A retrospective study of prostate-specific antigen and international prostate symptoms scores from participants at a men's health screening initiative in Trinidad.

Background: This study describes the characteristics of men attending a primary health care screening initiative, determines the proportion of men who have elevated International Prostate Symptom Score (IPSS) scores and prostate-specific antigen (PSA) levels, and determines any correlation between these scores as indicators for benign prostatic hyperplasia (BPH) or prostate cancer. Methods: Data were collected from all patient records during men's health screening initiatives that occurred in December 2018, January 2019, and March 2019 in Trinidad and Tobago. A total of 350 medical records were analyzed to record patient demographics, PSA levels, and IPSS scores. Analysis of the data was performed with the use of Statistical Package for the Social Sciences software (version 27). Results: Most men who attended the screening initiative belonged to the 61-65 age group (20.57%), with more than half of the men being married (57.71%) and employed (52.57%) and of patients with comorbidities (17%), the most prevalent included hypertension (6%) and diabetes mellitus (3.7%). A mean PSA level of 2.94 ng/ml and a mean IPSS of 7.62 were recorded. Moreover, 11.5% of the males had elevated PSA levels (>4 ng/ml) and 32.9% had elevated IPSS levels (>8). There were correlations between PSA and IPSS values (r = 0.161 and P = 0.006). Age was a predictor of both IPSS and PSA values (r = 0.214, P = 0.000 and r = 0.192, P = 0.000, respectively). Among diabetic participants, a small but significant correlation between IPSS and diabetes was shown (r = 0.223, P = 0.028). As a predictor of elevated IPSS, diabetes had an odds ratio of 1.132 (95% confidence interval (CI): 1.021-1.255). Conclusion: Our findings are similar to those described in previous studies; however, further investigations are required to fully describe the relationship between PSA and IPSS. This may assist in advancing screening measures and improving health outcomes for men with BPH and prostate cancer. Primary care physicians should recognize the possible association between BPH and diabetes mellitus and offer appropriate screening where indicated.

Non-inferiority, randomised, open-label clinical trial on the effectiveness of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia: study protocol for the TUMT-PAE-1 trial.

BACKGROUND: One-fourth of men older than 70 years have lower urinary tract symptoms (LUTS) that impair their quality of life. Transurethral resection of the prostate (TURP) is considered the gold standard for surgical treatment of LUTS caused by benign prostatic hyperplasia (BPH) that cannot be managed conservatively or pharmacologically. However, TURP is only an option for patients fit for surgery and can result in complications. Transurethral microwave thermotherapy (TUMT) and prostatic artery embolisation (PAE) are alternative minimally invasive surgical therapies (MISTs) performed in an outpatient setting. Both treatments have shown to reduce LUTS with a similar post-procedure outcome in mean International Prostate Symptom Score (IPSS). It is however still unknown if TUMT and PAE perform equally well as they have never been directly compared in a randomised clinical trial. The objective of this clinical trial is to assess if PAE is non-inferior to TUMT in reducing LUTS secondary to BPH. METHODS: This study is designed as a multicentre, non-inferiority, open-label randomised clinical trial. Patients will be randomised with a 1:1 allocation ratio between treatments. The primary outcome is the IPSS of the two arms after 6 months. The primary outcome will be evaluated using a 95% confidence interval against the predefined non-inferiority margin of + 3 points in IPSS. Secondary objectives include the comparison of patient-reported and functional outcomes at short- and long-term follow-up. We will follow the patients for 5 years to track long-term effect. Assuming a difference in mean IPSS after treatment of 1 point with an SD of 5 and a non-inferiority margin set at the threshold for a clinically non-meaningful difference of + 3 points, the calculated sample size was 100 patients per arm. To compensate for 10% dropout, the study will include 223 patients. DISCUSSION: In this first randomised clinical trial to compare two MISTs, we expect non-inferiority of PAE to TUMT. The most prominent problems with MIST BPH treatments are the unknown long-term effect and the lack of proper selection of candidates for a specific procedure. With analysis of the secondary outcomes, we aspire to contribute to a better understanding of durability and provide knowledge to guide treatment decisions. TRIAL REGISTRATION: ClinicalTrials.gov NCT05686525. Registered on January 17, 2023, https://clinicaltrials.gov/study/NCT05686525 .

Two-Year Outcomes of Prostatic Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: An International, Multicenter, Prospective Study.

PURPOSE: To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE). MATERIALS AND METHODS: This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics. RESULTS: Four hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p < 0.001); QoL at baseline was 4.7 and decreased to 2.0, 2.1, and 2.3 at 3, 12, and 24 months, respectively (all p < 0.001). The mean SHIM score at baseline and 12 months following PAE was 13.8 and 13.9, respectively. Of the 73 patients treated for AUR, 48 (65.8%) had their indwelling catheter removed within 3 months of PAE and remained catheter free at 24 months. Fifty-five patients (11.5%) experienced ≥ 1 AE and 10 (2.1%) experienced a serious AE. CONCLUSION: PAE is a safe and effective treatment for symptomatic BPH and LUTS. Level of Evidence Level 3 Trial registration ClinicalTrials.gov NCT03527589.

The Assessment of Patient-Reported Outcomes in the Medical Management of Patients With Benign Prostatic Hyperplasia.

Background Benign prostatic hyperplasia (BPH) is a prevalent condition that a large portion of the male population develops with aging, in which the prostate gland enlarges and results in urinary symptoms. Objective The objective of this article is to assess patient-reported outcomes (PRO) of medical management of benign prostate hyperplasia in terms of international prostate symptoms score (IPSS), BPH impact index (BPHII), and treatment satisfaction score (TSS). Methods This descriptive study included 114 patients who received medical management for BPH during the period 5th May 2021 till 30th December 2023, at the Department of Urology, Institute of Kidney Disease Peshawar. Patient-reported outcomes were measured in terms of IPSS, BPHII, and TSS. Readings were recorded at the start of treatment and at three months of treatment and then compared. Data was analyzed using SPSS v.25 (IBM Inc., Armonk, New York). Results The mean age of the patients was 64.33 ± 6.12 years. The mean prostate size was 77.35 ± 12.83 ml. Overall mean pre-treatment and post-treatment IPSS was 24.82 ± 4.90 versus 15.57 ± 5.15, respectively (p-value 0.00). Mean pre-treatment and post-treatment BPHII were 11.98 ± 1.02 and 7.12 ± 2.46, respectively (p-value 0.000). The overall mean treatment satisfaction score was 6.89 ± 1.44. Conclusion Medical management improved symptomatology in BPH patients. This study is a step in the direction of the development of larger and longer-term PRO studies in BPH management.

Pre-and Post-Prostatectomy Detrusor Wall Thickness and the Symptom Profile in Patients with Benign Prostatic Enlargement: A Prospective Review.

INTRODUCTION: The urinary bladder undergoes morphological and functional changes in patients with symptomatic benign prostatic enlargement (BPE). These detrusor changes reflect chronically increased intravesical pressure as a result of outlet obstruction. This study aims to determine the relationship between the Pre- and Post-op detrusor wall thickness (DWT), international prostate symptom score (IPSS), and duration of lower urinary tract symptoms (LUTS) in patients who had open simple prostatectomy (OSP). METHOD: This was a prospective study of a cohort of patients who had OSP for symptomatic BPE. The IPSS and symptom duration for each patient were noted. Each patient also had an abdominal ultrasound scan with a measurement of their DWT. Retropubic OSP was done for each patient. The detrusor wall thickness was also measured 12 weeks after the prostatectomy. RESULTS: Fifty-two patients completed the study; the mean age was 66.37 ± 8.09 years. The median pre-operative IPSS was 28 (IQR = 13.75), and the median duration of symptoms was 24 months (IQR = 37 months). The mean pre-operative DWT was 4.41 ± 1.38mm, while the mean post-operative DWT was 2.16 ± 0.98mm. The preoperative IPSS (p = 0.833) and duration of symptoms (p = 0.375) did not significantly correlate with the pre-operative DWT. There was a significant reduction in the mean DWT (p < 0.001) and IPSS (p < 0.001) following prostatectomy. CONCLUSION: DWT appears not to be significantly influenced by the severity or duration of LUTS. However, it reduced significantly following OSP with corresponding improvement in urinary symptoms.

INTRODUCTION: La vessie subit des changements morphologiques et fonctionnels chez les patients présentant une hyperplasie bénigne de la prostate (HBP) symptomatique. Ces modifications du détrusor reflètent une pression intravésicale chroniquement augmentée en raison de l'obstruction de la sortie. Cette étude vise à déterminer la relation entre l'épaisseur de la paroi du détrusor (EPD) avant et après l'opération, le score international des symptômes prostatiques (IPSS) et la durée des symptômes des voies urinaires inférieures (LUTS) chez les patients ayant subi une prostatectomie simple ouverte (OSP). MÉTHODE: Il s'agissait d'une étude prospective d'une cohorte de patients ayant subi une OSP pour une HBP symptomatique. L'IPSS et la durée des symptômes pour chaque patient ont été notés. Chaque patient a également subi une échographie abdominale avec mesure de leur EPD. Une OSP rétropubienne a été réalisée pour chaque patient. L'épaisseur de la paroi du détrusor a également été mesurée 12 semaines après la prostatectomie. RÉSULTATS: Cinquante-deux patients ont terminé l'étude ; l'âge moyen était de 66,37 ± 8,09 ans. L'IPSS médian préopératoire était de 28 (IQR = 13,75), et la durée médiane des symptômes était de 24 mois (IQR = 37 mois). L'EPD moyenne préopératoire était de 4,41 ± 1,38 mm, tandis que l'EPD moyenne postopératoire était de 2,16 ± 0,98 mm. L'IPSS préopératoire (p = 0,833) et la durée des symptômes (p = 0,375) n'ont pas significativement corrélé avec l'EPD préopératoire. Il y a eu une réduction significative de l'EPD moyenne (p < 0,001) et de l'IPSS (p < 0,001) après la prostatectomie. CONCLUSION: L'EPD ne semble pas être significativement influencée par la gravité ou la durée des LUTS. Cependant, elle a considérablement diminué après l'OSP avec une amélioration correspondante des symptômes urinaires. MOTS-CLÉS: Hyperplasie bénigne de la prostate, Épaisseur de la paroi du détrusor, Score international des symptômes prostatiques, Prostatectomie simple ouverte.

Effect of nocturia in patients with different severity of obstructive sleep apnea on polysomnography: A retrospective observational study.

Objective: Obstructive sleep apnea (OSA) is one of the etiologies of nocturia. We analyzed polysomnography (PSG) results to determine correlated factors related to nocturia in OSA patients with different severity. Methods: Patients with suspected OSA were examined using PSG. They were divided into two groups based on the presence of nocturia. Nocturia was defined as a patient who needed to void at least once. Apnea-hypopnea index (AHI) was employed to classify patients according to degrees of severity: AHI<5 events/h, 5 events/h≤AHI<15 events/h, 15 events/h≤AHI<30 events/h, and AHI≥30 events/h, defined as normal, mild OSA, moderate OSA, and severe OSA, respectively. Demographic variables, PSG parameters, International Prostate Symptom Scores (IPSSs), and quality of life scores due to urinary symptoms were analyzed. Results: In total 140 patients, 114 patients had OSA (48 had mild OSA; 34 had moderate OSA; and 32 had severe OSA) and 107 patients had nocturia. The total IPSS was significantly higher in nocturia patients in all groups except the group of severe OSA patients. With the increasing severity of OSA, more correlated factors related to nocturia were determined. In mild OSA patients, nocturia related to increased age (p=0.025), minimum arterial blood oxygenation saturation (p=0.046), and decreased AHI of non-rapid eye movement (p=0.047), AHI of total sleep time (p=0.010), and desaturation index (p=0.012). In moderate OSA patients, nocturia related to increased age (p<0.001), awake time (p=0.025), stage 1 sleep (p=0.033), and sleep latency (p=0.033), and decreased height (p=0.044), weight (p=0.025), and sleep efficiency (p=0.003). In severe OSA patients, nocturia related to increased weight (p=0.011), body mass index (p=0.009), awake time (p=0.008), stage 1 sleep (p=0.040), arousal number (p=0.030), arousal index (p=0.013), periodic limb movement number (p=0.013), and periodic limb movement index (p=0.004), and decreased baseline arterial blood oxygenation saturation (p=0.046). Conclusion: Our study revealed that there were more correlated factors related to nocturia with increasing severity of OSA. This study helps in clinical education and treatment for OSA patients with different severity.

[Electrophysiological technique for treatment of chronic prostatiti: Curative effect observation].

OBJECTIVE: To observe the clinical effect of electrophysiological technique in treating chronic prostatitis. METHODS: Choose 40 patients of chronic prostatitis/chronic pelvic pain syndrome (chronicprostatis/chronicpelvicpainsyndrome, CP/CPPS) in People's Hospital in Zhijin and People's hospital in Guizhou Province from January 2022 to April 2023, The patients were randomly divided into control group (n=20) and treatment group (n=20). The treatment group received low-frequency neuromuscular electrical stimulation combined with drug therapy, while the control group received drug therapy alone. The improvement of prostatitis symptom score (NIH-CPSI) and International Prostatitis Symptom score (IPSS) before and after treatment was compared and analyzed. RESULTS: A total of 37 patients were followed up (1 patient in the treatment group withdrew due to hypersensitivity to the electrode; 2 patients in the control group were lost to follow-up. )There was no significant difference in baseline data between the two groups (P > 0.05). The NIH-CPSI score and IPSS score before and after treatment were compared between the two groups, and the difference was statistically significant (P< 0.05). The IPSS score of the two groups after treatment was compared, the average reduction of the treatment group was 15.84±0.92 points, and that of the control group was 7.17±0.40 points, and the difference was statistically significant (t=4.792, P< 0.05). The NIH-CPSI score of the two groups after treatment was compared, and the average reduction was 17.47±0.92 points in the treatment group and 10.56±0.49 points in the control group. The difference between the two groups was statistically significant (t=6.654, P< 0.05). CONCLUSION: The effect of electrophysiological combined drug therapy is obviously better than that of simple drug therapy. Electrophysiological therapy for chronic prostatitis has definite clinical effect and is worth promoting and applying.

Enhancing the Management of Benign Prostatic Hyperplasia: The Role of Electronic Health Record Patient Portal Distribution of the International Prostate Symptom Score.

INTRODUCTION: Recent AUA guidelines for the management of benign prostatic hyperplasia (BPH) recommend routine collection of the International Prostate Symptom Score (IPSS) data, but routine collection can be challenging to fully implement. We investigated the impact of distributing the IPSS by electronic patient portal (EPP) on IPSS completion and its impact on BPH management. METHODS: We performed a retrospective, longitudinal study of men undergoing a new patient visit (NPV) for BPH at our academic medical center. From September 2019 to November 2022, we identified patients undergoing an NPV for BPH. Prior to January 2021, the IPSS was collected in person at NPVs via paper forms; afterwards, the IPSS was distributed before the NPV using the EPP. Our primary outcome was IPSS completion; secondary outcomes were new BPH medications and BPH surgery ordered within 6 months. RESULTS: We identified 485 patients who underwent an NPV for BPH. EPP implementation significantly increased IPSS questionnaire completion (36.5% vs 56.9%, P < .0001). Following EPP implementation, we found that new BPH medications ordered at time of NPV decreased (10.4% vs 4.7%, P = .02). Although BPH surgery ordered within 6 months was similar, patients following EPP implementation had shorter time to BPH surgery compared to prior. CONCLUSIONS: Our study revealed that EPP distribution of the IPSS improves IPSS collection compliance, aligning our practice closer with AUA guidelines. Routine collection of the IPSS may impact clinical practice through the detection of more severe BPH, which reduces medical BPH management and time to definitive BPH therapy. Further work is needed to confirm findings.

Association of detrusor wall thickness (DWT) with lower urinary tract symptom severity in benign prostatic hyperplasia: a cross-sectional study.

Background and objective: Benign prostatic hyperplasia manifests as lower urinary tract symptoms (LUTS) and prostate gland enlargement, leading to bladder outlet obstruction with consequent structural and functional impacts on the bladder. Urodynamic studies are resource-intensive and invasive. Detrusor wall thickness (DWT) assessment offers a cost-effective, reproducible alternative for evaluating LUTS severity in males with bladder outlet obstruction, utilizing ultrasonographic examination. Methods: This prospective cross-sectional study, conducted at a tertiary care center from May 2023 to January 2024, included 171 patients with LUTS who underwent transabdominal ultrasound for DWT measurements. LUTS severity, assessed using International Prostate Symptom Scores (IPSS) classified participants into mild and moderate-to-severe symptom groups. Pearson's correlation coefficient assessed the association between DWT and IPSS, and an independent sample t-test compared means, using a significance level of 5% (P-value ≤0.05). Results: This study involved participants aged 65.01±11.55 years with an IPSS score ranging from 1 to 35, with a mean for mild and moderate-to-severe symptom groups were 4±2.12 and 15.93±6.74, respectively. DWT mean of 1.64±0.38 mm for mild, and 2.4±0.43 mm for moderate to severe symptoms. Pearson's correlation (r=0.697, n=171, P<0.001) indicated a strong DWT-LUTS correlation and a significant DWT mean difference between mild and moderate-to-severe symptom groups was found via an independent t-test (P<0.001, 95% CI: -0.8970 to -0.6414). Conclusion: The study establishes the value of transabdominal ultrasound-detected DWT as a cost-effective, noninvasive, and reproducible tool for assessing LUTS severity in males with benign prostatic hyperplasia.

Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis.

Despite the availability of various drugs for benign prostatic hyperplasia (BPH), alpha(α)-blockers are the preferred first-line treatment. However, there remains a scarcity of direct comparisons among various α-blockers. Therefore, this network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of α-blockers in the management of BPH. A comprehensive electronic search covered PubMed, Embase, Ovid MEDLINE, and Cochrane Library until August 2023. The primary endpoints comprised international prostate symptom score (IPSS), maximum flow rate (Qmax), quality of life (QoL), and post-void residual volume (PVR), while treatment-emergent adverse events (TEAEs) were considered as secondary endpoints. This NMA synthesized evidence from 22 studies covering 3371 patients with six kinds of α-blockers with 12 dose categories. IPSS has been considerably improved by tamsulosin 0.4 mg, naftopidil 50 mg and silodosin 8 mg as compared to the placebo. Based on the p-score, tamsulosin 0.4 mg had the highest probability of ranking for IPSS, PVR, and Qmax, whereas doxazosin 8 mg had the highest probability of improving QoL. A total of 297 adverse events were reported among all the α-blockers, silodosin has reported a notable number of TEAEs. Current evidence supports α-blockers are effective in IPSS reduction and are considered safer. Larger sample size with long-term studies are needed to refine estimates of IPSS, QoL, PVR, and Qmax outcomes in α-blocker users.