 01/04/2022] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To explore the clinicopathological features and analyze the relevant risk factors and short-term renal outcomes of acute tubular injury (ATI) patients. MATERIALS AND METHODS A total of 83 patients with biopsy-proven ATI were included in this retrospective cohort study. Clinical characteristic and histological feature data were collected, and renal recovery at 1 month postbiopsy was recorded. RESULTS The severity of renal dysfunction, percentage of acute tubular lesions, interstitial inflammation and fibrosis of oliguric ATI patients were all significantly higher than those of nonoliguric patients. In the subgroup analysis of the oliguric patients, the serum creatinine and urinary microalbumin levels, severity of epithelial cell degeneration and cast formation of patients in the polyuric phase at biopsy were significantly lower than those of patients in the oliguric phase. A total of 59 patients had 1-month follow-up records, and complete renal recovery was observed in 42 patients. In the multivariate analysis, the total acute tubular injury area at biopsy was the most important independent risk factor for poor renal outcomes. CONCLUSIONS Oliguric ATI patients had severe clinicopathological conditions. The severity of tubular lesions seriously influenced renal function recovery, demonstrating the importance of renal biopsy in assessing the prognosis of patients with kidney disease.
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Obesity and Voiding Parameters in a Community-Based Population of Okinawa, Japan: Kumejima Digital Health Project (KDHP). Metabolites 2022; 12:metabo12050468. [PMID: 35629972 PMCID: PMC9145398 DOI: 10.3390/metabo12050468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Evidence has accumulated regarding the etiology of lower urinary tract symptoms associated with obesity and metabolic syndrome. Therefore, the present study aimed to identify which subjectively and objectively measured voiding parameters were associated with obesity in a community-based population. (2) Methods: Voiding parameters on a self-administered questionnaire and a digital self-health monitoring system for urine excretion (s-HMSU) were compared between participants with and without obesity, defined as a body mass index ≥ 25 kg/m2 (n = 30 and 29, respectively), from a community in Okinawa, Japan. Logistic regression analysis was employed to calculate the odds ratios of abnormalities in voiding parameters for the obese group, with the non-obese group serving as a reference. (3) Results: The obese group had odds ratios of 5.17 (95% confidence interval: 1.33−20.0) for shortened hours of undisturbed sleep (<302 min) by s-HMSU and 7.65 (1.88−31.1) for nighttime urinary frequency by a questionnaire after adjusting for age and sex. In addition, the obese group had an adjusted odds ratio of 2.27 (0.76−6.78) for decreased maximum bladder capacity (<212 mL) by s-HMSU. (4) Conclusion: the results of the present study suggest that nocturia and shortened hours of undisturbed sleep are signs of obesity.
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Maximum Flow Rate Is Lowest in the Early Morning in Hospitalized Men With Nocturia Evaluated Over 24 Hours by Toilet Uroflowmetry. Urology 2022; 166:196-201. [DOI: 10.1016/j.urology.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022]
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Eckerbom P, Hansell P, Cox E, Buchanan C, Weis J, Palm F, Francis S, Liss P. Circadian variation in renal blood flow and kidney function in healthy volunteers monitored with noninvasive magnetic resonance imaging. Am J Physiol Renal Physiol 2020; 319:F966-F978. [PMID: 33073586 DOI: 10.1152/ajprenal.00311.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Circadian regulation of kidney function is involved in maintaining whole body homeostasis, and dysfunctional circadian rhythm can potentially be involved in disease development. Magnetic resonance imaging (MRI) provides reliable and reproducible repetitive estimates of kidney function noninvasively without the risk of adverse events associated with contrast agents and ionizing radiation. The purpose of this study was to estimate circadian variations in kidney function in healthy human subjects with MRI and to relate the findings to urinary excretions of electrolytes and markers of kidney function. Phase-contrast imaging, arterial spin labeling, and blood oxygen level-dependent transverse relaxation rate (R2*) mapping were used to assess total renal blood flow and regional perfusion as well as intrarenal oxygenation in eight female and eight male healthy volunteers every fourth hour during a 24-h period. Parallel with MRI scans, standard urinary and plasma parameters were quantified. Significant circadian variations of total renal blood flow were found over 24 h, with increasing flow from noon to midnight and decreasing flow during the night. In contrast, no circadian variation in intrarenal oxygenation was detected. Urinary excretions of electrolytes, osmotically active particles, creatinine, and urea all displayed circadian variations, peaking during the afternoon and evening hours. In conclusion, total renal blood flow and kidney function, as estimated from excretion of electrolytes and waste products, display profound circadian variations, whereas intrarenal oxygenation displays significantly less circadian variation.
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Affiliation(s)
- Per Eckerbom
- Section of Radiology, Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - Peter Hansell
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Eleanor Cox
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte Buchanan
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - Jan Weis
- Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Fredrik Palm
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - Per Liss
- Section of Radiology, Department of Surgical Sciences, University Hospital, Uppsala, Sweden
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Bliwise DL, Howard LE, Moreira DM, Andriole GL, Hopp ML, Freedland SJ. Nocturia and associated mortality: observational data from the REDUCE trial. Prostate Cancer Prostatic Dis 2018; 22:77-83. [DOI: 10.1038/s41391-018-0090-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/28/2022]
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Fischer KM, Xu M, Weiss JP. Nocturnal Polyuria: What We Need to Know in 2015. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hofmeester I, Kollen BJ, Steffens MG, Bosch JLHR, Drake MJ, Weiss JP, Blanker MH. Impact of the International Continence Society (ICS) report on the standardisation of terminology in nocturia on the quality of reports on nocturia and nocturnal polyuria: a systematic review. BJU Int 2015; 115:520-36. [PMID: 24684483 DOI: 10.1111/bju.12753] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To systematically review and evaluate the impact of the International Continence Society (ICS)-2002 report on standardisation of terminology in nocturia, on publications reporting on nocturia and nocturnal polyuria (NP). In 2002, the ICS defined NP as a Nocturnal Polyuria Index (nocturnal urine volume/total 24-h urine volume) of >0.2-0.33, depending on age. MATERIALS AND METHODS In April 2013 the PubMed and Embase databases were searched for studies (in English, German, French or Dutch) based on original data and adult participants, investigating the relationship between nocturia and NP. A methodological quality assessment was performed, including scores on external validity, internal validity and informativeness. Quality scores of items were compared between studies published before and after the ICS-2002 report. RESULTS The search yielded 78 publications based on 66 studies. Quality scores of studies were generally high for internal validity (median 5, interquartile range [IQR] 4-6) but low for external validity. After publication of the ICS-2002 report, external validity showed a significant change from 1 (IQR 1-2) to 2 (IQR 1-2.5; P = 0.019). Nocturia remained undefined in 12 studies. In all, 19 different definitions were used for NP, most often being the ICS (or similar) definition: this covered 52% (n = 11) of studies before and 66% (n = 27) after the ICS-2002 report. Clear definitions of both nocturia and NP were identified in 67% and 76% before, and in 88% and 88% of the studies after the ICS-2002 report, respectively. CONCLUSION The ICS-2002 report on standardisation of terminology in nocturia appears to have had a beneficial impact on reporting definitions of nocturia and NP, enabling better interpretation of results and comparisons between research projects. Because the external validity of most of the 66 studies is considered a problem, the results of these studies may not be validly extrapolated to other populations. The ICS definition of NP is used most often. However, its discriminative value seems limited due to the estimated difference of 0.6 nocturnal voids between individuals with and without NP. Refinement of current definitions based on robust research is required. Based on pathophysiological reasoning, we argue that it may be more appropriate to define NP based on nocturnal urine production or nocturnal voided volumes, rather than on a diurnal urine production pattern.
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Affiliation(s)
- Ilse Hofmeester
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
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van Doorn B, Kok ET, Blanker MH, Westers P, Ruud Bosch J. Determinants of Nocturia: the Krimpen Study. J Urol 2014; 191:1034-9. [DOI: 10.1016/j.juro.2013.10.105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Boris van Doorn
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esther T. Kok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco H. Blanker
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul Westers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J.L.H. Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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Abdel Rahman TT, El Gaafary MM. Nocturia among elderly men living in a rural area in Egypt, and its impact on sleep quality and health-related quality of life. Geriatr Gerontol Int 2013; 14:613-9. [DOI: 10.1111/ggi.12145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2013] [Indexed: 11/25/2022]
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Breyer BN, Shindel AW, Erickson BA, Blaschko SD, Steers WD, Rosen RC. The association of depression, anxiety and nocturia: a systematic review. J Urol 2013; 190:953-7. [PMID: 23680309 DOI: 10.1016/j.juro.2013.03.126] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE This systematic review focuses on the relationship between nocturia and depression/anxiety. Our objective is to provide an overview of current data on the epidemiology, pathophysiology and patient management implications of the association between nocturia and depression/anxiety. MATERIALS AND METHODS We queried PubMed®, Web of Science® and Embase™ in July 2012 to identify abstracts, and original, review and editorial articles on nocturia and mood disorders, specifically depression and anxiety. The search was done using the key words "nocturia," "depression" and "anxiety." We complied with the Assessment of Multiple Systemic Reviews (AMSTAR) instrument. We retrieved a total of 500 records, including 95, 81 and 324 from PubMed, Web of Science and Embase, respectively. RESULTS Cross-sectional (level 3) data indicated that nocturia and depression/anxiety are strongly associated. One prospective study contended that depression leads to nocturia in a unidirectional relationship. Nocturia poses a greater risk for depression in men vs women. Results conflict on the effect of serotonin reuptake inhibitors on nocturia. CONCLUSIONS The results of this systematic review suggest a bidirectional association between depression and nocturia. The relationship between anxiety and nocturia is less clear. Practicing clinicians should consider administering a brief self-administered scale to assess for depression in patients with nocturia.
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Affiliation(s)
- Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California 94143, USA.
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Blanker MH. Re: Kojima Y, et al. Tamsulosin reduces nighttime urine production in benign prostatic hyperplasia patients with nocturnal polyuria: A prospective open-label long-term study using frequency-volume chart. Neurourol Urodyn 2012;31:80-85. Neurourol Urodyn 2013; 32:104. [DOI: 10.1002/nau.22260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 03/19/2012] [Indexed: 11/12/2022]
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Huang MH, Chiu AF, Wang CC, Kuo HC. Prevalence and risk factors for nocturia in middle-aged and elderly people from public health centers in Taiwan. Int Braz J Urol 2012; 38:818-24. [DOI: 10.1590/1677-553820133806818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 11/22/2022] Open
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Abstract
OBJECTIVE To estimate the relation of smoking status and smoking intensity with bladder symptoms. METHODS Questionnaires were mailed to 3,000 women (aged 18-79 years) randomly identified from the Finnish Population Register. Case definitions for stress urinary incontinence (SUI), urgency, and urgency urinary incontinence (UUI) were "often" or "always" based on reported occurrence (never, rarely, often, always). Case definitions for urinary frequency were based on reporting of longest voiding interval as less than 2 hours and for nocturia reporting of at least two voids per night. Potential confounders included comorbidities, medications, sociodemographic, lifestyle, and reproductive factors. RESULTS Responses totaled 2,002 (67.0%). Frequency was reported by 7.1%, nocturia 12.6%, SUI 11.2%, urgency 9.7%, and UUI 3.1%. In the multivariable analyses, smoking was associated with urgency (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7-4.2 for current and OR 1.8, CI 1.2-2.9 for former compared with never smokers) and frequency (OR 3.0, CI 1.8-5.0 for current and OR 1.7, CI 1.0-3.1 for former smokers) but not with nocturia and SUI. Adjusted prevalence differences between never and current smokers were 6.0% (3.0-9.1%) for urgency and 6.0% (3.3-8.7%) for frequency. Similarly, current heavy (compared with light) smoking was associated with additional risk of urgency (OR 2.1, CI 1.1-3.9) and frequency (OR 2.2, CI 1.2-4.3). CONCLUSION Urgency and frequency are approximately three times more common among current than never smokers. Parallel associations for urgency and frequency with smoking intensity suggest a dose-response relationship. Nocturia and SUI are not associated with smoking. These results suggest an additional rationale for smoking cessation in women seeking medical attention for bladder symptoms and highlight the diversity between such symptoms. LEVEL OF EVIDENCE II.
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Abstract
This review examines the current knowledge of water intake as it pertains to human health, including overall patterns of intake and some factors linked with intake, the complex mechanisms behind water homeostasis, and the effects of variation in water intake on health and energy intake, weight, and human performance and functioning. Water represents a critical nutrient, the absence of which will be lethal within days. Water's importance for the prevention of nutrition-related noncommunicable diseases has received more attention recently because of the shift toward consumption of large proportions of fluids as caloric beverages. Despite this focus, there are major gaps in knowledge related to the measurement of total fluid intake and hydration status at the population level; there are also few longer-term systematic interventions and no published randomized, controlled longer-term trials. This review provides suggestions for ways to examine water requirements and encourages more dialogue on this important topic.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina 27516, USA.
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Kaye M. Aging, Circadian Weight Change, and Nocturia. ACTA ACUST UNITED AC 2008; 109:p11-8. [DOI: 10.1159/000129653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 02/26/2008] [Indexed: 11/19/2022]
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Sooriakumaran P, Brown C, Emberton M. Frequency volume charts should be used in men with lower urinary tract symptoms. Int J Surg 2007; 3:147-50. [PMID: 17462276 DOI: 10.1016/j.ijsu.2005.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A frequency volume chart is a simple, easy-to-use, non-invasive tool that is useful in the assessment of patients with lower urinary tract symptoms. Though more sophisticated techniques are now available for diagnosis, the frequency volume chart should still be considered the first line investigation. In this review we summarize the indications and value of this age old investigation. Urologists and primary care physicians should use the frequency volume chart more frequently in their practice.
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Shenfeld OZ, Meir KS, Yutkin V, Gofrit ON, Landau EH, Pode D. Do atherosclerosis and chronic bladder ischemia really play a role in detrusor dysfunction of old age? Urology 2005; 65:181-4. [PMID: 15667900 DOI: 10.1016/j.urology.2004.08.055] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Accepted: 08/27/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine whether atherosclerosis-induced chronic pelvic ischemia plays a role in the pathogenesis of aging bladder dysfunction. METHODS Old (70 weeks of age), apolipoprotein E gene knockout (APOEKO) mice, known to develop atherosclerosis spontaneously were used. A group of 70-week-old C57B mice were used as controls. The mice were killed and bladder smooth muscle strips obtained for in vitro contractile force determinations. The maximal contractions in response to 110 mM KCl, 10(-5) M bethanechol, and resting muscle tone were compared. The abdominal aortas and iliac arteries were harvested from the mice, and computerized image analysis was used to determine the percentage of surface area of atherosclerosis in each mouse. RESULTS Although the APOEKO mice had massive atherosclerosis of the abdominal aortas and iliac arteries (lesion surface area +/- SEM 15.93% +/- 3.02%, n = 4), the control mice (n = 5) had no atherosclerosis at all. No statistically significant difference was found in detrusor function (KCl 0.48 +/- 0.11 versus 0.49 +/- 0.05, bethanechol 0.11 +/- 0.02 versus 0.13 +/- 0.04, tone 0.063 +/- 0.019 versus 0.07 +/- 0.004, respectively) between the APOEKO mice (n = 6) and the control mice (n = 6). CONCLUSIONS Pelvic atherosclerosis caused no statistically significant changes in bladder smooth muscle contractile responses to bethanechol, KCl, or resting tone. The difference between these and previously reported results may have been a result of the more gradual onset of atherosclerosis in our model, which better mimics pelvic organ ischemia in the elderly.
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Affiliation(s)
- Ofer Z Shenfeld
- Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Abstract
There is increasing evidence that mild dehydration plays a role in the development of various morbidities. In this review, the effects of hydration status on chronic diseases are categorized according to the strength of the evidence. Positive effects of maintenance of good hydration are shown for urolithiasis (category lb evidence); constipation, exercise asthma, hypertonic dehydration in the infant, and hyperglycemia in diabetic ketoacidosis (all category IIb evidence); urinary tract infections, hypertension, fatal coronary heart disease, venous thromboembolism, and cerebral infarct (all category III evidence); and bronchopulmonary disorders (category IV evidence). For bladder and colon cancer, the evidence is inconsistent.
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Affiliation(s)
- Friedrich Manz
- Research Institute of Child Nutrition, Heinstück 11, D-44225 Dortmund, Germany.
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Porru D, Scarpa RM, Prezioso D, Bertaccini A, Rizzi CA. Home and office uroflowmetry for evaluation of LUTS from benign prostatic enlargement. Prostate Cancer Prostatic Dis 2005; 8:45-9. [PMID: 15655566 DOI: 10.1038/sj.pcan.4500763] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A group of 107 patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE) participated to the HOUSE Study (Home and Office Uroflowmetry Specific Evaluation). Patients received routine investigation, consisting of medical history taking, physical examination including digital rectal examination, prostate-specific antigen (PSA), assessment of symptoms listed both on the International Prostate Symptom Score and on ICS-male questionnaire. We examined the results of uroflowmetry evaluation in this population; data were analysed to observe if any circadian changes of parameters obtained with home uroflowmetry could be detected. We searched a correlation between Q(max), Q(ave) and ICS-benign prostatic hyperplasia symptom score: a significantly inverse correlation was found only for Q(max), confirming Q(max) as a reliable parameter to quantify subjective symptoms. When examining the multiple flow curves recorded in the same patient with home uroflowmetry, voided volume and flow time had usually higher values during night-time: the existence of circadian changes of uroflowmetry parameters in patients with LUTS from BPE was confirmed, and lower values of average and maximum flow rates during sleep hours were recorded in the same patient. In conclusion, when evaluating the natural history or treatment outcome of individual patients or group of patients in clinical trials for evaluation of BPE and LUTS, an assessment including multiple measurements may be useful and of value.
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Affiliation(s)
- D Porru
- Divisione Urologia, IRCCS Policlinico S. Matteo, Piazzale Golgi 19, 27100 Pavia, Italy.
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Bhargava S, Canda AE, Chapple CR. A rational approach to benign prostatic hyperplasia evaluation: recent advances. Curr Opin Urol 2004; 14:1-6. [PMID: 15091041 DOI: 10.1097/00042307-200401000-00001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this article we aim to outline the recent advances in the evaluation of a patient with symptoms suggestive of benign prostatic hyperplasia. We define the role of the clinical evaluation and techniques that are evolving for the appropriate management of a patient with benign prostatic hyperplasia. Both non-invasive and invasive investigation techniques are reviewed. RECENT FINDINGS Initiating early and appropriate treatment is the primary aim of investigation for a patient with lower urinary tract symptoms. Both clinical history and examination and appropriate investigations are vital to establishing a diagnosis. Symptom scores, prostate specific antigen and prostate volume were found to closely relate in predicting the progression of benign prostatic hyperplasia and in recent years increased interest has centred on the progression of this disease principally related to the development of new pharmacotherapy. Despite these positive findings further research is needed to develop reliable tools to predict progression. Newer ultrasound techniques hold promise for the future. Conventional pressure flow studies have a defined role in excluding patients who are less likely to benefit from prostatic surgery by providing information on detrusor function; and non-invasive urodynamic techniques need further evaluation but appear to be promising. SUMMARY The minimal initial evaluation of a patient with benign prostatic hyperplasia should include a thorough history, digital rectal and neurological examinations, symptom scoring (including quality of life and sexual score) and measurement of serum prostate specific antigen. Other methods should be reserved for more complex situations. Attempts should be made at identifying those patients in whom the disease process is likely to progress.
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Affiliation(s)
- Saurabh Bhargava
- Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
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