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Schönburg S. [Botulinum toxin in male lower urinary tract symptoms (LUTS): What can we expect?]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:653-657. [PMID: 38698262 DOI: 10.1007/s00120-024-02352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
During the last two decades botulinum toxin has also conquered urology. Botulinum toxin reduces the contractility and sensitivity of the detrusor muscle and relieves pain. It is therefore a promising drug whose use in men also appears promising. The following article highlights the practical relevance of botulinum toxin for male lower urinary tract symptoms (LUTS). But first of all, a distinction must be made between use in male LUTS due to benign prostate syndrome (BPS) and use in cases of overactive bladder (OAB) alone. A differentiated diagnosis and treatment of male LUTS is therefore essential.
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Affiliation(s)
- Sandra Schönburg
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität Halle/Saale, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland.
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Garbas K, Zapała Ł, Ślusarczyk A, Piecha T, Gwara P, Żuk-Łapan A, Piekarczyk H, Zapała P, Radziszewski P. (A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS. Int Urol Nephrol 2024:10.1007/s11255-024-04093-7. [PMID: 38819576 DOI: 10.1007/s11255-024-04093-7] [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: 04/27/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). METHODS Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. RESULTS Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). CONCLUSION Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.
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Affiliation(s)
- Karolina Garbas
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
- Urodynamic Lab of Private Hospital "Prostalith", Kielce, Poland
| | - Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Tomasz Piecha
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Gwara
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Aleksandra Żuk-Łapan
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Hanna Piekarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
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An Z, Zhou Q, Shao J, Xiao S, Zhao K, Wei W, Wu Y, Song Y, Yuan Q, Fu W, Zhang X. Life disturbance and hospital visit experiences among Chinese patients with benign prostatic hyperplasia: a qualitative study. BMC PRIMARY CARE 2024; 25:149. [PMID: 38702603 PMCID: PMC11069269 DOI: 10.1186/s12875-024-02378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The impact of lower urinary tract symptoms (LUTS) on the quality of life of patients with benign prostatic hyperplasia (BPH) has been rarely reported. Additionally, the challenges faced by these patients in seeking medical care have often been overlooked. In order to explore the personal struggles caused by LUTS and the difficulties or barriers experienced by Chinese patients with BPH when seeking help, we conducted a qualitative interview study. METHODS Qualitative interviews were conducted among 46 patients with BPH who were hospitalized in three tertiary hospitals in China from July 2021 to November 2022. Grounded theory was adopted as the methodology for the qualitative study. After obtaining written informed consent from the study participants, semi-structured interviews were conducted according to the question guidelines. The interview process was audio-recorded; subsequently, the recordings were transcribed, coded, and thematically analyzed. RESULTS The difficulties faced by Chinese patients with BPH were classified into seven main themes: (i) disturbed life, (ii) mental burden, (iii) disease cognition and communication, (iv) delayed treatment, (v) medication status, (vi) hospital visits barriers, and (vii) medical insurance issues. Further, each theme was subdivided into 2-5 sub-themes. CONCLUSIONS LUTS have a certain effect on the life and spirit of patients with BPH. These patients face different degrees of difficulties in treatment and hospital visits. Therefore, better healthcare systems and additional social support are crucial for improving the current plight of these patients.
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Affiliation(s)
- ZiYan An
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China
- Medical School of PLA, Beijing, 100853, China
| | - QiWei Zhou
- Department of Urology, Third Affiliated Hospital of Naval Military Medical University, Shanghai, 200438, China
| | - JinPeng Shao
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China
- Medical School of PLA, Beijing, 100853, China
| | - ShuWei Xiao
- Department of Urology, Air Force Medical Center, Beijing, 100142, China
| | - Kun Zhao
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China
- Medical School of PLA, Beijing, 100853, China
| | - WenJie Wei
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China
- Medical School of PLA, Beijing, 100853, China
| | - YangYang Wu
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China
- Medical School of PLA, Beijing, 100853, China
| | - Yong Song
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China
| | - Qing Yuan
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China
| | - WeiJun Fu
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China.
| | - Xu Zhang
- Department of Urology, Third Medical Center, PLA General Hospital, YongDing Road No. 69, Beijing, 100039, China
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Cho KJ, Kim JC. Novel pharmacotherapeutic avenues for bladder storage dysfunction in men. Expert Opin Pharmacother 2024; 25:585-594. [PMID: 38651268 DOI: 10.1080/14656566.2024.2346278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Bladder storage dysfunction is associated with low quality of life in men and remains a challenging field in pharmacotherapy because of low persistence followed by patient-perceived lack of efficacy and adverse effects. The persistent desire for the development of novel pharmacotherapy is evident, leading to numerous research efforts based on its pathophysiology. AREAS COVERED This review describes the pathophysiology, current pharmacotherapeutic strategies, and emerging novel drugs for male bladder storage dysfunction. The section on emerging pharmacotherapy provides an overview of current research, focusing on high-potential target molecules, particularly those being evaluated in ongoing clinical trials. EXPERT OPINION As pharmacotherapies targeting alpha-adrenergic, beta-adrenergic, and muscarinic receptors - the current primary targets for treating male bladder storage dysfunction - have demonstrated insufficient efficacy and side effects, researchers are exploring various alternative molecular targets. Numerous targets have been identified as central to regulating bladder afferent nerve activity, and their pharmacological effects and potential have been evaluated in animal-based experiments. However, there is a limited number of clinical trials for these new pharmacotherapies, and they have not demonstrated clear superiority over current treatments. Further research is needed to develop new effective pharmacotherapies for bladder storage dysfunction in men.
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Affiliation(s)
- Kang Jun Cho
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Chul Kim
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Åkerla J, Pesonen JS, Peltonen E, Huhtala H, Häkkinen J, Koskimäki J, Tammela TLJ, Auvinen A, Pöyhönen A. Do men adapt to lower urinary tract symptoms? An 11-year longitudinal study of male urinary urgency and associated bother. Scand J Urol 2024; 59:47-53. [PMID: 38406924 DOI: 10.2340/sju.v59.18289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The study objective is to evaluate prognosis and predictors of bother caused by urinary urgency among middle-aged and older men. MATERIAL AND METHODS A population-based sample of men born in 1974, 1964, 1954, 1944, 1934 and 1924 was followed-up from 2004 to 2015. The course of urgency and associated bother was evaluated with the Danish Prostatic Symptom Score at baseline and follow-up. Logistic regression was utilized to explore risk factors of increased bother at follow-up. RESULTS A total of 2,480 men (39%) who had responded at baseline and follow-up were included in the study. Of them, 1,056 men (43%) had persistent mild urgency and 132 men (5%) persistent moderate or severe urgency at follow-up. The proportions of men experiencing at least moderate bother due to persistent urgency at follow-up were 6% (95% confidence interval 4.5-7.3) of those with mild and 79% (71.7-85.9) of the men with moderate or severe urgency. In multivariable-adjusted logistic regression, moderate to severe urgency was strongly associated with bother (odds ratio, OR 55.2, 95% CI 32.1-95.2). Other predictors of bother included cardiac disease (OR 1.8, 95% CI 1.0-31.1), pulmonary disease (OR 1.9, 95% CI 1.1-3.5) and medical treatment (OR 2.7, 95% CI 1.6-4.6). CONCLUSIONS Most men with urinary urgency have mild symptoms and bother. Only one out of five men with persistent moderate or severe urgency adapt to the symptoms. Men with a history of medical treatment for lower urinary tract symptoms (LUTS) or impaired cardiopulmonary health are more likely to experience bother from urinary urgency.
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Affiliation(s)
- Jonne Åkerla
- Department of Urology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Jori S Pesonen
- Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Essi Peltonen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jukka Häkkinen
- Department of Urology, Länsi-Pohja healthcare district, Kemi, Finland
| | - Juha Koskimäki
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teuvo L J Tammela
- Department of Urology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Antti Pöyhönen
- Centre for Military Medicine, The Finnish Defence Forces, Riihimäki, Finland
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Meister MR, Sutcliffe S, Ghetti C, Chu CM, Spitznagle TM, Lowder JL. A pilot trial of movement-based pelvic floor physical therapy to address pelvic floor myofascial pain and lower urinary tract symptoms. Int Urogynecol J 2023; 34:1261-1270. [PMID: 36125508 PMCID: PMC10174754 DOI: 10.1007/s00192-022-05353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor myofascial pain (PFMP) is associated with lower urinary tract symptoms (LUTS). The objective of this study was to test movement-based pelvic floor physical therapy (PT) for patients with PFMP and LUTS. We hypothesized that movement-based PT designed to target PFMP would result in significant improvement in both PFMP and concomitant LUTS. METHODS This pilot trial enrolled patients with moderate-to-severe PFMP on palpation who were referred to movement-based PT to diagnose and treat pelvic floor dysfunction in the context of body alignment and movement patterns. The primary outcome was change in Urogenital Distress Inventory (UDI) scores after PT. Factors associated with PT attendance were also measured. We aimed to enroll 55 participants to achieve 80% power to detect a difference in 11 points on the UDI scores with an alpha-level of 0.05, accounting for a 10% loss to follow-up. The sample size was increased to 65 owing to a higher-than-expected loss-to-follow-up rate. RESULTS Sixty-five patients were enrolled and 62 analyzed. Thirty-eight (61.3%) attended PT, and 30 (48.4%) completed a follow-up PT Attendance (PTA) survey. Overall, UDI score and irritative, obstructive, and stress subscales (p<0.0001) improved in participants who attended PT as well as mean myofascial examination scores at each site. CONCLUSIONS Participants who attended movement-based PT demonstrated an improvement in LUTS. Future studies should extend our findings by: first, confirming whether the myofascial pain-directed elements of PT improved LUTS; second, investigating whether movement-based PT improves prolapse symptoms; and third, including a non-PT control arm to rule out the possible influence of a placebo effect and behavioral modifications on LUTS and PFMP.
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Affiliation(s)
- Melanie R Meister
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, University of Kansas School of Medicine, 2000 Cambridge, Kansas City, MO, 66160, USA.
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Chiara Ghetti
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Christine M Chu
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Theresa M Spitznagle
- Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Jerry L Lowder
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Przydacz M, Gasowski J, Grodzicki T, Chlosta P. Lower Urinary Tract Symptoms and Overactive Bladder in a Large Cohort of Older Poles-A Representative Tele-Survey. J Clin Med 2023; 12:jcm12082859. [PMID: 37109196 PMCID: PMC10142045 DOI: 10.3390/jcm12082859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND A reliable reference of population-based parameters for lower urinary tract symptoms (LUTS) and overactive bladder (OAB) is lacking for the elderly. Thus, the objective of this study was to estimate the prevalence, bother, effect on quality of life, and treatment-related behavior for LUTS and OAB in a large population-level cohort of Polish adults aged ≥ 65 years. METHODS We used data from the telephone LUTS POLAND survey. Respondents were categorized by sex, age, and residence. All LUTS and OAB were assessed with validated questionnaires and a standard protocol based on the International Continence Society definitions. RESULTS The mean (standard deviation) age of 2402 participants (60.4% women) was 72.5 (6.7) years. The prevalence of LUTS was 79.5% (men: 76.6%; women: 81.4%), and the prevalence of OAB was 51.4% (men: 49.4%; women: 52.8%). The prevalence of both conditions increased with age. The most prevalent symptom was nocturia. LUTS and OAB were often bothersome, and almost half of participants who reported LUTS or OAB had decreased quality of life related to their urinary functioning. Nevertheless, only one third of participants sought treatment for their bladder problems, and most of these participants received treatment. We did not observe differences between urban and rural areas in all analyzed population-level parameters. CONCLUSIONS LUTS and OAB were prevalent conditions with significant bother and negative effects on quality of life among Polish adults aged ≥ 65 years. Nevertheless, most affected respondents had not sought treatment. Thus, for older persons, there is a need to increase public awareness about LUTS and OAB, and the negative effects of LUTS and OAB on healthy aging. In addition, greater government and healthcare system resources are needed to better manage LUTS and OAB in older patients.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Krakow, Poland
| | - Jerzy Gasowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Krakow, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Krakow, Poland
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Chow PM, Chuang YC, Hsu KCP, Shen YC, Liu SP. Impact of Female Stress Urinary Incontinence on Quality of Life, Mental Health, Work Limitation, and Healthcare Seeking in China, Taiwan, and South Korea (LUTS Asia): Results from a Cross-Sectional, Population-Based Study. Int J Womens Health 2022; 14:1871-1880. [PMID: 36597480 PMCID: PMC9805714 DOI: 10.2147/ijwh.s383651] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/17/2022] [Indexed: 12/29/2022] Open
Abstract
Background Stress urinary incontinence (SUI) is common among adult women with negative effects on psychosocial well-being, mental health, and health-related quality of life. The purpose of the research is to determine if SUI in women is a factor implicated in changes in health-related quality of life (HRQoL) in both physical and mental health domains and in work difficulties. Methods Data of women 40 years or older from a cross-sectional, population-based, internet survey were examined post-hoc. The effect of SUI frequency on HRQoL (SF12 score), in physical and mental health domains, was assessed. In addition, multivariate and univariate analyses were used to show the influence of SUI on HADS (Hospital Anxiety and Depression Scale) depression score and HADS anxiety score. The effects of demographic factors and physical ailments and SUI on work difficulties were similarly analyzed using multivariate logistic regression. Results A total of 4208 women with mean age of 60 were included in the analysis. The more frequent SUI episodes were associated with a greater reduction of HRQoL in both physical and mental health domains. In addition, both multivariate and univariate analyses showed that SUI could be correlated with a negative effect on HADS anxiety score (OR 1.617, CI 1.335-1.958, p=0.000) and HADS depression score (OR 1.263, CI 1.044-1.527, p=0.016). Univariate analyses suggested that work difficulties were correlated with SUI. Available data revealed that many sufferers, including up to 40% of individuals with SUI frequency rating 1 (less than once a month) to 3 (a few times a week), failed to seek treatment. Conclusion SUI, common in women ≥40 years of age, impairs quality of life in both physical and mental health domains. SUI is an independent risk factor for anxiety and depression and has been linked to significant work dysfunctions. Trial Registration This study is registered at ClinicalTrials.gov: NCT02618421 (Date of registration: December 1, 2015).
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Affiliation(s)
- Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Karina Chin Po Hsu
- Medical Affairs Department, Former Employee of Astellas Pharma Taiwan, Inc., Taipei, Taiwan
| | - Yuan-Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan,Correspondence: Shih-Ping Liu, Department of Urology, National Taiwan University Hospital and College of Medicine, No. 7, Chung Shan South Road, Taipei, 10002, Taiwan, Tel +886 2 2312-3456 ext. 62135, Fax +886 2 2321-9145, Email
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Castellani D, Di Rosa M, Saredi G, Pacchetti A, Banchero R, Ambrosini F, Meroni P, Guano G, Boltri M, Bucci S, Simonetti E, Maestroni U, Ferretti S, Terrone C, Dellabella M. Change in postoperative storage symptoms and de novo urge-incontinence after Thulium: YAG laser enucleation of the prostate: results from a prospective, multicenter study. J Endourol 2022; 36:1223-1230. [PMID: 35414264 DOI: 10.1089/end.2022.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the change of storage symptoms and their impact on quality of life in men undergoing Thulium: YAG laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS BPH patients requiring surgery were prospectively evaluated (April 2019-October 2020). INCLUSION CRITERIA International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate ≤15 ml/s, and urinary retention. EXCLUSION CRITERIA previous urethral/prostatic surgery, pelvic irradiation, bladder/prostate cancer, neurogenic bladder, concomitant transurethral surgery, and active urinary tract infection. IPSS, International Continence Society-Overactive Bladder (ICIQ-OAB) and International Continence Society-Overactive Bladder Quality of Life (ICIQ-OABq) scores were gathered before surgery and 1,3,6 and 12 months after surgery. RESULTS 117 men were included. Mean age was 68.0±7.7 years. Mean prostate volume was 86.6±34 cc. Mean IPSS subscore was 8.7±3.1 and 11.7±4.7 for storage and voiding symptoms, respectively. Mean ICIQ-OAB was 29.1±16.8. Mean ICIQ-OABq was 80.3±30.6. Voiding IPSS decreased 72.8% at 1-month, whereas the reduction of storage IPSS was 38.0%. ICIQ-OAB decreased 49.6% at 1-month. ICIQ-OABq showed a 30.0% reduction. One year after surgery, the reduction of voiding IPSS was 94.8%, ICIQ-OAB 85.5%, storage IPSS 76.7%, and ICIQ-OABq 60.5%. Urge-incontinence was present in 26.5% of men at 1-month, 15.4% at 3-month and 4.3% at 6-month. 4(3.4%) patients complained of urge-incontinence 12 months after surgery. CONCLUSION Both storage and voiding LUTS significantly decreased after ThuLEP but storage symptoms showed less reduction with a significant impact on patients' quality of life, particularly during the first 3 months.
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Affiliation(s)
- Daniele Castellani
- AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126;
| | | | - Giovanni Saredi
- Ospedale di Circolo e Fondazione Macchi, Urology, Varese, Italy;
| | - Andrea Pacchetti
- Ospedale di Circolo e Fondazione Macchi, Urology, via Tagliamento 14, Induno Olona, Italy, 21056;
| | | | | | - Paola Meroni
- Ospedale di Circolo e Fondazione Macchi, Urology, Varese, Italy;
| | - Giovanni Guano
- University of Genoa, 9302, Urology, Genova, Liguria, Italy;
| | - Matteo Boltri
- Hospital of Cattinara, 415994, Trieste, Friuli-Venezia Giulia, Italy;
| | | | - Elisa Simonetti
- Azienda Ospedaliero-Universitaria di Parma, 18630, Parma, Emilia-Romagna, Italy;
| | - Umberto Maestroni
- Hospital and University of Parma, Urology OU, Surgical Department, Parma, Italy;
| | - Stefania Ferretti
- Hospital and University of Parma, O.U. Urology, Via Gramsci, n° 14, Parma, Italy, 43100;
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Esteban-Fuertes M, Prieto-Chaparro L, Arlandis-Guzmán S, Salinas-Casado J, Gago-Ramos JL. Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units? Actas Urol Esp 2021; 46:41-48. [PMID: 34848162 DOI: 10.1016/j.acuroe.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ = 0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p < 0.001), UUI (3dBD; p = 0.008) and nocturia (B-SAQ; p < 0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p < 0.05) according to the obstruction degree. CONCLUSIONS Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.
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Affiliation(s)
| | | | | | | | - J L Gago-Ramos
- Hospital Germans Trias i Pujol y Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
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11
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Przydacz M, Chłosta M, Belch Ł, Czech AK, Wiatr T, Gronostaj K, Lipinski M, Chłosta P. Treatment patterns for lower urinary tract symptoms and overactive bladder in an Eastern European country: a nationwide population-representative survey. Cent European J Urol 2021; 74:382-387. [PMID: 34729230 PMCID: PMC8552947 DOI: 10.5173/ceju.2021.0087] [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: 03/26/2021] [Revised: 04/06/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to establish at the population level the treatment patterns for lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in Poland. Material and methods We used data from LUTS POLAND, a survey representative of the entire Polish population classified by age, sex, and place of residence. The treatment patterns we considered were lifestyle changes, physiotherapy, non-prescription drugs, prescription drugs, and surgical treatment. Results We obtained 6,005 completed interviews. About one-third of respondents who reported LUTS or OAB were seeking treatment, and many of these persons received treatment. Men were more proactive in seeking treatment than women, and men more often received treatment. Management with prescription drugs was the most common treatment modality of LUTS and OAB respondents. There were some disparities in distribution of other treatment options between LUTS and OAB persons, but, disappointingly, non-invasive and low-cost management strategies were rarely reported as being used. Specialists (mainly urologists) provided most of the treatments. We did not identify differences between urban and rural areas in treatment seeking, treatment receiving, and the treatment methods that were used. Conclusions In Poland, the scale was low for seeking treatment for LUTS and OAB. As well, there was little reliance on non-invasive and low-cost management strategies for LUTS and OAB. Our findings underline the need for education of patients and physicians about LUTS and OAB, and for greater healthcare and financial resources for LUTS and OAB patients.
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Affiliation(s)
- Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Marcin Chłosta
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Łukasz Belch
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Anna K Czech
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Wiatr
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Gronostaj
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Marek Lipinski
- 2 Department of Urology, Medical University of Łódź, Łódź, Poland
| | - Piotr Chłosta
- Department of Urology, Jagiellonian University Medical College, Cracow, Poland
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12
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Ali M, Landeira M, Covernton PJO, Choudhury N, Jaggi A, Fatoye F, van Maanen R. The use of mono- and combination drug therapy in men and women with lower urinary tract symptoms (LUTS) in the UK: a retrospective observational study. BMC Urol 2021; 21:119. [PMID: 34474675 PMCID: PMC8414666 DOI: 10.1186/s12894-021-00881-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combination drug therapy for lower urinary tract symptoms (LUTS) is beneficial to selected patients and recommended by guidelines. Patterns of real-world LUTS drug use, especially combination drug therapy, have not been studied extensively. Moreover, further understanding of the recent landscape is required following the introduction of the beta-3-adrenoceptor agonist mirabegron in the UK in 2013 for overactive bladder (OAB). The objective was to describe mono- and combination drug therapy use for LUTS in patients in UK clinical practice. METHODS This was a retrospective, descriptive, observational database study using UK Clinical Practice Research Datalink GOLD and linked databases. Men and women ≥ 18 years with a first prescription for any LUTS drug from 2014 to 2016 with ≥ 12 months continuous enrollment pre- and post-index date were included. Primary endpoints were mono- or combination drug therapy use for LUTS in male and female cohorts. Secondary endpoints were description of treatment prescribed, treatment persistence and patient demographics. Data were analyzed descriptively. Sub-cohorts were defined by drugs prescribed at index date. RESULTS 79,472 patients (61.3% male) were included, based on index treatments. Of all men, 82.5% received any benign prostatic obstruction (BPO) drug, 25.4% any OAB drug, and 7.9% any BPO drug plus any OAB drug. As either mono- or combination drug therapy, 77.1% received an alpha-blocker, 18.9% a 5-alpha reductase inhibitor, 23.9% an antimuscarinic agent, and 2.1% mirabegron. Of all women, 94.5% received any OAB drug, 6.0% duloxetine, and 0.5% any OAB drug plus duloxetine. As either mono- or combination drug therapy, 87.7% received an antimuscarinic, and 9.7% mirabegron. In men or women receiving OAB treatment, approximately 2.5% received combination drug therapy with an antimuscarinic agent and mirabegron. For OAB drug monotherapies, mirabegron had the highest persistence in both male and female cohorts. CONCLUSIONS This study provides a better understanding of the recent landscape of LUTS drug use in UK clinical practice. It highlights potential undertreatment of storage symptoms in men with LUTS and the low use of combination OAB treatments.
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Affiliation(s)
- Mahmood Ali
- Manchester Metropolitan University, Manchester, UK. .,Astellas Pharma Europe Ltd, Addlestone, UK.
| | | | | | | | - Ashley Jaggi
- Manchester Metropolitan University, Manchester, UK.,Astellas Pharma Europe Ltd, Addlestone, UK
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13
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Sessa F, Campi R, Granieri S, Tuccio A, Polverino P, Spatafora P, Sebastianelli A, Cocci A, Rivetti A, Gacci M, Carini M, Serni S, Oriti R, Minervini A. Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience. Front Surg 2021; 8:705105. [PMID: 34395511 PMCID: PMC8358301 DOI: 10.3389/fsurg.2021.705105] [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: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate. Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate. Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times. Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.
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Affiliation(s)
- Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Granieri
- Azienda Socio-Sanitaria Territoriale (ASST)-Brianza, General Surgery Unit, Vimercate, Italy
| | - Agostino Tuccio
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Oriti
- Unit of Urology, S.Stefano Hospital, University of Florence, Prato, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
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14
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Esteban-Fuertes M, Prieto-Chaparro L, Arlandis-Guzmán S, Salinas-Casado J, Gago-Ramos JL. Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units? Actas Urol Esp 2021; 46:S0210-4806(21)00120-0. [PMID: 34332808 DOI: 10.1016/j.acuro.2021.06.002] [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: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree. CONCLUSIONS Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.
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Affiliation(s)
| | | | | | | | - J L Gago-Ramos
- Hospital Germans Trias i Pujol y Universidad Autónoma de Barcelona, Badalona, Barcelona, España
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15
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Hou J, Xu F, Du H, Li N. Adverse events associated with mirabegron 50mg versus placebo: A systematic review and meta-analysis. Prog Urol 2021; 31:627-633. [PMID: 34312078 DOI: 10.1016/j.purol.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The safety of mirabegron 50mg monotherapy was comprehensively assessed versus placebo for overactive bladder. METHODS A systematic literature search was conducted up to June, 2020 using PUBMED, EMBASE and Cochrane Library. Randomized controlled trials evaluating safety of mirabegron in overactive bladder were collected, and safety was assessed according to 15 adverse events. Adverse events were widely selected to be assessed if they could be calculated. Heterogeneity among studies was assessed by using the χ2 test based on the Q and I2 tests. Pooled effect sizes were calculated using fixed model if I2<50%, otherwise a random-effects model was chosen. The outcomes were nasopharyngitis, dry mouth, hypertension, constipation, headache, dyspepsia, urinary tract infection, dizziness, blurred vision, nausea, cardiovascular events, influenza, electrocardiogram QT prolonged, upper respiratory tract infection and high blood pressure. RESULTS In all, 10 peer-reviewed trials comprising 6135 patients were identified. Compared with placebo, mirabegron 50mg had an unfavorable safety profile resulting in nasopharyngitis (OR, 1.54[95% credible interval, 1.05-2.25]; P=0.03. No statistical difference was found between mirabegron 50mg and placebo groups in other 14 outcomes. CONCLUSION Mirabegron 50mg is further confirmed to be nearly as safe as placebo, expect for nasopharyngitis. Nasopharyngitis is associated with mirabegron 50mg monotherapy for patients with overactive bladder.
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Affiliation(s)
- J Hou
- Department of Urology, Fourth Affiliated Hospital, China Medical University, 4 Chong Shan East Road, Shenyang, Liaoning, China
| | - F Xu
- Department of Urology, Fourth Affiliated Hospital, China Medical University, 4 Chong Shan East Road, Shenyang, Liaoning, China
| | - H Du
- Department of Urology, Fourth Affiliated Hospital, China Medical University, 4 Chong Shan East Road, Shenyang, Liaoning, China
| | - N Li
- Department of Urology, Fourth Affiliated Hospital, China Medical University, 4 Chong Shan East Road, Shenyang, Liaoning, China.
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16
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Song QX, He F, Sun X, Liu K, Chen Z, Li M, Lin J, Xu Z, Li Y, Zhang Y, Huang H, Zhang Y, Ye X, Peng Y, Li L, Yin L, Gao X, Song B, Sun Y, Wang J, Xue W, Abrams P. The characteristics and risk factors of healthcare-seeking men with lower urinary tract symptoms in China: Initial report from the POInT group. Neurourol Urodyn 2021; 40:1740-1753. [PMID: 34252243 DOI: 10.1002/nau.24737] [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: 03/09/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022]
Abstract
AIMS To investigate the clinical characteristics of health care-seeking men presenting with lower urinary tract symptoms (LUTS) in China and to reveal risk factors for symptom severity. METHODS This multicenter, hospital-based, cross-sectional study recruited 1477 eligible male subjects, who were at least 45 years, seeking health care at 9 participating hospitals across the mainland China. The general medical information and subjective symptoms were recorded, followed by the measurement of prostate volume, urodynamic indices, and laboratory tests for kidney function, plus glucose/lipid metabolism. Univariate and multivariate linear regression were employed for the detection of risk factors for symptom severity. RESULTS The proportion of mild, moderate, and severe LUTS was 14.6%, 32.6%, and 52.8%, respectively, with 62.2% reporting the triple combination of storage, voiding, and postmicturition symptoms. Median prostate volume was 44.6 ml, and 71.1% were experiencing comorbidities. Thirteen independent risk factors for LUTS severity were identified, namely, nocturnal voiding episodes and the presence of straining and weak steam; the triple combination of symptom subtypes; general and nocturia quality of life; Qmax and bladder outlet obstruction index; and numbers of comorbidities, hypertension, estimated glomerular filtration rate, and cholesterol and glycosylated hemoglobin. CONCLUSIONS The majority of health care-seeking LUTS men present with moderate-to-severe and overlapping symptoms, with a high prevalence of both lower urinary tract dysfunction and systemic comorbidities. The evidence from both urological and nonurological independent risk factors demonstrate the multifactorial nature of LUTS, for which a multidisciplinary management is essential.
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Affiliation(s)
- Qi-Xiang Song
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Fan He
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xionglin Sun
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Ke Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhong Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingzhao Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianhai Lin
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhihui Xu
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou, Shanghai, China
| | - Yan Li
- Department of Urology, Qilu Hospital, Shandong University, Shandong, China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Hai Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Guangzhou, China
| | - Yi Zhang
- Department of Military Health Service, Naval Medical University, Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Yonghan Peng
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Longkun Li
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | | | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bo Song
- Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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17
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Chow PM, Chuang YC, Hsu KCP, Shen YC, Hsieh AWJ, Liu SP. Impacts of nocturia on quality of life, mental health, work limitation, and health care seeking in China, Taiwan and South Korea (LUTS Asia): Results from a cross-sectional, population-based study. J Formos Med Assoc 2021; 121:285-293. [PMID: 33958270 DOI: 10.1016/j.jfma.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While nocturia has been proposed to be related to various systemic diseases and even mortality, there has been little information of the impact of nocturia in other aspects of physical and mental well-being. We evaluated the impact of nocturia on quality of life (QoL), mental health, work limitation, and health-care seeking behavior. METHODS An internet-based self-administered survey was distributed among individuals aged ≥40 years with the ability to use a computer and to read the local language. Survey questions included demographic details, International Continence Society symptom definitions and the international prostate symptom score. Impact on nocturia on health-related QoL physical and mental health domain, Hospital Anxiety and Depression Scale (HADS) score and Work Limitations Questionnaire (WLQ) measures was evaluated. RESULTS There were 8284 participants (women, 51%) of whom 34% were aged ≥60 years. Prevalence of nocturia ≥2 was 35% in men and 37% in women. Across both genders, QoL decreased with increasing frequency of nocturia. Besides nocturia, hypertension, presence of neurological disorder, lower urinary tract symptom measures and female gender were also associated with HADS anxiety and depression scores of ≥8. Nocturia significantly impacted work ability across WLQ measures. Though the utilization of prescription medications increased with the increase in frequency of nocturia, it was also noted that up to 30% of participants who reported nocturia frequency of ≥3 did not seek any treatment for their complaints. CONCLUSION Nocturia significantly affects QoL, work productivity, and mental well-being. However, healthcare utilization remains low and warrants increased awareness and education in the patients, caregivers and physicians.
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Affiliation(s)
- Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, No. 7, Chung Shan South Road, Taipei, 10002, Taiwan
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Yuan-Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, No. 7, Chung Shan South Road, Taipei, 10002, Taiwan.
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18
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Wagg A. Male Overactive Bladder: Underappreciated, Under-researched. More Please? Eur Urol 2021; 79:505-506. [PMID: 33483177 DOI: 10.1016/j.eururo.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Canada.
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19
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Relationship between Lower Urinary Tract Symptoms and Treatment-Related Behavior in an Eastern European Country: Findings from the LUTS POLAND Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020785. [PMID: 33477665 PMCID: PMC7831922 DOI: 10.3390/ijerph18020785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
Background: The aim of this study was to investigate the effect of lower urinary tract symptoms (LUTS) on behavior related to treatment of Polish adults aged ≥ 40 years. Methods: We conducted a computer-assisted telephone survey with a study sample stratified by age, sex, and place of residence (type, size, urban versus rural) reflecting the entire Polish population. Participants rated the frequency and symptom-specific bother of individual LUTS and their effects on seeking and receiving treatment, treatment satisfaction, and treatment continuation. We adjusted multiple logistic regression models to analyze the simultaneous effects of predictor variables on each dependent variable. Results: Overall, 6005 participants completed the interview. One third (29.6–33.5%) of participants with LUTS were seeking treatment, and 24.0–26.4% received treatment. There was no difference in treatment seeking and receiving between urban and rural areas. Whereas storage and voiding symptoms were significantly related to treatment seeking by both men and women, treatment receiving correlated only with voiding symptoms in men and only with storage symptoms in women. Most respondents who received treatment were satisfied; treatment dissatisfaction was related to the presence of storage symptoms in both men and women. Only 50% of all participants continued their treatment; discontinuation of treatment was statistically more prevalent for women than for men. Conclusion: This investigation, the first population-representative study performed in Eastern Europe, revealed a low frequency of seeking treatment for LUTS. In addition, symptoms that inclined participants to seek treatment might not have been adequately addressed by the treatment they received. We also found a relatively high rate of treatment discontinuation. Clearly, there is a need for both improved patient education about LUTS treatment and a need for increased clinician awareness of the coexistence of different symptoms in men and women plus proactive evaluation by physicians for all types of LUTS and associated bother.
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Vesco KK, Leo MC, Bulkley JE, Beadle KR, Stoneburner AB, Francisco M, Clark AL. Improving management of the genitourinary syndrome of menopause: evaluation of a health system-based, cluster-randomized intervention. Am J Obstet Gynecol 2021; 224:62.e1-62.e13. [PMID: 32693097 DOI: 10.1016/j.ajog.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Genitourinary symptoms are common in postmenopausal women and adversely affect the quality of life. National surveys and data collected from our healthcare system indicate that postmenopausal women with the genitourinary syndrome of menopause often fail to receive appropriate diagnosis or treatment. OBJECTIVE To promote greater detection and treatment of the genitourinary syndrome of menopause, we created and tested a clinician-focused health system intervention that included clinician education sessions and a suite of evidence-based electronic health record tools. STUDY DESIGN Using a cluster-randomized design, we allocated primary care (16) and gynecology (6) clinics to the intervention or control group. From September to November 2014, we provided training about the diagnosis and treatment of genitourinary syndrome of menopause in face-to-face presentations at each intervention clinic and in an online video. We developed clinical decision support tools in the electronic health record that contained an evidence-based, point-of-care knowledge resource, a standardized order set, and a checklist of patient education materials for the patient's after visit summary. The tools aimed to facilitate accurate diagnostic coding and prescribing (SmartSet, SmartRx) along with relevant patient information (SmartText). Clinicians who only performed visits at control clinics received no training or notification about the tools. Our primary outcome was vulvovaginal diagnoses made at well visits for women at the age of 55 years and older from November 15, 2014 to November 15, 2015. We also assessed urinary diagnoses, vaginal estrogen prescriptions, and use of the electronic tools. There was departmental support for the intervention but no prioritization within the healthcare system to incentivize change. RESULTS In the 1-year period, 386 clinicians performed 14,921 well visits for women at the age of 55 years and older. Among the 190 clinicians who performed well visits in the intervention clinics, 109 (57.4%) completed either in-person or online educational training. The proportion of visits that included a vulvovaginal (7.2% vs 5.8%; odds ratio, 1.27; 95% confidence interval, 0.65-2.51) or urinary diagnosis (2.5% vs 3.1%; odds ratio, 0.79; 95% confidence interval, 0.55-1.13) or vaginal estrogen prescription (4.5% vs 3.7%; odds ratio, 1.24; 95% confidence interval, 0.63-2.46) did not differ between study arms. There was a significant interaction for primary care and gynecology, which revealed more vulvovaginal diagnoses by gynecology but not primary care intervention clinics (odds ratio, 1.63; 95% confidence interval, 1.15-2.31), but there was no significant interaction for prescriptions. Clinicians in the intervention clinics were more likely to use decision support tools than those in control clinics-SmartSet (22.2% vs 1.5%; odds ratio, 18.8; 95% confidence interval, 5.5-63.8) and SmartText for patient information (38.0% vs 24.4%; odds ratio, 1.91; 95% confidence interval, 1.10-3.34). A per-protocol analysis revealed similar findings. CONCLUSION Overall, the intervention did not lead to more diagnoses or prescription therapy for postmenopausal genitourinary symptoms but did result in greater distribution of patient information. Gynecology clinicians were more likely to address genitourinary symptoms generally and were more likely to make a vulvovaginal diagnosis after the intervention. Further efforts for improving care should consider ongoing clinician education beginning with enhanced menopause curricula in residency training. Additional interventions to consider include greater access for postmenopausal women to gynecologic care, addressing treatment barriers, and development of national performance metrics.
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Affiliation(s)
- Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, OR; Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR.
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Kate R Beadle
- Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Amanda L Clark
- Kaiser Permanente Center for Health Research, Portland, OR; Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR
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Prevalence, Bother and Treatment Behavior Related to Lower Urinary Tract Symptoms and Overactive Bladder among Cardiology Patients. J Clin Med 2020; 9:jcm9124102. [PMID: 33352663 PMCID: PMC7766299 DOI: 10.3390/jcm9124102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose: The aim of this study was to measure, at the population level, the prevalence, bother, and treatment-related behavior for lower urinary tract symptoms (LUTS) and overactive bladder syndrome (OAB) in a large cohort of cardiology patients. Methods: This report is a further analysis of data from LUTS POLAND, a computer-assisted telephone survey that reflected the entire Polish population, stratified by age, sex, and place of residence. LUTS and OAB were assessed by a standardized protocol, the International Continence Society definitions, and validated questionnaires. In addition, all participants provided information regarding their behavior as it related to LUTS treatment. Results: Overall, 6005 participants completed interviews, and 1835 (30.6%) had received treatment by cardiologists. The prevalence of LUTS was 73.3% for cardiology participants compared with 57.0% for respondents who were not treated by cardiologists (p < 0.001). There were no differences between men and women in LUTS prevalence for cardiology patients. Nocturia was the most prevalent LUTS. LUTS were often bothersome, and storage symptoms were more bothersome than voiding or postmicturition symptoms. The prevalence of OAB syndrome was 50.7% in cardiology patients, higher than in noncardiology participants (36.6%, p < 0.001), and more women were affected than men. Only one-third of cardiology patients who reported LUTS were seeking treatment for LUTS, and most of them received treatment. There were no differences between persons living in urban and rural areas. Conclusions: LUTS and OAB were highly prevalent among cardiology patients. Although LUTS were often bothersome in this unique population, we found that the seeking of treatment for LUTS was minimal. These results highlight the need for cooperation between cardiologists and urologists.
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Kang TW, Chung HC. Add-on treatment with mirabegron may improve quality of life in patients with benign prostatic hyperplasia complaining of persistent storage symptoms after tamsulosin monotherapy. Ther Adv Urol 2020; 12:1756287220974130. [PMID: 33414845 PMCID: PMC7750565 DOI: 10.1177/1756287220974130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/25/2020] [Indexed: 01/31/2023] Open
Abstract
Background The aim of this study was to evaluate the change in lower urinary tract symptoms and quality of life (QoL) after combination therapy of solifenacin and mirabegron in patients with benign prostatic hyperplasia presenting with persistent storage symptoms after treatment with tamsulosin. Material & Methods We evaluated the International Prostatic Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), prostate-specific antigen, prostate volume, peak flow rate (Qmax), and post-voided residual volume (PVR) before and after treatment. Patients showing baseline OABSS ⩾3 were included and treated with tamsulosin 0.2 mg as an initial drug for 1 month. After 1 month, add-on treatment with solifenacin 5 mg or mirabegron 50 mg was provided to patients who did not show improvement in OABSS with tamsulosin 0.2 mg. After 2 months, we evaluated changes in OABSS, IPSS, Qmax, and PVR. Results After combination therapy for 2 months, there were no significant differences between patients receiving add-on treatment with solifenacin and those receiving mirabegron. However, the IPSS QoL score improved in patients treated with mirabegron and tamsulosin more than in those treated with solifenacin and tamsulosin (p < 0.05). Conclusion A combination of tamsulosin and mirabegron might improve the QoL of patients presenting with persistent storage symptoms after tamsulosin monotherapy. Better QoL due to mirabegron compared with solifenacin could be associated with fewer adverse effects, such as dry mouth and constipation.
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Affiliation(s)
- Tae Wook Kang
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hyun Chul Chung
- Department of Urology, Yonsei University Wonju College of Medicine, 20Ilsan-ro, Wonju-si, Kangwon-do, 220-701, South Korea
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Abstract
Apoptosis has been found in bladder affected by various types of voiding dysfunction. In animal studies, higher levels of apoptosis were observed in conditions of both detrusor overactivity and underactivity than in normal bladders. However, it has been difficult to establish the exact underlying mechanism of apoptosis in these conditions and to find new therapeutic targets because the causes of voiding dysfunction are diverse and the coexistence of various types of voiding problems is common. Furthermore, the lack of studies of the human detrusor contributes to our incomplete understanding of these issues. Therefore, this revies discuss the role of apoptosis in detrusor contractility based on previous studies.
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The impact of adding solifenacin to tamsulosin therapy for treatment of storage lower urinary tract symptoms owing to benign prostatic hyperplasia. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00094-x] [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
Benign prostatic hyperplasia (BPH) is a common problem in aging males which has a potential impact on patients’ health-related quality of life. In the present prospective study, we evaluated the effect of adding solifenacin to tamsulosin, compared to tamsulosin alone on overactive bladder symptoms scores (OABSS) and patients’ quality of life (QoL) in patients with filling lower urinary tract symptoms due to BPH.
Methods
Patients included in our study were randomly assigned into 2 groups: group 1 included patients with BPH who received tamsulosin alone and group 2 included patients with BPH who received a combination of tamsulosin and sofinacin. Treatment period was 12 weeks in both groups. Quality of life and overactive bladder symptoms score questionnaires were obtained and compared in both groups before and after treatment.
Results
No significant differences were found between both groups before treatment. At the end of treatment period, The QoL score for Group 1 patients was significantly greater than the other group (mean rank was 138.98 in tamsulosin group versus 62.02 in the combination group, P-value < 0.01). Similarly, OABSS for tamsulosin only group was significantly higher than combined treatment patients (mean rank was 145.03 in tamsulin group versus 55.98 in the combination group, P-value < 0.01).
Conclusion
Adding solifenacin to tamsulosin was associated with an improvement of QoL and OABSS in patients with irritative urinary symptoms due to BPH when compared with tamsulosin monotherapy.
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Przydacz M, Golabek T, Dudek P, Lipinski M, Chlosta P. Prevalence and bother of lower urinary tract symptoms and overactive bladder in Poland, an Eastern European Study. Sci Rep 2020; 10:19819. [PMID: 33188254 PMCID: PMC7666180 DOI: 10.1038/s41598-020-76846-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) has been measured by population-based investigations in many parts of the world. However, data are lacking for Eastern Europe, and there has not been any large population-representative study in any country of this region. Therefore, the aim of this study was to evaluate the prevalence and associated bother of LUTS and OAB in a population-representative sample of persons aged ≥ 40 years in Poland. This investigation was conducted as a computer-assisted telephone interview. The survey sample was stratified by age, sex, and place of residence to reflect the entire Polish population. LUTS and OAB were assessed by a standardized protocol based on the International Continence Society definitions and validated questionnaires. Of 6005 participants, 57% were women, and the mean age (range) was 60.7 (40-93) years. The prevalence of LUTS was 69.8% (men 66.2%; women 72.6%). There was no difference in prevalence between urban and rural areas. LUTS were often bothersome among men and women, but women were more likely to be bothered compared with men. There were also statistically significant correlations between the frequency and the bother intensity of each of the LUTS. The prevalence of OAB was higher in women (39.5%) than in men (26.8%), and OAB increased with age. Lastly, LUTS had detrimental effects on the quality of life because one third of the participants had concerns about their urinary-specific quality of life. This investigation was the first nationwide, population-representative epidemiological study of LUTS and OAB in an Eastern-European country. LUTS were highly prevalent, often bothersome, and had negative effects on the quality of life of men and women aged ≥ 40 years. Our findings are comparable with other epidemiologic studies of LUTS and OAB conducted in different regions of the world.Trial registration: NCT04121936.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland.
| | - Tomasz Golabek
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Przemyslaw Dudek
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Lipinski
- Department of Urology, Medical University of Lodz, Lodz, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
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Landeira M, Mora Blázquez AM, Martins de Almeida R, Covernton PJO, Medina‐Polo J, Montero AA. A retrospective analysis comparing persistence and adherence to treatment with free- vs fixed-dose combination of an alpha blocker and an antimuscarinic agent in men with LUTS in Spain. Int J Clin Pract 2020; 74:e13616. [PMID: 32681522 PMCID: PMC7685104 DOI: 10.1111/ijcp.13616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/08/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Combination therapy with an alpha blocker (AB) plus an antimuscarinic (AM) is recommended for men with moderate-to-severe mixed lower urinary tract symptoms (LUTS) when monotherapy is not effective in relieving storage symptoms. This study compared treatment persistence and adherence with an AB plus AM fixed-dose combination (FDC) vs an AB plus AM free-dose combination in men with LUTS in Spain. METHODS Retrospective study using the Spanish IQVIA Cegedim Electronic Medical Records database. Men prescribed AB plus AM combination therapy were included in an FDC or free-dose combination cohort based on their index treatment. Treatment persistence was the time from index date to first discontinuation of ≥1 of the two index drugs over 12 months. Adherence was measured using the fixed medication possession ratio (MPR). RESULTS Of 3114 patients identified, 999 were included (FDC, n = 790; free-dose combination, n = 209). Median (95% CI) persistence was longer in the FDC (125 [109-151] days) than in the free-dose combination (31 [31-36] days) cohort (hazard ratio [HR], 2.9; 95% CI, 2.4-3.4; P < .0001). The 12-month persistence rates were 31.1% (FDC cohort) and 8.9% (free-dose cohort). The mean (SD) fixed MPR was higher in the FDC cohort (48.8 [37.2]) compared with the free-dose cohort (23.1 [28.4]); more patients in the FDC cohort (34.2%) than in the free-dose cohort (10.0%) were adherent (MPR ≥ 80%). The probability of treatment persistence and adherence increased with age (>80 vs <65 years, persistence HR, 0.7 [95% CI, 0.5-0.9]; MPR difference, 12.5), polypharmacy (persistence HR, 0.7 [95% CI, 0.6-0.9]; MPR difference, 10.7) and previous use of AB (persistence HR, 0.8 [95% CI, 0.7-1.0]; MPR difference, 5.7) or AB/AM combinations (persistence HR, 0.7 [95% CI, 0.5-0.9]; MPR difference, 11.1). CONCLUSIONS Treatment with an AB/AM FDC is associated with better persistence and adherence vs a free-dose combination in men with LUTS in Spain.
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Rogo-Gupta LJ, Nelson DA, Young-Lin N, Shaw JG, Kurina LM. Incidence of Pelvic Floor Disorders in US Army Female Soldiers. Urology 2020; 150:158-164. [PMID: 32650018 DOI: 10.1016/j.urology.2020.05.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the incidence of pelvic floor disorders (PFD) among active-duty US Army female soldiers. MATERIALS AND METHODS We studied 102,015 women for incident PFD using the Stanford Military Data Repository, which comprises medical, demographic and service-related information on all soldiers on active duty in the US Army during 2011-2014. Cox proportional hazards estimated adjusted associations with PFD diagnoses. In the adjusted models, military-specific characteristics and fitness were evaluated alongside known PFD predictors. RESULTS Among 102,015 subjects at risk there was a cumulative incidence of 6.4% over a mean of 27 months (median 29, range 1-42). In adjusted models, obese soldiers were more likely to have a PFD compared to those of normal weight (hazard ratio [HR] 1.23, confidence interval [CI] 1.14-1.34, P <0.001) and those with recent weight gain were more likely to have a PFD compared to those without (HR 1.32, CI 1.24-1.40, P <0.05). Women with the lowest physical fitness scores were more likely to have a PFD (HR 1.14, CI 1.04-1.25) compared to those with the highest scores. CONCLUSION Over a median follow-up time of 29 months, 1 in 15 women in this active-duty cohort was diagnosed with a PFD. Optimizing risk factors including body mass index and physical fitness may benefit the pelvic health of female soldiers, independent of age, children, and years of service.
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Affiliation(s)
- Lisa J Rogo-Gupta
- Department of Obstetrics & Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA.
| | - D Alan Nelson
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Nichole Young-Lin
- Department of Obstetrics & Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jonathan G Shaw
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Lianne M Kurina
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
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Sex Differences in Prevalence and Patient Behavior Regarding Lower Urinary Tract Symptoms Among Japanese Medical Checkup Examinees. Urology 2020; 151:24-30. [PMID: 32540299 DOI: 10.1016/j.urology.2020.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the prevalence of lower urinary tract symptoms (LUTS) and patient behavior regarding LUTS and to reveal sex differences among medical checkup examinees. METHODS This cross-sectional, community-based study included participants age 40 years and above in Japan who presented for a medical checkup. The study parameters included the International Prostate Symptom Score, International Consultation on Incontinence Questionnaire-Short Form, overactive bladder symptom score, and an original questionnaire regarding patients' distress and behavior with respect to LUTS. RESULTS Of 1934 residents who presented for a medical checkup, 1582 (81.8%) individuals agreed to participants. Finally, the data of 1256 participants (808 men, 448 women) were analyzed in this study. The overall prevalence of LUTS was similar in both sexes (men 46.8%, women 44.5%; P = .156). Men had a significantly higher prevalence of LUTS than women for voiding and postmicturition symptoms, and a similar prevalence of storage symptoms and overactive bladder. Women had a significantly higher prevalence of urinary incontinence. The rate of distress regarding LUTS and the need to consult a physician were similar in both sexes. However, the consultation rate for LUTS was significantly lower in women than in men (men 38.5%, women 5.3%; P < .001), and women were more likely to restrict their activities owing to LUTS than men (men 13.0%, women 43.6%; P < .001). CONCLUSION Sufficient education regarding LUTS and providing appropriate medical facilities for consultation are warranted to encourage patients, particularly women, to treat their LUTS.
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Aydın A, Kocaöz S, Kara P. Prevalence of Lower Urinary Tract Symptoms in Pregnant Adolescents and the Influencing Factors. J Pediatr Adolesc Gynecol 2020; 33:160-166. [PMID: 31655179 DOI: 10.1016/j.jpag.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVE To determine the prevalence of lower urinary tract symptoms (LUTS) and associated risk factors in pregnant adolescents. DESIGN Descriptive study. SETTING The obstetrics and gynecology outpatient departments of a training and research hospital in Turkey. PARTICIPANTS Two hundred six pregnant adolescents younger than the age of 19 years. INTERVENTIONS None. Questionnaire-based data and the Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF) were collected from pregnant adolescents. MAIN OUTCOME MEASURES Comparisons were made with independent samples t test, one-way analysis of variance, Mann-Whitney U, and Kruskal-Wallis tests, and linear regression for the analysis of the potential risk factors. RESULTS The prevalence of at least 1 of the LUTS in pregnant adolescents was 78.6% (162/206). The prevalence of storage symptoms was more than those of urinary incontinence and voiding symptoms. Among LUTS, the prevalence of nocturia, urgency, frequency, bladder pain, and urinary incontinence was 59.3% (122/206), 54.4% (112/206), 39.3% (81/206), 37.4% (77/206), and 27.2% (56/206), respectively. Of pregnant adolescents with LUTS, 30.2% (49/162) of pregnant adolescents with LUTS reported seeking treatment for LUTS in this study. The total median scores from the BFLUTS-SF increased with gestational week, but no statistical significant difference was identified (P > .05). According to the results of the linear regression analysis, daily coffee consumption, smoking, chronic coughing, constipation, and urinary tract infection history were found to be associated with the total mean score on the BFLUTS-SF in pregnant adolescents. CONCLUSION LUTS were found to be common among pregnant adolescents, with storage symptoms being the most frequently reported. Prenatal education could increase the number of adolescents who seek treatment, thereby improving the clinical course of LUTS.
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Affiliation(s)
| | - Semra Kocaöz
- Niğde Ömer Halisdemir University, Niğde Zübeyde Hanım School of Health, Nursing Department, Department of Obstetrics and Gynecology Nursing, Niğde, Turkey.
| | - Pınar Kara
- Niğde Ömer Halisdemir University, Niğde Zübeyde Hanım School of Health, Nursing Department, Department of Obstetrics and Gynecology Nursing, Niğde, Turkey
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Gücük S, Ural ÜM, Kayhan M, Gücük A. Lower urinary tract symptoms and related factors in female university students. Low Urin Tract Symptoms 2020; 12:211-217. [PMID: 32110838 DOI: 10.1111/luts.12306] [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: 01/06/2020] [Revised: 02/05/2020] [Accepted: 02/13/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Our study aims to determine the symptoms and frequency of lower urinary tract in female university students and its related factors. METHODS This cross-sectional study was conducted between January and June 2017. To determine their sociodemographic characteristics and toilet habits, the Bristol Female Lower Urinary Tract Symptoms questionnaire, a 21-item questionnaire, was applied to female university students accepting to participate in the study using the face-to-face interview method. RESULTS The study was completed with 1091 individuals. The mean age of the participants was 20.27±1.69 years. The question "Do you feel a sudden urination sensation and run to the toilet?" was answered by 1.1% (n: 12) of the participants with "Always," while 34.8% (n: 380) replied "Never." In terms of feeling a sudden urination sensation, 0.5% (n: 6) of the participants stated that they "always" experience micturition, while 15.0% (n: 164) answered with "Seldom." The complaint of being unable to empty their bladder completely while urinating was higher in students with constipation problems (P .04) and a body mass index (BMI) > 24.9 (P .02). CONCLUSIONS Lower urinary tract complaints are a common problem. We believe that routine medical screening should be performed for female university students whose living conditions change when they start university; besides, we suggest that well-attended and repeatable training programs for healthy living behaviors, urinary habits, and hygiene should be organized for university students.
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Affiliation(s)
- Sebahat Gücük
- Department of Family Medicine, Medical Faculty, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Ülkü M Ural
- Department of Obstetrics and Gynecology, Medical Faculty, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Mehmet Kayhan
- Department of Family Medicine, Medical Faculty, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Adnan Gücük
- Department of Urology, Medical Faculty, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Bilgic D, Gokyıldız Surucu S, Kizilkaya Beji N, Yalcin O. Sexual function and urinary incontinence complaints and other urinary tract symptoms of perimenopausal Turkish women. PSYCHOL HEALTH MED 2019; 24:1111-1122. [DOI: 10.1080/13548506.2019.1595679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dilek Bilgic
- Gyneocologic and Obstetric Nursing Department, Dokuz Eylul University Faculty of Nursing, İzmir, Turkey
| | | | | | - Onay Yalcin
- Department of Obstetrics and Gynecology, Division of Urogynecology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
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Wu B, Li J, Xu Q, Hou R, Jia W, Chen Q. Vaporization of Prostate by 160W GreenLight Laser on Postoperative Erectile Function. Urology 2019; 132:164-169. [DOI: 10.1016/j.urology.2019.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
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Moossdorff-Steinhauser H, Rademakers KLJ, Nieman F, van Koeveringe GA, Berghmans B. A Survey on Voiding Complaints in Women Presenting at a Pelvic Care Center. Curr Urol 2019; 13:31-36. [PMID: 31579228 DOI: 10.1159/000499297] [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: 07/31/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction This article reports the prevalence of self-reported voiding complaints and the relationship with other pelvic floor and bladder dysfunctions (PFD). Materials and Methods Women with a variety of PFDs were referred to the pelvic care center. A standardised questionnaire on 6 PFDs was used. Frequencies of patient characteristics, PFDs and voiding complaints were calculated. Cross tabulation was used to investigate correlations and Pearson correlation coefficients to reveal the strength of the association between PFDs and self-reported voiding complaints. Results Data of 4470 women were included. Prevalence of (self-reported) voiding Lower urinary tract symptoms was 59.5%. Incomplete bladder emptying is the most prevalent voiding complaint. Self-reported voiding complaints are weakly correlated to age (r = 0.15, p < 0.01) and have moderate correlation with self-reported recurrent urinary tract infections (r = 0.34, p < 0.01), pelvic floor, bladder and bowel complaints. However, the correlation between the feeling of incomplete bladder emptying and the presence of recurrent urinary tract infections is weak (r = 0.06, p = 0.02). Conclusion Voiding complaints have a high prevalence and symptom bother in women visiting a pelvic care center.
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Affiliation(s)
| | | | - Fred Nieman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, Netherlands
| | | | - Bary Berghmans
- Pelvic Care Center, Maastricht University Medical Center, Maastricht, Netherlands
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Abstract
PURPOSE Lower urinary tract symptoms are common in men and women. Members of the LURN (Lower Urinary Tract Dysfunction Research Network) sought to create a brief, clinically relevant tool to improve existing measurements of lower urinary tract symptoms in men and women. MATERIALS AND METHODS Using a modified Delphi methodology during an expert consensus meeting we reduced the LURN CASUS (Comprehensive Assessment of Self-Reported Urinary Symptoms) questionnaire to a brief set of clinically relevant items measuring lower urinary tract symptoms. The sum score of these items was evaluated by comparing it to the AUA SI (American Urological Association Symptom Index), the UDI-6 (Urinary Distress Inventory Short Form) in women only and the CASUS lower urinary tract symptoms screening questions using the Pearson correlation, regression analysis and ROC curves. RESULTS The LURN SI-10 (10-Item LURN Symptom Index) assesses urinary frequency, nocturia, urgency, incontinence, bladder pain, voiding and post-micturition symptoms (score range 0 to 38). The correlation between LURN SI-10 and AUA SI scores was 0.77 in men and 0.70 in women. The UDI-6 and the LURN SI-10 correlated highly in women (r=0.76). The LURN SI-10 showed good accuracy to predict moderate and severe lower urinary tract symptoms as defined by the AUA SI (ROC AUC range 0.82-0.90). Similar accuracy was shown in predicting different levels of symptom status using the UDI-6 (AUC range 0.84-0.86). CONCLUSIONS The LURN SI-10 correlates well with the AUA SI and the UDI-6. It includes items related to a broader spectrum of lower urinary tract symptoms, particularly incontinence, bladder pain and post-micturition symptoms, and it applies to men and women.
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Yang DY, Jeong HC, Ko K, Lee SH, Lee SK, Shin TY, Cho JS, Lee WK. Effect of tadalafil 5 mg on post-micturition dribble in men with lower urinary tract symptoms: a multicentre, double-blind, randomized, placebo-controlled trial. BJU Int 2019; 124:862-869. [PMID: 31207030 DOI: 10.1111/bju.14849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the effects of taking tadalafil 5 mg and placebo once daily on post-micturition dribble (PMD) in men with lower urinary tract symptoms (LUTS). PATIENTS AND METHODS Our prospective, randomized, double-blind, placebo-controlled, multicentre trial enrolled 102 men with PMD and other LUTS. PMD was assessed using the Hallym Post-Micturition Dribble Questionnaire (HPMDQ) and according to PMD volume. Over a 12-week period, patients took either tadalafil 5 mg (n = 51) or placebo (n = 51) once daily and their HPMDQ and PMD volume results were evaluated. Adverse events (AEs) were also reported. RESULTS Over the course of 12 weeks, total HPMDQscores and PMD volumes improved significantly more in the tadalafil group than in the placebo group (reduction of total HPMDQ score of ≥2 points in the tadalafil and placebo group in 68.8% and 31.9% of patients (P < 0.001) and decreased mean PMD volume in the tadalafil and placebo group at 0.48 mL and 0.22 mL, respectively (P = 0.046). Specifically, PMD frequency decreased and quality of life increased significantly more in the tadalafil group than in the placebo group (P = 0.029 and P < 0.001, respectively). Furthermore, 66.7% of the tadalafil group reported moderate and significant PMD improvement, whereas only 4.2% reported that tadalafil was ineffective. Treatment-emergent AEs did not significantly differ between the groups (all P > 0.05), and no serious AEs were observed. CONCLUSION Taking tadalafil 5 mg once daily reduced PMD symptom severity and PMD volume in men with PMD, without inducing serious AEs, more effectively than placebo, suggesting that taking tadalafil 5 mg once daily may be an effective and well-tolerated PMD treatment.
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Affiliation(s)
- Dae Yul Yang
- Department of Urology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym Unversity, Seoul, Korea
| | - Hyun Cheol Jeong
- Department of Urology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym Unversity, Seoul, Korea
| | - Kyungtae Ko
- Department of Urology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym Unversity, Seoul, Korea
| | - Seong Ho Lee
- Department of Urology, College of Medicine, Dongtan Sacred Heart Hospital, Hallym Unversity, Hwaseong, Korea
| | - Sang Kon Lee
- Department of Urology, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym Unversity, Chuncheon, Korea
| | - Tae Young Shin
- Department of Urology, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym Unversity, Chuncheon, Korea
| | - Jin Seon Cho
- Department of Urology, College of Medicine, Hallym University Sacred Heart Hospital, Hallym Unversity, Anyang, Korea
| | - Won Ki Lee
- Department of Urology, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym Unversity, Chuncheon, Korea
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You JH, Shin YS, Ko MH, Jeon EJ, You H, Park JK. Friction underwear for ease of pulling down in elderly patients with overactive bladder: A prospective randomized control trial. Investig Clin Urol 2019; 60:216-221. [PMID: 31098430 PMCID: PMC6495041 DOI: 10.4111/icu.2019.60.3.216] [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: 01/08/2019] [Accepted: 03/03/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Friction underwear was developed by adding small silicon dots in front of the underwear to decrease the time for pulling down underwear in elderly patients with urge incontinence. We studied about the effects of the friction underwear for elderly overactive bladder (OAB) patients. Materials and Methods Male patients over 60 years of age diagnosed with OAB were prospectively enrolled and randomized to either the friction underwear first group (measuring for the time taken to pull down the friction underwear first and the non-friction underwear second) or the friction underwear later group (non-friction underwear first and the friction underwear second). An investigator measured the time to pulling down the underwear. And we measured the coefficient of friction of underwear. Results A total of 56 male patients were randomly divided into two groups using a random number table envelope method. There were no significant differences in demographics and clinical characteristics between the two groups. Of the total 56 patients, the time taken to pull down underwear for the friction underwear (3.79±0.15 seconds) was found significantly shorter than that for the non-friction underwear (4.10±0.17 seconds) (p=0.03). The static and dynamic coefficients of friction of the friction were 4.21 and 2.88, respectively, while those of the non-friction underwear were 0.64 and 0.45, respectively. Conclusions Our study demonstrates that friction underwear significantly shortened the time to pull down underwear. This functional underwear may be effective in preventing the underwear from getting wet in patients who suffer from urge incontinence.
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Affiliation(s)
- Jae Hyung You
- Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
| | - Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
| | - Eun Jin Jeon
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Korea
| | - Heecheon You
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
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Soler R, Averbeck MA, Koyama MAH, Gomes CM. Impact of LUTS on treatment-related behaviors and quality of life: A population-based study in Brazil. Neurourol Urodyn 2019; 38:1579-1587. [PMID: 31037759 PMCID: PMC6850518 DOI: 10.1002/nau.24004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/19/2019] [Accepted: 03/31/2019] [Indexed: 12/11/2022]
Abstract
AIMS To report on the impact of lower urinary tract symptoms (LUTS) on treatment-related behaviors and quality of life in Brazilian adults greater than or equal to 40 years. METHODS Data were from a computer-assisted telephone survey conducted in Brazil between 1 September and 31 December 2015 (Brazil LUTS study). Participants were adults greater than or equal to 40 years with landlines living in major cities from five geographical regions in Brazil. Participants rated how often they experienced individual LUTS during the previous month and associated bother, and the impact on quality of life (QoL), treatment seeking, treatment, treatment satisfaction, and treatment discontinuation. Multiple logistic regression models were adjusted to analyze the simultaneous effects of predictor variables on each dependent variable. RESULTS When the presence of LUTS was defined as symptoms occurring less than half the time or more, one-quarter of respondents sought treatment but 6% fewer actually received treatment. Of these, around 25% reported dissatisfaction with treatment and almost 10% reported treatment discontinuation. The occurrence of some symptoms and, in particular, the resultant bother were significantly related to worse QoL and to treatment-related outcomes, such as treatment seeking, actual treatment, treatment dissatisfaction, and treatment discontinuation. Symptoms of all three categories were associated with all these domains for both sexes. CONCLUSIONS This is the first population-based study carried out in South America showing that treatment seeking and treatment rates for LUTS are low. Since the LUTS prevalence is high, this reinforces the importance of a comprehensive medical assessment, focusing on the resulting bother, for more appropriate and personalized patient management.
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Affiliation(s)
- Roberto Soler
- Medical Affairs, Astellas Pharma Brazil, São Paulo, Brazil
| | - Márcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Mitti A H Koyama
- Research and Statistical Methodology, Kamiyama Statistical Consulting, São Paulo, Brazil
| | - Cristiano M Gomes
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
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Yang DY, Lee WK. A current perspective on post-micturition dribble in males. Investig Clin Urol 2019; 60:142-147. [PMID: 31098420 PMCID: PMC6495033 DOI: 10.4111/icu.2019.60.3.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/19/2019] [Indexed: 01/22/2023] Open
Abstract
Post-micturition dribble (PMD) is the involuntary loss of urine immediately after urination. It is classified as a post-micturition symptom and is more common in males. Traditionally, PMD has been considered to be part of the aging process, to have a low prevalence, and to be less bothersome than other lower urinary tract symptoms (LUTS). However, recent evidence suggests that PMD is not less common and does not elicit less discomfort compared with other LUTS in males. Also, PMD seems to commonly overlap with other LUTS and to be associated with erectile dysfunction. Although the etiology of PMD is not fully understood, a weakness or failure of the pelvic floor muscles is considered to be the most important factor. Although bulbar urethral massage and pelvic floor exercises are known to be effective in treating PMD, pharmacologic treatment has not yet been introduced. Recently, the possibility of treating PMD with phosphodiesterase-5 inhibitor has been suggested.
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Affiliation(s)
- Dae Yul Yang
- Department of Urology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Won Ki Lee
- Department of Urology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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Rees J, Foley S, Huang M, Rosa Arias J, Skoumal R, Walters C, Yavuz Y, De Wachter S. Vesomni improves the quality of life in men with lower urinary tract symptoms in routine clinical practice in Europe. Neurourol Urodyn 2019; 38:981-989. [PMID: 30801782 PMCID: PMC6916269 DOI: 10.1002/nau.23944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 01/08/2023]
Abstract
Aim To evaluate the impact of Vesomni/Urizia/Volutsa, a fixed‐dose combination tablet containing 6 mg solifenacin (antimuscarinic) and 0.4 mg tamsulosin (α‐blocker), on health‐related quality of life (HRQoL) and treatment satisfaction in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in routine clinical practice. Methods EUROPA was a noninterventional study of men with LUTS/BPH not responding to monotherapy who were prescribed Vesomni in routine clinical practice. Data were collected retrospectively (1 year) and prospectively (1 year). Assessments were performed at baseline, weeks 4 to 8, weeks 9 to 18 (optional), weeks 19 to 39 (optional), and Weeks 40 to 52. The primary endpoint was change from baseline in HRQoL, as assessed by the Overactive Bladder Questionnaire (OAB‐q) symptom bother subscale score. Change from baseline in OAB‐q total and coping, sleep, and social interaction subscale scores, treatment satisfaction‐visual analog scale (TS‐VAS), International Prostate Symptom Score (IPSS), and European Quality of Life 5‐Dimension‐5‐Level (EQ‐5D‐5L) questionnaire were also evaluated. Results Five hundred and eighty‐nine patients were enrolled. The mean changes in adjusted mean (95% confidence interval [CI]) OAB‐q symptom bother subscale scores were −16.40 (−24.31, −8.49) at weeks 4 to 8 and −19.59 (−28.26, −10.92) at weeks 40 to 52; at weeks 40 to 52, changes were clinically meaningful in 84.6% of patients. Adjusted mean (95% CI) change from baseline to weeks 40 to 52 were 15.02 (7.35, 22.69), 19.37 (10.86, 27.89), 18.65 (7.44, 29.86), 9.85 (3.90, 15.81), and 16.09 (9.07, 23.11) for concern, coping, sleep, social interaction, and total, respectively. TS‐VAS, IPSS, and EQ‐5D‐5L all improved, and treatment persistence at weeks 40 to 52 was 77.1%. Urinary retention was reported in four (0.7%) patients. Conclusions Vesomni was well‐tolerated and improved HRQoL and treatment satisfaction in patients with LUTS/BPH.
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Affiliation(s)
- Jonathan Rees
- Department of Brockway Medical Centre, Tyntesfield Medical Group, Bristol, UK
| | - Steve Foley
- Department of Urology, Royal Berkshire Hospital, Reading, RG 1 5AN, Berkshire, UK
| | - Moses Huang
- Department of European Medical Affairs, Astellas Pharma Europe Ltd., Chertsey, UK
| | - José Rosa Arias
- Department of Urology, Hospital Santiago Apóstol, Miranda de Ebro-Burgos, Spain
| | - René Skoumal
- Department of Urology, Urocentrum Brno, Brno, Czechia
| | - Carien Walters
- Department of Medical and Clinical Operations EMEA, Astellas Pharma Europe Ltd., Chertsey, UK
| | - Yalcin Yavuz
- Department of Data Science, Formerly with Astellas Pharma Global Development, Leiden, The Netherlands
| | - Stefan De Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium
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Shaw C, Rajabali S, Tannenbaum C, Wagg A. Is the belief that urinary incontinence is normal for ageing related to older Canadian women's experience of urinary incontinence? Int Urogynecol J 2019; 30:2157-2160. [PMID: 30796477 DOI: 10.1007/s00192-019-03906-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Many women consider urinary incontinence (UI) a normal part of ageing. This belief may contribute to delays in treatment seeking. This study examined the relationship among holding that belief, UI type and severity, impact on quality of life, management and healthcare seeking in a sample of older community-dwelling Canadian women. METHODS This was a secondary analysis of a controlled trial examining the impact of continence promotion workshops on UI self-management. All women who consented and provided baseline data were included in this analysis regardless of eligibility for the main study. RESULTS The sample included 4446 women (2022 with UI) of mean (SD) age 78.2 (9.0) years and BMI 26.6 (5.6). The belief that UI is normal for ageing was held by 2149 women [48.3% (83.7% of 1798 incontinent women)] and was not associated with age [adjusted odds ratio (OR) (95% CI): 1.00 (0.99, 1.01), p = 0.72] or perception of overall health. Women with this belief had more impaired QoL compared with the women who felt UI was not normal for ageing [mean (SD) 83.9 (19.4) vs. 87.4 (18.6) (p < 0.01)]. This belief remained unaffected by daily UI and pad use up to 2/day. CONCLUSIONS More than two-thirds of women thought UI normal for ageing. This belief was not associated with age or perception of overall health. More severe incontinence and greater quantities of pad use did not make women less likely to hold this belief.
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Affiliation(s)
- Christina Shaw
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 1-198 Clinical Sciences Bldg, 11350 83 Ave, Edmonton, AB, T6G 2P4, Canada
| | - Saima Rajabali
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 1-198 Clinical Sciences Bldg, 11350 83 Ave, Edmonton, AB, T6G 2P4, Canada
| | - Cara Tannenbaum
- Michel Saucier Chair of Pharmacy, University of Montreal, Montreal, QC, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 1-198 Clinical Sciences Bldg, 11350 83 Ave, Edmonton, AB, T6G 2P4, Canada.
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Matsukawa Y, Takai S, Majima T, Funahashi Y, Sassa N, Kato M, Yamamoto T, Gotoh M. Comparison in the efficacy of fesoterodine or mirabegron add‐on therapy to silodosin for patients with benign prostatic hyperplasia complicated by overactive bladder: A randomized, prospective trial using urodynamic studies. Neurourol Urodyn 2019; 38:941-949. [DOI: 10.1002/nau.23935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 01/13/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Yoshihisa Matsukawa
- Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Shun Takai
- Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Tsuyoshi Majima
- Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Yasuhito Funahashi
- Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Naoto Sassa
- Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Masashi Kato
- Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Tokunori Yamamoto
- Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Momokazu Gotoh
- Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
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Shore N, Tutrone R, Roehrborn CG. Efficacy and safety of fexapotide triflutate in outpatient medical treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia. Ther Adv Urol 2019; 11:1756287218820807. [PMID: 30719081 PMCID: PMC6348527 DOI: 10.1177/1756287218820807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/03/2018] [Indexed: 02/01/2023] Open
Abstract
Male lower urinary tract symptoms (LUTS) is an increasingly important problem for the majority of late middle aged and elderly men. Fexapotide triflutate (FT) is a first in-class compound given by local injection via the transrectal intraprostatic route under ultrasound guidance. Data from >1700 FT and control injections in prospective randomized blinded controlled multicenter trials are reviewed and discussed in relation to current developments in the field of treatments for LUTS associated with benign prostatic hyperplasia (BPH). Long-term studies of FT in the United States have shown statistically significant improvement in BPH symptoms and objective outcomes including significant reduction in both spontaneous acute urinary retention as well as the subsequent incidence of BPH surgery. FT has been shown to be well tolerated with an excellent safety profile, and is an efficacious clinic-based treatment for BPH involving an intraprostatic injection that requires only a few minutes to administer, with no catheter nor anesthesia requirements.
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Affiliation(s)
| | - Ronald Tutrone
- Chesapeake Urology Research Associates, Baltimore, MD, USA
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Åkerla J, Pesonen JS, Pöyhönen A, Häkkinen J, Koskimäki J, Huhtala H, Tammela TLJ, Auvinen A. Impact of lower urinary tract symptoms on mortality: a 21-year follow-up among middle-aged and elderly Finnish men. Prostate Cancer Prostatic Dis 2018; 22:317-323. [PMID: 30410016 DOI: 10.1038/s41391-018-0108-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/25/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The usefulness of lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. Repeated assessments are required to take into account symptom fluctuation and de novo symptom appearance. The study objective was to evaluate mortality in relation to three urinary storage symptoms-urgency, daytime frequency, and nocturia-in middle-aged and elderly men, considering also other time-varying factors during follow-up. METHODS A mail survey of a population-based cohort of men initially aged 50, 60, and 70 years was conducted in Finland in 1994, 1999, 2004, and 2009. The questionnaire included assessments of LUTS based on the Danish Prostatic Symptom Score and comorbidities. The men were followed up for mortality through the population registry through 2014. LUTS-related hazard ratios (HR) were analyzed with time-dependent Cox regression adjusted for the year of birth and comorbidities using variable values updated every 5 years. Sensitivity analyses were conducted using values of all variables fixed to the baseline assessment of 1994. RESULTS Of the 1332 eligible men with data on LUTS from each preceding survey, 514 (38.6%) died during the 21-year follow-up. In time-dependent analyses, daytime frequency, and nocturia were significantly associated with increased mortality: the adjusted HR was 1.42 (95% CI 1.11-1.83) for daytime frequency, 1.38 (1.07-1.79) for nocturia and 1.19 (0.94-1.50) for urgency. In sensitivity analyses with fixed baseline characteristics, only nocturia was suggestively associated with an increased risk of death: the adjusted HR was 1.09 (0.84-1.42) for daytime frequency, 1.41 (0.99-2.02) for nocturia and 0.94 (0.52-1.68) for urgency. CONCLUSIONS Among aging men, LUTS are more accurate predictors of short-term than longer-term mortality risk. Repeated assessments are needed to detect clinically relevant and persistent symptoms, often associated with ill health. Accordingly, men with daytime frequency or nocturia exhibit a 1.4-fold risk of death and therefore, should be evaluated for underlying comorbidity.
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Affiliation(s)
- Jonne Åkerla
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland. .,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Jori S Pesonen
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Antti Pöyhönen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jukka Häkkinen
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Juha Koskimäki
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Teuvo L J Tammela
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Robert G, De La Taille A, Descazeaud A. Données épidémiologiques en rapport avec la prise en charge de l’HBP. Prog Urol 2018; 28:803-812. [DOI: 10.1016/j.purol.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Antunes-Lopes T, Vale L, Coelho AM, Silva C, Rieken M, Geavlete B, Rashid T, Rahnama'i SM, Cornu JN, Marcelissen T. The Role of Urinary Microbiota in Lower Urinary Tract Dysfunction: A Systematic Review. Eur Urol Focus 2018; 6:361-369. [PMID: 30270128 DOI: 10.1016/j.euf.2018.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/30/2018] [Accepted: 09/16/2018] [Indexed: 01/01/2023]
Abstract
CONTEXT Until 2012, the urinary tract of healthy individuals was considered to be sterile. The advent of metagenomic sequencing revealed a unique urinary microbiota (UM). This paradigm shift appears to have prolific implications in the etiology of several functional lower urinary tract (LUT) disorders. OBJECTIVE To systematically summarize recent data on the role of UM in LUT dysfunction. EVIDENCE ACQUISITION We performed a critical review according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. We conducted a search on PubMed/MEDLINE and SCOPUS with the following MESH terms/keywords: "Microbiome OR Microbiota AND (urinary disorder OR urinary tract symptom OR overactive bladder OR urinary incontinence OR interstitial cystitis OR chronic prostatitis)." The range of search was placed between January 2010 and April 2018, and articles with no full text available or those not written in English were excluded. All retrieved papers were first reviewed by title and abstract, yielding a total of 303 papers. Additional manuscripts, such as those referenced by reviews, were further included. Thirty-six publications were included. EVIDENCE SYNTHESIS Analysis by 16S rRNA sequence and expanded quantitative urine culture provided evidence for the presence of live bacteria in urine, nondetectable by standard culture protocols. Moreover, differences in the UM between healthy individuals and patients with LUT dysfunction were demonstrated. CONCLUSIONS In the near future, urologists must consider urinary dysbiosis as a possible cause of different functional LUT disorders, with potential clinical implications in their diagnosis and treatment. PATIENT SUMMARY Development of metagenomic sequencing revealed a unique urinary microbiota nondetectable by standard culture protocols. This systematic review summarizing recent data on the role of urinary microbiota in lower urinary tract (LUT) dysfunction supports urinary dysbiosis as a possible cause of different functional LUT disorders.
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Affiliation(s)
- Tiago Antunes-Lopes
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal.
| | - Luis Vale
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal
| | | | - Carlos Silva
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal
| | - Malte Rieken
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Bogdan Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - Tina Rashid
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sajjad M Rahnama'i
- Maastricht University, Maastricht, The Netherlands; Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | | | - Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
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Solvang M, Elnegaard S, Jarbøl DE. Urological symptoms among 23,240 men in the general danish population - concerns about symptoms, their persistence and influence on primary care contacts. Scand J Prim Health Care 2018; 36:227-236. [PMID: 30043660 PMCID: PMC6381536 DOI: 10.1080/02813432.2018.1487377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To analyse possible associations between men's likelihood of contacting a general practitioner (GP) for urological symptoms and the persistence of the symptoms, the influence on daily activities and the level of concern about the symptoms. DESIGN Web-based nationwide cross-sectional questionnaire study. SETTING The general population in Denmark. SUBJECTS 48,910 randomly selected men aged 20+ years. MAIN OUTCOME MEASURES Urological symptom prevalence and odds ratios for GP contact with urological symptoms in regard to concern for the symptom, influence on daily activities and the persistence of the symptom. RESULTS Some 23,240 men responded to the questionnaire, yielding a response rate of 49.8%. The prevalence of at least one urological symptom was 59.9%. Among men experiencing at least one urological symptom almost one-fourth reported contact to general practice regarding the symptom. Approximately half of the symptoms reported to be extremely concerning were discussed with a GP. CONCLUSION Increased symptom concern, influence on daily activities and long-term persistence increased the likelihood of contacting a GP with urological symptoms. This research points out that guidelines for PSA testing might be challenged by the high prevalence of urological symptoms. Key points The decision process of whether to contact the general practitioner (GP) is influenced by different factors, but contradictory results has been found in triggers and barriers for help-seeking with urological symptoms. • Increased symptom concern, influence on daily activities and long-term persistence consistently increased the likelihood of contacting a general practitioner with urological symptoms in men. • Only 50% of the symptoms reported to be extremely concerning were however discussed with the GP. • Guidelines for PSA testing might be challenged by the high prevalence of urological symptoms.
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Affiliation(s)
| | - Sandra Elnegaard
- Research Unit of General Practice, University of Southern Denmar
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, University of Southern Denmar
- CONTACT Dorte Ejg Jarbøl J.B. Winsløws Vej 9A, 5000Odense C, Denmark
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Brady SS, Bavendam TG, Berry A, Fok CS, Gahagan S, Goode PS, Hardacker CT, Hebert-Beirne J, Lewis CE, Lewis JB, Kane Low L, Lowder JL, Palmer MH, Wyman JF, Lukacz ES. The Prevention of Lower Urinary Tract Symptoms (PLUS) in girls and women: Developing a conceptual framework for a prevention research agenda. Neurourol Urodyn 2018; 37:2951-2964. [PMID: 30136299 DOI: 10.1002/nau.23787] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/02/2018] [Indexed: 12/30/2022]
Abstract
AIMS The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium was established by the National Institutes of Health in 2015 to expand research beyond the detection and treatment of lower urinary tract symptoms (LUTS) to the promotion and preservation of bladder health and prevention of LUTS in girls and women. While many multi-disciplinary scientific networks focus on pelvic floor dysfunction and LUTS, the PLUS Consortium stands alone in its focus on prevention. This article describes the PLUS approach to developing a conceptual framework to guide the Consortium's initial prevention research agenda. METHODS The conceptual framework was informed by traditional social ecological models of public health, biopsychosocial models of health, Glass and McAtee's Society-Behavior-Biology Nexus, and the World Health Organization's conceptual framework for action on the social determinants of health. RESULTS The PLUS conceptual framework provides a foundation for developing prevention interventions that have the greatest likelihood of promoting and preserving bladder health among diverse populations. CONCLUSIONS PLUS Consortium work is premised on the notion that programs, practices, and policies designed to promote health will have optimal impact if the conceptual foundation upon which efforts are based is comprehensive and informed by multiple disciplines. The PLUS conceptual framework is broadly applicable to domains of health that have historically focused on the treatment of illness and symptoms rather than the promotion of health. It is also applicable to domains of health that have been examined from a predominantly biological or social ecological perspective, without integration of both perspectives.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Tamara G Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cynthia S Fok
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Sheila Gahagan
- Division of Academic General Pediatrics, University of California San Diego, San Diego, California
| | - Patricia S Goode
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham, Alabama
| | - Cecilia T Hardacker
- Howard Brown Health, Chicago, Illinois.,Rush University College of Nursing, Chicago, Illinois
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, University of Illinois at Chicago, School of Public Health, Chicago, Illinois
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Lisa Kane Low
- School of Nursing, Women's Studies, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Jerry L Lowder
- Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Mary H Palmer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Emily S Lukacz
- Division of Female Pelvic Medicine & Reconstructive Surgery, University of California San Diego, San Diego, California
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- Division of Female Pelvic Medicine & Reconstructive Surgery, University of California San Diego, San Diego, California
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Helfand BT, Smith AR, Lai HH, Yang CC, Gore JL, Erickson BA, Kreder KJ, Cameron AP, Weinfurt KP, Griffith JW, Lentz A, Talaty P, Andreev VP, Kirkali Z. Prevalence and Characteristics of Urinary Incontinence in a Treatment Seeking Male Prospective Cohort: Results from the LURN Study. J Urol 2018; 200:397-404. [PMID: 29477718 PMCID: PMC6145092 DOI: 10.1016/j.juro.2018.02.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Male urinary incontinence is thought to be infrequent. We sought to describe the prevalence of urinary incontinence in a male treatment seeking cohort enrolled in the LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network). MATERIALS AND METHODS Study inclusion and exclusion criteria, including men with prostate cancer or neurogenic bladder, were previously reported. LURN participants prospectively completed questionnaires regarding lower urinary tract symptoms and other clinical variables. Men were grouped based on incontinence type, including 1) no urinary incontinence, 2) post-void dribbling only and 3) urinary incontinence. Comparisons were made using ANOVA and multivariable regression. RESULTS Of the 477 men 24% reported no urinary incontinence, 44% reported post-void dribbling only and 32% reported urinary incontinence. African American men and those with sleep apnea were more likely to be in the urinary incontinence group than in the no urinary incontinence group (OR 3.2, p = 0.02 and OR 2.73, p = 0.003, respectively). Urinary incontinence was associated with significantly higher bother compared to men without leakage (p <0.001). Compared to men without urinary incontinence and men with only post-void dribbling those with urinary incontinence were significantly more likely to report higher scores (more severe symptoms) on the PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaires regarding bowel issues, depression and anxiety than men without urinary incontinence (p <0.01). CONCLUSIONS Urinary incontinence is common among treatment seeking men. This is concerning because the guideline recommended questionnaires to assess male lower urinary tract symptoms do not query for urinary incontinence. Thus, clinicians may be missing an opportunity to intervene and improve patient care. This provides a substantial rationale for a new or updated symptom questionnaire which provides a more comprehensive symptom assessment.
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Affiliation(s)
- Brian T Helfand
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland.
| | - Abigail R Smith
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - H Henry Lai
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Claire C Yang
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - John L Gore
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Brad A Erickson
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Karl J Kreder
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Anne P Cameron
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Kevin P Weinfurt
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - James W Griffith
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Aaron Lentz
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Pooja Talaty
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Victor P Andreev
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
| | - Ziya Kirkali
- NorthShore University Health System (BTH, PT), Evanston, Illinois; Feinberg School of Medicine, Northwestern University (JWG), Chicago, Illinois; Arbor Research Collaborative for Health (ARS, VPA), Ann Arbor, Michigan; University of Michigan (APC), Ann Arbor, Michigan; Washington University School of Medicine (HHL), St. Louis, Missouri; University of Washington (CCY, JLG), Seattle, Washington; Department of Urology, University of Iowa (KJK), Iowa City, Iowa; Duke University Medical Center (KPW, AL), Durham, North Carolina; National Institute of Diabetes and Digestive and Kidney Diseases (ZK), Bethesda, Maryland
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Errando-Smet C, Müller-Arteaga C, Hernández M, Roset M. Diagnosis and treatment of male patients with lower urinary tract symptoms in Spain - The MERCURY Study. Do urologists follow the recommendations of the European guidelines? Actas Urol Esp 2018; 42:323-330. [PMID: 29428420 DOI: 10.1016/j.acuro.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the management of lower urinary tract symptoms (LUTS) in men in Spain and assess the compliance with recommendations established in the European Association of Urology (EAU) guidelines. MATERIAL AND METHODS MERCURY was an epidemiological and cross-sectional study which involved 227 Urology Units across Spain assessing adult male patients with mixed LUTS and persisting storage symptoms. Sociodemographic, clinical and resource use data for the 6 months prior to study inclusion were collected. Additionally, through a theoretical clinical case, clinicians described their attitude toward the diagnostic and therapeutic management of males with mixed LUTS and persisting storage symptoms during the first and second visits. Answer options given to clinicians about LUTS management were aligned with those recommended by EAU guidelines. RESULT 610 patients included in the study were evaluated. 87.7% of them consumed some health resource mainly due to: urologist visits (79.7%), PSA determination (76.6%) and treatment with alpha-blockers (37.5%) and alpha-blockers plus antimuscarinics (37.2%). According to the theoretical clinical case, urologists preference toward diagnostic tools and pharmacological treatment in first visit were mainly PSA determination (97.7%), digital rectal examination (91.4%) and treatment with alphablockers as monotherapy (56.6%), whereas in the second visit uroflowmetry (48.9%), voiding diary (40.3%) and treatment with alpha-blockers plus antimuscarinics (70.6%) were mainly preferred. CONCLUSIONS Urologists attitude toward management of male patients with mixed LUTS and persisting storage symptoms is aligned with that recommended in the EAU guidelines.
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Affiliation(s)
- C Errando-Smet
- Unidad de Urología Funcional y Femenina, Servicio de Urología, Fundació Puigvert, Barcelona, España.
| | - C Müller-Arteaga
- Departamento de Urología, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - M Hernández
- Departamento Médico de Urología, Astellas Pharma S. A., Madrid, España
| | - M Roset
- Health Economics and Outcomes Research, IQVIA, Barcelona, España
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50
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Lukacz ES, Bavendam TG, Berry A, Fok CS, Gahagan S, Goode PS, Hardacker CT, Hebert-Beirne J, Lewis CE, Lewis J, Low LK, Lowder JL, Palmer MH, Smith AL, Brady SS. A Novel Research Definition of Bladder Health in Women and Girls: Implications for Research and Public Health Promotion. J Womens Health (Larchmt) 2018; 27:974-981. [PMID: 29792542 DOI: 10.1089/jwh.2017.6786] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bladder health in women and girls is poorly understood, in part, due to absence of a definition for clinical or research purposes. This article describes the process used by a National Institutes of Health funded transdisciplinary research team (The Prevention of Lower Urinary Tract Symptoms [PLUS] Consortium) to develop a definition of bladder health. METHODS The PLUS Consortium identified currently accepted lower urinary tract symptoms (LUTS) and outlined elements of storage and emptying functions of the bladder. Consistent with the World Health Organization's definition of health, PLUS concluded that absence of LUTS was insufficient and emphasizes the bladder's ability to adapt to short-term physical, psychosocial, and environmental challenges for the final definition. Definitions for subjective experiences and objective measures of bladder dysfunction and health were drafted. An additional bioregulatory function to protect against infection, neoplasia, chemical, or biologic threats was proposed. RESULTS PLUS proposes that bladder health be defined as: "A complete state of physical, mental, and social well-being related to bladder function and not merely the absence of LUTS. Healthy bladder function permits daily activities, adapts to short-term physical or environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational, or other activities)." Definitions for each element of bladder function are reported with suggested subjective and objective measures. CONCLUSIONS PLUS used a comprehensive transdisciplinary process to develop a bladder health definition. This will inform instrument development for evaluation of bladder health promotion and prevention of LUTS in research and public health initiatives.
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Affiliation(s)
- Emily S Lukacz
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego , San Diego, California
| | - Tamara G Bavendam
- 2 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland
| | - Amanda Berry
- 3 Division of Urology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Cynthia S Fok
- 4 Department of Urology, University of Minnesota , Minneapolis, Minnesota
| | - Sheila Gahagan
- 5 Division of Academic General Pediatrics, University of California San Diego , San Diego, California
| | - Patricia S Goode
- 6 Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham , Birmingham, Alabama.,7 Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center , Birmingham, Alabama
| | - Cecilia T Hardacker
- 8 Howard Brown Health, Rush University College of Nursing , Chicago, Illinois
| | - Jeni Hebert-Beirne
- 9 Division of Community Health Sciences, University of Illinois at Chicago , School of Public Health, Chicago, Illinois
| | - Cora E Lewis
- 10 Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Jessica Lewis
- 11 Yale School of Public Health , New Haven, Connecticut
| | - Lisa Kane Low
- 12 University of Michigan School of Nursing , Ann Arbor, Michigan
| | - Jerry L Lowder
- 13 Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri
| | - Mary H Palmer
- 14 School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Ariana L Smith
- 15 Division of Urology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Sonya S Brady
- 16 Division of Epidemiology and Community Health, University of Minnesota School of Public Health , Minneapolis, Minnesota
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