1
|
Oelke M, Abt SD, Becher KF, Dreikorn K, Madersbacher S, Magistro G, Michel MC, Muschter R, Reich O, Rieken M, Salem J, Schönburg S, Höfner K, Bschleipfer T. [Diagnostic work-up of benign prostatic hyperplasia : The German S2e-guideline 2023 part 1]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02142-0. [PMID: 37401972 DOI: 10.1007/s00120-023-02142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; in German guidelines: benign prostatic syndrome [BPS]) is the most frequent urological disease in men and can result in a considerable deterioration of quality-of-life. BPS can be associated with LUTS, benign prostatic enlargement (BPE), and bladder outlet obstruction (BOO) or benign prostatic obstruction (BPO), respectively. The expert group on BPS of the German Society of Urology has re-evaluated the tests for the assessment of BPH and provides evidence-based recommendations. OBJECTIVES Presentation and evidence-based rating of tests for the assessment of patients with BPS. MATERIALS AND METHODS Summary and overview of chapters 5, 6, and 8 of the latest long version of the German S2e guideline on BPS. RESULTS The diagnostic work-up should clarify (1) whether the complaints of the patient are caused by BPS, (2) how relevant the complaints are and whether treatment is necessary, (3) whether complications of the lower or upper urinary tract already exist, and (4) which treatment will be most suitable. Baseline assessment should be done in all BPS patients and include history, measurement of LUTS and quality-of-life, urinalysis, serum prostate-specific antigen, post-void residual, ultrasound of the lower urinary tract, including measurements of prostate volume, intravesical prostatic protrusion and detrusor wall thickness, and ultrasound of the upper urinary tract. Additional tests can follow when questions remain unanswered after baseline assessment. These optional tests include bladder diaries, uroflowmetry, serum creatinine, urethrocystoscopy, other noninvasive tests for the determination of BOO/BPO such as penile cuff test, condom catheter method and near-infrared spectroscopy, and other imagining tests such as X‑ray and MRI investigations. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations on the diagnostic work-up, including the assessment of the BPS components BPE, LUTS, and BOO/BPO.
Collapse
Affiliation(s)
- Matthias Oelke
- Klinik für Urologie, Urologische Onkologie und Roboter-assistierte Chirurgie, St. Antonius-Hospital GmbH, Möllenweg 22, 48599, Gronau, Deutschland.
| | - S Dominik Abt
- Klinik für Urologie, Spitalzentrum Biel, Biel, Schweiz
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | | | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Martin C Michel
- Abteilung Pharmakologie, Johannes Gutenberg Universität, Mainz, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Oliver Reich
- Urologische Privatpraxis Prof. Dr. Oliver Reich, München, Deutschland
| | | | - Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
| | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
| |
Collapse
|
2
|
Wang Q, Zhang B, Li B, Yang S, Wang Z, Han C, Wu J, Tian R. Correlation Between Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms and Renal Function in Elderly Men Aged 80 Years and Older. Clin Interv Aging 2023; 18:61-69. [PMID: 36660542 PMCID: PMC9844101 DOI: 10.2147/cia.s392519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Purpose To investigate the relationship between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and renal function in elderly men aged 80 years and older. Patients and Methods We selected 389 elderly men aged 80-97 years with BPH/LUTS hospitalized at The Second Division of General Geriatrics, The First Affiliated Hospital of Zhengzhou University, between July 2018 and July 2020. In the cross-sectional study, patients were divided into the treatment (233 patients) and non-treatment (156 patients) groups based on whether they received treatment for BPH/LUTS. In the prospective self-case-control study, we included 129 of the non-treatment group patients who received oral BPH/LUTS medication and completed the 6-month outpatient follow-up. We compared prostate indicators and renal function in the cross-sectional study and baseline and after-treatment data in the prospective self-case-control study. Multiple linear regression analysis was performed for risk factors affecting renal function before and after BPH/LUTS treatment. Results In the cross-sectional study, renal function was significantly better in the treatment group than in the non-treatment group. In the subgroup analysis of the prospective self-case-control study, renal function significantly improved after treatment among patients with hypertension and those with chronic kidney disease (CKD) 3a, but not in the entire cohort. Multivariable linear regression analysis showed that hypertension (β=2.06, 95% CI 0.40 to 3.71) and CKD 3a (β=17.16, 95% CI 15.53 to 18.79) were independent risk factors for creatinine differences before and after treatment, whereas hypertension (β=-2.27, 95% CI -3.65 to -0.89), CKD 3a (β=-11.93, 95% CI -13.29 to -10.58), and baseline prostate volume (β=-0.11, 95% CI -0.20 to -0.02) were independent risk factors for estimated glomerular filtration rate differences before and after treatment. Conclusion Treatment for moderate and severe BPH/LUTS can improve renal function in elderly patients with hypertension or CKD 3a.
Collapse
Affiliation(s)
- Qian Wang
- The Second Division of General Geriatrics, Department of Geriatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China,Correspondence: Qian Wang; Rui Tian, The Second Division of General Geriatrics, Department of Geriatrics, the First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Erqi District, Zhengzhou, Henan, 450052, People’s Republic of China, Tel +8615838328873, Fax +8637166295183, Email ;
| | - Bin Zhang
- The Second Division of General Geriatrics, Department of Geriatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Bing Li
- The Second Division of General Geriatrics, Department of Geriatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Shengnan Yang
- The Second Division of General Geriatrics, Department of Geriatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Zhifang Wang
- Division of Endocrinology, Department of Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Chao Han
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jie Wu
- Division of Ultrasound, Department of Medical Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Rui Tian
- The Second Division of General Geriatrics, Department of Geriatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| |
Collapse
|
3
|
Coguplugil AE, Topuz B, Ebiloglu T, Zor M, Gurdal M. Primary bladder neck obstruction is one of the rare causes for renal failure in young adult males. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary bladder neck obstruction (PBNO) is one of the causes of bladder outlet obstruction (BOO) and rarely results in renal failure. We are presenting the clinical characteristics of young male patients with PBNO and renal failure.
Methods
Medical records of patients between 18 and 40 years old with PBNO and renal failure were retrospectively reviewed (2014–2020). Patients with anatomical cause of BOO, and any urological or systemic disease or previous history of any surgical procedure associated with renal failure and/or lower urinary tract dysfunction were excluded. Serum creatinine measurement, ultrasonography, uroflowmetry, cystoscopy, and videourodynamics were performed.
Results
Seven male patients were identified, and the mean age of the patients was 28.8 years. Symptom duration was > 5 years in all patients. Two patients presented with difficult voiding, and five patients presented with both storage and voiding lower urinary tract symptoms (LUTS). Three patients were previously misdiagnosed as overactive bladder. At presentation, serum creatinine levels were between 1.7 and 2.4 mg/dl. One patient was under hemodialysis treatment and waiting for renal transplantation. Mean detrusor pressure at maximum measured flow rate, mean maximum flow rate (Qmax), and mean average flow rate (Qave) was 67.6 cm H2O, 9.5 ml/s, and 5.5 ml/s, respectively. With α-blocker treatment, serum creatinine levels were stable or decreased after 12 months follow-up and mean Qmax and Qave were increased to 14.8 ml/s and 10.1 ml/s, respectively.
Conclusions
PBNO is a common disease in young men presenting with a long history of LUTS. Videourodynamics is mandatory for accurate diagnosis, but having a high clinical suspicion for PBNO is key to ensure the diagnosis. Clinicians should pay more attention to PBNO in young male patients with a long history of LUTS to prevent misdiagnosis, incorrect treatment, and possible decrease in renal function by years.
Collapse
|
4
|
Eljamal K, Kajioka S, Maki T, Ushijima M, Kawagoe K, Lee K, Sasaguri T. New mouse model of underactive bladder developed by placement of a metal ring around the bladder neck. Low Urin Tract Symptoms 2020; 13:299-307. [PMID: 33089671 DOI: 10.1111/luts.12359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To develop a new mouse model of underactive bladder (UAB) caused by chronic bladder outlet obstruction (BOO). METHODS BOO was created in 6-week-old male C57BL/6 mice using surgery to loosely place a silver jump ring around the bladder neck of each mouse. Micturition behavior (assessed with a metabolic cage) and cystometry were used to evaluate bladder function at 8 and 16 weeks after BOO. Following completion of the functional studies, the bladders of the mice were excised, weighed, and subjected to histological analysis. RESULTS Micturition behavior analysis showed that mice subjected to BOO for 16 weeks had a lower frequency of micturition (7.3 ± 1.1 vs 12.5 ± 3.0 times/d, P < .05) and volume per void (106.0 ± 0.1 vs 133.9 ± 3.2 μL, P < .05) than mice subjected to BOO for 8 weeks. Cystometry revealed that mice subjected to BOO for 16 weeks had lower baseline pressure (8.4 ± 0.6 vs 14.0 ± 0.7 cmH2 O, P < .01) and micturition pressure (13.9 ± 1.1 vs 42.8 ± 1.7 cmH2 O, P < .05) than mice subjected to BOO for 8 weeks. BOO caused progressive increases in bladder mass and collagen deposition over time. CONCLUSIONS We successfully established a novel mouse model of UAB using surgery to place a silver jump ring loosely on the bladder neck. BOO initially induced bladder overactivity but subsequently resulted in UAB due to deterioration of detrusor smooth muscle contractility and progressive deposition of collagen in the bladder wall.
Collapse
Affiliation(s)
- Kareman Eljamal
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunichi Kajioka
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoko Maki
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miho Ushijima
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kentaro Kawagoe
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Lee
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiyuki Sasaguri
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
5
|
Huang Y, Li J, Yang S, Yuan D, Wang S. Efficacy and safety of transurethral split of prostate for benign prostatic hyperplasia: a meta-analysis. BMC Urol 2020; 20:141. [PMID: 32883254 PMCID: PMC7469103 DOI: 10.1186/s12894-020-00704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is the first choice for the treatment of benign prostatic hyperplasia. However, Transurethral split of prostate (TUSP) also seems to have clear clinical efficacy and clinical promotion value. To better clarify the potential and limitations of this treatment of prostate hyperplasia. This study objectively evaluated the clinical efficacy and safety of TUSP. METHODS The Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Database for Chinese Technical Periodicals (VIP), Wanfang (Wanfang data), and SinoMed databases were searched for relevant studies. We then used Revman Manager 5.3 to perform a meta-analysis of all randomized controlled trials that evaluated the efficacy and safety of TUSP versus the classic surgical procedures commonly used in the clinic. RESULTS A total of 7 studies involving 592 patients were included. The combined data showed that TUSP can shorten the operation time [MD: -33.68; 95% CI: - 38.45 to - 28.91; P < 0.001], reduce intraoperative blood loss [MD: -56.06; 95% CI: - 62.68 to - 49.43; P < 0.001], shorten the time of indwelling catheter [MD: -1.83; 95% CI: - 1.99 to - 1.67; P < 0.001], shorten the postoperative hospital stay length [MD: -1.61; 95% CI: - 1.90 to - 1.32; P < 0.001] and improved postoperative quality of life score (QOL) [MD: 0.16; 95% CI: 0.02 to 0.29; P = 0.02] compared to traditional surgical approaches. There were no statistically significant differences in international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), residual urine volume (RUV), or complications between TUSP and traditional approached. CONCLUSION TUSP can be an effective alternative for clinical treatment of benign prostatic hyperplasia. Given the limitations of the included studies, more high-quality randomized controlled trials are needed in the future to validate or update the results of this analysis.
Collapse
Affiliation(s)
- Yiyu Huang
- Department of Urology, GuangDong Second Traditional Chinese Medicine Hospital, No.212, Luogang Road Street, Luogang District, Guangzhou, 510700, Guangdong, China
| | - Jiaxin Li
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Shan Yang
- Department of Emergency, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Daozhang Yuan
- Department of Urology, GuangDong Second Traditional Chinese Medicine Hospital, No.212, Luogang Road Street, Luogang District, Guangzhou, 510700, Guangdong, China.
| | - Shusheng Wang
- Department of Urology, Guangdong Provincial Hospital of Chinese Medicine, No.261, Datong Road, Yuexiu District, Guangzhou, 510030, Guangdong, China.
| |
Collapse
|
6
|
Functional Evaluation of Upper Urinary Tract with Diuretic Mercaptoacetyltriglycine Renal Scans in Patients with Benign Prostatic Obstruction before and after Surgical Intervention: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4605683. [PMID: 32851073 PMCID: PMC7436344 DOI: 10.1155/2020/4605683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 11/17/2022]
Abstract
Introduction We investigated which benign prostatic hyperplasia-related lower urinary parameters are related to upper urinary tract obstruction and whether transurethral prostatectomy could improve upper urinary tract obstruction. Materials and Methods Patients with prostate size over 30 g and urodynamically proven bladder outlet obstruction were enrolled in this prospective observational study. Bladder wall thickness and prostate size were measured by ultrasonography. A urodynamic study with laboratory tests including serum creatinine, prostate-specific antigen, and urinalysis was performed. Finally, a diuretic scintigraphy using mercaptoacetyltriglycine was performed. Tests except the urodynamic evaluation were repeated after transurethral prostatectomy. Results In total, 24 patients were enrolled, and 19 patients completed the present study. The mean values of age (yrs), prostate size (mL), bladder thickness (mm), bladder compliance (ΔmL/Δpr), and the bladder outlet obstruction index were 68.42 ± 8.25, 72.29 ± 32.78, 4.42 ± 1.14, 50.17 ± 32.15, and 82.11 ± 34.68, respectively. The mean T1/2 (min) was 17.51 ± 16.34 on the left side and 15.30 ± 11.96 on the right side. Statistical analysis showed that bladder compliance and bladder thickness were preoperatively related to upper urinary tract obstruction (p = 0.001 and p = 0.007, respectively). Diuretic mercaptoacetyltriglycine scan in 19 patients showed improvement 6 months after prostate surgery. Clinically significant proteinuria was associated with upper urinary tract obstruction, and proteinuria was also improved after prostate surgery. Conclusion Storage-phase bladder dysfunction could be a reliable urodynamic factor for the indication of upper urinary tract obstruction in patients with benign prostatic hyperplasia, and upper urinary tract obstruction with subsequent kidney damage could be improved by surgical decompression of benign prostatic obstruction.
Collapse
|
7
|
Yazdi H, Restrepo C, Foltz C, Hammad M, Chung PH, Gomella LG, Parvizi J. Symptomatic Benign Prostatic Hyperplasia: A Risk Factor for Periprosthetic Joint Infection in Male Patients. J Bone Joint Surg Am 2020; 102:543-549. [PMID: 32079872 DOI: 10.2106/jbjs.19.00865] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Male patients undergoing total joint arthroplasty have a higher risk of periprosthetic joint infection (PJI) compared with female patients. The exact reason for this finding is not well known. This study aimed to determine if patients with symptomatic benign prostatic hyperplasia (BPH) are at increased risk of PJI. METHODS A total of 12,902 male patients who underwent primary or revision total joint arthroplasty from January 2006 to April 2017 were retrospectively identified. The mean patient age was 62.47 years and the mean patient body mass index was 30.1 kg/m. The majority of patients were Caucasian or African American. Most surgical procedures involved the hip joints (57.8%) and were primary arthroplasties (86%). Of these patients, 386 (3%) had symptomatic BPH. Among this group, 250 patients with symptomatic BPH were identified and were matched in an approximate 1:3 ratio with 708 control patients. Using the International Consensus Meeting criteria, patients who developed PJI were identified. RESULTS The PJI rate was 7.9% in the symptomatic BPH group and 2.8% in the control group. Multivariate regression analysis in unmatched groups showed that symptomatic BPH was a strong independent risk factor for PJI. After matching for variables related to outcomes, symptomatic BPH remained a significant risk factor for PJI (p = 0.01). CONCLUSIONS Patients with symptomatic BPH had a higher risk of PJI compared with the control patients. This may partly explain the higher rate of PJI that is seen in male patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Hamidreza Yazdi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Orthopaedic Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Camilo Restrepo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol Foltz
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mohammed Hammad
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Paul H Chung
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Leonard G Gomella
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
8
|
Ikeyi AP, Okagu IU, Ezeanyika LUS, Alumanah EO. Zapoteca portoricensis root crude methanol extract and its fractions normalizes aberrations associated with benign prostatic hyperplasia in rats. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1788653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Adachukwu Pauline Ikeyi
- Medical Parasitology, Toxicology and Drug Discovery Unit, Department of Biochemistry, University of Nigeria, Nsukka, Nigeria
| | - Innocent Uzochukwu Okagu
- Medical Parasitology, Toxicology and Drug Discovery Unit, Department of Biochemistry, University of Nigeria, Nsukka, Nigeria
| | | | - Edwin Olisah Alumanah
- Medical Parasitology, Toxicology and Drug Discovery Unit, Department of Biochemistry, University of Nigeria, Nsukka, Nigeria
| |
Collapse
|
9
|
Lee DS, Kim HW, Lee SJ. Transurethral prostate surgery as a preventive method against progression of chronic kidney disease in patients with urodynamically proven bladder outlet obstruction. World J Urol 2019; 38:2583-2593. [PMID: 31802205 DOI: 10.1007/s00345-019-03041-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The present study was aimed to investigate (1) whether urodynamic factors are responsible for kidney damage in patients with bladder outlet obstruction (BOO) and (2) whether transurethral prostate surgery for BOO can alleviate the damage to the kidneys. METHODS This prospective observational study involved men aged 50-80 years. Prostate size and urodynamic test were performed during screening period. Laboratory tests to measure the glomerular filtration rate, the urinary protein to creatinine ratio and dipstick urinalysis were performed before and 6 months after the transurethral prostate surgery. RESULTS Sixty-seven patients completed the laboratory study among a hundred enrolled patients with urodynamically proven BOO. Among the urodynamic parameters, only low bladder compliance (lower than 60 mL/cmH2O) was associated with clinically significant proteinuria (p < 0.001). Transurethral prostate surgery significantly improved proteinuria (p = 0.007), especially in patients with low bladder compliance (p = 0.004), and subsequently decreased the risk grade of CKD progression (p < 0.001). CONCLUSIONS Low bladder compliance in patients with BOO may be a risk factor for kidney damage. Transurethral prostate surgery to relieve BOO could be a preventive method against CKD progression in patients with low bladder compliance.
Collapse
Affiliation(s)
- Dong Sup Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong Paldal-gu, Suwon, 16247, Korea
| | - Hyung Wook Kim
- Department of Nephrology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong Paldal-gu, Suwon, 16247, Korea.
| |
Collapse
|
10
|
Abstract
BACKGROUND Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is the fourth most common and the fifth most costly disease in men aged 50 years or older. Despite the high prevalence of LUTS/BPH in clinical practice and evidence-based guideline recommendations, there are still plenty of misconceptions on the terminology and pathophysiology of the disease, leading to false assumptions and malpractice. OBJECTIVES Listing of commonly used false assumptions and clarification of the correct terminology and pathophysiology. MATERIALS AND METHODS Critical reflection of 12 selected fake news based on PubMed search. RESULTS Average prostate weight in healthy men is 20 g but varies between 8-40 g. The BPH-disease does not progress in stages; therefore, the BPH-classifications according Alken or Vahlensieck should not be used anymore. There is only a weak and inconsistent relationship between bladder outlet obstruction (BOO) and prostate size, diverticula/pseudo-diverticula, postvoid residual, urinary retention or renal insufficiency, which is too unreliable for BOO-diagnosis in the individual patient. Urethro-cystoscopy with grading of the degrees of occlusion of the prostatic urethra and bladder trabeculation is insufficient for BOO-diagnosis. There is no clinically relevant reduction of BOO with licensed BPH-drugs and no convincing data that prostate resection (TURP) has to be complete until the surgical capsule in order to obtain optimal results. CONCLUSIONS The reasons for the persistent use of wrong terminology and pathophysiology are diverse. One reason is lack of implementation of evidence-based guidelines into clinical practice due to lack of knowledge, individual beliefs, costs, availability and reimbursement policies. Another reason is the increasing focus on oncology, coupled with underrepresented education and training on BPH.
Collapse
|
11
|
Sarier M, Tekin S, Duman İ, Yuksel Y, Demir M, Alptekinkaya F, Guler M, Yavuz AH, Kosar A. Results of transurethral resection of the prostate in renal transplant recipients: a single center experience. World J Urol 2017; 36:99-103. [DOI: 10.1007/s00345-017-2094-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 11/24/2022] Open
|
12
|
Baten E, van Renterghem K. The Advantages of Transurethral Resection of the Prostate in Patients with an Elevated or Rising Prostate Specific Antigen, Mild or Moderate Lower Urinary Tract Symptoms, Bladder Outlet Obstruction and Negative Prostate Cancer Imaging or Prostate Biopsies: A Prospective Analysis in 105 Consecutive Patients. Curr Urol 2017; 10:140-144. [PMID: 28878597 DOI: 10.1159/000447168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate elevated or rising prostate specific antigen (PSA) as a marker for bladder outlet obstruction (BOO) in patients with minor lower urinary tract symptoms (LUTS) and without prostate cancer. MATERIALS AND METHODS One hundred and five consecutive patients were prospectively analyzed between 2005 and 2013. All patients were referred to the principal investigator by their general practitioner as a result of an elevated and/or rising PSA. Only patients with minor LUTS [International Prostate Symptom Score (I-PSS) 0-19] and without suspicion for prostate cancer were included. All patients had BOO, shown by full urodynamics, and underwent transurethral resection of the prostate. The resected tissue was histologically examined and PSA and I-PSS were evaluated after 3, 6 and 12 months and later on yearly. RESULTS Mean pre-operative PSA and I-PSS values were 8.8 ng/ml and 11.1, respectively. The mean detrusor pressure at maximum flow was 93.6 cmH2O. The mean resected volume was 52 g and the mean prostate biopsy rate was 1.8. Eighty-three of 105 patients (79%) had no malignancy and were diagnosed with BOO due to benign prostate hyperplasia (subgroup 1). Their mean PSA decreased from 9.2 to 0.7 ng/ml and 0.9 ng/ml after 6 and 12 months post-operation, respectively. The mean I-PSS declined from 11 to 3 after 6 and 12 months. Sixteen of 105 patients (15%) were treated for prostate cancer (subgroup 2). Radical prostatectomy was performed in 11 patients, brachytherapy in 3 patients and external beam radiotherapy in 2 patients. Six of 105 patients (5.7%) had active surveillance (subgroup 3). CONCLUSION BOO can cause an elevated or rising PSA in patients with minor LUTS and negative screening for prostate cancer. Transurethral resection of the prostate is an adequate treatment for these patients.
Collapse
|
13
|
Abstract
The underactive bladder (UAB)/detrusor underactivity (DU) is a relatively common condition. It is difficult to diagnose and can be difficult to manage. The aim of this review is to provide a review of the diagnosis and different surgical treatment options for UAB/DU. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, UAB, DU, TURP, reduction cystoplasty, bladder diverticulectomy and sacral neuromodulation (SNM). Search results were assessed for their overall relevance to this review. Definitions, general overview and management options were extracted from the relevant medical literature. DU affects up to 45% of men and women >70 years of age. The symptoms of DU overlap significantly with overactive bladder (OAB) and bladder outlet obstruction (BOO). Urodynamic findings include low voiding pressure combined with slow intermittent flow and incomplete bladder emptying. Non-operative management for DU is acceptable; only 1 in 6 male patients may need a TURP and acute urinary retention (AUR) is rare. TURP for DU is feasible and is associated with good short and medium term outcomes, but over time, there is a return to baseline symptoms. Bladder diverticulectomy can also improve DU, but there is a paucity of guidelines on patient selection. SNM provides excellent outcomes for DU, but patient selection is important.
Collapse
Affiliation(s)
- Johan Gani
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Derek Hennessey
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| |
Collapse
|
14
|
Han NY, Sung DJ, Kim MJ, Park BJ, Sim KC, Cho SB. Perirenal fat stranding on CT: is there an association with bladder outlet obstruction? Br J Radiol 2016; 89:20160195. [PMID: 27123701 DOI: 10.1259/bjr.20160195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the association between perirenal fat stranding (PFS) on CT and bladder outlet obstruction (BOO). METHODS CT scans from 122 patients who had undergone urodynamic study for lower urinary tract symptoms (LUTS) were registered after exclusion of patients with renal or retroperitoneal disease. Images were independently reviewed by two radiologists and compared with those of 244 age- and sex-matched control patients without LUTS. The PFS severity was scored on a four-point scale, and the interobserver agreement was assessed with kappa statistics. The severity score and incidence was compared between the groups, and the association with baseline characteristics was analyzed. For the LUTS group, an association between PFS severity and urodynamic and laboratory data was evaluated. RESULTS PFS was more frequent and more severe in the LUTS group than in the control group (p-value < 0.001); its presence was significantly associated with male gender and older age (p-value < 0.001). PFS was predominantly bilateral in both groups (80.1-93.2%). In the LUTS group, PFS severity scores were significantly correlated with the maximum flow rate, maximum detrusor pressure and estimated glomerular filtration rate (p-value < 0.001). Interobserver agreements were excellent for PFS presence (κ = 0.883) and severity (κ = 0.816). CONCLUSION Severe PFS was observed in older, male patients with LUTS. PFS severity was associated with the degree of BOO and impaired renal function. ADVANCES IN KNOWLEDGE Recognition of PFS on the CT scan may warrant further evaluation of BOO and appropriate management to prevent renal impairment.
Collapse
Affiliation(s)
- Na Y Han
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Deuk J Sung
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min J Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Beom J Park
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ki C Sim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung B Cho
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
15
|
Cho SY, Ro YK, Kim H, Son H. Preoperative Urinary Retention Increased the Risk of Urinary Retention after Photoselective Vaporization of the Prostate. World J Mens Health 2015; 33:182-7. [PMID: 26770938 PMCID: PMC4709434 DOI: 10.5534/wjmh.2015.33.3.182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 06/14/2015] [Accepted: 06/30/2015] [Indexed: 11/15/2022] Open
Abstract
Purpose The aim of the present study was to evaluate preoperative acute urinary retention (AUR) as a factor affecting the outcomes of patients who underwent photoselective vaporization of the prostate (PVP), both in terms of overall effectiveness and the postoperative incidence of AUR. Materials and Methods Baseline prostate characteristics were obtained for patients who underwent PVP, including prostate-specific antigen (PSA) levels, transrectal ultrasound findings, voiding diary parameters, the International Prostate Symptoms Score (IPSS), and uroflowmetry parameters. These parameters were assessed two weeks, one month, three months, six months, and three years postoperatively. Subjects were divided into AUR and non-AUR groups based on the preoperative occurrence of AUR. Results Of the 476 patients, 91 had at least one episode of preoperative AUR. The AUR group was found to be significantly older and to have significantly higher PSA levels, lower body mass indices, and larger prostates. At one year of follow-up, the total IPSS was 7.6±6.8 in the AUR group and 11.4±8.2 in the non-AUR group, with the AUR group showing a more significant improvement. In the non-AUR group, 17 of the 385 patients (4.4%) experienced postoperative retention, compared to 16 of the 91 patients (17.6%) patients in the AUR group. Conclusions Almost all patients exhibited improvements in subjective and objective voiding parameters following PVP, regardless of the presence of preoperative urinary retention. Patients with a preoperative history of AUR had a higher risk of postoperative retention.
Collapse
Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.; Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Yun Kwan Ro
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hwanik Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.; Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.; Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| |
Collapse
|
16
|
Epstein N, Rosenberg P, Samuel M, Lee J. Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician. CAN J EMERG MED 2014; 15:167-74. [PMID: 23663464 DOI: 10.2310/8000.2012.120914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Many emergency physicians (EPs) order "confirmatory" abdominal computed tomography (CT) in young flank pain patients, despite a high clinical suspicion of renal colic and the risk of radiation exposure. We measured the adverse outcome rate among flank pain patients identified as not requiring abdominal CT by the EP on a data form, regardless of whether CT was eventually ordered. Our secondary objective was to describe diagnoses other than renal colic identified by CT in this population. METHODS We conducted a prospective observational study at two community EDs. We asked staff EPs to complete a data sheet on patients ages 18 to 50 years with a first episode of flank pain, recording 1) if the flank pain was consistent with renal colic and 2) if the EP felt abdominal CT was indicated. Adverse outcomes (defined a priori as urgent surgical procedures, disability, or death) were assessed by research assistants at 4 weeks using telephone follow-up and a hospital records search. RESULTS We enrolled 389 patients; 353 completed follow-up (91%). The average age was 38.8 years, and 72.0% were male. Of 212 patients identified in the "CT not indicated" group, 2 had another diagnosis identified (unruptured diverticulitis and a ruptured ovarian cyst), but none had adverse outcomes (95% CI 0-1.4). CONCLUSIONS Adverse events were rare (< 1.5%) among patients < 50 years old with flank pain when CT was not required according to the clinical assessment of the EP. Future research should assess the adverse outcomes of withholding CT in low-risk patients using a larger patient sample.
Collapse
|
17
|
Abstract
Most men will develop histological BPH if they live long enough. Approximately, half will develop benign prostatic enlargement (BPE) and about half of these will get BOO with high bladder pressures and low flow, this in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS) but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic), haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction. Recognition of the complications of BPH/BOO early allows more effective management of these complications. This is particularly important for the more serious urinary infections and also for high-pressure chronic retention (HPCR). Complications of LUTS/BPH are very rare in clinical trials because of their strict inclusion and exclusion criteria but are more common in real life practice.
Collapse
Affiliation(s)
- Mark J Speakman
- Department of Urology, Musgrove Park Hospital, Taunton, Somerset TA1 5DA UK
| | - Xi Cheng
- Department of Urology, Musgrove Park Hospital, Taunton, Somerset TA1 5DA UK
| |
Collapse
|
18
|
Riyach O, Ahsaini M, Kharbach Y, Bounoual M, Tazi MF, El Ammari JE, Mellas S, Fassi MEJ, Khallouk A, Farih MH. Bilateral ureteral obstruction revealing a benign prostatic hypertrophy: a case report and review of the literature. J Med Case Rep 2014; 8:42. [PMID: 24513237 PMCID: PMC3930078 DOI: 10.1186/1752-1947-8-42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/12/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Prostatic hyperplasia is the most frequent tumor in men older than 50 years of age. Bilateral hydronephrosis secondary to benign prostatic hypertrophy is a rare condition most often due to vesicoureteral reflux. Herein we report a case of a patient with bilateral hydronephrosis with distal ureter obstruction caused by detrusor hypertrophy due to prostatic hyperplasia, our analysis of the clinical data and a review of the relevant published literature. CASE PRESENTATION We report a case of a 65-year-old Berber man with clinically significant storage, bladder-emptying symptoms and bilateral low back pain with renal biologic failure and bilateral ureterohydronephrosis, distal ureteral stenosis, detrusor hypertrophy and prostate hyperplasia without significant post-void residual urine volume visualized by abdominal sonography. The patient underwent bilateral JJ stent insertion with transurethral resection of the prostate. The patient was discharged 3 days after surgery without any obvious complications. At his 3-month follow-up examination, the JJ stent was removed and the patient had comfortable urination without renal failure. CONCLUSION This is an extremely rare condition that has important diagnostic considerations because of the possibility of comorbid severe obstructive uropathy and chronic renal failure.
Collapse
Affiliation(s)
- Omar Riyach
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
- Faculty of Medicine and Pharmacy, Fez, BP: 1893 –Km 2.200 Route de Sidi Harazem, Fez, Morocco
| | - Mustapha Ahsaini
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | - Youssef Kharbach
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | - Mohammed Bounoual
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | - Mohammed Fadl Tazi
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | | | - Soufiane Mellas
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | | | - Abdelhak Khallouk
- Department of Urology, University Hospital Center Hassan II, Fez, Morocco
| | | |
Collapse
|
19
|
Seitz M, Herlemann A, Magistro G, Stief CG. [Diagnostics of benign prostate syndrome]. Urologe A 2013; 52:193-6. [PMID: 23417045 DOI: 10.1007/s00120-012-3085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The diagnostic work-up of lower urinary tract symptoms (LUTS) in the German guidelines consists of obligatory and optional diagnostic parameters. Recommendations for assessing LUTS include patient history, symptom questionnaires (IPSS international prostate symptoms score), physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder, including postvoid residual urine and ultrasound examination of the upper urinary tract. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography and urethrocystoscopy. Ultrasound measurement of detrusor wall thickness in particular has a 95 % positive predictive value in diagnosing bladder outlet obstruction. With all diagnostic parameters it is possible to treat LUTS in a risk-adapted manner.
Collapse
Affiliation(s)
- M Seitz
- UroClinic Bogenhausen, Richard-Strauss-Straße 82, Munich, Germany.
| | | | | | | |
Collapse
|
20
|
Yang L, Liu R, Wang X, He D. Imbalance between matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) contributes to bladder compliance changes in rabbits with partial bladder outlet obstruction (PBOO). BJU Int 2013; 112:E391-7. [PMID: 23305285 DOI: 10.1111/j.1464-410x.2012.11740.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lin Yang
- The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University; Xi'an; Shaanxi; China
| | - Runming Liu
- The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University; Xi'an; Shaanxi; China
| | - Xinyang Wang
- The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University; Xi'an; Shaanxi; China
| | - Dalin He
- The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University; Xi'an; Shaanxi; China
| |
Collapse
|
21
|
Zhang Y, Zhang X, Ji Z, Bai H, Peng X, Zong H. Incidence of and risk factors for symptomatic benign prostatic hyperplasia in kidney transplant recipients: a cohort study. Scand J Urol 2012; 47:290-4. [PMID: 23095082 DOI: 10.3109/00365599.2012.735701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of immunosuppressants on the incidence of and risk factors for symptomatic benign prostatic hyperplasia (BPH) in relative-donor kidney transplant recipients. MATERIAL AND METHODS A retrospective cohort study was performed to determine the incidence of symptomatic BPH in kidney transplant recipients according to standard diagnostic criteria, the expression levels of keratinocyte growth factor, transforming growth factor-β (TGF-β) and serum testosterone, and the CD4/CD8 ratio in T lymphocytes. Results. The incidence of symptomatic BPH (50-59-year-old group, p = 0.010; 60-69-year-old group, p = 0.004; ≥ 70-year-old group, p = 0.032), testosterone level (50-59-year-old group, p = 0.045; 60-69-year-old group, p = 0.035; ≥ 70-year-old group, p = 0.041) and the CD4/CD8 ratio (50-59-year-old group, p = 0.013; 60-69-year-old group, p = 0.010; ≥ 70-year-old group, p = 0.015) of kidney transplant recipients with long-term calcineurin inhibitor (CNI) and prednisone use were all lower than those values in a normal group that had not received transplants. The TGF-β (p < 0.001) expression level was higher in kidney transplant recipients than in the non-transplant group, and the keratinocyte growth factor expression level was not statistically different between the kidney transplant recipients and the non-transplant group. CONCLUSIONS Kidney transplant recipients with long-term CNI and prednisone use may have a low incidence of symptomatic BPH, which may be related to TGF-β and keratinocyte growth factor expression, testosterone levels and lymphocyte infiltration. Further high-quality prospective studies are needed to confirm these conclusions.
Collapse
Affiliation(s)
- Yong Zhang
- Urology Department, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, PR China.
| | | | | | | | | | | |
Collapse
|
22
|
Yamasaki T, Naganuma T, Iguchi T, Kuroki Y, Kuwabara N, Takemoto Y, Shoji T, Nakatani T. Association between chronic kidney disease and small residual urine volumes in patients with benign prostatic hyperplasia. Nephrology (Carlton) 2011; 16:335-9. [PMID: 21126286 DOI: 10.1111/j.1440-1797.2010.01430.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM It has been well described that large residual urine volumes (≥300 mL) affect renal function in advanced benign prostatic hyperplasia (BPH). However, it is not clear whether small residual urine volumes (<100 mL) are related to renal function. The present study was performed to examine the association between chronic kidney disease (CKD) and the post-void residual urine volume (PVR) in BPH patients. METHODS A cross-sectional study was performed in 160 consecutive BPH patients with PVR of less than 100 mL. We first determined the stage of CKD and compared the PVR in subjects with/without CKD. Next, we divided the subjects into three groups according to the extent of PVR (PVR < 12 mL, 12 mL ≤ PVR < 50 mL, 50 mL ≤ PVR < 100 mL) and compared the estimated glomerular filtration rate (eGFR) among these groups. Moreover, risk factors associated with CKD, including the presence of post-void residual urine, were explored by multiple logistic regression analysis. RESULTS The PVR of the patients with CKD was significantly greater than that of the patients without CKD. The group with the normal PVR (group PVR < 12 mL) had a significantly higher eGFR compared with the other two groups. Multivariate analysis demonstrated that the presence of post-void residual urine (PVR ≥ 12 mL) was a significant and independent risk factor associated with the presence of CKD. CONCLUSION In BPH patients, the PVR of the patients with CKD was significantly greater than that of the patients without CKD and the presence of post-void residual urine (PVR ≥ 12 mL) was independently associated with CKD, indicating a close association between CKD and small residual urine volumes.
Collapse
Affiliation(s)
- Takeshi Yamasaki
- Departments of Urology Endocrinology, Metabolism and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Shirazi M, Noorafshan A, Farrokhi A. Effects of pentoxifylline on renal structure after urethral obstruction in rat: A stereological study. Cent European J Urol 2011; 64:30-3. [PMID: 24578857 PMCID: PMC3921697 DOI: 10.5173/ceju.2011.01.art6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 01/30/2011] [Accepted: 02/04/2011] [Indexed: 11/22/2022] Open
Abstract
Objective Chronic renal failure due to tubulointerstitial fibrosis is one of complications of lower urinary tract obstruction. Since pentoxifylline is a xanthine derivative that inhibits some inflammatory mediators, we conducted this study to investigate whether pentoxifylline inhibits renal fibrosis in a rat model of partial urethral obstruction (PUO). Methods All the rats underwent experimental PUO. Then, the animals were divided randomly into two groups: positive control group and experimental group. The experimental group received pentoxifylline 100 mg/kg per day via oral gavages for 4-weeks. The control group received the same dose of normal saline. After 4-weeks, all the rats underwent left nephrectomy. Kidney volume and weight and fractional and absolute volumes of the glomeruli, tubules, interstitium and vessels were determined with stereological methods. To reduce the workload of reference (kidney) volume estimation, the total kidney volume was determined after estimation of tissue shrinkage on isotropic uniform random histological sections. The total volume (amount) of each renal structure including fibrosis was estimated to avoid the bias conclusion due to relying on volume density alone. Results The absolute volume of interstitial fibrosis was lower in the experimental group (PUO with pentoxifylline treatment) (~84%; p ≤0.006) in comparison with the control group (PUO with no treatment). Conclusion Pentoxifylline reduces interstitial renal fibrosis after partial urethral obstruction in rats.
Collapse
Affiliation(s)
- Mehdi Shirazi
- Histomorphometry & Stereology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Noorafshan
- Histomorphometry & Stereology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Farrokhi
- Department of Urology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
24
|
Hallan SI, Kwong D, Vikse BE, Stevens P. Use of a Prostate Symptom Score to Identify Men at Risk of Future Kidney Failure: Insights From the HUNT II Study. Am J Kidney Dis 2010; 56:477-85. [DOI: 10.1053/j.ajkd.2010.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 03/04/2010] [Indexed: 11/11/2022]
|
25
|
Berges R, Dreikorn K, Höfner K, Madersbacher S, Michel MC, Muschter R, Oelke M, Reich O, Rulf W, Tschuschke C, Tunn U. [Diagnostic and differential diagnosis of benign prostate syndrome (BPS): guidelines of the German Urologists]. Urologe A 2010; 48:1356-60, 1362-4. [PMID: 19756468 DOI: 10.1007/s00120-009-2066-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
26
|
Hong SK, Lee ST, Jeong SJ, Byun SS, Hong YK, Park DS, Hong JY, Son JH, Kim C, Jang SH, Lee SE. Chronic kidney disease among men with lower urinary tract symptoms due to benign prostatic hyperplasia. BJU Int 2009; 105:1424-8. [DOI: 10.1111/j.1464-410x.2009.08975.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
27
|
Li L, Zepeda-Orozco D, Patel V, Truong P, Karner CM, Carroll TJ, Lin F. Aberrant planar cell polarity induced by urinary tract obstruction. Am J Physiol Renal Physiol 2009; 297:F1526-33. [PMID: 19794107 DOI: 10.1152/ajprenal.00318.2009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Flow sensing by primary cilia of the epithelial cells is involved in cystogenesis in polycystic kidney disease. We investigate whether a similar mechanism applies to the pathogenesis of cyst-like tubular dilatation induced by ureteral obstruction in mice. Robust proliferation occurs in the obstructed tubules when urine flow is interrupted as well as in the repairing tubules when urine flow is reestablished after relief of the obstruction, suggesting a urine flow-independent mechanism of proliferation. In the urothelium, proliferation is only detected above the obstruction, although urine flow ceased both above and below the obstruction. Our results support mechanical strain- rather than flow-mediated proliferation in obstructive uropathy. To understand the mechanism of cell proliferation leading to increased tubular diameter in cyst-like tubular dilatation, we examine planar cell polarity (PCP), which is necessary for oriented cell division and maintenance of tubular diameter. In dilated tubules, the orientation of cell division is randomized, atypical PKC (aPKC) is mislocalized, and the pattern of the expression of a core PCP protein, Frizzled3 (Fz3), is altered. In addition, the level of Fz3 expression is increased. These results indicate that aberrant PCP may contribute to cyst-like tubular dilatation in obstructive uropathy. Interestingly, the orientation of cell division, localization of aPKC, and Fz3 expression return to normal when obstruction is relieved, which suggest a role of normal PCP signaling in tubular repair.
Collapse
Affiliation(s)
- Ling Li
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas TX 75390-9063, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
van Renterghem K, Van Koeveringe G, Achten R, van Kerrebroeck P. A new algorithm in patients with elevated and/or rising prostate-specific antigen level, minor lower urinary tract symptoms, and negative multisite prostate biopsies. Int Urol Nephrol 2009; 42:29-38. [PMID: 19496018 PMCID: PMC2844972 DOI: 10.1007/s11255-009-9596-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 05/17/2009] [Indexed: 01/21/2023]
Abstract
Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple) extended prostate biopsies are a regularly encountered problem in urological practice. Even now, patients are seen with no objective explanation of this persistent elevated and/or rising PSA. So far, many strategic proposals have been elaborated and published to deal with this specific population including the use of different PSA derivates; applying different biopsy schemes—strategies—biopsy target imaging; diagnostic use of prostate cancer genes; and many more. In this review, we propose a new algorithm in which an urodynamic evaluation should be included since bladder outlet obstruction (BOO) can be expected. Once BOO is confirmed, a transurethral resection of the prostate (TURP) can be offered to these patients. This procedure will result in subjective and biochemical improvement and allows extensive histological examination. Current literature was reviewed with regard to this specific population. This research was performed using the commercially available Medline online search tools and applying the following search terms: “diagnostic TURP”; “elevated PSA”; and “prostate biopsy”. Furthermore, subsequent reference search was executed on retrieved articles.
Collapse
|
29
|
Homma Y. Should an antimuscarinic agent be used for persistent LUTS after treatment with an alpha(1)-blocker? NATURE CLINICAL PRACTICE. UROLOGY 2009; 6:66-67. [PMID: 19107113 DOI: 10.1038/ncpuro1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 11/28/2008] [Indexed: 05/27/2023]
Abstract
This Practice Point discusses the study by MacDiarmid and colleagues, which is the latest to support a beneficial effect of adding antimuscarinic agents to alpha(1)-blockers in men with persistent lower urinary tract symptoms. Such studies have also alleviated concerns about the adverse effects of antimuscarinic agents, particularly the risk of developing urinary retention. In practice, however, some issues regarding the use of antimuscarinic agents in this patient population remain. First, persistent storage symptoms are suggestive of other pathologies, and this possibility must be carefully evaluated before combined treatment is initiated. Second, postvoid residual urine volume should be repeatedly monitored during antimuscarinic therapy to avoid sequelae of residual urine or urinary retention. Third, the effect of adding an antimuscarinic agent is statistically significant, but might not be clinically significant for the majority of men. Better evaluation of storage symptoms might facilitate the more-appropriate use of combined treatment in this setting.
Collapse
Affiliation(s)
- Yukio Homma
- Department of Urology, Tokyo University Graduate School of Medicine, Tokyo, Japan.
| |
Collapse
|
30
|
Hurst FP, Neff RT, Falta EM, Jindal RM, Lentine KL, Swanson JS, Agodoa LY, Abbott KC. Incidence, predictors, and associated outcomes of prostatism after kidney transplantation. Clin J Am Soc Nephrol 2009; 4:329-36. [PMID: 19176793 DOI: 10.2215/cjn.04370808] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Renal transplantation is increasingly performed in elderly patients, and the incidence of benign prostatic hyperplasia (BPH) increases with age. Anuric males on dialysis may have occult BPH and not develop obstructive symptoms until urine flow is restored after transplantation. If left untreated, BPH poses a risk for numerous complications, including acute urinary retention (AUR), recurrent urinary tract infections (UTI), and renal failure. The authors hypothesized that incident BPH after renal transplantation would adversely affect allograft survival. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Medicare claims for BPH, AUR, UTI, and prostate resection procedures (transurethral resection of the prostate; TURP) were assessed in a retrospective cohort of 23,622 adult male Medicare primary renal transplant recipients in the United States Renal Data System database who received transplants from 1 January 2000 to 31 July 2005 and followed through 31 December 2005. RESULTS The 3-yr incidence of BPH post-transplant was 9.7%. The incidences of AUR, UTI, and TURP after BPH diagnosis (up to 3 yr posttransplant) were 10.3%, 6.5%, and 7.3% respectively, and each was significantly associated with BPH. Cox regression analysis showed that recipient age per year, later year of transplant, and dialysis vintage were associated with incident BPH. Using Cox nonproportional hazards regression, BPH was significantly associated with renal allograft loss (including death). CONCLUSIONS BPH is common in males after renal transplant and is independently associated with AUR, UTI, and graft loss. It is unknown whether treatment of BPH, either medical or surgical, attenuates these risks.
Collapse
Affiliation(s)
- Frank P Hurst
- Department of Nephrology, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307, USA.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Fu WJ, Gao JP, Hong BF, Yang Y, Cai W, Zhang L. Photoselective laser vaporization prostatectomy for acute urinary retention in China. J Endourol 2008; 22:539-43. [PMID: 18355150 DOI: 10.1089/end.2007.0045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the clinical efficacy and safety of photoselective laser vaporization of the prostate (PVP) in the treatment of patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Forty-two patients (mean age 72 +/- 5 years, range 65-89) with AUR because of BPH were treated with a prospective trial of PVP with the potassium-titanyl-phosphate (KTP) laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), disease-specific quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The International Index of Erectile Function questionnaire and a self-designed ejaculatory questionnaire were completed at different follow-up times to determine patient satisfaction and changes in sexual function. RESULTS After preliminary urine drainage and adequate preoperative preparation, PVP was performed and bladder outlet obstruction was effectively relieved. The mean prostate volume was 62.5 +/- 11.7 cc, and the mean residual volume with retention was 650 mL (range 240-1200 mL). Mean operative time was 28.6 +/- 5.7 minutes. Mean catheterization duration was 5.6 days (range 3-14 d). There was significant subjective improvement of symptoms and objective improvement in urinary flow rates at 12 months. The mean IPSS and QoL score decreased significantly (P < 0.05). Mean PVR volume also decreased. The mean Qmax was 16.2 +/- 4.6 mL/sec after treatment. Only two patients had recurrent urinary retention during follow-up. There were no intraoperative or postoperative adverse events. CONCLUSIONS The early clinical results suggest that the PVP is a promising safe, effective, and less-invasive treatment with minimal morbidity for patients with urine retention secondary to BPH.
Collapse
Affiliation(s)
- Wei-Jun Fu
- Department of Urology, General Hospital of PLA, Beijing, China.
| | | | | | | | | | | |
Collapse
|
32
|
Mrkobrada M, Thiessen-Philbrook H, Haynes RB, Iansavichus AV, Rehman F, Garg AX. Need for quality improvement in renal systematic reviews. Clin J Am Soc Nephrol 2008; 3:1102-14. [PMID: 18400967 PMCID: PMC2440265 DOI: 10.2215/cjn.04401007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 02/11/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Systematic reviews of clinical studies aim to compile best available evidence for various diagnosis and treatment options. This study assessed the methodologic quality of all systematic reviews relevant to the practice of nephrology published in 2005. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched electronic databases (Medline, Embase, American College of Physicians Journal Club, Cochrane) and hand searched Cochrane renal group records. Clinical practice guidelines, case reports, narrative reviews, and pooled individual patient data meta-analyses were excluded. Methodologic quality was measured using a validated questionnaire (Overview Quality Assessment Questionnaire). For reviews of randomized trials, we also evaluated adherence to recommended reporting guidelines (Quality of Reporting of Meta-Analyses). RESULTS Ninety renal systematic reviews were published in year 2005, 60 of which focused on therapy. Many systematic reviews (54%) had major methodologic flaws. The most common review flaws were failure to assess the methodologic quality of included primary studies and failure to minimize bias in study inclusion. Only 2% of reviews of randomized trials fully adhered to reporting guidelines. A minority of journals (four of 48) endorsed adherence to consensus guidelines for review reporting, and these journals published systematic reviews of higher methodologic quality (P < 0.001). CONCLUSIONS The majority of systematic reviews had major methodologic flaws. The majority of journals do not endorse consensus guidelines for review reporting in their instructions to authors; however, journals that recommended such adherence published systemic reviews of higher methodologic quality.
Collapse
Affiliation(s)
- Marko Mrkobrada
- Division of Nephrology, University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
33
|
van Renterghem K, Van Koeveringe G, Achten R, van Kerrebroeck P. Prospective study of the role of transurethral resection of the prostate in patients with an elevated prostate-specific antigen level, minor lower urinary tract symptoms, and proven bladder outlet obstruction. Eur Urol 2008; 54:1385-92. [PMID: 18599187 DOI: 10.1016/j.eururo.2008.06.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 06/16/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Deciding on strategy for patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels, unsuspicious digital rectal examination (DRE) and/or transrectal ultrasound (TRUS), and multiple negative extended prostate biopsies is complex. OBJECTIVES To define the role and clinical significance of transurethral resection of the prostate (TURP) in these patients. DESIGN, SETTINGS, AND PARTICIPANTS Thirty-three patients with elevated PSA; minor LUTS, as assessed by the International Prostate Symptoms Score (IPSS); no suspicion for prostate cancer on DRE and/or TRUS; and negative extended prostate biopsies were prospectively enrolled in a cohort study at a tertiary care institution. INTERVENTION After full urodynamic investigation showing all patients to be bladder outlet obstructed, TURP was performed. MEASUREMENTS Resected tissue was histologically examined for presence of prostate cancer. Within 6 mo after TURP, patients were clinically reevaluated by means of IPSS and PSA level. RESULTS AND LIMITATIONS Preoperatively, mean PSA and IPSS values were 8.2ng/ml and 6.8, respectively. Mean detrusor pressure at maximum flow was 80.3cm H(2)O. Histological examination after TURP revealed benign prostate hyperplasia in 81.8% (subgroup 1) and aggressive prostate cancer in 6.1% of patients (subgroup 2). In 12.1% of patients, only a few chips of nonaggressive prostate cancer (T1a) were detected. In patients without signs of aggressive prostate cancer (93.9%=12.1%+81.8%, subgroup 3), mean postoperative PSA and IPSS values were 0.6ng/ml and 2.4, respectively, while these values were 0.6ng/ml and 2.5ng/ml in subgroup 1 (p<0.0001). This study is limited in sample size, requiring more research to confirm these results. CONCLUSIONS This prospective study shows that, in patients with minor LUTS and no suspicion for prostate cancer, bladder outlet obstruction can result in elevated PSA levels. These patients will benefit from TURP regarding symptomatology and supernormalisation of PSA levels. Moreover, albeit in few cases, histological examination will reveal aggressive prostate cancer.
Collapse
|
34
|
Affiliation(s)
- Christopher S Saigal
- Department of Urology, University of California at Los Angeles, Los Angeles, CA 90095, USA.
| |
Collapse
|
35
|
Markland AD, Thompson IM, Ankerst DP, Higgins B, Kraus SR. Lack of disparity in lower urinary tract symptom severity between community-dwelling non-Hispanic white, Mexican-American, and African-American men. Urology 2007; 69:697-702. [PMID: 17445654 PMCID: PMC2396510 DOI: 10.1016/j.urology.2007.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 10/04/2006] [Accepted: 01/05/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine whether disparities exist in the reporting of lower urinary tract symptoms (LUTS) in non-Hispanic white (NHW), Mexican-American (MA), and African-American (AA) men. METHODS Data were collected from a prospective, community-based cohort assembled to study risk factors associated with prostate cancer. Measures included demographics, prostate-specific antigen (PSA), body mass index (BMI), and family history of prostate cancer. Lower urinary tract symptom severity was assessed in 2804 men (1485 NHW, 964 MA, 355 AA) without prostate cancer according to the American Urological Association Symptom Index. RESULTS No significant difference (P = 0.998) was seen in the prevalence of moderate or severe LUTS in NHW (34%), MA (34%), and AA (33%) men. No differences were found in either obstructive or irritative symptoms among the three groups. Age, PSA level, BMI, and family history did not affect symptom severity. CONCLUSIONS Rates of moderate to severe LUTS symptoms in this cohort were similar to those in other community-based populations of NHW men. Lower rates of moderate or severe symptoms were noted in AA men than previously reported. Mexican-American men had similar degrees of LUTS as the general population, and with their increased risk for diabetes and renal disease, in-depth study of this population is warranted.
Collapse
Affiliation(s)
- Alayne D. Markland
- From the Division of Gerontology and Geriatric Medicine, Department of Medicine, the University of Alabama at Birmingham and the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center at the Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Ian M. Thompson
- From the Department of Urology at the University of Texas Health Science Center at San Antonio, Texas
- From the San Antonio Center for Biomarkers of Risk of Prostate Cancer (SABOR), San Antonio Cancer Institute, San Antonio, TX
| | - Donna P. Ankerst
- From the Department of Urology at the University of Texas Health Science Center at San Antonio, Texas
- From the San Antonio Center for Biomarkers of Risk of Prostate Cancer (SABOR), San Antonio Cancer Institute, San Antonio, TX
| | - Betsy Higgins
- From the Department of Urology at the University of Texas Health Science Center at San Antonio, Texas
- From the San Antonio Center for Biomarkers of Risk of Prostate Cancer (SABOR), San Antonio Cancer Institute, San Antonio, TX
| | - Stephen R. Kraus
- From the Department of Urology at the University of Texas Health Science Center at San Antonio, Texas
| |
Collapse
|
36
|
Ponholzer A, Temml C, Obermayr RP, Rauchenwald M, Madersbacher S. The Association Between Lower Urinary Tract Symptoms and Renal Function in Men: A Cross-Sectional and 5-Year Longitudinal Analysis. J Urol 2006; 175:1398-402. [PMID: 16516007 DOI: 10.1016/s0022-5347(05)00641-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2005] [Indexed: 11/16/2022]
Abstract
PURPOSE We assessed the association between LUTS and renal function in men in a cross-sectional and a longitudinal study. MATERIALS AND METHODS Men participating in health investigation in Vienna entered this study. In the cross-sectional analysis a consecutive series of men were studied and in the longitudinal analysis men were reevaluated after 5 years. LUTS were assessed by I-PSS and renal function was evaluated by GFR, as calculated by the Cockcroft-Gault equation. RESULTS A total of 2.469 men with a mean age of 47.1 years (range 30 to 80) entered the cross-sectional study and 439 with a mean age of 51.7 years (range 45 to 79) could be assessed in longitudinal analysis. In the cross-sectional study there was no association between the degree of LUTS and GFR during 5 life decades (p = 0.55). An identical pattern was observed for irritative and obstructive scores. In the longitudinal cohort mean GFR +/- SD decreased from 84.3 +/- 20.2 ml per minute at baseline to 79.2 +/- 18.7 ml per minute after 5 years (-6.0%, p <0.0001). The mean decrease in GFR after 5 years was 4.5 ml per minute (-5.4%) in men without/mild LUTS (I-PSS 7 or less at ages 55.4 +/- 11.0 years), 3.9 ml per minute (-4.9%) in those with moderate LUTS (I-PSS 8 to 20 at ages 61.3 +/- 11.6 years) and 4.2 ml per minute (-5.2%) in those with severe LUTS (I-PSS greater than 20 at ages 64.3 +/- 7.4 years). On linear regression analysis in the 2 study cohorts neither I-PSS, nor obstructive or irritative score affected GFR (p >0.05). The only determinants for GFR less than 90 ml per minute were age (p <0.0001) and hypertension (p <0.0001). CONCLUSIONS LUTS do not represent an independent risk factor for impaired renal function in men.
Collapse
Affiliation(s)
- Anton Ponholzer
- Departments of Urology and Andrology, Donauspital, Vienna, Austria
| | | | | | | | | |
Collapse
|