Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM).

BACKGROUND: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies). OBJECTIVE: To report participants' sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are noninferior and surgery rates are lower if UDS is included. DESIGN, SETTING, AND PARTICIPANTS: A total of 820 men (≥18 yr of age) seeking treatment for bothersome LUTS were recruited from 26 National Health Service hospital urology departments. INTERVENTION: Care pathway based on routine, noninvasive tests (control) or routine care plus UDS (intervention arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome is International Prostate Symptom Score (IPSS) and the key secondary outcome is surgery rates 18 mo after randomisation. International Consultation on Incontinence Questionnaires were captured for MLUTS, sexual function, and UDS satisfaction. Baseline clinical and patient-reported outcome measures (PROMs), and UDS findings were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick's test, and questionnaire items were compared using Pearson's correlation coefficient. RESULTS AND LIMITATIONS: Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia, and erectile dysfunction, and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS testing expressed high satisfaction with the procedure. CONCLUSIONS: Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage LUTS and impaired sexual function. PATIENT SUMMARY: We describe initial assessment findings from a large clinical study of the treatment pathway for men suffering with bothersome urinary symptoms who were referred to hospital for further treatment, potentially including surgery. We report the patient characteristics and diagnostic test results, including symptom questionnaires, bladder diaries, flow rate tests, and urodynamics.

Regulation of Na+ channel density at the apical surface of rabbit urinary bladder epithelium.

We have investigated the effects of various manipulations on Na(+) transport across the rabbit urinary bladder epithelium. After bladders were mounted in Ussing chambers there was a spontaneous and significant (>4-fold) increase in amiloride-sensitive short-circuit current (equivalent to net Na(+) transport) over a 6-h period. The increase in current was almost abolished by brefeldin A, an inhibitor of anterograde vesicular transport, and reduced after a 3-h delay by cycloheximide, an inhibitor of protein synthesis. The spontaneous increase in short-circuit current was potentiated by treatment of bladders with either forskolin, which causes an elevation in cAMP levels, or aldosterone. Acting together, these two agents produced a significant synergistic effect on short-circuit current. The short-circuit current recovered rapidly after reduction in intracellular Na(+) levels, achieved either by lowering the extracellular Na(+) concentration or blockade of epithelial Na(+) channels with the sulphydryl modifying reagent p-chloromercuribenzenesulphonic acid (PCMBS). Recovery after PCMBS treatment was partially sensitive to brefeldin A. Short-circuit current saturated as the extracellular Na(+) concentration was increased (EC(50) = 51 mM). Saturation occurred over a range of Na(+) concentrations in which single channel permeability is known to remain constant, indicating that it depends on a reduction in epithelial Na(+) channel density at the apical plasma membrane. Exposure of bladders to a high Na(+) concentration caused an increase in endocytotic activity, detected through an increase in the uptake of the fluid-phase marker fluorescein isothiocyanate (FITC)-dextran into vesicles located beneath the apical plasma membrane. We conclude that the urinary bladder epithelium is able to respond rapidly and efficiently to changes in its environment by regulating the density of epithelial Na(+) channels in its apical surface.