The prevalence of lower urinary tract symptoms in korean men aged 40 years or older: a population-based survey

Is Prostate Urethral Lift Effective in Patients with Multiple Comorbidities?

A prostatic urethral lift (PUL) can be performed under local anesthesia in patients normally at high risk for general anesthesia due to multiple comorbidities. However, the clinical efficacy of PULs in patients with multiple comorbidities remains unknown. Therefore, in this this study, we aimed to evaluate the clinical efficacy of the PUL in patients with a high number of comorbidities by comparing its clinical efficacy in these patients with that in healthy individuals. We performed a retrospective observational cohort study, in which patients who underwent a PUL between December 2016 and January 2019 at a single tertiary care center were categorized into two groups: healthy individuals who wanted to preserve sexual function (Group 1) and patients with a high number of comorbidities who were at high risk for general anesthesia, based on an American Society of Anesthesiologists (ASA) score of ≥3 (Group 2). The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were obtained preoperatively and compared throughout the 2-year follow-up. A total of 66 patients were enrolled, of whom 36 patients were included in Group 1 and 30 in Group 2. In Group 1, IPSS, IPSS quality of life (QoL), and Qmax significantly improved and were then maintained during follow-up, whereas, in Group 2, improvements in these parameters were not maintained during follow-up, except for IPSS QoL. Eleven patients (36%) in Group 2 required additional treatment for the recurrence of lower urinary tract symptoms. In conclusion, patients with a high number of comorbidities had a low therapeutic effect after PUL, suggesting a high rate of treatment failure. Therefore, comorbidity status should be considered when evaluating the potential benefits of the PUL procedure during preoperative counseling.

Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases

Aging and major chronic diseases are risk factors for lower urinary tract symptoms (LUTS). On the other hand, oxidative stress (OS) is one of the fundamental mechanisms of aging and the development of chronic diseases. Therefore, OS might be a candidate mechanism linking these two clinical entities. This article aims to summarize the studies on the prevalence of LUTS, the role of OS in aging and chronic diseases, and the potential mechanisms supporting the putative link. A comprehensive literature search was performed to identify recent reports investigating LUTS and OS in major chronic diseases. In addition, studies on the impact of OS on the lower urinary tract, including bladder, urethra, and prostate, were collected and summarized. Many studies showed LUTS are prevalent in aging and major chronic diseases, including obesity, metabolic syndrome, diabetes, cardiovascular disease, hypertension, obstructive sleep apnea, autoimmune diseases, Alzheimer’s disease, and Parkinson’s disease. At the same time, OS is a key component in the pathogenesis of those chronic diseases and conditions. Recent studies also provided evidence that exacerbated OS can cause functional and/or structural changes in the bladder, urethra, and prostate, leading to LUTS. The reviewed data support the concept that OS is involved in multiple risk factors-associated LUTS, although further studies are needed to confirm the causative relationship. The specific ROS/RNS and corresponding reactions/pathways involved in chronic diseases and associated LUTS should be identified in the future and could serve as therapeutic targets.

Efficacy of 0.4 mg tamsulosin monotherapy in patients with moderate-to-severe lower urinary tract symptoms

Purpose:

To evaluate efficacy of 0.4 mg tamsulosin monotherapy in patients with benign prostatic hyperplasia with moderate-to-severe International Prostate Symptom Score.

Material and methods:

From May 2015 to May 2017, 102 patients were analyzed, retrospectively. The patients were classified into three groups according to the combination of medication (tamsulosin 0.4 mg vs tamsulosin 0.4 mg + solifenacin 5 mg vs tamsulosin 0.4 mg + mirabegron 50 mg). Baseline characteristics (e.g. age, body weight, height, and underlying medical disease) were collected. International Prostate Symptom Score, prostate specific antigen, prostate volume, peak urinary flow rate (Qmax), voided volume, and post-voided volume before after treatment were evaluated.

Results:

We classified and analyzed the patients into three groups depending on the medication. And there were no significant differences between all parameters among the groups. Voided volume at 3 months after treatment in each group was 170.54 ± 125.83, 121.55 ± 46.19, and 274.63 ± 132.30 (p = 0.019). Differences of voiding symptom score and difference of post-voided volume among the groups before after treatment was 5.00 ± 5.42, 1.92 ± 3.92, and 0.11 ± 5.11 and 8.37 ± 34.32, 0.78 ± 14.86, −33.63 ± 28.58 (p = 0.037, p = 0.007).

Conclusion:

We think tamsulosin monotherapy will be feasible as a first-line therapy for the patients with benign prostatic hyperplasia who has struggled with moderate-to-severe lower urinary tract symptoms.

Prevalence and predictors of lower urinary tract symptoms in Solomon Islander adult men

Background:

Despite growing interest in the prevention of lower urinary tract symptoms (LUTS) globally and in the Asia-Pacific region, population-based evidence is limited in the smaller Pacific Island countries such as in the Solomon Islands. This study aimed to investigate the prevalence and describe the risk factors associated with moderate to severe LUTS among Solomon Islander men.

Methods:

A cross-sectional survey was conducted among 400 men aged ⩾18 years living in Honiara, Solomon Islands. LUTS were assessed using the International Prostate Symptom Score (IPSS). The association between moderate to severe LUTS and sociodemographic, health conditions and health-related factors were estimated using logistic regression adjusted for age.

Results:

Overall, 13.8% reported moderate LUTS, and 0.8% reported severe LUTS. Frequent night-time urination was the most commonly reported LUTS. The adjusted odds of moderate to severe LUTS decreased with increasing level of education. The odds increased among men reporting elevated psychological distress, increased stressful events in the past 12 months and depression.

Conclusions:

About one in six Solomon Islander men experience moderate to severe LUTS, having a negative impact on their mental health and general well-being.

Urinary Symptoms and Urodynamic Findings in Patients with Spinocerebellar Ataxia

Urinary dysfunctions are not considered symptoms of spinocerebellar ataxias (SCAs). However, given that a patient with SCAs without a family history might be misdiagnosed as MSA-C when having urinary dysfunctions, characterization of urinary dysfunctions in SCAs is needed not only to understand SCAs but also to correctly diagnosis patients with ataxia. We retrospectively reviewed medical records of 143 patients with genetically confirmed SCA1, 2, 3, 6, 7, 17, and DRPLA. Twenty-two patients (men n = 9; age 62.1 ± 10.9; disease duration 8.2 ± 2.9 years) who had lower urinary track symptoms (LUTS) were included in this study. Six patients underwent urodynamic study (UDS), and 2 underwent uroflowmetry. LUTS was present in 1 of 11 patients with SCA1, in 4 of 51 with SCA2, in 2 of 26 with SCA3, in 3 of 20 with SCA6, in 2 of 4 with SCA7, in 8 of 26 with SCA17, and in 2 of 5 with DRPLA. Overall, urinary frequency was the most common symptom (16 patients, 72.7%) followed by voiding difficulty. In three of the 6 patients with UDS, post-micturition residuals were > 100 ml. Detrusor overactivity was noted in three patients. Detrusor areflexia was observed in one. Four patients were diagnosed with a neurogenic bladder, 3 with a storage problem, and 1 with both storage and voiding problems. Fifteen percent of the patients with SCAs had LUTS, and LUTS occurred in various types of SCAs. Our results indicate that SCAs should be considered in patients with progressive cerebellar ataxia and urinary dysfunctions.

The prevalence of urinary incontinence in men and women aged 40 years or over in China, Taiwan and South Korea: A cross-sectional, prevalence-based study

OBJECTIVES

To assess prevalence of urinary incontinence (UI), including urgency UI (UUI), stress UI (SUI) and mixed UI (MUI) in individuals aged ≥40 years in China, Taiwan and South Korea.

METHOD

This was a post hoc analysis of a cross-sectional, questionnaire-based internet survey. Participants were asked questions relating to urinary symptoms, health-related quality of life (HRQoL) and mental health (using the HRQoL 12-item short form health survey mental health and physical domains, and the Hospital Anxiety and Depression Scale), visits to healthcare professionals (HCPs) for any reason or for urinary symptoms, treatments for urinary symptoms and treatment satisfaction.

RESULTS

Of 8284 survey participants, 1818 (22%) reported any UI (men 17.3%, women 26.4%). MUI was the most prevalent (overall 9.7%, men 6.8%, women 12.6%) followed by SUI (overall 7.9%, men 5.1%, women 10.7%) and UUI (overall 4.3%, men 5.5%, women 3.2%). HRQoL, anxiety and depression scores were poor in all participants with UI; MUI was associated with the worst scores. Of the participants with UI, 46.9% visited HCPs for urinary symptoms (highest proportion [62.7%] among participants with MUI). Approximately 80% of participants with UI followed treatment, with prescribed medicine being the most common form (38.1%). Over half of participants (59.6%) were somewhat, very, or extremely satisfied with their treatment. MUI was associated with least satisfaction.

CONCLUSION

UI was associated with substantial problems, including an adverse impact on HRQoL. Medication failed to satisfy many individuals with UI. Efforts to educate the public and physicians about the impact of UI could improve diagnosis and treatment rates.

The role of intravesical prostatic protrusion in the evaluation of overactive bladder in male patients with LUTS

PURPOSE

To evaluate the association of intravesical prostatic protrusion (IPP) and overactive bladder (OAB) in male patients with lower urinary tract symptoms (LUTS). IPP has been suggested to correlate with storage symptoms in addition to bladder outlet obstruction.

METHODS

This was an open-labeled, single-center, prospective study involving 128 men older than 40 years presenting with LUTS. We analyzed the relationship of IPP with age, prostate volume, uroflowmetry, post-void residual urine volume (PVR), International Prostate Symptom Score (IPSS), urgency severity scale (USS), and OAB symptom score (OABSS). The patients with an urgency score of ≥ 2 (OABSS question 2) and sum score of ≥ 3 were considered to have OAB. IPP was measured in the mid-sagittal section using transrectal ultrasound. The degree of IPP was classified as grade 1 (≤ 5 mm), grade 2 (> 5-10 mm), and grade 3 (> 10 mm).

RESULTS

The mean age of the patients was 64.9 ± 9.2 years, and 101 patients were diagnosed with OAB (79%). Mean IPPs were 2.4 ± 1.4 mm (grade 1, n = 77), 7.6 ± 1.4 mm (grade 2, n = 27), and 14.8 ± 4.4 mm (grade 3, n = 24). IPP was positively correlated with age, prostate size, PSA, PVR, and OABSS nocturia subscore, but not correlated with the presence or severity of OAB. Areas under the receiver-operating characteristic (ROC) curves for the diagnosis of OAB were 0.807 and 0.604 for IPSS-storage subscore and IPP, respectively.

CONCLUSION

IPP is not a good predictor of OAB in men presenting with LUTS. However, grade 3 IPP indicates higher frequency of nocturia.

Development and validation of a symptom assessment tool for postmicturition dribble: A prospective, multicenter, observational study in Korea

Objectives

Postmicturition dribble (PMD) is a very common symptom in males with lower urinary tract symptoms (LUTS) worldwide, but there is no adequate questionnaire to assess it. Therefore, we developed a questionnaire named the Hallym Post Micturition Dribble Questionnaire (HPMDQ) to assess PMD, and the aim of this study is to validate it.

Methods

A series of consecutive male patients newly diagnosed with LUTS and over 40 years of age who visited any of 5 medical institutions were included. LUTS were assessed in all patients using the International Prostate Symptom Score (IPSS), and PMD was assessed using the HPMDQ.

Results

In total, 2134 male patients aged 40 to 91 years were included in this study. Of these patients, 1088 (51.0%) reported PMD. In the PMD group, the mean values for HPMDQ-Q1, HPMDQ-Q2, HPMDQ-Q3 and HPMDQ total score were 1.39, 1.10, 1.76 and 4.25, respectively. In the non-PMD group, the mean values of these scores were 0, 0.18, 1.52 and 1.58, respectively. The difference in HPMDQ scores between the 2 groups was statistically significant. PMD was significantly associated with the voiding symptoms of LUTS, prostate size and postvoid residual but not with storage symptoms.

Conclusions

The HPMDQ, which consists of 5 questions (frequency, severity, bother, quality of life and response to treatment for PMD), was developed, and its use for assessing PMD is validated in this study. It may be a useful tool for further research and in clinical practice for PMD.

Evaluation of Clinical Outcomes of Prostatic Urethral Lift for Benign Prostatic Hyperplasia: An Asian Population Study

PURPOSE

This study aimed to assess the clinical outcomes of prostatic urethral lift in Korean patients with bothersome lower urinary tract symptoms due to benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

Thirty-two men with symptomatic BPH were consecutively treated in a tertiary care center in Korea. To be included in the present analysis, patients had to meet the following criteria: age ≥50 years, International Prostatic Symptom Score (IPSS) >12, and prostate volume between 30 mL and 80 mL. Patients were evaluated up to a median follow-up period of 1 year post-procedure. The primary outcomes included symptom relief, improvement of quality of life (QOL), and preservation of sexual function.

RESULTS

All procedures were finished with a mean of 2.2 implants without any serious complication. The numbers of patients diagnosed with diabetes mellitus, hypertension, and ischemic heart disease were 16 (50.0%), 24 (75.0%), and 9 (28.1%), respectively. Patients experienced symptom relief by 1 week that was sustained for 12 months. The mean IPSS, QOL, and maximum flow rate improved to 43%, 70%, and 25% by 1 week, and to 41%, 60%, and 32% by 12 months (p<0.001), respectively. There were no occurrences of early urge incontinence, retrograde ejaculation, or erectile dysfunction. Patient-reported adverse events were mild and transient.

CONCLUSIONS

Prostatic urethral lift is a safe and effective treatment for BPH in the Asian population. This treatment is minimally invasive, can be performed under local anesthesia, and may be an appropriate method for fragile patients.

The prevalence of lower urinary tract symptoms in population aged 40 years or over, in South Korea

Purpose

Lower urinary tract symptoms (LUTS) can be distressing and socially isolating, and the economic impact can be substantial. Further data to characterize the epidemiology and effects of LUTS in South Korea would be beneficial.

Materials and Methods

In an international, internet-based survey, the prevalence and impact of LUTS was evaluated in adults aged ≥40 years. Questions related to International Continence Society (ICS) symptom definitions and the bother associated with each symptom. The international prostate symptom score (IPSS) and the overactive bladder symptom score (OABSS) were assessed.

Results

Of the 2,080 participants from South Korea, 1,090 (52.4%) were women and 740 (35.6%) were aged ≥60 years. The prevalence of LUTS according to ICS criteria was 68.2% (men, 70.6%; women, 66.0%). LUTS prevalence increased significantly with age (p=0.01 in men and women). Storage symptoms only were reported in 16.2% of men and 30.5% of women, making this the most common ICS symptom group overall. Individual symptoms with the highest prevalence in the overall population were nocturia, frequency, and weak stream (36%, 30%, and 29%, respectively). IPSS results showed that 40.1% of participants had at least moderate symptoms. The prevalence of OABSS-defined overactive bladder was 19.7% (men, 19.5%; women, 19.9%). Fourteen percent of individuals with any LUTS visited healthcare professionals regarding urinary symptoms.

Conclusions

LUTS affect the majority of adults aged ≥40 years in South Korea. The low percentage of individuals with LUTS consulting healthcare professionals regarding urinary symptoms indicates a need to improve rates of diagnosis and treatment.

Effect of lower urinary tract symptoms on the quality of life and sexual function of males in China, Taiwan, and South Korea: Subgroup analysis of a cross-sectional, population-based study

Objective

Lower urinary tract symptoms (LUTS) in males can reduce patients’ quality of life (QoL) and affect sexual function and satisfaction. Although this has been documented in the US, Canada, Germany, Italy, UK, and Sweden, data are limited on the effects of LUTS on QoL and sexual function in Asian men. The present subgroup analysis of an Internet‐based survey correlated the incidence of male LUTS by severity and category with self‐assessed QoL and sexual function and satisfaction measures.

Methods

Males aged ≥40 years were randomly selected from consumer survey panels in China, Taiwan, and South Korea. LUTS were defined using the International Continence Society (ICS) 2002 symptom definitions; symptom severity was assessed by the International Prostate Symptom Score (IPSS). The effect of LUTS on QoL was assessed using Patient Perception of Bladder Condition (PPBC) and IPSS QoL scores. Sexual function and satisfaction were assessed using the International Index of Erectile Function (IIEF).

Results

Men with moderate‐to‐severe LUTS and overlap of voiding, storage, and post‐micturition symptom categories reported dissatisfaction with their QoL and sexual function. LUTS severity was negatively correlated with IIEF scores. Overlap of LUTS categories had a greater effect on QoL and sexual satisfaction than the incidence of just 1 LUTS.

Conclusion

The findings of the present study suggest that LUTS is prevalent in >60% of Asian males aged ≥40 years and is associated with reduced QoL and sexual function, particularly in those with overlap of LUTS categories and greater symptom severity.

Prevalence of Lower Urinary Tract Symptoms in China, Taiwan, and South Korea: Results from a Cross-Sectional, Population-Based Study

Introduction

Few population-based data are available evaluating the prevalence of lower urinary tract symptoms (LUTS) in Asia. The objective of our study was to determine LUTS prevalence in China, Taiwan, and South Korea using International Continence Society (ICS) 2002 criteria.

Methods

An Internet-based self-administered survey among individuals aged at least 40 years with the ability to use a computer and to read the local language. Survey questions included ICS symptom definitions and the international prostate symptom score (IPSS). Data analysis was based on descriptive statistics and post hoc significance testing.

Results

There were 8284 participants, of whom 51% were women and 34% were aged at least 60 years. LUTS prevalence was slightly higher in men than women (62.8% vs. 59.6%; p = 0.004), increasing significantly with age (p = 0.001). All three ICS symptom groups (voiding, storage, and post-micturition) were present in 35% of individuals with LUTS. Symptoms with the highest overall prevalence were nocturia, frequency, incomplete emptying, and terminal dribble. The most bothersome symptoms were terminal dribble, nocturia, and urgency. According to IPSS scores, 87% of participants had at least mild symptoms; 43% of those aged over 60 years had moderate/severe symptoms. The percentage of participants with any LUTS who had visited healthcare professionals because of urinary symptoms was 26%, rising to 45% amongst individuals with all three symptom groups (p = 0.001 vs. other ICS symptom groups).

Conclusions

LUTS are highly prevalent in men and women aged at least 40 years who participated in this study in China, Taiwan, and South Korea and increases with increasing age. A minority of individuals with LUTS seek healthcare and our results suggest an increased patient awareness of LUTS is required.

Funding

Astellas Pharma Singapore Pte. Ltd.

Trial registration

ClinicalTrials.gov identifier, NCT02618421.

Electronic supplementary material

The online version of this article (doi:10.1007/s12325-017-0577-9) contains supplementary material, which is available to authorized users.

Sociodemographic Factors Related to Lower Urinary Tract Symptoms in Men: A Korean Community Health Survey

Purpose

This study estimated the prevalence of lower urinary tract symptoms (LUTS) in Korean men and the conditions for being diagnosed with or treated for LUTS/benign prostatic hyperplasia (BPH).

Methods

We analyzed cross-sectional data collected from 69,851 Korean men who were 40 years of age or older and had participated in the Korean Community Health Survey performed in 2011. Interviewers performed face-to-face surveys that included sociodemographic questions, the International Prostate Symptom Score (IPSS), and questions regarding whether the subjects had been diagnosed with or treated for LUTS/BPH. We estimated the prevalence of LUTS and assessed whether the subjects had been diagnosed with or treated for LUTS/BPH.

Results

Moderate to severe LUTS, storage symptoms, and voiding symptoms increased with age. The IPSS quality of life score was 1.5±0.004 in the mild LUTS group (n=57,701), 3.3±0.01 in the moderate LUTS group (n=9,203), and 4.3±0.02 in the severe LUTS group (n=2,947) (P<0.0001). The prevalence of moderate to severe LUTS in those who had not been diagnosed with LUTS/BPH was 64.5% (7,847 of 12,150), and the prevalence of moderate to severe LUTS in those who had been diagnosed with LUTS/BPH but had not been treated was 23.5% (2,853 of 12,150).

Conclusions

The severity of LUTS in Korean men increased with age, and the IPSS quality of life score increased with the severity of LUTS. Many Korean men with moderate to severe LUTS had not been diagnosed or treated for LUTS/BPH. Socioeconomic conditions played an important role in health-seeking behavior among patients with LUTS/BPH.

Efficacy of Holmium Laser Transurethral Incision of the Prostate in Symptomatic Mild-to-Moderate Benign Prostate Enlargement Based on Preoperative Characteristics

OBJECTIVE

To investigate the efficacy of Holmium laser transurethral incision of the prostate (Ho-TUIP) with preoperative characteristics based on urodynamic parameters.

METHODS

The medical records of 40 consecutive cases of Ho-TUIP in patients unresponsive to medical treatment were retrospectively reviewed. The efficacy of Ho-TUIP was analyzed according to preoperative factors, including urodynamic parameters. Treatment success was confirmed if overall efficacy demonstrated an improvement that was "good or greater" according to the criteria developed by Homma et al. Predictive factors of treatment success were analyzed using logistic regression analysis with demographics, symptom questionnaires, prostate size, and urodynamic parameters. Postoperative complications and Global Response Assessment (GRA) were investigated.

RESULTS

Mean age was 60.9 years (range 37-84), mean follow-up period was 36.6 months (range 6.3-114.8), and mean prostate size was 23.5 mL (range 12.7-39.5). All patients underwent medical treatment before Ho-TUIP, and mean medication duration was 50.5 months (range 3.4-140.0). The treatment success rate was 60.0%. Treatment success rates were higher in the bladder outlet obstruction index (BOOI) ≥20 group (n = 26) than in the BOOI <20 group (n = 14) (p = 0.003). In logistic regression analysis, BOOI ≥20 was a predictor of treatment success (OR 7.60, 95% CI 1.60-35.90, P = 0.010). Among patients who maintained an active sex life, 77.8% (14/18) reported retrograde ejaculation. In terms of GRA, 81.5% (31/38, two patients expired) of patients improved at the final follow-up.

CONCLUSIONS

Ho-TUIP is an effective procedure with tolerable complications for the treatment of symptomatic mild-to-moderate BPE in patients with BOOI ≥20 that are unresponsive to medical treatment.

The Influence of Androgen Deprivation Therapy on Prostate Size and Voiding Symptoms in Prostate Cancer Patients in Korea

Purpose

The goal of this study is to investigate the effects of androgen deprivation therapy (ADT) on total prostate volume and lower urinary tract symptoms (LUTS).

Methods

Between January 2007 and June 2014, 110 patients who received androgen deprivation treatment were enrolled in this retrospective study. Clinical parameters and urodynamic parameters along with changes at follow-up were analyzed. Factors such as reduction in prostate volume, changes in LUTS, and prostate volume tertiles were compared 1 year after ADT.

Results

After ADT, the total International Prostate Symptom Score (IPSS) score decreased from 17.45 to 12.21 and the IPSS voiding subscore decreased from 9.16 to 6.24. Maximal uroflow rate increased from 8.62 to 11.50 mL/sec and residual urine also reduced significantly by 29.34 mL. Change in prostate size was more prominent (–51.14%) in the patients with less than 1 year of ADT (n=21) than those who had more than 1 year of treatment (n=89, –44.12%). The decrease in the IPSS voiding subscore was greater within 1 year of ADT than after 1 year of treatment (–4.10 vs. –2.65). The differences were more significant in the 30–50 g group (n=59) and >50 g group (n=11) than the <30 g group (n=40) of the IPSS voiding subscore improvement (–3.76 , –4.91 vs. –2.10), and maximal uroflow rate improvement (2.78, 2.90 vs 1.49).

Conclusion

ADT resulted in statistically significant clinical improvement in terms of prostate volume, urodynamic parameters, and LUTS for patients with prostate cancer when analyzed by ADT duration and prostate volume.

Lower Urinary Tract Symptoms: Prevalence, Perceptions, and Healthcare-Seeking Behavior amongst Nigerian Men

Purpose

The aim of this study was to determine the prevalence of lower urinary tract symptoms (LUTS) and the factors influencing the healthcare-seeking behavior of men with LUTS.

Materials and Methods

A cross-sectional survey was performed of 658 men selected using multi-staged sampling techniques. They were interviewed about LUTS and their healthcare-seeking behavior. The data were analysed using PASW Statistics ver. 18. Associations between specific factors and healthcare-seeking behavior were examined using the chi-square and Fisher exact tests.

Results

The overall prevalence of LUTS was 59.1%. Storage symptoms (48.2%) were more prevalent than voiding (36.8%) or post-micturition (29.9%) symptoms. Approximately a quarter (25.5%) had a poor quality of life (QoL) score. The average duration of symptoms before seeking help was 3.4 years. Almost half (46.8%) of the men with LUTS had never sought help. Perceptions of LUTS as an inevitable part of ageing, subjective feelings of wellness, financial constraints, and fear of surgery were the most common reasons for not seeking help. The most common reasons for seeking help were to moderate-severe symptoms, impaired QoL, and fear of cancer. Severe LUTS, impaired QoL, and the concomitant presence of erectile dysfunction, dysuria, or haematuria were clinical factors that positively influenced healthcare-seeking behavior.

Conclusions

In this population-based study, we found that the prevalence of LUTS was very high amongst adult males. However, only about half of these men sought medical attention. Their healthcare-seeking behavior was influenced by severity of symptoms, QoL scores, and socio-demographic factors such as educational status.

Nationwide incidence and treatment pattern of benign prostatic hyperplasia in Korea

PURPOSE

To investigate the incidence of benign prostatic hyperplasia (BPH) in Korea and treatment patterns for 3 years after the diagnosis in a nationwide database.

MATERIALS AND METHODS

We created a cohort of patients diagnosed of BPH between 2007 and 2011 from the Health Insurance Review & Assessment database, a nationwide database of reimbursement. The diagnosis of BPH was defined as having the diagnosis of BPH (N40.0 in International Classification of Diseases, 10th revision) as a primary or secondary diagnosis ≥2 times in 2008. The incidence of BPH in 2008 was calculated. Treatment patterns were determined in 3 months interval and traced for 3 years. The incidence and timing of surgery were also determined. For patients taking medications preoperatively, medication-free rate was calculated.

RESULTS

The incidence of BPH was 2,105 per 100,000 men (mean age, 59.7±11.4 years), and increased with age. Surgery was performed for 7,955 patients (2.1%), half of the surgery being performed within the first 6 months. Transurethral resection of the prostate was the most commonly performed surgery. The proportion of treatment increased with age until the 7th decade of life. The patients taking medication for >1 year after the initial diagnosis was 21.4%. On average, 82% of patients became medication-free at postoperative 1 year. For patients taking preoperative anticholinergics, 1 year medication-free rate was 73.3%.

CONCLUSIONS

The incidence of BPH increased with age. Surgery was performed in 2.1% of patients. More than 4/5 patients discontinued medication after surgery, while patients taking preoperative anticholinergics were less likely to.

Association of Functional Ability and Benign Prostatic Hyperplasia With Urinary Incontinence in Older Korean Men

Purpose:

The purpose of this study was to determine the prevalence of urinary incontinence (UI) and analyze its association with instrumental activities of daily living (IADL) and benign prostatic hyperplasia (BPH) in community-dwelling older men in Korea.

Methods:

This study was a secondary analysis of data from the Actual Living Condition of the Elderly and Welfare Need Survey conducted in the year 2008. Data was subjected to hierarchical logistic regression analysis to examine the association of IADL and BPH with UI in older men, entering IADL and BPH in model 1, and age, body mass index (BMI) and education in model 2, and then comorbidities and walking speed in model 3.

Results:

Of 6,185 men, 243 (3.9%) had self-reported UI. The prevalence of UI was 1.8% in men aged 60–64 years and 11.7% in those aged 85 years and above, indicating an increase in the prevalence of UI with their age. IADL and BPH remained the only significant factors associated with UI in model 1 (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.44–1.64 and OR, 2.73; 95% CI, 1.47–5.10, respectively), model 2 (OR, 1.50; 95% CI, 1.40–1.61 and OR, 2.68; 95% CI, 1.42–5.07), and model 3 (OR, 1.43; 95% CI, 1.32–1.54 and OR, 2.58; 95% CI, 1.36–4.90).

Conclusions:

IADL limitations and presence of BPH were associated with UI in older men after controlling for BMI, education, comorbidities, and walking speed. Thus, UI should be assessed in older Korean men with IADL decline and BPH. Gender-sensitive interventions to attenuate IADL limitations and manage BPH should be developed and applied to improve UI in older men.

Overview of the Epidemiology of Lower Urinary Tract Dysfunction in South Korea

This review assessed the epidemiology of voiding dysfunctions in South Korea. Comprehensive understanding of this epidemiology is crucial because the senior population and the social burden are increasing because of voiding dysfunctions is growing. We searched the medical records using several terms related to voiding dysfunction: benign prostatic hyperplasia, urinary incontinence, lower urinary tract symptoms, overactive bladder, and nocturia. We then estimated the prevalence of voiding dysfunctions in South Korea; our data were comparable with those from other countries, with slight differences. The ranges of incidences varied widely between studies, mostly because investigators defined disorders differently. Voiding dysfunction greatly affects healthcare costs and individual quality of life; therefore, more proper and valuable epidemiologic data are needed. In addition, efforts to unify the definitions of various voiding dysfunctions and progress in investigational methodologies using multimedia are warranted.

Changes in Nocturia and Lower Urinary Tract Symptoms after Radical Prostatectomy

Purpose

The goal of this study was to evaluate changes in nocturia and other lower urinary tract symptoms (LUTS) after laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP).

Materials and Methods

We reviewed the medical records of 96 patients who underwent LRP or RALP for clinically localized prostate cancer and completed the International Prostate Symptom Score (IPSS) questionnaire, which provided a basis for assessing their symptoms. We also evaluated maximal flow rate and post-void residual urine volume over a follow-up period of at least 24 months. We divided the patients into three groups according to postoperative changes in the frequency of nocturia.

Results

Voiding symptoms significantly improved over the course of 24 months in patients who underwent LRP or RALP. However, most patients showed persistent or increased nocturia after LRP or RALP. Moreover, more than one third of the patients (33/96) presented with exacerbated nocturia (1.0±0.9 episodes of preoperative nocturia vs. 3.0±1.3 episodes of postoperative nocturia). Multiple regression analysis showed that preoperative IPSS storage sub-score had negative association with the nocturia after radical prostatectomy (p=0.005). However, patients' age, body mass index, preoperative prostate specific antigen, Gleason score, T-stage, and prostate volume had no association.

Conclusions

The present study showed that nocturia was influenced by a range of factors, including other storage LUTS and the relief of bladder outlet obstruction after radical prostatectomy. Moreover, the preoperative storage symptoms are regarded as an important factor which influences the changes of nocturia after radical prostatectomy.

Frequency and Pattern of Lower Urinary Tract Symptoms in a screened population of Men above 40 Years in Ibadan, Southwestern Nigeria

BACKGROUND

The epidemiology of lower urinary tract symptoms in adult men in Nigeria is presently not well known.

AIM

To evaluate a screened population of men for lower urinary tract symptoms and their impact on the participants' quality of life.

METHODS

A cohort study was conducted among men aged 40 years and older from 3 selected centres in Ibadan, Southwestern Nigeria. The presence of lower urinary tract symptoms and their impact was determined using the International Prostate Symptom Score (IPSS) administered via standardized questionnaires.

RESULTS

Six hundred and fifty-five men participated in the study. The median age was 56 years with a range of 40 - 92 years. Eight percent (8%) of respondents were asymptomatic, whilst 66%, 20% and 6% had mild, moderate and severe symptoms respectively. Nocturia was the most common symptom and the second most troublesome. Overall storage (irritative) symptoms occurred with the similar frequency to voiding (obstructive) symptoms (91% v 92%), but voiding symptoms were more likely to be severe and thus more troublesome (p = <0.000.1). The severity of the individual symptoms as well as the overall score also increased significantly with age [p = 0.001]. There was a high correlation between IPSS and Quality of Life (QoL) scores (correlation coefficient 'r' = 0.75 [p = <0.0001]. Despite this, 72% of QoL respondents were satisfied with their quality of life.

CONCLUSION

The frequency of non-troublesome lower urinary tract symptoms was high in adult men in this cohort of men in Southwestern Nigeria and that severity was age-related. In addition, whilst storage and voiding symptoms occurred with similar frequency, voiding symptoms were the more severe and troublesome.

Comparison of the efficacy and safety of tolterodine 2 mg and 4 mg combined with an α-blocker in men with lower urinary tract symptoms (LUTS) and overactive bladder: a randomized controlled trial

OBJECTIVE

To evaluate the efficacy and safety of low-dose (2 mg) tolterodine extended release (ER) with an α-blocker compared with standard-dose (4 mg) tolterodine ER with an α-blocker for the treatment of men with residual storage symptoms after α-blocker monotherapy.

PATIENTS AND METHODS

The study was a 12-week, single-blind, randomized, parallel-group, non-inferiority trial that included men with residual storage symptoms despite receiving at least 4 weeks of α-blocker treatment. Inclusion criteria were total International Prostate Symptom Score (IPSS) ≥12, IPSS quality-of-life item score ≥3, and ≥8 micturitions and ≥2 urgency episodes per 24 h. The primary outcome was change in the total IPSS score from baseline. Bladder diary variables, patient-reported outcomes and safety were also assessed.

RESULTS

Patients were randomly assigned to addition of either 2 mg tolterodine ER (n = 47) or 4 mg tolterodine ER (n = 48) to α-blocker therapy for 12 weeks. Patients in both treatment groups had a significant improvement in total IPSS score (-5.5 and -6.3, respectively), micturition per 24 h (-1.3 and -1.7, respectively) and nocturia per night (-0.4 and -0.4, respectively). Changes in IPSS, bladder diary variables, and patient-reported outcomes were not significantly different between the treatment groups. All interventions were well tolerated by patients.

CONCLUSIONS

These results suggest that 12 weeks of low-dose tolterodine ER add-on therapy is similar to standard-dose tolterodine ER add-on therapy in terms of efficacy and safety for patients experiencing residual storage symptoms after receiving α-blocker monotherapy.

Alcohol, Smoking, Physical Activity, Protein, and Lower Urinary Tract Symptoms: Prospective Longitudinal Cohort

Purpose:

To evaluate risk factors for deterioration of lower urinary tract symptoms (LUTS) in elderly men in a community-based, prospective longitudinal cohort study.

Methods:

In a suburban area in Korea, 1,514 subjects aged ≥45 years were randomly selected by systematic sampling. A total of 918 elderly subjects were enrolled in this in-depth clinical study in 2004. Of these, 547 participants were followed up for 3 years and the data was analyzed in 2014. Standard questionnaires were administered face-to-face by trained interviewers. After excluding women, 224 male participants with complete data including transrectal ultrasonography were included in the final analysis. LUTS were diagnosed using the International Prostate Symptom Score (IPSS) questionnaire. Symptom deterioration was defined as a score of ≥8 points during the 3-year follow-up period.

Results:

LUTS prevalence increased to 13.1% and the mean IPSS increased by 2.6 points during the 3-year period. After adjusting for confounders, a smoking history of ≥50 pack-years was an independent risk factor for deterioration of LUTS and storage subsymptoms compared with no history of smoking (3.1 and 5.1 odds, respectively). Physical activity had a protective effect on voiding subsymptoms. However, high protein diet and alcohol intake were not associated with LUTS deterioration.

Conclusions:

The LUTS prevalence among elderly men living in a suburban area increased to 13.1% and the IPSS increased by 2.6 points during the 3-year period. A history of heavy smoking, low physical activity, and high protein intake were associated with LUTS deterioration. However, there was no significant association between alcohol intake and LUTS deterioration.

The Effectiveness of Silodosin for Nocturnal Polyuria in Elderly Men With Benign Prostatic Hyperplasia: A Multicenter Study

Purpose:

To investigate improvement in nocturia and nocturnal polyuria in nocturnal polyuria patients after silodosin administration by using a 3-day frequency volume chart.

Methods:

This was a prospective multicenter study. We enrolled nocturnal polyuria patients (nocturnal polyuria index [NPi]>0.33), aged ≥60 years, diagnosed with the 3-day frequency volume charts of patients with benign prostatic hyperplasia taking α-blockers. Of the 54 patients, 30 (55.6%) completed the study according to the study protocol (per-protocol group), and 24 dropped out (dropout group).

Results:

Of the 24 patients in the dropout group, 5 withdrew consent due to side effects or lack of efficacy, 7 were lost to follow-up at 4 weeks, 8 were lost to follow-up at 12 weeks, and 4 dropped out due to failure to complete 3-day frequency volume charts at 12 weeks. In the per-protocol group, there was significant improvement in the International Prostate Symptom Score (IPSS), especially question numbers 1, 3, 4, 5, 6, 7, and the quality of life question (P=0.001, P=0.007, P<0.001, P=0.003, P=0.049, P<0.001, and P<0.001, respectively). The Leeds sleep evaluation questionnaire (LSEQ) score for the sleep question improved from 64.36 to 70.43 (P=0.039). The NPi reduced from 0.4005 to 0.3573 (P=0.027); however, in many cases, there was no improvement in nocturnal polyuria itself. In intention-to-treat analysis, there were significant improvements in IPSS and LSEQ in 45 patients.

Conclusions:

In elderly nocturnal polyuria patients, silodosin monotherapy exhibits good efficacy in improving nocturia and nocturnal polyuria; however, the mean NPi was still >0.33. Considering the high dropout rate of our study due to no implementation of 3-day frequency volume charts, prospective and large-scale studies are needed to confirm our results.

The Impact of Lower Urinary Tract Symptoms on Quality of Life, Work Productivity, Depressive Symptoms, and Sexuality in Korean Men Aged 40 Years and Older: A Population-Based Survey

Purpose:

To examine the impact of lower urinary tract symptoms (LUTS) on health-related quality of life (HRQoL) in Korean men aged ≥40 years.

Methods:

A population-based, cross-sectional door-to-door survey was conducted among men aged ≥40 years. Individuals with LUTS were defined as men reporting at least one LUTS using 2002 International Continence Society definitions. Structuredquestionnaires were used to assess several dimensions of HRQoL, including generic health status (EuroQoL-five-dimensions questionnaire), work productivity (work productivity and activity impairment questionnaire), depressive symptoms (center for epidemiologic studies depression scale), and sexual health (sexual satisfaction and erectile dysfunction). The impact of LUTS was assessed by comparing several dimensions of HRQoL among men with and without LUTS.

Results:

Of the 1,842 participants, 1,536 (83.4%) reported having at least one LUTS. The prevalence of LUTS increased with age (78.3% among those aged 40–49 years to 89.6% among those aged 60 years or older). Those with LUTS reported a significantlylower level of generic health status and worse work productivity compared with those without LUTS. Significantly more individuals with LUTS reported having a higher level of major depressive symptoms compared with those without LUTS.Those with LUTS reported worse sexual activity and enjoyment, and were significantly more likely to have erectile dysfunction than those without LUTS.

Conclusions:

LUTS seem to have a substantial impact on several dimensions of HRQoL in Korean men aged ≥40 years.