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LUTS
Kinds of LUTS Terms modified by LUTS Selected AbstractsA practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care settingINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2007M. T. Rosenberg Summary Aims:, Lower urinary tract symptoms (LUTS) are common in both men and women, and are among the most prevalent patient complaints heard by primary care physicians (PCPs). This article aims to provide PCPs with a logical algorithm for the assessment and initiation of treatment for LUTS in the male patient. Results:, Management of LUTS involves a focused history and physical, as well as the assessment of bother. In patients for whom treatment is warranted, a series of decisions regarding therapy should be considered. Male patients commonly suffer from storage and/or voiding symptoms. Treatment of male LUTS is commonly begun with agents that are aimed at remedying the outlet symptoms of benign prostatic hyperplasia (BPH). When this intervention is ineffective or when refractory symptoms persist, consideration should be given to treating the storage symptoms characteristic of overactive bladder (OAB). Discussion:, This article is intended to provide the PCP with a logical guide to the treatment of male LUTS. Benign prostatic hyperplasia and OAB predominate among the causes of these symptoms, and the PCP should be comfortable treating each. Recent data detailing the safety of the use of these treatments in the male patient are reviewed and incorporated into the algorithm. Conclusion:, Primary care physicians are in a unique position to successfully identify and treat male patients with LUTS. With this paper, they now have a tool to approach treatment logically and practically. [source] Prevalence of storage and voiding symptoms among men aged 40 years and older in a US population-based study: results from the Male Attitudes Regarding Sexual Health studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2007D. B. Glasser Summary Aims:, Lower urinary tract symptoms (LUTS) are categorised as storage (urgency, frequency, nocturia and incontinence), voiding (sensation of incomplete emptying, hesitancy, weak stream and straining) or mixed symptoms. Methods:, In this US population-based study, we investigated the prevalence of male LUTS and the relative frequency of the LUTS subtypes, and we evaluated associations between LUTS and age, race/ethnicity and erectile dysfunction (ED). The Male Attitudes Regarding Sexual Health study included a nationally representative sample of non-Hispanic black, non-Hispanic white and Hispanic men aged , 40 years. Participants completed a questionnaire including items on ED and the International Prostate Symptom Score (IPSS). The prevalence and subtypes of LUTS were investigated post hoc by age, race/ethnicity and the presence of ED. Results:, The overall prevalence rates of storage (13%) and mixed (9%) symptoms were higher than that of voiding symptoms (6%). The prevalence of storage symptoms was similar across age groups, whereas voiding and mixed symptoms increased with age. Among men with IPSS , 8, the rates of storage (29%) and mixed (38%) symptoms were also higher than voiding symptoms (23%). Distributions of the LUTS subtypes were comparable among black, white and Hispanic respondents with IPSS , 8. The overall prevalence rate of ED (40%) increased with age among those with IPSS , 8. Isolated storage symptoms were more than twice as common as isolated voiding symptoms among US men , 40 years of age. Conclusion:, Careful attention to individual symptoms may help distinguish storage LUTS from voiding LUTS, a distinction that has important implications for treatment. [source] Systematic pelvic floor training for lower urinary tract symptoms post-prostatectomy: a randomized clinical trialINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2008Joanne P. Robinson Abstract Because the majority of prostate cancers are diagnosed in the local or regional stages, radical prostatectomy is a treatment of choice for many patients, particularly men younger than 65 years of age. However, radical prostatectomy carries a significant risk of lower urinary tract symptoms (LUTS) and may also impair quality of life. The aim of the study was to examine the effects of systematic postoperative pelvic floor training (PFT) on LUTS intensity, LUTS distress and health-related quality of life (HRQL) at 3, 6 and 12 months following radical prostatectomy. This randomized clinical trial was guided by the Theory of Unpleasant Symptoms. All participants (n = 126) received brief instructions for exercising pelvic floor muscles before surgery and the offer of a biofeedback evaluation session 1 month following catheter removal. The intervention group (n = 62) received an additional 4 weeks of PFT immediately following catheter removal. Intervention and control groups both reported steady declines in the intensity and distress associated with LUTS, but no between-group differences were found. Similarly, no between-group differences were found in impact on HRQL; however, the pattern of HRQL impact differed by group (p < 0·01) in the direction of greater impairment over time for the control group. LUTS intensity, LUTS distress and negative effects on HRQL decline for many radical prostatectomy patients over the first postoperative year; however, improvement does not occur in all patients. Further research is needed to improve our understanding of factors that influence development, resolution and management of LUTS following radical prostatectomy. [source] Clinical guideline for male lower urinary tract symptomsINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2009Yukio Homma Abstract: This article is a shortened version of the clinical guideline for lower urinary tract symptoms (LUTS), which has been developed in Japan for symptomatic men aged 50 years and over irrespective of presumed diagnoses. The guideline was formed on the PubMed database between 1995 and 2007 and other relevant sources. The causes of male LUTS are diverse and attributable to diseases/dysfunctions of the lower urinary tract, prostate, nervous system, and other organ systems, with benign prostatic hyperplasia, bladder dysfunction, polyuria, and their combination being most common. The mandatory assessment should comprise medical history, physical examination, urinalysis, and measurement of serum prostate-specific antigen. Symptom and quality of life questionnaires, bladder diary, residual urine measurement, urine cytology, urine culture, measurement of serum creatinine, and urinary tract ultrasonography would be optional tests. The Core Lower Urinary Tract Symptom Score Questionnaire may be useful in quickly capturing important symptoms. Severe symptoms, pain symptoms, and other clinical problems would indicate urological referral. One should be careful not to overlook underlying diseases such as infection or malignancy. The treatment should be initiated with conservative therapy and/or medicine such as ,1 -blockers. Treatment with anticholinergic agents should be reserved only for urologists, considering the risk of urinary retention. The present guideline should help urologists and especially non-urologists treat men with LUTS. [source] Lower urinary tract symptoms in relation to lifestyle and medical conditions in Japanese workersINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2009Kentaro Tomita Objectives: To examine the association of medical conditions and lifestyle with lower urinary tract symptoms (LUTS) in a population of Japanese male workers. Methods: A questionnaire survey on LUTS was conducted at the time of a periodic health examination among workers of a group of engineering and shipbuilding companies in Southern Kanto, Japan. A total of 1278 (85%) men responded. LUTS were assessed by using a modified International Prostate Symptom Score questionnaire. Men having at least one point of the score were regarded as positive. Logistic regression analysis was used to examine the relation of the LUTS to age, smoking, drinking, body mass index, and medical treatment of diabetes mellitus, hypertension, and dyslipidemia. Results: Age was a strong determinant of LUTS. Men undergoing medical treatment for diabetes mellitus were significantly more likely to have LUTS than men without treatment (multivariate-adjusted odds ratio, 1.8; 95% confidence interval, 1.0,3.2). Increased odds of LUTS were also observed in men undergoing medical treatment for hypertension or dyslipidemia. Smoking, drinking alcohol, and obesity were not related to LUTS. Conclusions: Our present findings, together with previous epidemiological and experimental evidence, suggest that LUTS might share common etiological factors with diabetes mellitus, hypertension, and dyslipidemia. [source] ,1 -Adrenoceptor subtypes and lower urinary tract symptomsINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2008Debra A Schwinn Abstract: Benign prostatic hyperplasia (BPH) is a common cause of urinary outflow obstruction in aging men leading to lower urinary tract symptoms (LUTS). ,1 -Adrenoceptors (,1ARs) antagonists (blockers) have become a mainstay of LUTS treatment because they relax prostate smooth muscle and decrease urethral resistance, as well as relieving bladder LUTS symptoms. A review of key recent clinical trials suggests new insights into the role of specific ,1AR subtypes in the treatment of LUTS. [source] Influence of hypertension on lower urinary tract symptoms in benign prostatic hyperplasiaINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2003KIMIO SUGAYA Abstract Aim:, To clarify the influence of hypertension on lower urinary tract symptoms (LUTS) we examined the relationship between blood pressure, LUTS, and the effect of terazosin on LUTS in patients with benign prostatic hyperplasia (BPH). Methods:, The subjects were patients who had LUTS and BPH. They were treated with terazosin (1 mg, twice-a-day) for 12 weeks. Calculation of the International Prostate Symptom Score (IPSS), measurement of blood pressure, and uroflowmetry were performed before and after 12 weeks of therapy. Patients were divided into a normotensive (NT) group and a hypertensive (HT) group at the time of first examination. Results:, The IPSS for urinary frequency and nocturia in BPH-HT patients (n = 21; mean age, 71 years) were significantly higher than those in the BPH-NT patients (n = 21; mean age, 69 years) before the administration of terazosin. The total IPSS the BPH-HT patients was also significantly higher than that of the BPH-NT patients. There were no differences of uroflowmetric parameters between the two groups. After 12 weeks of therapy, systolic and diastolic blood pressure decreased in the BPH-HT patients, but not in the BPH-NT patients. However, the systolic pressure of the BPH-HT patients was still significantly higher than that of the BPH-NT patients. The score for each IPSS parameter decreased in both groups, but the difference of the score between the two groups increased. Conclusion:, Hypertension may worsen LUTS and may decrease the improvement of symptoms by terazosin. [source] Prevalence of lower urinary tract symptoms in a community-based survey of men in TurkeyINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2003FAZIL TUNCAY AKI Abstract Aim: The aim of the present study was to determine the frequency of lower urinary tract symptoms (LUTS), assess the impact of LUTS on quality of life (QOL) and compare the results with recent reports from other population-based studies. Methods: A total of 266 men participated in the study. The men were stratified into 10-year age groups between 40 and 79 years. All participants were asked to complete a questionnaire that included a Turkish translation of the International Prostate Symptom Score (IPSS) with QOL questions, and void into a uroflowmeter to obtain voided urine volume, peak and mean flow rate. Results: While 14.8% of men had no symptoms (IPSS = 0), 24.9% had moderate to severe symptoms (IPSS> 7). Severity of symptoms increased with age (P= 0.0018). There was a strong relationship between bother score and IPSS (rs= 0.79, P= 0.0001). Fifty-five percent of moderately symptomatic and 78% of severely symptomatic men reported poor QOL (QOL score , 3). The results of the survey provide a general picture of the symptomatology and urinary flow profiles of elderly men living in Turkey. Conclusion: The prevalence of LUTS in the Turkish community is fairly high, it increases with age and has an impact on QOL that is not negligible. [source] 5,-reductase inhibition for men with enlarged prostateJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 8 2007MBA (Associate Professor of Urology), Muta M. Issa MD Abstract Purpose: Increasingly, men with lower urinary tract symptoms (LUTS) are seeking treatment in the primary care setting. This article reviews the use of ,-blockers and 5,-reductase inhibitors (5ARIs) in the management of LUTS and enlarged prostate. Data sources: Information is based on a critical review of the published literature. Relevant studies were identified using MEDLINE and review of reference lists of published studies. Conclusions: Enlargement of the prostate is a common occurrence among aging men. Nurse practitioners (NPs) are in a unique, frontline position to evaluate symptoms and bother and to recommend appropriate treatment of patients with enlarged prostate. Both ,-blockers and 5ARIs are effective at reducing symptoms in the short term. However, only the 5ARIs impact disease progression and maintain improvement in symptoms in the long term. Implications for practice: NPs play an important role in assessing and treating LUTS in men with enlarged prostate. When treating men with LUTS, assess the severity of symptoms and the extent of prostate enlargement. For symptomatic men with enlarged prostate, long-term therapy with 5ARIs should be considered to treat symptoms as well as address the disease progression. [source] Catheter-Free 120W lithium triborate (LBO) laser photoselective vaporization prostatectomy (PVP) for benign prostatic hyperplasia (BPH)LASERS IN SURGERY AND MEDICINE, Issue 8 2008Massimiliano Spaliviero MS Abstract Introduction and Objective We evaluate the safety and efficacy of catheter-free LBO laser PVP for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Methods We prospectively evaluated our initial LBO laser PVP experience and the need for urethral catheterization. Results Seventy consecutive patients were identified. 49 (70%) were discharged without (C,) and 21 (30%) were discharged with (C+) a urethral catheter. There were no significant differences in pre-operative parameters, including age (C,: 65±10 vs. C+: 69±9 years), AUASS (C,: 22±6 vs. C+: 21±6), Qmax (C,: 10±4 vs. C+: 8±3 ml/second), PVR (C,: 62±105 vs. C+: 57±82 ml) and prostate volume (C,: 65±35 vs. C+: 86±53 ml). There were no significant differences in laser time and energy usage. AUASS, Qmax and PVR values showed significant improvement within each group (P<0.05), but there were no significant differences between the two groups. All were outpatient procedures. 2/70 (2.9%) patients required catheter reinsertion in C+. The overall incidence of adverse events was low and did not differ between the two groups. Conclusions Our experience suggests that catheter-free LBO laser PVP is safe and effective for the treatment of LUTS secondary to BPH. Lesers Surg. Med. 40:529,534, 2008. © 2008 Wiley-Liss, Inc. [source] Effects of ,1-Blockers for Lower Urinary Tract Symptoms and Sleep Disorders in Patients with Benign Prostatic HyperplasiaLUTS, Issue 2 2010Takahiro SAKUMA Objectives: We evaluated the association of lower urinary tract symptoms (LUTS) and sleep disorders (SD) in patients with benign prostatic hyperplasia (BPH). We also examined improvement of SD following the ,1-blocker therapy for LUTS. Methods: Sixty-eight male patients were enrolled in the study, consisting of 38 cases with LUTS and BPH (BPH group), and 30 men without significant LUTS or BPH (non-BPH group). The degree of LUTS and SD was evaluated by the International Prostate Symptom Score and the Pittsburg Sleep Quality Index (PSQI), respectively. The patients of BPH group then were treated with ,1-blocker for 4 weeks, and were re-examined by all the questionnaires to evaluate the therapeutic efficacies. Results: The correlation analyses showed a significant association of LUTS with SD in BPH group (r = 0.4995, P = 0.0068). Twenty cases (52.6%) in BPH group showed 5.5 or more PSQI scores. Following 4 weeks of ,1-blocker administration, the average PSQI decreased significantly from 6.3 to 4.8 points (P < 0.001). Significant improvement was observed in domains of "sleep quality" and "sleep disturbances" among PSQI (P = 0.0215 and 0.0391, respectively). Moreover, significant association between ,1-blocker induced improvements of nocturia and SD was identified in patients with 5.5 or more PSQI score at baseline (r = 0.445, P = 0.0334). Conclusion: These results suggested that SD is associated with LUTS among BPH patients and therapeutic effects of ,1-blockers on LUTS lead to improvements of SD. [source] Early Results of Photoselective Vaporization of the Prostate in Medical Control-failed PatientsLUTS, Issue 2 2009Shen Kuang CHANG Objectives: We present here our early results and learning curve for photoselective vaporization of the prostate (PVP) performed by an experienced urologist and we provide an analysis of the morbidity and early functional outcomes. Methods: Forty-four patients were selected, from May 2006 to January 2009, who had benign prostate hyperplasia (BPH) accompanied by lower urinary tract symptoms (LUTS). After undergoing PVP for BPH at our hospital, the patients were followed up for approximately 2 years. PVP was performed by the same experienced urologist using potassium-titanyl-phosphate (KTP) laser. Baseline characteristics, preoperative and perioperative data, and postoperative complications were evaluated. Regular outpatient department follow-up was conducted after patients were discharged from the hospital at 1, 4 and 12 weeks. Results: The mean age of the 44 patients was 71.6 years. The mean prostate volume was 47.52 mL. The mean PVP surgery time was 79.11 min. The mean urinary catheterization time was 23.41 h. Few complications arose after PVP, except that 47.7% of the patients developed pyuria after being discharged from hospital. The average hospital stay was 2.45 days. There were no significant differences in the efficiency of tissue vaporization among the patients. Conclusion: PVP for BPH has various advantages, including reducing postoperative complications. An experienced urologist can easily perform PVP. However, early results show no significant differences in the efficiency for the PVP technique. [source] Lower urinary tract symptoms and bladder control in advanced Parkinson's disease: Effects of deep brain stimulation in the subthalamic nucleusMOVEMENT DISORDERS, Issue 2 2007Kristian Winge MD Abstract Deep brain stimulation in the subthalamic nucleus (STN) leads to significant improvement in motor function in patients with advanced Parkinson's disease (PD). In this prospective study including 16 patients with PD, we investigated (1) lower urinary tract symptoms (LUTS) by questionnaires International Prostate Symptom Score (IPSS, symptoms only) and Danish Prostate Symptom Score (DanPSS, symptoms and bother of symptoms) and (2) bladder control (assessed by urodynamics) before and after implantation of electrodes in the STN. PD symptoms (Unified Parkinson's Disease Rating Scale score) improved significantly (P < 0.0001), and symptoms of overactive bladder (IPSS) decreased along with the troublesome symptoms of overactive bladder (DanPSS; P < 0.01 for both). Urodynamic parameters before and after implantation of electrodes in the STN, evaluated with and without the stimulation on, did not change significantly. © 2006 Movement Disorder Society [source] Urodynamic standardization in a large-scale, multicenter clinical trial examining the effects of daily tadalafil in men with lower urinary tract symptoms with or without benign prostatic obstruction,NEUROUROLOGY AND URODYNAMICS, Issue 5 2010Stephen R. Kraus Abstract Aims To present the methodology, standardization techniques, and results from post hoc test,retest reproducibility analyses for a large, placebo-controlled, multicenter trial, employing urodynamic studies (UDS) to assess the impact of daily tadalafil on men with lower urinary tract symptoms (LUTS) with or without benign prostatic obstruction (BPO). Methods UDS implemented International Continence Society (ICS) Good Urodynamic Practice guidelines and standardized urodynamic and LUTS terminology. Further standardization procedures included: equipment calibration; a detailed procedure manual and centralized training; and implementation of a central reader. Measures included: monitoring of invalid studies, comparison of actual versus expected standard deviation (SD) for primary outcome (detrusor pressure at maximum urinary flow rate [pdetQmax]), and test,retest reproducibility of the placebo arm at baseline and endpoint. Results Two hundred men with moderate to severe LUTS (baseline IPSS ,13) at 20 sites were randomized to receive either tadalafil 20,mg or placebo. All men underwent non-invasive uroflow and pressure-flow studies. Numbers of invalid studies at baseline and endpoint were 9.3% and 0.6%, respectively. Variability of pdetQmax was lower than anticipated based on actual versus expected SD of 15 and 30, respectively. Correlation coefficients were very good for pressure-flow parameters including pdetQmax (r,=,.83). Conclusions Multicenter clinical trials using urodynamic outcomes require additional standardized procedures to limit inter-site variability. By implementing centralized training with a detailed procedure manual and use of a central reader, we were able to limit common difficulties arising in multicenter clinical trials, as well as demonstrate good test,retest reproducibility of pressure flow measures. Neurourol. Urodynam. 29:741,747, 2010. © 2010 Wiley-Liss, Inc. [source] Urodynamic effects of silodosin, a new ,1A -adrenoceptor selective antagonist, for the treatment of benign prostatic hyperplasia,,NEUROUROLOGY AND URODYNAMICS, Issue 4 2010Tomonori Yamanishi Abstract Aims To investigate urodynamically the effects of silodosin, a new ,1A -adrenoceptor-selective antagonist, in the treatment of benign prostatic hyperplasia (BPH). Methods Thirty six male patients with BPH (69.9,±,7.3 years), who were referred as candidates for surgery, were treated with silodosin (4,mg twice daily). The total International Prostate Symptom Score (IPSS) was 20.7,±,7.4, maximum flow rate (Qmax) was 6.7,±,3.0,ml/sec, and prostate volume was 45.6,±,24.5,ml. Results Total IPSS, storage and voiding symptom subscores and QOL score decreased significantly, and Qmax increased significantly after 1,12 months of therapy (all P,<,0.05). In urodynamic study (n,=,29), maximum cystometric capacity increased significantly (P,=,0.0027), and detrusor overactivity disappeared in 8 of 20 patients (40%) and improved (bladder capacity increased more than 50%) in 7 (35%) after the therapy. In pressure/flow studies (n,=,27), the obstruction grade was improved in 15 patients (56%). Detrusor opening pressure, detrusor pressure at Qmax, bladder outlet obstruction index, and Schäfer's obstruction class decreased significantly after therapy (all P,<,0.01). After 12 months, 16 patients (44%) are still on silodosin for 23.3,±,7.0 (range 12,36) months, and the improvements in IPSS and Qmax were stable. Twenty patients withdrew because of insufficient effectiveness in 13 patients (12 patients underwent surgery), side effects in 3, and unknown reasons in 4. Conclusion Silodosin appears to improve detrusor overactivity and obstruction grade in patients with BPH. With silodosin treatment, LUTS could be managed effectively for more than a year in at least 44% of the patients. Neurourol. Urodynam. 29:558,562, 2010. © 2009 Wiley-Liss, Inc. [source] Lower urinary tract symptoms following neurological illness may be influenced by multiple factors: Observations from a neurorehabilitation service in a developing country,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Jalesh N. Panicker Abstract Aims To evaluate the pattern of lower urinary tract dysfunction (LUTD) in patients with neurological disease in the setting of a rehabilitation service in a developing country, and analyze causes for unexpected lower urinary tract symptoms (LUTS). Methods Patients with neurological disorders and having significant LUTS were prospectively evaluated. Level of neurological lesion was localized by neurological examination and investigations. LUTD was evaluated by symptom analysis, bladder diaries and ultrasonography. Storage symptoms were managed using antimuscarinic medications and voiding dysfunction, when significant, was managed by catheterization and patients were regularly followed up. Patients with symptoms that had not been expected based upon their level of neurological lesion were further evaluated. Results Fifty patients (mean age 43.5,±,18.3 years) were included and according to neurological localization, were categorized into suprapontine (n,=,9; 18%), infrapontine/suprasacral (n,=,25; 50%) or infrasacral (n,=,16; 32%) groups. Incontinence was more common in patients with suprapontine and infrapontine/suprasacral lesions (n,=,20) (P,<,0.03), hesitancy more common with infrapontine/suprasacral lesions (n,=,20) (P,=,0.004) and retention more with infrasacral lesions (n,=,13) (P,<,0.001). Patients belonging to suprapontine and infrapontine/suprasacral groups more likely showed improvement at follow up (P,=,0.008). Fourteen patients (28%) had unexpected LUTS and this was due to urological causes (n,=,6) or multiaxial neurological involvement (n,=,8). Potentially treatable factors were managed, resulting in symptom relief. Conclusion LUTS in neurological disease may be at variance with the pattern expected based upon level of neurological lesion. Such patients may require further evaluation and consideration should be given to concomitant urological conditions and multiaxial neurological involvement. Neurourol. Urodynam. 29:378,381, 2010. © 2009 Wiley-Liss, Inc. [source] Urodynamic findings in female diabetic patients with and without overactive bladder symptoms,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Chen-Hsun Ho Abstract Aims The purpose was to analyze urodynamic findings in female diabetic patients with OAB symptoms. Methods Data from 94 female diabetic patients who underwent urodynamic studies in evaluation of various LUTS were retrospectively reviewed. Urodynamic findings, demographic data, and clinical symptoms were compared between patients with and without OAB. Results Among the 94 subjects analyzed, 34 (36.2%) were diagnosed as OAB. Demographic data were similar between the patients with and without OAB. In the OAB group, patients had significantly higher storage symptom scores and marginally higher voiding symptom scores. On cystometry, the OAB group had a higher percentage of increased bladder sensation (41.2% vs 11.7%, P,=,0.001) and detrusor overactivity (29.4% vs 10.0%, P,=,0.023). The OAB group had lower peak flow rate (16.2,±,5.9 vs 19.3,±,6.3 ml/s, P,=,0.023), greater PVR volume (60.3,±,29.4 vs 45.0,±,25.1 ml, P,=,0.009), and lower bladder voiding efficiency (BVE, 75.2,±,2.8 vs 81.5,±,2.9%, P,<,0.001). On pressure-flow studies, the OAB group had a higher percentage of BOO (26.5% vs 6.7%, P,=,0.008). Conclusions Our study shows that the most frequent urodynamic finding of OAB in female diabetic patients is increased bladder sensation, followed by detrusor overactivity. Compared to those without OAB, female diabetic patients with OAB are more likely to have impaired voiding function, characterized by lower peak flow rate, greater PVR volume, lower BVE, and a higher percentage of BOO. In these patients, BOO not only causes voiding difficulty but may also contribute to the development of OAB. Neurourol. Urodynam. 29:424,427, 2010. © 2009 Wiley-Liss, Inc. [source] Nocturia: An austrian study on the multifactorial etiology of this symptom,,NEUROUROLOGY AND URODYNAMICS, Issue 5 2009H. Christoph Klingler Abstract Aims To identify the different factors contributing to nocturia in a clinical setting. Patients and Methods Three hundred twenty-four patients (133 women, 191 men; mean age 63 years) were entered into this multi-institutional study. When presenting with nocturia we obtained detailed medical history and performed urine analysis, post-void residual volume and renal ultrasonography. Bothersome score and quality of life were evaluated using visual analogue scale and Kings' Health Questionnaire (KHQ), respectively. Patients were asked to complete a 48-hr voiding diary (VD). Nocturia and its associated problems were evaluated using KHQ and VD in conjunction with concurrent health variables. Results Mean nocturia was 2.8 in men versus in 3.1 women. Fifty percent of patients were aged >65 years, 60% had daytime lower urinary tract symptoms (LUTS) as well as nocturia, 33% had cardiac pathologies and 7% had peripheral edema. Principal causes for nocturia were global polyuria in 17%, nocturnal polyuria (NP) in 33% and reduced functional capacity <250 ml in 16.2%; 21.2% had mixed forms of NP and reduced bladder capacity and 12.6% suffered from other causes. Mean bothersome score was higher in women (P,<,0.001) and in patients with NP (P,=,0.012). Quality of life was significantly lower in women (P,=,0.001), in patients aged >65 years (P,=,0.029) and in those with reduced functional capacity (P,<,0.001). Mean voided 24-hr urine was higher in women (P,=,0.033) and in patients aged <65 years (P,=,0.019). Conclusions Nocturia had a high impact on bothersome score, strong associations with poor health and other LUTS. NP was the predominant cause of nocturia. Neurourol. Urodynam. 28:427,431, 2009. © 2009 Wiley-Liss, Inc. [source] Arabic validation of the short form of Urogenital Distress Inventory (UDI-6) questionnaire,,NEUROUROLOGY AND URODYNAMICS, Issue 4 2009Waleed Altaweel FRCS(C) Abstract Aims To translate and validate the Arabic version of the short form of Urogenital Distress Inventory (UDI-6) questionnaire in a sample of women with lower urinary tract symptoms (LUTS). Methods Two native Saudis independently translated the original UDI-6 into Arabic. These two translations were harmonized, and then checked by independent back translation by two English teachers. They collaborated with the clinical investigators to reach a consensus version of the questionnaire. The harmonized version was pre-tested in a pilot study on 20 patients. The final version of the UDI-6 was applied to 68 consecutive patients aged 22 years or over complaining of LUTS for at least 3 months at our tertiary care hospital. The patients were rerated after 1 week to assess test,retest reliability. To assess the capacity of the questionnaire to discriminate between women with and without LUTS, cases, and controls of healthy women sample were involved and assessed. The psychometric properties of the questionnaire, such as reliability and validity were assessed. Results The correlation co-efficient between ratings was >0.75 and the discriminate power between cases and control were confirmed. The UDI showed good internal consistency total score cronbach ,,=,0.71. Conclusions The Arabic version of UDI-6 is a valid and robust instrument and a reliable method to use in daily practice and clinical research. Neurourol. Urodynam. 28:330,334, 2009. © 2009 Wiley-Liss, Inc. [source] Is there a discrepancy between patient and physician quality of life assessment?,NEUROUROLOGY AND URODYNAMICS, Issue 3 2009Sushma Srikrishna Abstract Aims Quality of Life (QoL) assessment remains integral in the investigation of women with lower urinary tract dysfunction. Previous work suggests that physicians tend to underestimate patients' symptoms and the bother that they cause. The aim of this study was to assess the relationship between physician and patient assessed QoL using the Kings Health Questionnaire (KHQ). Methods Patients complaining of troublesome lower urinary tract symptoms (LUTS) were recruited from a tertiary referral urodynamic clinic. Prior to their clinic appointment they were sent a KHQ, which was completed before attending. After taking a detailed urogynecological history, a second KHQ was filled in by the physician, blinded to the patient responses, on the basis of their impression of the symptoms elicited during the interview. These data were analyzed by an independent statistician. Concordance between patient and physician assessment for individual questions was assessed using weighted kappa analysis. QoL scores were compared using Wilcoxons signed rank test. Results Seventy-five patients were recruited over a period of 5 months. Overall, the weighted kappa showed relatively poor concordance between the patient and physician responses; mean kappa: 0.33 (range 0.18,0.57). The physician underestimated QoL score in 4/9 domains by a mean of 5.5% and overestimated QoL score in 5/9 domains by a mean of 6.9%. In particular, physicians underestimated the impact of LUTS on social limitations and emotions (P,<,0.05). Conclusion This study confirms that physicians often differ from patients in the assessment of QoL. This is most likely due to a difference in patient,physician perception of "significant" LUTS and clearly demonstrates the importance of patient evaluated QoL in routine clinical assessment. Neurourol. Urodynam. 28:179,182, 2009. © 2008 Wiley-Liss, Inc. [source] Diabetes mellitus and female lower urinary tract symptoms: A reviewNEUROUROLOGY AND URODYNAMICS, Issue 5 2008Simon R. Hill Abstract Diabetes mellitus (DM) has reached epidemic proportions world wide. Many chronic complications of DM, including neuropathy, retinopathy and nephropathy, have been well studied and although urologic complications have been recognized since 1935, little is known about DM as a pathophysiological risk factor for development of lower urinary tract symptoms (LUTS) in women. Diabetic nephropathy, a life-threatening condition, has received considerable attention in the last few years. Diabetic cystopathy, on the other hand, has received far less attention despite having a significant impact on quality of life, and with significant individual health risks. Initial studies suggested that long standing DM causes paralysis of the detrusor muscle leading to voiding difficulties and this has been the received wisdom regarding diabetic cystopathy for many years. In this review, we discuss what is currently known about lower urinary tract function and urinary incontinence in diabetic females, with a critical analysis of the available evidence and suggest areas for future research. Neurourol. Urodynam. 27:362,367, 2008. © 2007 Wiley-Liss, Inc. [source] Factors related to lower urinary tract symptoms among a sample of employed women in Taipei,,§NEUROUROLOGY AND URODYNAMICS, Issue 1 2008Yuan-Mei Liao Abstract Aim To identify factors associated with lower urinary tract symptoms (LUTS) among female elementary school teachers in Taipei. Methods This study is a cross-sectional, descriptive study. A total of 520 surveys were distributed to 26 elementary schools in Taipei. Logistic regression was used to identify possible factors related to individual LUTS. Results Study results were based on the information provided by 445 participants. Of the 445 teachers, 293 (65.8%) experienced at least one type of LUTS. Factors associated with urinary incontinence were body mass index (BMI), vaginal delivery, obstetric and/or gynecological surgery, bladder habits, and job control. Increased daytime urinary frequency was associated with chronic cough and chronic constipation. Bladder habits, straining to lift heavy objects at work and chronic constipation were associated with urgency. Nocturia was associated with age and caffeine consumption while intermittent stream was associated with the presence of a family history of LUTS and chronic constipation. Bladder habits and regular exercise were associated with weak urinary stream. Incomplete emptying was more likely to occur in teachers with chronic constipation and in those who did not exercise regularly. Conclusion All the LUTS under logistic regression analyses were associated with 1,3 modifiable factors. Identification of these modifiable contributing factors may be useful to health care providers. Education of women may include the importance of maintaining normal body weight, good bladder/bowel habits, and regular exercise, treating chronic cough, decreasing daily caffeine consumption, and implementing feasible environmental modifications in employment settings. Neurourol. Urodynam. © 2007 Wiley-Liss, Inc. [source] A critical review of the pharmacology of the plant extract of Pygeum africanum in the treatment of LUTS,NEUROUROLOGY AND URODYNAMICS, Issue 4 2007Alan D. Edgar Abstract Despite an unremitting increase in the number of patients presenting symptoms of benign prostate hyperplasia (BPH), the viable treatment options remain relatively limited when compared to other disorders of aging. This has spurred an interest in so-called alternative medicines, many of which continue to be used in spite of the more recent emergence of rationally targeted therapies. Nonetheless, in the case of plant extracts, the vast majority of these have not been subjected to the same rigorous pre-clinical pharmacological testing and large-scale clinical trials now required by health authorities. Furthermore, demonstration of their clinical efficacy in BPH has been hindered by trials of limited duration with a high placebo response. Beginning with a preliminary demonstration of in vitro inhibition of growth factor-mediated fibroblast proliferation with Pygeum africanum extract, a detailed series of in vitro and in vivo studies on prostate growth and bladder function were undertaken. These studies, reviewed herein, have permitted the identification of putative molecular targets of Pygeum africanum extract affecting both growth factor-mediated prostate growth as well as specific parameters of bladder function. These results, corroborated in part by short-term clinical efficacy, set the stage for a large-scale clinical trial to investigate the efficacy of Pygeum africanum extract in the treatment of lower urinary tract symptoms. Neurourol. Urodynam. 26:458,463, 2007. © 2007 Wiley-Liss, Inc. [source] Psychogenic urinary dysfunction: A uro-neurological assessment,NEUROUROLOGY AND URODYNAMICS, Issue 4 2007Ryuji Sakakibara Abstract Aims The diagnosis of psychogenic urinary dysfunction (PUD) is one of exclusion, particularly from urologic and neurologic causes, and is usually accompanied by more obvious psychologic/ psychiatric features. We here describe patients with PUD who were diagnosed in our uro- neurological laboratory. Materials and Methods We reviewed the digitized records of 2,300 urodynamic cases treated in the past 6 years to identify patients who fulfilled the diagnostic criteria of PUD. All 2,300 patients had completed a urinary questionnaire and undergone both electromyography (EMG)-cystometry and a detailed neurological examination. In addition, pressure-flow analysis, neurophysiology tests including sphincter EMG analysis, and MRI of the brain and spinal cord were performed as applicable. Results PUD was seen in 16 cases (0.7%): 6 men, 10 women, mean age 37 years. Lower urinary tract symptoms (LUTS) included overactive bladder (OAB) alone in 5, difficult urination alone in one, and both in 10. LUTS commonly occurred in particular situations, for example, OAB only while riding the train. Some patients showed extremely infrequent toileting. The urodynamic findings were normal except for increased bladder sensation (50%) for OAB and acontractile detrusor (31%) for difficulty. The final diagnosis was conversion reaction in six followed by anxiety in four. Conclusions PUD patients experienced the situational occurrence of OAB and/or difficult urination and, in some patients, extremely infrequent toileting. The main urodynamic abnormalities were increased bladder sensation and acontractile detrusor. However, even in cases suggestive of PUD, a non-PUD pathology behind the symptoms should be explored. Neurourol. Urodynam. 26:518,524, 2007. © 2007 Wiley-Liss, Inc. [source] The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire is reliable in stroke patients,NEUROUROLOGY AND URODYNAMICS, Issue 4 2006Sigrid Tibaek Abstract Aims To investigate the test,retest reliability of Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire in a sample of stroke patients. Methods A prospective study design was used in which the stroke patients were invited to complete a postal self-administrated DAN-PSS-1 questionnaire twice. The questionnaire consists of 12 questions related to lower urinary tract symptoms (LUTS). The participants were asked to state the frequency and severity of their symptoms (symptom score) and its impact on their daily life (bother score). Seventy-one stroke patients were included and 59 (83%) answered the questionnaire twice. The reliability test was done in two aspects: (a) detecting the frequency of each symptom and its bother factor, the scores were reduced to a two-category scale (=0, >0) and simple kappa statistics was used; (b) detecting the severity of each symptom and its bother factor, the total scale (0,3) and weighted kappa statistics was used. Results The proportion of agreement for the frequency symptom scores ranged from 76% to 97% and the simple kappa coefficient ranged from poor (,,=,0.00) to excellent (,,=,0.91). The proportion of agreement for the corresponding bother scores ranged from 76% to 95% and the simple kappa coefficient ranged from good (,,=,0.61) to excellent (,,=,0.84). The weighted kappa coefficient for the severity symptom scores ranged from moderate (,w,=,0.43) to good (,w,=,0.75) and the corresponding bother scores ranged from moderate (,w,=,0.48) to good (,w,=,0.68). Conclusions The DAN-PSS-1 questionnaire had acceptable test,retest reliability and may be suitable for measuring the frequency and severity of LUTS and its bother factor in stroke patients. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study)NEUROUROLOGY AND URODYNAMICS, Issue 1 2006Attila Majoros Abstract Aims During this prospective study we analyzed the effects of radical retropubic prostatectomy (RRP) on bladder and sphincter function by comparing preoperative and postoperative urodynamic data. The aim of the study was to determine the reason for urinary incontinence after RRP and explain why one group of patients will be immediately continent after catheter removal, while others need some time to reach complete continence. Methods Urodynamic examination was performed in 63 patients 3,7 days before and 2 months after surgery. Results Forty-three (68.2%) and 53 (84.1%) patients regained continence at 2 and 9 months following RRP, respectively. Ten patients (15.9%) were immediately continent after catheter removal. Urodynamic stress incontinence was detected in 18 (28.6%), and detrusor overactivity incontinence in 2 (3.2%) patients 2 months after surgery. The amplitude of preoperative maximal voluntary sphincteric contractions was significantly higher in the postoperative continent group (125 vs. 96.5 cmH2O, P,<,0.0001). The patients who were immediately continent following catheter removal had no lower urinary tract symptoms (LUTS) and urodynamic abnormality preoperatively, and they had significantly higher preoperative and postoperative maximum urethral closure pressure (at rest and during voluntary sphincter contraction) than those who became continent later on. Conclusions These data suggest that the main cause of incontinence after RRP is sphincteric weakness. In the continent group, those who became immediately continent had significantly higher maximum urethral closure pressure values at rest and at voluntary sphincteric contraction even before the surgery. Neurourol. Urodynam. © 2005 Wiley-Liss, Inc. [source] Impact of different sized catheters on pressure-flow studies in women with lower urinary tract symptomsNEUROUROLOGY AND URODYNAMICS, Issue 2 2005Elisabetta Costantini Abstract Aims This study assessed the impact of two catheters on urinary flow in women undergoing a pressure/flow (P/F) study for lower urinary tract symptoms (LUTS). Materials and Methods Women who agreed to undergo urodynamic testing were assigned prospectively to a 7 or 9 Fr catheter in P/F study according to a balanced randomized block design. Exclusion criteria: urinary tract infection, bladder stone or tumor, neuropathy, complete urinary retention, inability to void with catheter in place, free flowmetry volume below 150 ml, and urine volume varying by more than 20% on both free and P/F studies. We compared free flowmetry and P/F flowmetry with a 9 Fr catheter in 126/239 patients (Group A) and with a 7 Fr catheter in 113/239 (Group B). We determined the differences in the P/F results in terms of pre-voided bladder volume, clinical and urodynamic categories, and age groups in the two groups. We compared the diagnosis of obstruction based on Qmax during the P/F study and on Qmax in free uroflowmetry. Results In Groups A and B, the Qmax rate was significantly less (P,<,0.001) in P/F studies. Catheter size did not impact significantly. In patients with cystocele, post-void residue or obstruction flow was reduced more than in the other categories. Qmax diminished with age, by about 15% in women aged 50,60 and by 21% in women over 70 years old. Conclusions Qmax in P/F studies is always reduced independently of catheter size, volume of urine, age, and clinical or urodynamic category. This may have clinical implications when interpreting P/F results and in accurately diagnosing obstruction. © 2004 Wiley-Liss, Inc. [source] Lower urinary tract dysfunctions in patients with spinal cord tumorsNEUROUROLOGY AND URODYNAMICS, Issue 1 2004Tomoyuki Uchiyama Abstract Aims The objective of this study was to elucidate the incidence and pathophysiology of lower urinary tract dysfunctions (LUTS) in patients with spinal cord tumors. Methods Urinary questionnaire and urodynamic studies were done in 76 patients with spinal cord tumors. Results The patients included 56 with cervical-thoracic (C1 to T11) and 20 with lumbosacral tumors. The lumbosacral tumors consisted of 12 epiconus/conus medullaris (below T11) and 8 cauda equina tumors. These tumors were further subdivided into intramedullary, intradural extramedullary, and dumbbell-type. More than 83% of the patients had urinary symptoms. Patients with cervical-thoracic tumors commonly had voiding symptoms (75%). Detrusor hyperreflexia (39%), and detrusor areflexia on voiding (21%) were the main urodynamic features. Patients with epiconus/conus medullaris tumors commonly had voiding symptoms as well (58%), but decreased urge to void (50%), detrusor-sphincter dyssynergia (42%), and detrusor areflexia on voiding (32%) were the main features. Patients with cauda equina tumors commonly had storage symptoms (88%), of which sensory urgency was most common (63%). Severe LUTS occurred in the epiconus/conus medullaris tumors and in the intramedullary tumors. These dysfunctions tended to appear late and rarely appeared as the initial symptom in the course of the disease. There was no significant relationship between neurologic abnormalities and LUTS. Urodynamics showed that spinal cord tumors cause a variety of LUTS, depending on the location and the type of the tumor. Conclusion Spinal cord tumors are commonly accompanied by LUTS. Clinical and urodynamic evaluation is crucial to diagnosis and management since there is little relationship between symptoms and findings. Neurourol. Urodynam. 23:68,75, 2004. © 2003 Wiley-Liss, Inc. [source] Data from frequency-volume charts versus filling cystometric estimated capacities and prevalence of instability in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 2 2002Ger E.P.M. van Venrooij Abstract The aim was to examine associations of filling cystometric estimated compliance, capacities, and prevalence of bladder instability with data from frequency-volume charts in a well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Men with LUTS suggestive of BPH were included if they met the criteria of the International Consensus Committee on BPH, i.e., they voided more than 150 mL during uroflowmetry, their residual volume and prostate size were estimated, and they completed frequency-volume charts correctly. From the frequency-volume charts, voiding habits, and fluid intake in the daytime and at night were evaluated. Filling cystometric studies were performed in these men as well. Decreased compliance was an exceptional finding. Cystometric capacity and especially effective capacity (cystometric capacity minus residual volume) corresponded significantly with the maximum voided volume on the frequency-volume charts. Effective capacity was almost twice as high as the average voided volume. Minimum voided volume on frequency-volume charts was not related to filling cystometric data. The presence of instability in the supine or sitting position or in both positions was not significantly associated with smaller voided volumes, higher nocturia, or diuria. Filling cystometric capacities were strongly associated with maximal and mean voided volumes derived from frequency-volume charts. The presence of detrusor instability during filling cystometry did not significantly affect voided volumes, diuria, or nocturia. Neurourol. Urodynam. 21:106,111, 2002. © 2002 Wiley-Liss, Inc. [source] The risk of lower urinary tract symptoms five years after the first delivery,NEUROUROLOGY AND URODYNAMICS, Issue 1 2002Lars Viktrup Abstract Aim of the study To estimate the prevalence and 5-year incidence of lower urinary tract symptoms (LUTS) after the first delivery and to evaluate the impact of pregnancy per se and delivery per se on long-lasting symptoms. Materials and methods A longitudinal cohort study of 305 primiparae questioned a few days, 3 months, and 5 years after their delivery. The questionnaire used was tested and validated, and the questions were formulated according to the definitions of the International Continence Society (ICS). Maternal, obstetric, and neonatal data concerning every delivery and objective data concerning surgeries during the observation period were obtained from the records. From the sample of 278 women (91%) who responded 5 years after their first delivery, three subpopulations were defined: 1) women without initial LUTS before or during the first pregnancy or during the puerperal period, 2) women with onset of LUTS during the first pregnancy, and 3) women with onset of LUTS during the first puerperium. The risk of LUTS 5 years after the first delivery was examined using bivariate analyses. The obstetric variables in the bivariate tests with a significant association with long-lasting urinary incontinence were entered into a multivariate logistic regression. Results The prevalence of stress and urge incontinence 5 years after first delivery was 30% and 15%, respectively, whereas the 5-year incidence was 19% and 11%, respectively. The prevalence of urgency, diurnal frequency, and nocturia 5 years after the first delivery was 18%, 24%, and 2%, respectively, whereas the 5-year incidence was 15%, 20%, and 0.5%, respectively. The prevalence of all LUTS except nocturia increased significantly during the 5 years of observation. The risk of long-lasting stress and urge incontinence was related to the onset and duration of the symptom after the first pregnancy and delivery in a dose-response,like manner. Vacuum extraction at the first delivery was used significantly more often in the group of women with onset of stress incontinence during the first puerperium, whereas an episiotomy at the first delivery was performed significantly more often in the group of women with onset of stress incontinence in the 5 years of observation. The prevalence of urgency and diurnal frequency 5 years after the first delivery was not increased in women with symptom onset during the first pregnancy or puerperium compared with those without such symptoms. The frequency of nocturia 5 years after the first delivery was too low for statistical analysis. Conclusion The first pregnancy and delivery may result in stress and urge incontinence 5 years later. Women with stress and urge incontinence 3 months after the first delivery have a very high risk of long-lasting symptoms. An episiotomy or a vacuum extraction at the first delivery seems to increase the risk. Subsequent childbearing or surgery seems without significant contribution. Long-lasting urgency, diurnal frequency, or nocturia cannot be predicted from onset during the first pregnancy or puerperium. Neurourol. Urodynam. 21:2,29, 2002. © 2002 Wiley-Liss, Inc. [source] | ||||||||||