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1.
Arch Esp Urol ; 73(2): 81-88, 2020 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-32124837

RESUMO

OBJECTIVES: The questionnaire International Prostate Symptom Score (IPSS) is well known and used in clinical practice as diagnostic tool and allows for obtaining a total score regarding the severity of the urinary symptoms. The objective of this analysis is to determine if the IPSS storage score (sum of the punctuation of the questions 2, 4 and 7) could be a predictive variable of the impact on quality of life. MATERIALS AND METHODS: Post-hoc analysis of an epidemiological, multicenter, cross-sectional study inmale patients, ≥18 years old with ≥6 micturitions and≥1 urgency and/or ≥2 nocturia and/or ≥1 daily incontinence episodes recruited by 291 urologists across Spain. Socio demographic variables, symptoms reported by patients (IPSS) and clinical variables were collected. The impact of voiding symptoms (IPSS-V) and storage symptoms (IPSS-S) on the quality of life, measured using the Overactive Bladder questionnaire Short Form(OABq-SF HRQoL), was evaluated using multivariate regression models (linear and logistic). RESULTS: 958 patients, whose mean score (standard deviation) of the OABq-SF HRQoL was 57.9 (18.3),were included in the study. 55.6% received drug treatment for urinary symptoms. 616 patients (64.4%) reported a puntuation >3 in the item 8 of the IPSS. The adjusted analysis showed a significant reduction in the qualityof life of -1.1 (p<0.001) and -3.3 (p<0.001) points associated with the worsening of the symptoms of voiding and storage respectively. This worsening was also associated with a minor risk of satisfaction (OR=1.14;p<0.001 and 1.36; p<0.001) for the voiding and storage symptoms respectively. CONCLUSION: In patients with mixed LUTS both components show a negative effect on the quality of life, with a greater impact of the storage symptoms.


Assuntos
Sintomas do Trato Urinário Inferior , Bexiga Urinária Hiperativa , Adolescente , Adulto , Estudos Transversais , Humanos , Sintomas do Trato Urinário Inferior/terapia , Masculino , Qualidade de Vida , Espanha , Bexiga Urinária Hiperativa/terapia
2.
Urology ; 137: 138-145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899227

RESUMO

OBJECTIVE: To evaluate treatment preferences of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) before and after using a web-based decision aid (DA). PATIENTS AND METHODS: Between July 2016 and January 2017 patients were invited to use a web-based LUTS/BPH DA. Treatment preferences (for lifestyle advices, medication or surgery) before and after DA use and responses on values clarification exercises were extracted from the DA. RESULTS: In total, 126 patients were included in the analysis. Thirty-four percent (43/126) had not received any previous treatment and were eligible for (continuation of) lifestyle advices or to start medication, as initial treatment. The other 66% (83/126) did use medication and were eligible, either for continuing medication or to undergo surgery. Before being exposed to the DA, 67 patients (53%) were undecided and 59 patients (47%) indicated an initial treatment preference. Half of the patients who were initially undecided were able to indicate a preference after DA use (34/67, 51%). Of those with an initial preference, 80% (47/59) confirmed their initial preference after DA use. Five out of 7 values clarification exercises used in the DA were discriminative between final treatment preferences. In 79%, the treatment preferred after DA use matched the received treatment. Overall, healthcare providers were positive about DA feasibility. CONCLUSION: Our findings suggest that a LUTS/BPH DA may help patients to confirm their initial treatment preference and support them in forming a treatment preference if they did not have an initial preference.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Sintomas do Trato Urinário Inferior , Preferência do Paciente/estatística & dados numéricos , Hiperplasia Prostática , Qualidade de Vida , Idoso , Tratamento Conservador/métodos , Tratamento Conservador/psicologia , Humanos , Estilo de Vida , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/psicologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Países Baixos , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Hiperplasia Prostática/psicologia , Hiperplasia Prostática/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/psicologia , Inquéritos e Questionários , Conduta Expectante
3.
Medicine (Baltimore) ; 99(4): e18918, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977907

RESUMO

BACKGROUND: Benign prostatic enlargement (BPE) causes discomfort in daily life, including lower urinary tract symptoms (LUTSs) caused by the enlarged prostate, and requires long-term management as a chronic, irreversible disease. To improve LUTS, certain complementary therapies have been used with or without doctors' directions. Conventional treatments and complementary therapies tend to be combined unsystematically, depending on patient preference; thus, research for safe and efficient combination therapy is warranted. METHODS: Twenty-nine participants were randomly assigned to an integrative group (IG, n = 15) or a conventional group (CG, n = 14). The IG received moxibustion (twice weekly for 4 weeks, at the acupuncture points SP6, LR3, and CV4) and conventional medication for 4 weeks, followed by conventional medication alone for 8 weeks. The CG received conventional medication alone for 12 weeks. The outcome measures were International Prostate Symptom Score (IPSS), patient's global impression of changes (PGIC), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and frequency-volume chart. RESULTS: Total IPSS (IG, -2.4 ±â€Š4.2; CG, 0.9 ±â€Š4.0; P = .039), PGIC-A (IG, 3.5 ±â€Š1.0; CG, 2.2 ±â€Š1.0; P = .001), and PGIC-B (IG, 3.5 ±â€Š0.1; CG, 4.7 ±â€Š0.6; P = .004) were significantly improved in the IG compared with the CG, 4 weeks after baseline. Among the IPSS items, incomplete emptying (IG, -0.6 ±â€Š0.7; CG, 0.4 ±â€Š1.2; P = .019), straining (IG, -0.6 ±â€Š0.8; CG, 0.2 ±â€Š1.2; P = .046), and nocturia (IG, -0.8 ±â€Š1.4; CG, 0.1 ±â€Š1.0; P = .045) showed significant differences. The Qmax and PVR volume did not differ significantly at 12 weeks after the baseline. CONCLUSION: Moxibustion can be considered an adjunct therapy to improve LUTS in BPE patients. A full-sized randomized controlled trial would be feasible with comparator modifications and an extended study period. The study design should include a placebo group and narrow the eligibility to subjects who do not respond well to conventional treatments.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Moxibustão/métodos , Hiperplasia Prostática/complicações , Idoso , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Resultado do Tratamento
4.
Urology ; 135: 165-170, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31626855

RESUMO

OBJECTIVE: To describe the urologic sequalae of several rare congenital neuromuscular diseases. METHODS: We retrospectively reviewed medical records at Gillette Specialty Healthcare (2014-2018) of patients presenting to urology clinic with lower urinary tract symptoms and select rare congenital diseases: muscular dystrophy, spinal muscular atrophy, and Rett syndrome. RESULTS: Muscular dystrophies (n = 19) are X-linked myogenic disorders characterized by progressive muscle wasting and weakness. Men present to the urologist at variable ages, typically with complaints of functional incontinence and normal cystometrograms; we manage them with oral anticholinergic medications, condom catheter, or suprapubic catheter. Spinal muscular atrophy (n = 6) is a rare autosomal recessive disease characterized by degeneration of the anterior horn cells in the spinal cord and motor nuclei in the lower brainstem leading to progressive muscle weakness and atrophy. Patients typically present with nephrolithiasis and urinary retention in late adolescence/early adulthood, but timing varies. Filling cystometrograms have been normal. We allow passive retention with intermittent catheterization and creation of catheterizable channels, when indicated. Rett syndrome (n = 5) is a rare, noninheritable genetic condition affecting females characterized by a brief period of normal development followed by loss of speech and purposeful hand use; there are characteristic behaviors. Patients present in early adulthood with complaints of urinary retention. We manage retention with permissive retention or sphincter chemodenervation. CONCLUSION: Several congenital neuromuscular conditions can cause lower urinary tract symptoms when these individuals become adults. We have discussed the clinical characteristics and management of select neurogenic and myogenic bladder conditions seen in adults with congenital conditions.


Assuntos
Cateterismo Uretral Intermitente , Sintomas do Trato Urinário Inferior/terapia , Doenças Neuromusculares/complicações , Doenças Raras/complicações , Agentes Urológicos/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Fraldas para Adultos , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Neuromusculares/congênito , Doenças Neuromusculares/epidemiologia , Prevalência , Doenças Raras/congênito , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Trials ; 20(1): 546, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477160

RESUMO

BACKGROUND: Lower urinary tract symptoms (LUTS) can relate to urinary storage or voiding. In men, the prevalence and severity of LUTS increases with age, with a significant impact on quality of life. The majority of men presenting with LUTS are managed by their general practitioner (GP) in the first instance, with conservative therapies recommended as the initial treatment. However, the provision of conservative therapies in primary care is variable and can be time and resource limited. GPs require practical resources to enhance patient engagement with such interventions. TRIUMPH aims to determine whether a standardised and manualised care intervention delivered in primary care achieves superior symptomatic outcome for LUTS versus usual care. METHODS/DESIGN: TRIUMPH is a two-arm, cluster randomised controlled trial (RCT) being conducted in 30 National Health Service (NHS) general practices in England. The TRIUMPH intervention comprises a standardised LUTS advice booklet developed for the trial with patient and healthcare professional (HCP) consultation. The booklet is delivered to patients by nurses/healthcare assistants following assessment of their urinary symptoms. Patients are directed to relevant sections of the booklet, providing the manualised element of the intervention. To encourage adherence, HCPs provide follow-up contacts over 12 weeks. Practices are randomised 1:1 to either deliver the TRIUMPH intervention or a usual care pathway. The patient-reported International Prostate Symptom Score (IPSS) at 12 months post consent is the primary outcome. Secondary outcomes include cost-effectiveness, patient-reported outcomes on LUTS, quality of life, and patient and HCP acceptability and experience of the intervention. Primary analyses will be conducted on an intention-to-treat basis. DISCUSSION: It is unclear whether conservative therapies for male LUTS are effectively delivered in primary care using current approaches. This can lead to men being inappropriately referred to secondary care or experiencing persistent symptoms. Primary care, therefore, holds the key to effective treatment for these men. The TRIUMPH intervention, through its standardised and manualised approach, has been developed to support GP practices in delivering effective conservative care. This pragmatic, cluster RCT should provide robust evidence in a primary-care setting to inform future guidelines. TRIAL REGISTRATION: ISCRTN registry, ID: ISRCTN11669964 . Registered on 12 April 2018.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise por Conglomerados , Humanos , Masculino
6.
Urologe A ; 58(9): 1029-1038, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31451881

RESUMO

The demographic developments of western society and the resulting increase in the number of very old patients in urology represents a challenge for the design of clinical studies and, consequently, recommendations of guidelines. While in internal medicine there is already a subspecialization with a focus on the treatment of elderly and multimorbid patients, in urology there is hardly any subspecialization into the problems of geriatric patients. Thus, using a case study as an example, the treatment decisions for benign prostatic hyperplasia (BPH) in geriatric patients are discussed. In addition the available evidence from the literature and guidelines are presented in order to assiste in daily management of geriatric patients with lower urinary tract symptoms and to critically discuss potential fields of application and limitations of the existing guidelines. In this context, we also examine the challenges when choosing a drug therapy and in deciding which of the many surgical options should be used.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/terapia , Urologia/normas , Idoso , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/etiologia
7.
Curr Urol Rep ; 20(10): 58, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31468204

RESUMO

PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) and sexual health have common links. Medical and surgical treatments for LUTS can significantly affect various domains of sexual health including erectile function, ejaculatory function, and libido. This review summarizes recent findings. RECENT FINDINGS: Current literature demonstrates a strong association between LUTS, sexual health, and metabolic syndrome. The role of miRNA is also being investigated. Combination medical therapy with phosphodiesterase 5 inhibitors (PDE5-I) shows promise but needs further investigation. Newer surgical therapies for benign prostatic hyperplasia (BPH) aim to preserve sexual function without sacrificing efficacy and durability. Although we are beginning to acknowledge the link between LUTS and sexual health, a better understanding of the underlying biochemistry is needed. Only then can more effective therapies be developed. Further prospective studies should focus on the long-term durability and safety of treatments for both conditions.


Assuntos
Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/terapia , Síndrome Metabólica/complicações , Saúde Sexual , Ejaculação , Humanos , Libido , Masculino , Síndrome Metabólica/cirurgia , Ereção Peniana , Inibidores da Fosfodiesterase 5/uso terapêutico , Estudos Prospectivos , Hiperplasia Prostática/complicações
8.
Urologiia ; (3): 7-12, 2019 Jul.
Artigo em Russo | MEDLINE | ID: mdl-31356007

RESUMO

INTRODUCTION: In recent years, there has been a persistent tendency to a decrease in surgical treatment of patients with lower urinary symptoms (LUTS). This fact can be explained by variety drugs which have acceptable safety and high efficiency for treatment of urinary disorders. As part of our survey of men in Moscow region, the trends in prescribing the different drugs for the LUTS was studied. In addition, the duration of therapy and patient adherence were analyzed. MATERIALS AND METHODS: A prospective multicenter epidemiological study "Characteristics of lower urinary tract symptoms in men in the Moscow region" was carried out using data obtained from April 1 to May 31, 2017 with anonymous survey of 525 men with mean age of 64.2+/-9.93 years, living in Moscow and went to the urologist with urinary disorders. All respondents answered questions from specially designed questionnaire consisted from 140 items. All medical data were analyzed, including received drugs, the duration of the therapy and subjective assessment of efficiency. RESULTS: A total of 419 patients from 525 (79.8%) received any kind of therapy. The most commonly used drugs were -blockers, which consisted 65% of all prescriptions. Other drugs were administered significantly rarely. It is surprisingly, that 85.6% of respondents in Moscow region received the original -blockers, not generic drugs. Satisfaction rate was 74.3%. Most of patients (58.3%) had received -blockers for 1-3 years and 33.3% administered these drugs for more than 3 years. Combined drug therapy was the second most popular (25.5%). The most commonly used combination included -blockers and inhibitors of 5-reductase. In 90.6% cases the appointment was made by urologist. CONCLUSION: Drug therapy is the most popular treatment in patients with LUTS. Our data suggest that -blockers as monotherapy or in combination with inhibitors of 5-reductase is the most often prescribed therapy. These results are in concordance with the main conclusions of international studies dedicated to this issue.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Idoso , Quimioterapia Combinada , Humanos , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Moscou , Estudos Prospectivos , Hiperplasia Prostática/terapia
9.
Urol Int ; 103(3): 337-343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31362290

RESUMO

OBJECTIVE: To evaluate the intervention effect of sacral neuromodulation (SNM) in the treatment of lower urinary tract dysfunction after spinal cord injury (SCI). METHODS: We selected relevant studies published between January 1, 1971 and November 15, 2018 by searching the PubMed, EMBASE, Cochrane databases. The outcome was assessed as follows: patients who had at least 50% improvement in bladder diary variables (number of leakages, pad use, number of voids, number of catheterizations, and so on). All analyses were performed with R software (version 3.5.1). We used Cochran's Q test and I2 statistics to evaluate the heterogeneity. RESULTS: A total of 8 articles met all inclusion criteria for the systematic review. According to the Oxford Centre for Evidence-Based Medicine hierarchy, the evidence levels ranged from 2b to 4. During the test phase of SNM, we considered 108 patients. During the test phase, the merged success rate was 45% (95% CI 36-55%, p = 0.23, I2 = 31%). Overall, 99 patients were considered during the permanent implantation phase of SNM; the mean follow-up time ranged from 8.4 to 61.3 months, and the merged success rate of the permanent SNM phase was 75% (95% CI 64-83%, p = 0.46, I2 = 0%). All the reported adverse events were resolved. CONCLUSIONS: Based on current evidence, the success rate of the test phase of SNM for LTUD in SCI patients was low, but in the permanent phase, the success rate of SNM was optimistic. In the future, well-designed randomized controlled trial with adequate sample sizes and power are necessary to validate the efficacy and safety of SNM.


Assuntos
Terapia por Estimulação Elétrica/métodos , Sintomas do Trato Urinário Inferior/terapia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Plexo Lombossacral , Traumatismos da Medula Espinal/complicações
10.
World J Urol ; 37(6): 1023-1027, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31037402

RESUMO

PURPOSE: When medications fail to satisfactorily treat bothersome lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), procedural treatments are indicated. There is much interest in minimally invasive office-based treatments which can be performed under local anesthesia, allow fast recovery and have minimal morbidity. The purpose of this article is to review recent literature regarding safety and efficacy of office-based minimally invasive therapies for BPO. METHODS: A literature search using PUBMED and Medline was performed regarding minimally invasive office-based treatments for BPO, including the prostatic urethral lift (Urolift), water vapor therapy (Rezum) and stents. Literature published within the last 5 years were reviewed. RESULTS: The prostatic urethral lift (Urolift) is a safe and efficacious treatment for LUTS-BPO whilst also preserving sexual function. Rezum appears to be a safe and effective treatment in Phase 2 trials. Memokath prostatic stents do not appear to be a durable treatment; Allium prostatic stents warrant further investigation prior to recommendation. CONCLUSIONS: The prostatic urethral lift (Urolift) is a safe and effective treatment for LUTS-BPO whilst preserving sexual function. Rezum also appears to be a safe and effective treatment in small RCTs comparing performance with TURP. Memokath prostatic stents do not appear to have treatment durability. Further studies would be warranted to determine whether Allium prostatic stents are safe effective treatments for LUTS-BPO.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/terapia , Obstrução Uretral/terapia , Humanos , Sintomas do Trato Urinário Inferior/complicações , Masculino , Visita a Consultório Médico , Hiperplasia Prostática/complicações , Obstrução Uretral/etiologia
11.
Scand J Urol ; 53(2-3): 151-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096824

RESUMO

Background: Transurethral resection of the prostate (TURP) is 'Gold Standard' treatment for moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) with bladder-outlet obstruction (BOO). However, TURP is associated with a risk of complications, so minimally invasive methods have been developed. Prostate artery embolization (PAE) is a new minimally invasive procedure. This study reports the outcomes of PAE when introduced in a 'real life' clinical setting in a Swedish County hospital. Methods: A prospective, single-center, single-arm study in a consecutive vascular-anatomy 'all comers' population, eligible for TURP or adenomaenukleation, but unsuitable for this, treated with PAE from January 2015 to June 2018. Defined improvement of IPSS/QoL scores, or freedom from urinary catheter if previous urinary catheter-dependent, or clean intermittent catheterization (CIC) were considered as clinically successful treatments. PAE was performed until arterial stasis using the Perfected technique. Most patients were treated during a day-care procedure. Results: Of 37 treated men, bilateral PAEs were achieved in 32 patients, unilateral PAEs in four patients, and bilateral failure in one patient due to difficult vascular anatomy. Clinically successful treatment was achieved in 84%, without serious adverse events. Conclusions: PAE was introduced in Sweden, showing PAE as a novel and good minimally invasive alternative in treatment of symptomatic BPH, possible to perform as a day-care procedure.


Assuntos
Embolização Terapêutica/métodos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hiperplasia Prostática/complicações , Suécia , Ressecção Transuretral da Próstata , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/complicações
12.
J Urol ; 202(3): 585-591, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31063049

RESUMO

PURPOSE: Some patients continue to have bothersome lower urinary tract symptoms despite treatment. We examined characteristics associated with bother from lower urinary tract symptoms in a prospective cohort. MATERIALS AND METHODS: In this 1-year prospective, observational cohort study we obtained data on patients with lower urinary tract symptoms who were seeking care at a total of 6 tertiary care centers in the United States. Participants answered the AUA-SI (American Urological Association Symptom Index) global urinary bother question at study entry and 12 months later. Multilevel logistic and linear regression was used to identify factors associated with worsening bother and bother at 12 months, respectively. RESULTS: Of the 756 participants 121 (16%) had worsened lower urinary tract symptom bother during the study period. When adjusted for other variables, worsened lower urinary tract symptom bother was more likely among men who were nonwhite (OR 1.79, 95% CI 0.94-3.40) or who had diabetes (OR 1.68, 95% CI 0.86-3.27) and among women with diabetes (OR 1.77, 95% CI 0.85-3.67), prior treatment of lower urinary tract symptoms (OR 2.58, 95% CI 1.22-5.46) or a higher depression level (OR 1.29, 95% CI 1.10-1.52). Baseline factors associated with more severe bother at 12 months in men included more severe bother at baseline, nonwhite race, worse urinary frequency and incontinence, and higher levels of stress (p <0.05). Among women more severe bother at baseline, urinary urgency and frequency, and worse physical function were associated with more severe bother at 12 months. CONCLUSIONS: Urinary symptom severity at baseline, race, depression and psychological stress were associated with the bother of lower urinary tract symptoms in a prospective cohort of men and women treated at tertiary care facilities. These findings may inform the clinical care of patients with bothersome lower urinary tract symptoms and direct providers to better prognosticate for patients with challenging lower urinary tract symptoms cases.


Assuntos
Sintomas do Trato Urinário Inferior/psicologia , Autorrelato/estatística & dados numéricos , Estresse Psicológico/diagnóstico , Adulto , Idoso , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Estresse Psicológico/psicologia
13.
Cardiovasc Intervent Radiol ; 42(10): 1405-1412, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31062066

RESUMO

INTRODUCTION: Prostate artery embolization (PAE) is recognized as a treatment for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia. LUTS and urinary retention are common in men with prostate cancer (PCa). The purpose of this study was to estimate the efficacy and safety of palliative PAE on LUTS or urinary retention in men with advanced PCa. MATERIALS AND METHODS: This prospective, single-center trial was conducted from March 2017 to November 2018. The trial protocol was registered online (ClinicalTrials.gov Identifier: NCT03104907). Only men with advanced PCa suffering from LUTS or urinary retention were included. The primary outcome was the ability to void without a catheter and International Prostate Symptom Score (IPSS) in non-catheter-dependent patients. The paired t test was used to analyze changes from baseline with 95% confidence intervals (CI). A p value < 0.05 was considered statistically significant. RESULTS: Seventeen patients were assessed for eligibility, and 15 patients with a mean age of 73.8 years were enrolled. Four men did not complete follow-up: cancer-related death (n = 2), lost to follow-up (n = 1), and unsuccessful embolization due to severe atherosclerosis (n = 1). Bilateral embolization was achieved in ten cases, and urinary retention resolved in one of six patients. LUTS improved in the remaining (n = 5) patients by a mean 12.2-point reduction in IPSS (95% CI - 23.53; - 0.87). According to the CIRSE classification, two grade 1 and two grade 3 complications occurred. CONCLUSION: In this study, palliative PAE was safe and efficient for treatment for LUTS associated with PCa. LEVEL OF EVIDENCE: Level 4, Case Series. Trial registration ClinicalTrials.gov Identifier: NCT03104907.


Assuntos
Embolização Terapêutica/métodos , Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/terapia , Cuidados Paliativos/métodos , Neoplasias da Próstata/complicações , Retenção Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Retenção Urinária/complicações
14.
Scand J Prim Health Care ; 37(2): 155-164, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056998

RESUMO

Objective: (1) To identify possible factors of importance for reporting lower urinary tract symptoms (LUTS) among men and (2) to examine possible associations between socioeconomic status (SES), lifestyle factors, and likelihood of men contacting a general pracitioner (GP) regarding LUTS reported to be of concern or influencing daily activities (bothersome LUTS). Design: Nationwide population-based, cross-sectional survey. Data was collected in 2012. Setting: The general Danish population. Subjects: A total of 48,910 randomly selected men aged 20+. Main Outcome Measures: (1) Odds ratios for reporting LUTS by lifestyle and SES, and (2) Odds ratios for GP contact with bothersome LUTS by lifestyle and SES. Results: 23,240 men participated (49.8%). Nocturia was the most commonly experienced LUTS (49.8%). Incontinence was most often reported as bothersome (64.1%) and nocturia less often reported as bothersome (34.2%). Only about one third of the men reporting a bothersome LUTS contacted their GP. Odds for reporting LUTS significantly increased with increasing age, obesity, and lack of labor market affiliation. Increasing age and symptom burden significantly increased the odds for GP contact regarding bothersome LUTS. No overall associations were found between lifestyle, SES, and GP contact. Conclusion: Bothersome LUTS are common among Danish men. Concern and influence of LUTS on daily activities are important determinants of GP contact, yet only one in three bothersome LUTS are discussed with a GP. Advanced age and symptom burden were significantly associated with GP contact. Implications: Information on treatment options for LUTS might be desirable among Danish men regardless of SES and lifestyle. Key points Urological symptoms are common among men in the Danish population and are often managed without contacting healthcare professionals. Increasing age and symptom burden significantly increase the likelihood of consulting a general practitioner regarding bothersome urological symptoms Healthcare-seeking behavior with bothersome urological symptoms is not influenced by lifestyle or socioeconomic status among Danish men; Information about available, effective treatment options for urological symptoms might be desirable among men regardless of socioeconomic status and lifestyle.


Assuntos
Estilo de Vida , Sintomas do Trato Urinário Inferior , Aceitação pelo Paciente de Cuidados de Saúde , Classe Social , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dinamarca , Clínicos Gerais , Humanos , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Noctúria/terapia , Razão de Chances , Fatores Socioeconômicos , Inquéritos e Questionários , Incontinência Urinária/terapia , Adulto Jovem
15.
J Vasc Interv Radiol ; 30(5): 638-644, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31029381

RESUMO

PURPOSE: This study compared the safety and efficacy of prostatic arterial embolization (PAE) with that of trisacryl gelatin microspheres of different sizes for treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: This study consisted of a single-center, randomized controlled clinical trial in 138 patients who underwent PAE for BPH between July 2015 and December 2016. Patients were randomized to PAE using microspheres of different sizes: group A patients were treated with microspheres 100-300 µm, group B with 300-500 µm, and group C with 100-300 µm followed by 300-500 µm. All patients were evaluated before and at 1, 3, 6, 12, and 18 months after PAE. Baseline data were comparable across the 3 groups, using the following mean International Prostate Symptom Score/quality of life (IPSS/QoL); prostate volume (PV) scores, respectively: 23.0/4.14; 87.9 cm3 (group A); 23.0/4.09; 89.0 cm3 (group B); and 24.2/4.29; 81.0 cm3 (group C) (P > 0.05). RESULTS: Mean IPSS/QoL scores; PV after PAE were: 9.98/2.49; 65.1 cm3 (group A); 8.24/2.26; 63.1 cm3 (group B); and 10.1/2.69; 53.1 cm3 (group C) (P = 0.23; P = 0.39; P = 0.24). There were 26 clinical failures. The cumulative probabilities of clinical success at 18 months were 76.7% in group A, 82.6% in group B, and 83.3% in group C (P = 0.68). Nontarget embolization was prevented in 6 patients by coil embolization. All adverse events were mild and self-limited with rates of 86.0% in group A (37 of 43); 41.3% in group B (19 of 46); and 58.3% in group C (28 of 48) (P < 0.001). Dysuria was the most frequent adverse event (28 of 137 [20.4%]). CONCLUSIONS: PAE outcomes were not significantly different among microspheres of different sizes. The use of 100- to 300-µm microspheres was associated with an increased risk of minor adverse events.


Assuntos
Resinas Acrílicas/administração & dosagem , Artérias , Embolização Terapêutica , Gelatina/administração & dosagem , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Resinas Acrílicas/efeitos adversos , Idoso , Embolização Terapêutica/efeitos adversos , Gelatina/efeitos adversos , Humanos , Injeções Intra-Arteriais , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Estudos Prospectivos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Resultado do Tratamento
17.
J Vasc Interv Radiol ; 30(5): 661-667, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31029385

RESUMO

PURPOSE: To evaluate the efficacy and safety of prostatic artery embolization (PAE) performed to treat gross hematuria secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between February 2014 and December 2017, 20 patients with gross hematuria secondary to BPH refractory to medical treatment underwent PAE in our institution. Technical success was defined as bilateral PAE. International Prostate Symptom Score (IPSS), quality of life (QoL), and clinical review were assessed before PAE and at 3 and 12 months after procedure. Short- and medium-term clinical successes were defined as resolution of gross hematuria with no recurrence at 3 and 12 months, respectively. RESULTS: Technical success rate was 100%. No major adverse events were recorded. Minor complications included gluteal pain, nausea, and fever in 7 patients. At 3 months, there were improvements in IPSS (21.1 ± 6.6 to 9.8 ± 4.7, P < .001) and QoL (5.1 ± 1.7 to 2.4 ± 1.3, P < .001). At 12 months, there were improvements in IPSS (8.1 ± 2.5, P < .001) and QoL (2.1 ± 1.0, P < .001). At 3 months, recurrent hematuria was reported in 3 of 20 patients (85% short-term clinical success rate). One of the remaining 17 patients had developed recurrent hematuria by 12 months (80% medium-term clinical success rate). CONCLUSIONS: PAE is a safe and effective means of treating gross hematuria caused by BPH refractory to medical treatment. PAE offers a reasonable option for such patients who are not suitable for surgical therapy.


Assuntos
Artérias , Embolização Terapêutica , Hematúria/terapia , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Hematúria/diagnóstico por imagem , Hematúria/etiologia , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Urol Int ; 102(4): 476-481, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999304

RESUMO

BACKGROUND: Intermittent self-catheterization (ISC) is by far the most appealing therapy to achieve a complete bladder emptying in patients with neurogenic lower urinary tract dysfunction (NLUTD). Four questionnaires have been developed in French in order to assess patient's satisfaction, difficulties and acceptance of this technique. OBJECTIVES: The aim of this study was to translate, culturally adapt and validate Dutch versions of the Intermittent Catheterization Satisfaction Questionnaire (InCaSaQ), the Intermittent Catheterization Acceptance Test (ICAT), the Intermittent Self Catheterization Questionnaire (ISCQ) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ). METHODS: (1) Translation and cross-cultural adaptation of the questionnaires were performed according to the standardized guidelines. (2) The test of the pre-final version was performed by a group of bilingual lay people by comparing the original version of the questionnaires and the back translated one, assessing the comparability of language and comparability of interpretation. (3) Problematic issues were reviewed for correction. (4) Reliability was examined by intra-class correlation coefficients (ICC) statistics and Cronbach alpha analysis. RESULTS: Pre-test by 45 raters who are fluent in the source language led to an adapted and improved version of the translated questionnaires. Fifty native Dutch-speaking patients performing ISC (>6 months) due to an NLUTD were prospectively included. InCaSaQ, ICAT, ISCQ and ICDQ showed good internal consistency (α respectively (test and re-test): 0.79-0.88, 0.88-0.92, 0.85-0.88, and 0.88-0.86) and reproducibility (ICC respectively 0.77, 0.84, 0.84, and 0.87). CONCLUSION: The translated versions of InCaSaQ, ICAT, ISCQ and ICDQ are reliable and valid, allowing self-reported assessment of satisfaction, acceptance, difficulties and quality of life related to ISC in Dutch-speaking patients with NLUTD.


Assuntos
Cateterismo/métodos , Sintomas do Trato Urinário Inferior/terapia , Autocuidado/métodos , Inquéritos e Questionários , Bexiga Urinaria Neurogênica/terapia , Doenças Urológicas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/psicologia , Feminino , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Países Baixos , Satisfação do Paciente , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatística como Assunto , Adulto Jovem
19.
Arch Ital Urol Androl ; 91(1): 22-24, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932425

RESUMO

INTRODUCTION: The aim of this study was to report our experience in the management of hematospermia observed in 16 patients suffering from xanthogranulomatous prostatitis. METHODS: Recurrent episodes of hematospermia were the onset symptom in all patients, and in 25% of patients it was combined with fever. All patients reported PSA value elevation and the digital rectal examination (DRE) revealed an increase of the gland size and of its consistency in all cases. In all patients, the hematospermia was treated with the oral administration of two tablets of pollen extract in a single (1 g) dose daily for 30 days. RESULTS: Sixteen patients were observed between 2008 and 2016, referring hematospermia, progressive lower urinary tract symptoms (LUTS), and serum PSA level increase. To exclude the prostate cancer presence all patients were submitted to transperineal TRUS guided biopsy. In all the patients complete resolution of hematospermia was achieved treatment with pollen extract. All patients were subsequently treated for LUTS (alpha-adrenergic blockers), but none reported any significant improvement of symptoms. Basing on these pieces of evidence, after 90 days of alpha-blockers therapy, all patients underwent bipolar TURP. Histological examination of resected prostatic tissue revealed in all patients the diagnosis of xanthogranulomatous prostatitis. CONCLUSIONS: Patients with xanthogranulomatous prostatitis especially experience irritative symptoms, sometimes combined with fever or hematospermia. Hematospermia as the onset symptom has not been reported so far. The administration of the pollen extract for 30 days was associated with a complete resolution of hematospermia.


Assuntos
Hemospermia/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Pólen/química , Prostatite/terapia , Antagonistas Adrenérgicos alfa/administração & dosagem , Biópsia , Exame Retal Digital , Febre/etiologia , Hemospermia/diagnóstico , Hemospermia/etiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Antígeno Prostático Específico/sangue , Prostatite/complicações , Prostatite/diagnóstico , Ressecção Transuretral da Próstata/métodos
20.
Curr Urol Rep ; 20(6): 29, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30989392

RESUMO

PURPOSE OF REVIEW: Compare outcomes of medical therapy as compared to minimally invasive surgical therapy (MIST) for treatment of bladder outlet obstruction RECENT FINDINGS: Treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) remains largely driven by patient symptomatology with medical therapy or watchful waiting as the first-line management strategies. However, most patients are not adherent to prescribed medical therapies and are hesitant to accept the risks associated with more invasive therapies. Minimally invasive surgical therapies are treatments providing short-term symptom relief superior to medical therapies without the sequela of more invasive procedures. Though there are few direct comparisons, MIST seems to relieve LUTS/BPH symptoms at least as well as medical therapy without the need for daily adherence.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Procedimentos Cirúrgicos Minimamente Invasivos , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Transtornos Urinários/terapia , Agentes Urológicos/uso terapêutico , Humanos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Obstrução do Colo da Bexiga Urinária/tratamento farmacológico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Transtornos Urinários/tratamento farmacológico , Transtornos Urinários/etiologia , Transtornos Urinários/cirurgia
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