Are urge incontinence and aging risk factors of erectile dysfunction in patients with male lower urinary tract symptoms?

Introduction: Several studies have indicated that erectile dysfunction (ED) patients also suffer from lower urinary tract symptoms (LUTS). We investigated a group of men with LUTS and assessed their sexual function with the aim of being able to predict ED risk factors and introduce ED treatments earlier for this patient group.

Methods: International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS) and Sexual Health Inventory for Men (SHIM) score were obtained from 236 men with LUTS at their first out-patients visit. Clinical parameters such as body mass index, prostate volume, residual urine volume and prostate specific antigen were also evaluated. The relationship between the SHIM score and other clinical data was analyzed.

Results: According to the SHIM score, ED in men with LUTS was severe 15%, moderate 19%, moderate to mild 28%, mild 17%, normal 7% and data was incomplete in 14%. Based on the results of a multivariate analysis, aging (p?p?=?0.024) were significantly correlated to severe and moderate ED. Furthermore, among OAB symptoms score items, urge urinary incontinence was a risk factor for severe and moderate ED (p?=?0.005).

Conclusion: Aging and OAB (notably urinary urge incontinence) are risk factors for severe and moderate ED in men with LUTS.     

Coffee intake,health-related quality of life,and associated factors of overactive bladder in older Korean women living in rural South Korea

ABSTRACT

Overactive bladder (OAB) is a common health problem in older women. The aim of the study was to investigate coffee consumption, health-related quality of life (HRQOL), and associated factors of OAB in older Korean women living in rural South Korea. A total of 248 women aged 65 years and older participated in this study. Chi-square tests, t-tests, and multivariable logistic regressions were performed. The means of coffee consumption between OAB and non-OAB groups were not significantly different. Women with OAB showed significantly lower HRQOL than women with stress urinary incontinence only. OAB was associated with high body mass index and poor health status.     

Testosterone supplementation's effects on age-related bladder remodeling – experimental study in rats

Abstract

Objective: This study was designed to evaluate the effect of testosterone replacement on the fibrotic process of the detrusor bladder muscle during the normal aging process.

Methods: 15 Wistar senile rats, aged between 18 and 20 months were divided into two groups: testosterone group – 11 animals submitted to the administration of testosterone undecanoate (50?mg/kg intramuscular), once per month; and, Control group – four animals underwent a sham procedure. At the end of eight weeks, animals from both groups were sacrificed; bladders were removed and subsequently stereologically evaluated to determine the volumetric density of collagen fibers. The success of testosterone administration was confirmed by the measurement of serum testosterone at the beginning and end of the experiment.

Results: In the replacement group, testosterone average was 3.2?ng/ml, whereas in the control group, the mean testosterone at the end of the experiment was 0.64?ng/ml (p?<?0.05). Analysis of stereological collagenous fiber showed higher density in the control group compared to the testosterone group I (56% versus 37.02%, respectively). The difference of volume concentration of collagen between both groups was statistically significant (p?<?0.000).

Conclusion: Bladder wall fibrosis was reduced in senile rats subjected to testosterone replacement.     

Novel symptom questionnaire for the differential diagnosis of detrusor underactivity and bladder outlet obstruction in men

Objective: To develop a questionnaire for the differential diagnosis of detrusor underactivity (DUA) and bladder outlet obstruction (BOO) without performing invasive pressure flow studies.

Study design and methods: Symptoms of men with DUA were analyzed and compared with those of men with BOO using eight questions from the developing questionnaire. Patients with DUA have a bladder contractility index (PdetQmax+5xQmax) less than 100, whereas those with BOO have a BOO index (PdetQmax?2xQmax) greater than 40 in urodynamic studies (UDS). Men with detrusor overactivity in UDS and neurogenic issues were excluded from the analysis. One urologist reviewed patients’ medical records, and responded to eight questions without using information from UDS. Scores in the developing questionnaire were then compared to make a differential diagnosis between DUA and BOO.

Results: Overall, 318 men who underwent UDS were included. Symptoms were compared in patients diagnosed with DUA without BOO (n?=?165) and BOO without DUA (n?=?153). Questions 1, 2, 4, 5, 6, and 7 were significantly different between groups. The sensitivity and specificity of the questionnaire were 95.8% and 95.4%, respectively, for predicting DUA in patients with scores greater than 45 points (cutoff value).

Conclusions: Men with DUA and BOO may be distinguished using a developing questionnaire without invasive evaluation. Men with scores greater than 45 points would be expected to have DUA but not BOO.     

The effect of testosterone therapy on lower urinary tract symptoms/bladder and sexual functions in men with symptomatic late-onset hypogonadism

Objective.?To prospectively investigate the effect of testosterone therapy on lower urinary tract symptoms (LUTS)/bladder and sexual functions in men with symptomatic late-onset hypogonadism (SLOH).

Methods.?The study included 25 men (age range 38 to 73 years) presented with sexual dysfunction, having SLOH, at a single university hospital. All men received testosterone replacement therapy with transdermal testosterone 50–100 mg gel per day for one year. Urodynamic studies with pressure-flow analysis, measurement of prostate volume, prostate specific antigen (PSA) and free PSA level, International Prostate Symptom Score (IPSS), Aging Male Symptom (AMS) scale and International Index of Erectile Function (IIEF-5) score were recorded in all men before and after one year of the treatment.

Results.?The mean AMS score significantly decreased from 40.4 ± 7.3 to 28.8 ± 5.31 (p = 0.001), and mean IIEF-5 score significantly increased from 8.84 ± 3.76 to 14.36 ± 3.62 (p = 0.001). The mean maximal bladder capacity and compliance significantly increased (p = 0.007 and p = 0.032, respectively), and mean detrusor pressure at Qmax significantly decreased from pre-treatment to post-treatment (p = 0.017).

Conclusion.?This study suggests that in addition to improvement in sexual functions, testosterone therapy may also improve LUTS/bladder functions by increasing bladder capacity and compliance and decreasing detrusor pressure at maximal flow in men with SLOH.     

A Cellular Dynamics Model of Experimental Bladder Cancer: Analysis of the Effect of Sodium Saccharin in the Rat

To make the methodology of risk assessment more consistent with the realities of biological processes, a computer-based model of the carcinogenic process may be used. A previously developed probabilistic model, which is based on a two-stage theory of carcinogenesis, represents urinary bladder carcinogenesis at the cellular level with emphasis on quantification of cell dynamics: cell mitotic rates, cell loss and birth rates, and irreversible cellular transitions from normal to initiated to transformed states are explicitly accounted for. Analyses demonstrate the sensitivity of tumor incidence to the timing and magnitude of changes to these cellular variables. It is demonstrated that response in rats following administration of nongenotoxic compounds, such as sodium saccharin, can be explained entirely on the basis of cytotoxicity and consequent hyperplasia alone.     

The effective tool for self-assessment of adherence to treatment in patients with benign prostatic obstruction and overactive bladder symptoms

Purpose: Study of validity of the Medication Adherence Self-Report Inventory (MASRI) for use in clinical practice to treat patients with benign prostatic obstruction (BPO) accompanied with overactive bladder (OAB) symptoms.

Methods: During 12 weeks of the randomized study, 452 patients with BPO and OAB symptoms (mean age of 61.3 (12.7)) were studied for adherence to the treatment with Tamsulosin, Solifenacin and Trospium using the MASRI. External monitoring instruments included the Brief Medication Questionnaire (BMQ) and the visual remaining pill count. The state of the prostate gland and the lower urinary tract was monitored using questionnaires I-PSS, OAB Awareness Tool, uroflowmetry and voiding diaries.

Result: Correlation between the percentage of men non-adherent to treatment (MASRI) and the percentage of patients having a belief barrier on the screen of the BMQ was r?=?0.89, p?≤0.05, r?=?0.92, p?≤0.01, r?=?0.85, p?≤0.05, a number of missed doses on the Regimen Screen of the BMQ was r?=?0.79; p?≤0.05; r?=?0.81; p?≤0.05; r?=?0.75, p?≤0.05, a number of non-adherent patients according to the BMQ was r?=?0.83 (p?≤0.05), r?=?0.88 (p?≤0.05), r?=?0.79, p?≤0.05, the results of the pill count were r?=?0.65–0.76; p?≤0.05-0.01. These data confirm high validity of the MASRI.

Conclusion: The MASRI is a valid tool for rapid assessment of adherence to treatment of patients with BPO and OAB receiving Tamsulosin and antimuscarinic drugs and may be recommended for use in clinical practice.     

Cognitive functions and health-related quality of life in men with benign prostatic hyperplasia and symptoms of overactive bladder when treated with a combination of tamsulosin and solifenacin in a higher dosage

Aim: To study the cognitive functions and health-related quality of life (HRQoL) in individuals taking a combination of tamsulosin and solifenacin in a higher dosage.

Methods: All patients (n?=?262) were assigned to group A (N?=?93, tamsulosin 0.4?mg?+?solifenacin 10?mg per day), group B (N?=?83, tamsulosin 0.4?mg?+?solifenacin 20?mg), and control group C (N?=?86; tamsulosin 0.4?mg?+?placebo). The lower urinary tract (LUT) condition was assessed on the scales International Prostate Symptom Score, Over Active Bladder Awareness Tool and uroflowmetry. The state of cognitive status was assessed on the scales Mini-mental State Examination, Controlled Oral Word Association Test, Wechsler Adult Intelligence Scale-Revised, Wechsler III, Color Trails Test, California Verbal Learning Test.

Results: The values of cognitive function indicators in the individuals from all groups after treatment did not significantly differ from the respective values at the baseline (p?>?.05). The values of most HRQoL parameters of the functional state of the LUT significantly improved in groups A and B. A significant correlation between the state of cognitive status and HRQoL, as well as LUT was absent (r?<0.3).

Conclusion: The combination of solifenacin in a double dosage along with tamsulosin can be recommended for elderly benign prostatic hyperplasia patients with overactive bladder symptoms.     

The Relationship Between Urinary Tract Infections and the Collegiate Academic Calendar

Abstract

College students believe that they are more likely to be ill during examination periods than at other times in the academic year. We in the health service hypothesized that urinary tract infections are not affected by the demands of the academic calendar.

During a 4-year study, the university health service obtained urine culture data prospectively from 456 patients who had a total of 508 episodes of urinary tract infections. Each year, the number of urinary tract infections decreased during both midterm and final examination periods, but rebounded to higher-than-average levels in the second week following the midterm examination period, as well as during the second week of the second (spring) semester, immediately after the mid-winter recess. Mean duration of symptoms was 34 hours (range, from 12 to 60).

Urinary tract infections were less common during examination periods, when students were preoccupied with academic responsibilities, but such infections increased in frequency in the period immediately after examinations, when sexual intimacy was resumed or when sexual intercourse with a new partner began. Urinary tract infections in college women, the study indicated, are primarily related to sexual intercourse, and susceptibility is only indirectly affected by the demands of the academic calendar.