Effects of Calcium Oxalate on Expression of Clusterin and Lower Urinary Tract Symptoms in Prostatitis and Benign Prostatic Hyperplasia Patients with Calculi.

BACKGROUND Prostatic calculi are common in urological treatments. Our major purpose in the present study was to explore the occurrence and composition of prostatic calculi, and investigate the effect of calcium oxalate (CaOx) on clusterin expression and lower urinary tract symptom (LUTS) in prostatitis and benign prostatic hyperplasia (BPH) patients with calculi. MATERIAL AND METHODS From December 2016 to January 2017, a total of 79 prostatitis patients aged more than 50 years were enrolled. The patients were divided into 3 groups: group A had small calculi (discrete, small echoes); group B had large calculi (large masses of multiple echoes, much coarser), and group C had no calculi. Immunohistochemical analysis was performed to evaluate the tissue scores. The clusterin expression was detected by quantitative real-time CR (qRT-PCR), Western blot, and immunofluorescence. RESULTS According to multifactor analysis, age was significantly associated with prostatic calculus. The composition of prostatic calculus was an independent factor of LUTS. The clusterin expression was elevated in group B. The mRNA and protein levels of clusterin in prostatitis and BPH patients with stones were obviously higher than those in prostatitis and BPH patients without stones. CaOx enhanced clusterin expression in a dose-dependent manner. CONCLUSIONS Large prostatic calculi were associated with LUST. Furthermore, CaOx enhanced clusterin expression, leading to large prostatic calculi. These results may provide a therapeutic strategy for prostatitis and BPH.

Prostatic inflammation: a potential treatment target for male LUTS due to benign prostatic obstruction.

BACKGROUND: The purpose of this narrative review is to evaluate the role of prostatic inflammation as a treatment target for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) and provide an update on the available therapies. METHODS: An extensive literature search was conducted for studies on established and investigational treatments with anti-inflammatory mechanism of action that has been assessed for the management of male LUTS due to BPO. RESULTS: Data on phosphodiesterase 5 inhibitors, nonsteroidal anti-inflammatory drugs, vitamin D3 receptor analogs, phytotherapy, statins, and lifestyle changes have been reviewed and analyzed. Preclinical evidence has shown the anti-inflammatory effect of these treatments on prostate. However, there is a wide variation in the degree of mature of each therapy. In addition, there are significant differences between the studies in terms of design, number of patients, and duration of follow-up. CONCLUSIONS: Several drugs classes have been investigated for their impact on prostatic inflammation and improvement of male LUTS. The reviewed data support the rationale for use of agents that may alter and improve the inflammatory environment in the prostate in men with LUTS, but further high-quality long-term studies are required for the exact positioning of the new drugs in daily practice.

An evidence-based approach to emergency department management of acute urinary retention.

Approximately 10% of men in their 70s and 33% of men in their 80s report at least 1 episode of acute urinary retention, and this urological emergency presents unique assessment and treatment challenges in the emergency department setting. Patients presenting with acute urinary retention are often in severe pain and require urgent diagnosis and prompt treatment. The differential diagnosis of acute urinary retention is vast, with some causes leading to permanent impairment if not dealt with in a timely manner. Quick recognition of the cause and timely bladder decompression are of utmost importance in preventing morbidity and relieving pain. This review analyzes the etiology, key historical and physical findings, differential diagnosis, and diagnostic studies for acute urinary retention in both men and women. Treatment algorithms for men and women, current controversies regarding urinary catheter usage, and recommendations on criteria for disposition are also presented.

The relationship between lower urinary tract symptoms/benign prostatic hyperplasia and the number of components of metabolic syndrome.

OBJECTIVE: To investigate the relationship between lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and a number of components of metabolic syndrome (MetS). METHODS: A total of 1224 male police officers aged 50-59 years who had participated in a health examination were included. LUTS/BPH were assessed by prostate-specific antigen, international prostate symptom score (IPSS), total prostate volume (TPV), maximum urinary flow rate (Qmax), and postvoid residual (PVR) urine volume. Testosterone levels were also examined. MetS was defined using National Cholesterol Education Program-Adult Treatment Panel III guidelines. The subjects were classified into 4 groups according to the number of exhibited MetS components (0, 1-2, 3, and 4-5). We used the Mantel-Haenszel extension test and logistic regression analyses. RESULTS: MetS was diagnosed in 29.0% of the patients. The BPH ratio (IPSS >7, TPV ≥30 mL, and/or Qmax <15 mL/sec), TPV ≥30 mL, and PVR ≥50 mL significantly increased with an increasing number of metabolic abnormalities. The odds ratio (OR) in relation to a TPV ≥30 mL and a PVR ≥50 mL significantly rose as the number of positive MetS components increased after adjusting for age and testosterone. Additionally, the ORs (adjusting for age and testosterone) in relation to BPH also increased as the number of positive MetS components increased, with a suggestive threshold effect associated with 4-5 positive components (BPH: IPSS >7 + TPV ≥30 mL; 4 and 5 components, 3.496, 1.805-6.769, P = .001; BPH: IPSS >7 + TPV ≥30 mL + Qmax <15 mL/sec; 4 and 5 components, 5.458, 1.777-16.764, P = .002). CONCLUSION: According to our results, the cases of LUTS/BPH were positively associated with the number of MetS components.

Vitamin D and lower urinary tract symptoms among US men: results from the 2005-2006 National Health and Nutrition Examination Survey.

OBJECTIVE: To evaluate the association of vitamin D levels and lower urinary tract symptoms (LUTS) among US men. MATERIAL AND METHODS: Data were analyzed for 2387 men (≥20 years) who participated in the 2005-2006 cycle of the National Health and Nutrition Examination Survey, a cross-sectional survey of the US noninstitutionalized population. LUTS included nocturia, incomplete emptying, hesitancy, and urinary incontinence (UI). Plasma 25-hydroxyvitamin D was categorized as ≥30 ng/mL (normal), 20-30 ng/mL (insufficiency), and <20 ng/mL (deficiency). Other factors included age, race/ethnicity, education, body mass index, self-reported health status, chronic diseases, and prior diagnosis of benign prostatic enlargement and/or prostate cancer (men ≥40 years of age). Prevalence and prevalence odds ratios (POR) were estimated from a multivariable logistic regression analysis using appropriate sampling weights. RESULTS: A majority (89%, n = 1241) had vitamin D levels <30 ng/mL, of whom 55% (n = 684) had vitamin D levels <20 ng/mL. Vitamin D levels ranged from 2-56 ng/mL (median 19 ng/mL, mean ± SD 19.9 ± 8.0). Among the 1388 (58%) men with LUTS data and vitamin D levels, 48% (n = 666) had at least 1 LUTS. In multivariable analyses adjusting for age and race norms, vitamin D deficiency was associated with the presence of moderate-severe UI (POR 1.8, 95% CI 1.1, 3.0) and at least 1 LUTS (POR 1.4, 95% CI 1.0, 2.0). CONCLUSION: Vitamin D insufficiency and deficiency are highly prevalent among adult men in the US, and vitamin D deficiency is associated with moderate-severe UI and the presence of at least 1 LUTS.

The correlation between international prostate symptoms score and sexual health inventory in men with lower urinary tract symptoms.

OBJECTIVE: Lower urinary tract symptoms (LUTS) are common in aging men and are often associated with erectile dysfunction (ED). The International Prostate Symptoms Score (IPSS) and the Sexual Health Inventory for Men (SHIM) are commonly used validated instruments for LUTS and ED, respectively. We explored the correlation between LUTS (assessed by IPSS) and ED (assessed by SHIM) in men over 40 years of age. METHODS: A total of 585 men, 40 years and above, who presented with LUTS were prospectively enrolled into the study at single tertiary academic center. All patients were evaluated using SHIM and IPSS questionnaires. The self-administered IPSS and SHIM questionnaires were translated in the local language (not validated yet) as well. The data were analyzed using SPSS version 13.0. The correlation coefficient between IPSS and SHIM scores were determined, and the scatter diagram was made. RESULTS AND LIMITATIONS: The mean age (SD) of the group was 59.61 ± 11.75 years. The correlation between age and ED was statistically significant (P value < 0.001) with coefficient of 0.376. The correlation between age and LUTS was statistically significant (P value < 0.001) with coefficient of 0.312. Additionally, the correlation between ED and LUTS was statistically significant (P value < 0.001) with coefficient of 0.336. CONCLUSIONS: We noted a significant correlation between the severity of LUTS and ED, while confirming the earlier established correlation between age, LUTS, and ED. The exact nature of this relationship and its pathophysiology needs to be determined by further studies.

Low serum testosterone levels are poor predictors of sexual dysfunction.

OBJECTIVE: • To identify predictors of sexual dysfunction using baseline data from the reduction by dutasteride of prostate cancer events (REDUCE) study. PATIENTS AND METHODS: • REDUCE was a 4-year randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of once-daily dutasteride 0.5 mg in over 8000 men aged 50-75 years with a prostate-specific antigen (PSA) level of 2.5-10 ng/mL (50-60 years) or 3.0-10 ng/mL (>60 years) and a negative prostate biopsy within 6 months of enrolment. • Baseline values (mean serum testosterone, age, International Prostate Symptom Score [IPSS], total prostate volume [TPV], body mass index [BMI], and presence of diabetes/glucose intolerance) were compared in subjects with and without sexual dysfunction (sexual inactivity, impotence, decreased libido or a Problem Assessment Scale of the Sexual Function Index [PAS-SFI] score <9). RESULTS: • Multivariate logistic regression showed that baseline age and IPSS were significant predictors of all four sexual function criteria examined (P < 0.0001). • BMI was a significant predictor of decreased libido, impotence and a PAS-SFI score <9, while diabetes/glucose intolerance was a significant predictor of sexual inactivity, impotence and a PAS-SFI score <9. • Testosterone and TPV were not significant predictors of any sexual function criterion examined. CONCLUSIONS: • Age, IPSS, BMI and diabetes/glucose intolerance, but not serum testosterone or TPV, were significant independent predictors of sexual dysfunction in the REDUCE study population. • The lack of association between sexual dysfunction and serum testosterone questions the value of modestly reduced or low normal testosterone levels as criteria for choosing testosterone replacement in older men with sexual dysfunction.

Change in International Prostate Symptom storage subscore after long-term medical therapy in BPH patients: finasteride and alpha-blocker combination therapy in men with moderate-to-severe LUTS/BPH in Korea.

OBJECTIVE: To evaluate the efficacy and the change of International Prostate Symptom Score (IPSS) storage subscore after combination therapy (α-blocker and finasteride) in patients with lower urinary tract symptoms (LUTS) consistent with moderate-to-severe benign prostatic hyperplasia (BPH) and compared with α-blocker-only treatment. METHODS: A total of 1315 patients seen in 5 urology centers in Korea from January 2001 to August 2007, with LUTS secondary to BPH were enrolled. Patients were divided into 4 groups according to treatment pattern (α-blocker monotherapy vs combination therapy) and IPSS storage subscores (≥6 vs <6). The changes from baseline in prostate volume, prostate-specific antigen concentration, IPSS, and Q(max.) were analyzed. We also determined the statistical differences among 4 groups in the IPSS, Q(max.), quality of life score (QoL), and prostate volume. RESULTS: Of the 1315 men, 217 (16.5%) completed the month 48 visit. All groups showed significant improvements in the IPSS total score, IPSS voiding subscores, and QoL at 1 year. However, the high storage subscore group at baseline showed a significantly higher improvement in IPSS total scores and IPSS voiding subscores compared with the low storage subscore group at year 4. IPSS storage subscores were improved only in patients with high storage subscores at baseline, especially in combination treatment group. The mean change in QoL score from baseline to year 4 was significantly improved in high storage subscore groups. CONCLUSIONS: Data from this retrospective analysis suggest that long-term combination treatment would be beneficial, especially to patients with severe storage symptoms at baseline.

Effectiveness of doxazosin on erectile dysfunction in patients with lower urinary tract symptoms.

OBJECTIVE: We evaluated the effectiveness of doxazosin on ED in patients with LUTS/BPH and ED by using symptom score scales. We also evaluated whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the alteration in the symptom scores. PATIENTS AND METHODS: A total of 36 male patients were included in the study. For all the cases, "International Prostate Symptom Score" (IPSS), "National Health Institute Chronic Prostatitis Symptom Index" (NIH-CPSI) and "International Index of Erectile Function" (IIEF-5) were investigated, and the scores were calculated in the first visit. Doxazosin was given for 30 days, and at the second visit IPSS, NIH-CPSI and IIEF-5 scores, Qmax and PMR were once more analysed. Afterwards, the alterations of the scores between visits were statistically compared. RESULTS: Mean age of the 36 cases included in the study was 59.03 ± 1.35. The alterations in parameters between 1st and 2nd visit were compared in the cases who used doxazosin and a statistically significant decrease in IPSS, NIH-CPSI scores and statistically significant increase in Qmax were observed. Besides, there was a statistically significant increase in IIEF-5 score. In addition, when the cases were divided into two groups patients with asymptomatic inflammatory prostatitis and without asymptomatic inflammatory prostatitis, there was not any difference in all scores. CONCLUSION: Doxazocin use in cases with LUTS/BPH and ED has an improving effect on ED as well as LUTS. Therefore, we believe that in the future, single agents or combined therapies might have a place in cases with LUTS/BPH and ED.

External beam radiotherapy for prostate cancer: urinary outcomes for men with high International Prostate Symptom Scores (IPSS).

PURPOSE: To report the urinary outcome of men treated for prostate cancer with external beam radiotherapy (EBRT) who have pretreatment obstructive urinary symptoms (International Prostate Symptom Score [IPSS] ≥ 15). METHODS AND MATERIALS: We treated 368 patients with EBRT for localized prostate cancer, and pre- and post-radiotherapy (RT) IPSSs were recorded. In total, 80 men had an IPSS ≥ 15, 48% of whom were taking genitourinary (GU) medications before RT. The IPSS was followed over time and analyzed as a pretreatment factor against Radiation Therapy Oncology Group acute and late GU toxicity. RESULTS: The median follow-up was 44 months. Among men with a pre-RT IPSS ≥ 15, the median IPSS at baseline, first follow-up, and last follow-up was 18 (range, 15 to 34), 17 (range, 0 to 32), and 13 (range, 0 to 34), respectively. The mean patient declines in IPSS from baseline to first and last follow-up were -3.6 points (p < 0.0004) and -6.9 points (p < 0.0001), respectively. At last follow-up, 43 men (54%) took GU medications. Pre-RT IPSS ≥ 15 vs. ≤ 14 was associated with a higher incidence of Grade ≥ 2 acute GU toxicity (64% vs. 42%, p = 0.0005), and 4-year freedom from Grade ≥ 2 late GU toxicity was 38% vs. 64% (p < 0.0001). There was no greatly increased risk of Grade ≥ 3 late GU toxicity for men with IPSS ≥ 15 (4-year freedom from Grade ≥ 3 late GU toxicity of 90% vs. 96%, p = 0.0964). CONCLUSIONS: Although the improvement is not immediate, men with moderate to severe obstructive GU symptoms can have improvement in urinary function after EBRT, without significant risk for severe morbidity.

30 minutes high energy transurethral microwave thermotherapy (30 minutes TUMT) for the treatment of chronic urinary retention in patients with ASA II-III-IV.

OBJECTIVE: To investigate if 30-Minutes-TUMT was useful and safe in the treatment of chronic urinary retention due to BOO in patients with ASA II-III-IV. MATERIAL AND METHODS: 19 patients with chronic urinary retention (mean age 73.5 years) were scheduled for TUMT treatment because of absolute or relative contraindications to surgery. According to ASA classification there were 8 patients ASA II, 9 ASA III and 2 ASA IV. Routinely parameters were studied before and after treatment. Pain and patient's discomfort before, during and after TUMT treatment were registered using the VAS score (visual analogue scale: 0 = no pain and 10 = maximal pain). Urgency, irritation, and "how they feel" were registered at 2 days, 1, 2 and 4 weeks after TUMT using VAS technique. RESULTS: Mean follow-up was 31,6 months (range 24-47), among the 9 responders patients (47.4%) who void normally without need of catheterisation, one patient died 12 months after the treatment for reasons not connected to the TUMT. Six patients (21.6%) failed the treatment and underwent TURP one or two years later (5 were ASA II and one ASA III). Among the 4 of 19 (21.0%) who had intermittent catheterisation after the treatment two died 1 and 2 years later, one has detrusor instability and one continued intermittent catheterisation. VAS during treatment was: 0 minute = 0.0; 5' = 3.1; 15' = 2.9; 25' = 2.8; 2 h after the treatment = 0.3. At 3 years follow up IPSS, QoL and Qmax were still acceptable. No major complication occurred. CONCLUSIONS: 47.4% of the patients responded positively to the new 30 minutes TUMT removing the urethral catheter, without needing surgical procedure avoiding the operation risk. 68.4% also improved their QoL. Local anaesthesia and oral/intravenous analgesia were sufficient during treatment. TUMT seems to have no anesthesiological risk. It is an option in patients with high risk of operation.

[Lower urinary tract symptoms and erectile dysfunction]. / Sintomatología tracto urinario inferior y disfunción eréctil.

OBJECTIVES: The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED)is the result of their greater association in advanced age. Nevertheless, several investigations show that urinary tract symptoms have an independent relationship with sexual dysfunction and lower satisfaction. Likewise, the severity of LUTS correlates with the magnitude of sexual dysfunction in all age groups, which suggests a possible causal relationship. A series of hypothesis have been posed to explain the existence of a common physiopathology for LUTS and ED. Currently, this relationship between LUTS and ED is supported on four theories, which are not mutually excluding, (a) autonomic hyperactivity and metabolic syndrome hypothesis, (b) changes in nitric oxide/nitric oxide (NOS/NO) synthetase in the guanine monophosphatase pathway in penis and prostate, (c) the activation of Rho kinase and the endothelin pathway, and (d) the physiopathological consequences of pelvic arteriosclerosis. Given the contribution of sexual function to keep the quality of life, possible negative effects on sexual function should be taken into consideration when choosing treatment for benign prostatic hyperplasia. The combined therapeutic approach of these two entities (ED and LUTS)brings a benefit to the patient both in urinary symptoms and sexual sphere, although placebo controlled studies are required to confirm these data and to ascertain the role of combination therapy in the treatment of both conditions.

Concordance of near infrared spectroscopy with pressure flow studies in men with lower urinary tract symptoms.

PURPOSE: Near infrared spectroscopy is a technology with the potential to diagnose bladder outlet obstruction noninvasively. We investigated the correlation between the near infrared spectroscopy algorithm classification of obstructed or unobstructed (based on near infrared spectroscopy pattern, maximum flow rate and post-void residual) and pressure flow studies in men with lower urinary tract symptoms. We also assessed whether the near infrared spectroscopy pattern itself, independent of the near infrared spectroscopy algorithm (which also includes maximum flow rate and post-void residual urine), correlates with bladder outlet obstruction. MATERIALS AND METHODS: Subjects simultaneously underwent urodynamics and near infrared spectroscopy evaluation. Bladder outlet obstruction classification was based on the International Continence Society nomogram. The near infrared spectroscopy algorithm was evaluated against the comparable noninvasive algorithms with receiver operating characteristic curves. For significance the Mann-Whitney U test was used with p<0.05 considered significant. RESULTS: Of 42 subjects 33 (79%) had evaluable data. Area under the curve was 0.484 for the near infrared spectroscopy algorithm relative to pressure flow diagnosis. A downward near infrared spectroscopy pattern is associated with obstruction whereas an upward pattern is associated with nonobstruction. Of 26 patients with urodynamic bladder outlet obstruction 9 (35%) had a downward, 4 (15%) a flat and 13 (50%) an upward near infrared spectroscopy pattern. Of 7 unobstructed cases 4 (57%) had a downward, 1 (14%) a flat and 2 (29%) an upward near infrared spectroscopy pattern. CONCLUSIONS: The near infrared spectroscopy algorithm had a 0.484 AUC for diagnosing bladder outlet obstruction. The near infrared spectroscopy pattern component itself did not correlate strongly. The near infrared spectroscopy algorithm does not appear to provide substantial clinical usefulness in diagnosing bladder outlet obstruction in men with lower urinary tract symptoms. More studies are needed to further define and validate uses for near infrared spectroscopy in urology.

Use of a prostate symptom score to identify men at risk of future kidney failure: insights from the HUNT II Study.

BACKGROUND: Chronic kidney disease (CKD) screening beyond patients with diabetes mellitus or hypertension increasingly is discussed. Some guidelines recommend kidney function testing of patients with benign prostatic hyperplasia; however, the significance of extending this to general population screening is unclear. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 30,466 men from the HUNT II (Second Health Study in Nord-Trøndelag; 1995-1997) representing 66.8% of the entire adult male population in Nord-Trøndelag County, Norway. PREDICTOR: The International Prostate Symptom Score was used to detect the presence and severity of lower urinary tract symptoms (LUTS), a surrogate measure of benign prostate hyperplasia suitable for use in general practice. OUTCOMES: Kidney failure was defined as starting renal replacement therapy or CKD death with a documented stable estimated glomerular filtration rate<15 mL/min/1.73 m2. RESULTS: During 10.5 years of follow-up, 78 men developed kidney failure. Kidney failure risks were 2.60 (95% CI, 1.47-4.58) and 4.08 (95% CI, 1.74-9.53) times higher for men with moderate and severe LUTS compared with men with no/mild LUTS, respectively. However, age-stratified analysis showed that the incidence rate ratio for moderate/severe LUTS versus no/mild LUTS was 1.27 (95% CI, 0.76-2.13), and multivariable Cox analysis showed no significant association between LUTS and risk of kidney failure. Screening effectiveness was improved only slightly by including men with moderate/severe LUTS in addition to patients with diabetes, hypertension, or cardiovascular disease. Better effectiveness was achieved by simply including all men older than 60 years. LIMITATIONS: The ability of the International Prostate Symptom Score to predict the presence and severity of obstruction is only moderate. Ascertainment of severe CKD (estimated glomerular filtration rate, 30-15 mL/min/1.73 m2) was not possible. CONCLUSION: LUTS were not significantly associated with future kidney failure after adjusting for age and therefore in isolation are not a basis for kidney failure screening.

Reduction of prostate-specific antigen after tamsulosin treatment in patients with elevated prostate-specific antigen and lower urinary tract symptoms associated with low incidence of prostate cancer at biopsy.

OBJECTIVES: To evaluate the effect of tamsulosin on reducing the serum levels of prostate-specific antigen (PSA) in patients with lower urinary tract symptoms and an elevated PSA level. METHODS: From June 2004 to July 2006, patients with lower urinary tract symptoms, a PSA level of >or=4 ng/mL, and a maximal flow rate of <15 mL/s received tamsulosin 0.4 mg daily for 2 months. They were then scheduled for 12-core prostate biopsy. PSA determination and a uroflow study were performed before biopsy. RESULTS: A total of 80 patients completed the present study. The mean patient age was 66.3 years, and the mean PSA level was 7.8 +/- 8.4 ng/mL at baseline and 7.1 +/- 9.1 ng/mL after treatment (P < .001). A total of 29 patients (36.25%) were diagnosed with prostate cancer from the biopsy findings. A significant increment in the PSA level was observed in patients with prostate cancer (6.7 versus 7.9 ng/mL; P = .002). A significant decrease in the PSA level was observed in patients with negative biopsy findings (6.9 versus 5.1 ng/mL, P = .000). Of the 38 patients with a decrease in the PSA level, 1 (2.6%) was diagnosed with prostate cancer and 37 (97.4%) with an benign prostatic hyperplasia/prostatitis. Of the 42 patients with no change in the PSA level, 28 (66.7%) had prostate cancer and 14 (33.3%) had negative findings. A change in PSA level after treatment gave a sensitivity of 96.6%, specificity of 72.5%, and diagnostic accuracy of 81% for prostate cancer. CONCLUSIONS: Treatment with tamsulosin seemed to reduce the PSA levels and identified patients at high risk of prostate cancer.

[Impact of nocturia on sleep quality in patients with lower urinary tract symptoms suggesting benign prostatic hyperplasia (LUTS/BPH). The NocSu Study]. / Impacto de la nocturia en la calidad del sueño en pacientes con síntomas del tracto urinario inferior sugestivos de hiperplasia benigna de la próstata. Estudio NocSu.

INTRODUCTION: Nocturia is one of the main symptoms associated to BPH, causing significant sleep disturbances, including sleep interruptions. Such sleep interruptions may significantly impair quality of life. MATERIALS AND METHODS: A multicenter, observational, cross-sectional, epidemiological study was conducted in patients with LUTS/BPH aged 60 years or over. In the study visit, demographic and clinical data were collected and quality of sleep questionnaires (MOS-Sleep Scale and COS) were administered. RESULTS: Among the total 249 patients recruited, 205 had nocturia (82.3%) and 44 (17.7%) had no nocturia. All patients should have an I-PSS score ?13, and patients with mild symptoms were therefore excluded (62.9% had moderate and 37.1% severe symptoms). Patients with nocturia were seen to have more sleep problems than those without nocturia (more sleep disturbances, less sleep adequacy, more daily sleepiness, greater concern about their social and occupational functioning, etc). DISCUSSION: Patients with nocturia reported a worse quality of sleep than patients with LUTS/BPH but no nocturia. Nocturia resulted in frequent sleep interruptions, causing malaise and diurnal fatigue in affected patients. Use of therapeutic approaches to relieve or eliminate this undesirable effect may lead to an improvement in sleep quality and quality of life in BPH patients.

Ultrasound assessment of intravesical prostatic protrusion and detrusor wall thickness--new standards for noninvasive bladder outlet obstruction diagnosis?

PURPOSE: We evaluated the accuracy of detrusor wall thickness and intravesical prostatic protrusion, and the association of each test to diagnose bladder prostatic obstruction in patients with lower urinary tract symptoms. MATERIALS AND METHODS: We enrolled in the study 100 consecutive patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Baseline parameters were International Prostate Symptom Score, prostate volume, urinary flow rate, intravesical prostatic protrusion, detrusor wall thickness, Schaefer obstruction class, minimal urethral opening pressure and the urethral resistance algorithm bladder outlet obstruction index. A ROC curve was produced to calculate AUC and evaluate the diagnostic performance of intravesical prostatic protrusion, detrusor wall thickness and prostate volume for bladder prostatic obstruction. RESULTS: We noted a highly significant correlation between intravesical prostatic protrusion and the bladder outlet obstruction index (Spearman's rho = 0.49, p = 0.001), and Schaefer obstruction class (Spearman's rho = 0.51, p = 0.001). A highly significant correlation was also observed for detrusor wall thickness and the bladder outlet obstruction index (Spearman's rho = 0.57, p = 0.001), detrusor wall thickness and Schaefer obstruction class (Spearman's rho = 0.432, p = 0.02). On multivariate analysis intravesical prostatic protrusion and detrusor wall thickness were the only parameters associated with bladder prostatic obstruction (p = 0.015). The AUC for intravesical prostatic protrusion was 0.835 (95% CI 0.756-0.915) and for detrusor wall thickness it was 0.845 (95% CI 0.78-0.91). The association of intravesical prostatic protrusion and detrusor wall thickness produced the best diagnostic accuracy (87%) when the 2 tests were done consecutively. CONCLUSIONS: Suprapubic ultrasound of detrusor wall thickness and intravesical prostatic protrusion is a simple, noninvasive, accurate system to assess bladder prostatic obstruction in patients with lower urinary tract symptoms due to benign prostatic hyperplasia.