Diagnostic Tool for Assessing Overactive Bladder Symptoms: Could the International Prostate Symptom Storage Subscore Replace the Overactive Bladder Symptom Score?

Mid-term results of ReMEEX sling system in female stress urinary incontinence with various indications and feasibility of readjustment

PURPOSE

To examine efficacy and safety of ReMEEX implantation in patients with female stress urinary incontinence (SUI) associated with detrusor underactivity (DU), recurrence, or intrinsic sphincter deficiency (ISD).

MATERIALS AND METHODS

Retrospective cohort study included 303 females who underwent ReMEEX system (March 2008 to May 2021). Patients were stratified into three groups by purpose of surgery (SUI with DU, reoperation, and SUI with ISD) and evaluated with following criteria: cure (absence of subjective complaint of leakage and objective leakage in the stress test), improvement (rare leakage subjectively, but satisfaction regardless of stress test), and failure. Primary outcome was success rate of surgery assessed through patient interviews and a stress test. Surgical outcomes and complications were evaluated.

RESULTS

Mean follow-up was 34.4 months (range, 6.0-145.0 months). At the final follow-up visit, 42.9% and 49.2% of patients were cured and improved. Twenty-one point five percent required tension readjustment (mean number, 1.2). The total complication rate was 19.5% (none for grade ≥4). Preoperative Qmax was significantly higher in the ISD group (p<0.001) and preoperative total International Prostate Symptom Score (IPSS) score was significantly higher in the DU group (p=0.044). Moreover, at postoperative 1 year, both total IPSS score and IPSS quality of life score were significantly higher in the DU group (both p=0.001).

CONCLUSIONS

The success rate of ReMEEX system was 92.1% at mean follow-up of 34.4 months in female SUI with DU, reoperation, or ISD. It also enabled postoperative readjustment of sling tension, as needed, up to 130 months after surgery.

Efficacy of medication for overactive bladder symptoms in 70 patients with Parkinson's disease

Background

Managing overactive bladder (OAB) symptoms in Parkinson's disease (PD) is challenging. This study aimed to investigate the medical management of OAB symptoms in patients with PD.

Methods

Patients with OAB symptoms who were newly treated with tolterodine and/or tamsulosin were screened from a database of 187 PD patients. Before treatment, the Hoehn-Yahr scale, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and urodynamic evaluation were evaluated. On day 21 of treatment, the IPSS and OABSS were re-evaluated. The changes of these scores and urinary symptoms were analyzed.

Results

Seventy patients with a mean age of 62.2±7.9 years and median Hoehn-Yahr stage of 2 (IQR 2-3) were enrolled. Tolterodine, tamsulosin, and tolterodine + tamsulosin were used in 43, 20, and 7 patients, respectively. The IPSS storage symptoms (9.4±3 vs. 3.5±2.3) and OABSS (9±2.8 vs. 4.8±3.3) improved significantly after treatment (both P<0.01). However, 28 (40%) patients displayed moderate urinary symptoms, and nocturia and urgency still affected more than half of the patients after treatment.

Conclusions

Tolterodine and/or tamsulosin can significantly improve OAB symptoms in PD patients. Nocturia and urgency remain common after treatment.

Predictive factors for postoperative medication therapy for overactive bladder symptoms after holmium laser enucleation of prostate

OBJECTIVE

To preoperative factors that could predict the persisting storage symptoms after Holmium laser enucleation of the prostate (HoLEP).

METHODS

Medical records of 257 patients who underwent HoLEP between December 2014 and January 2021 were reviewed. Participants with a follow-up period exceeding 6 months were included. Preoperative data, including International Prostate Symptom Score (IPSS), uroflowmetry, prostate size, and prostate-specific antigen, were collected. All participants underwent a preoperative urodynamic study. The correlation between perioperative variables and postoperative medication therapy (antimuscarinics or beta-3 agonists) was assessed.

RESULTS

Out of 257 participants in the study, 46 (18.6%) were allocated to the medication group, of which 25 (54.3%) initiated medication therapy postoperatively. The medication group showed worse postoperative IPSS storage symptom score and quality of life score compared to the medication-free group (p = 0.048 and p = 0.002, respectively), but no significant differences were observed in complications or operative variables. In the de-novo medication group, patients had lower preoperative Qmax , larger prostate volume, and smaller maximum cystometric capacity (MCC) compared to the persisting medication group (p = 0.020, p = 0.009, and p = 0.008, respectively). Overactive bladder (OAB) history, terminal detrusor overactivity (DO), and IPSS urgency item were identified as possible predictive factors for post-HoLEP medication use.

CONCLUSIONS

Preoperative factors such as OAB history, terminal DO, and IPSS urgency item may predict the need for post-HoLEP medication therapy. Further follow-up studies are warranted to understand the characteristics of the de-novo medication group due to the significant discomfort it can cause to patients.

Validating 7-items Overactive Bladder Symptom Score (OABSS) through Arabic linguistic version

The scoring of the 7-item Overactive Bladder Symptom Score (OABSS) questionnaire is unusual because its scale varies with the same maximum and minimum scoring values and quantifies all aspects of OAB. The questionnaire also contains a graded response for urgency. The current study is mainly concerned with the development and validation of the OABSS questionnaire for Jordanian patients. The process of translating the English OABSS questionnaire into the Arabic language involved forward and backward translations. Afterward, a prospective study was conducted to validate the Arabic version of the OABSS questionnaire by examining 235 patients from the outpatient clinics of Karak Governorate Teaching Hospital. The Arabic OABSS questionnaire was completed by all the enrolled patients before and after three months of treatment with solifenacin 5 mg taken once daily. The study included 235 regular patients (152 females and 83 males) diagnosed with OAB in accordance with the definition of the International Continence Society (ICS). The results showed major and significant differences on all seven domains of the questions on the OABSS questionnaire before and after receiving treatment (p < 0.05). Confirmatory Factor Analysis was used to measure the reliability and the questionnaire was found to be highly reliable for the construct variables. The findings derived from the current study would be beneficial for local urologists and researchers, as the Arabic version of the OABSS questionnaire was proven to be a reliable instrument for use in the assessment of OAB. Future studies are needed to compare different translated questionnaires relating to OAB.Trial registration number: NCT04309890.

Factors Associated With Postoperative Voiding Dysfunction Post Renal Transplantation

INTRODUCTION

Renal transplantation offers a better quality of life and survival rate for patients with end-stage renal disease. However, voiding dysfunction may have results such as decreased bladder capacity that have been observed in patients with prolonged oliguria or anuria, impacting a patient's quality of life. This study aimed to investigate preoperative factors associated with the occurrence of voiding dysfunction after renal transplantation.

METHODS

Seventy-one patients' data who had undergone successful renal transplantation at Cipto Mangunkusumo General Hospital in Jakarta were collected. Preoperative characteristics including age, sex, history of hypertension, diabetes mellitus, preoperative anuria, and duration of renal substitution therapy were obtained. Multivariate analysis were performed examining the correlation of preoperative characteristics with postoperative voiding dysfunction measured by International Prostate Symptom Score storage (IPSS-s) sub-score > 5, overactive bladder symptom score (OABSS) > 5, maximum flow rate (Qmax) > 15 mL/cc, and postvoid residual volume (PVR) > 50 mL.

RESULTS

A significant correlation of IPSS-s score suggesting storage problem with duration of preoperative dialysis was observed (odds ratio [OR] 1.052; 95% confidence interval [CI] 1.006-1.1001, P = .027). Older age and preoperative anuria were positively correlated with OABSS score > 5 (OR 1.104 and 33.567, P value .004 and .002, respectively). Negative correlation was observed between male sex and Qmax > 15mL/s (OR 1.73; 95% CI 0.033-1.907, P = .038). Male sex was negatively correlated with PVR > 50 mL (OR 0.231; P = .043) but positively correlated with the presence history of diabetes mellitus (OR 8.146; 95% CI 1.548-42.864, P = .013).

CONCLUSION

This study demonstrated that assessment of patient age, sex, and past medical history could help determine patients' risk for developing voiding dysfunction after renal transplantation.

Lower urinary symptoms, resilience, and post-traumatic stress symptoms among rectal cancer patients after surgery

AIM

Disturbance of urinary function is a common complication after rectal cancer surgery, and it may affect patients' psychological well-being, consequently may develop post-traumatic stress disorder. Personal resilience might increase people's ability to manage life's challenges. However, limited study to explore their relationships. This study examined the relationships among lower urinary symptoms, resilience, and post-traumatic stress symptoms (PTSS) in post-surgery patients with rectal cancer.

METHODS

A cross-sectional study design was used and included 188 patients with diagnosed rectal cancer who had undergone surgery over 24 months and were recruited from a hospital in southern Taiwan. The outcome measurements included a resilience scale, International Prostate Symptom Score (IPSS), the Chinese Davidson Trauma Scale, personal characteristics, and disease-related variables.

RESULTS

There were significant relationships among age at diagnosed, self-reported physical status, perceived satisfied with recovery, urinary tract symptoms, resilience, and overall PTSS. The stepwise regression demonstrated that five factors, self-reported physical status, resilience, urinary tract symptoms, age at diagnosed and gender, and together explained 27.7% of overall PTSS variance (10.7, 6.7, 3.7, 4.8 and 1.8% of variance, respectively).

CONCLUSION

The study demonstrates that patients with diagnosed rectal cancers long-term outcomes of PTSS, urinary tract symptoms, and resilience after surgery; in addition, self-reported physical status, resilience, urinary tract symptoms, age at diagnosed and gender are the major predictors of PTSS. A better understanding of the long-term outcomes of post-surgery in rectal cancer patients and its related factors may help to decreasing the PTSS after surviving cancer.

Influence of solifenacin on the improvement of storage symptoms in the early period after photoselective vaporization of the prostate

Purpose

We studied the effect of solifenacin on reducing storage symptoms after photoselective vaporization of the prostate (PVP).

Materials and Methods

This study included patients with persistent storage symptoms of urgency and frequency in a 3-day voiding diary, International Prostate Symptom Score (IPSS) storage subscore (IPSS-s) ≥5, overactive bladder symptom score (OABSS) ≥5, and OABSS for question 3 ≥4 at 5 days after urethral catheter removal. The patients were randomly assigned to receive once-daily solifenacin 5 mg or placebo for 4 weeks. Evaluation of the 3-day voiding diary, IPSS, and OABSS was performed at 2 and 4 weeks after treatment.

Results

At 2 and 4 weeks after treatment, the urgency and frequency in the 3-day voiding diary, IPSS, IPSS-s, and OABSS were decreased in the solifenacin group. Although the OABSS of the solifenacin group was not significantly different from that of the placebo group, the OABSS of the placebo group increased at 4 weeks compared with that at 2 weeks after treatment. The Benefit, Satisfaction, and Willingness to continue questionnaire showed no significant difference in patient satisfaction between the groups. Although the solifenacin group showed increased post-void residual volume compared with the placebo group, there was no statistically significant difference.

Conclusions

Storage symptoms measured using OABSS tended to decrease after medication with solifenacin in the early period after PVP. Therefore, we suggest that anticholinergics have a potential role in improving storage symptoms after PVP.

Quantitative analysis of genitourinary toxicity after iodine-125 brachytherapy for localized prostate cancer: Followup of the International Prostate Symptom Score and Overactive Bladder Symptom Score

PURPOSE

To analyze genitourinary toxicity by followup of the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) after prostate brachytherapy.

METHODS AND MATERIALS

Six hundred eighty patients were treated with iodine-125 brachytherapy for localized prostate cancer. IPSS, OABSS, and two categories of IPSS questions (storage symptom score [IPSS-S] and voiding symptom score [IPSS-V]) were evaluated.

RESULTS

The median followup was 54 months (range, 24-108). All scales showed rapid increases followed by gradual decreases. The median times to IPSS peak and resolution were 1 and 6 months, respectively. The resolution rates of IPSS, IPSS-S, IPSS-V, and OABSS at the last followup were 84.2%, 86.3%, 89.5%, and 83.0%, respectively. The difference between IPSS baseline and peak was greater for larger preimplant prostate volumes (≥25 mL, p = 0.004). The time to resolution was longer for higher biologic effective dose (BED) (≥210 Gy, p = 0.019 [IPSS]), in those with larger prostate volumes (≥25 mL, p = 0.025 [OABSS]), in younger patients (younger than 70 years, p = 0.043 [IPSS-S]), and in those with androgen deprivation therapy (ADT) use (p = 0.049 [IPSS-V]). Urge incontinence, included in the OABSS, was observed more commonly in older patients (75 years and older, p = 0.018), with ADT use (p < 0.001), and for higher BED (≥210 Gy, p = 0.006).

CONCLUSIONS

The IPSS and OABSS showed similar patterns of change. Urinary symptoms improved more rapidly in those with high baseline IPSS levels. The OABSS was useful for following urinary symptoms after prostate brachytherapy. Age, ADT use, preimplant prostate volume, and BED were significantly associated with urinary outcomes.