Clinical Study Of Lower Urinary Tract Symptoms And Benign Prostatic Hyperplasia

Objective:To assess the prevalence, age distribution and presentation of low urinary tract symptoms (LUTS) in adult men.Methods:A random sample was obtained from men coming to our hospital for healthy physical examination during the period of 2008. By completion of the IPSS questionnaire and general health information, 1048 men aged 30-80 years old were assigned into five groups according to 10-year age stratum.The occurrence of symptoms and severity of discomfort from the respondents were assessed.Results:The occurrence of LUTS for each group was as follow. The average IPSS score was 2.48±0.38,3.80±0.53,4.78±1.07,5.33±0.68, 6.80±1.66 in 347 men in 30-39,311 men in 40-49,114 men in 50-59,207 men in 60-69,69 men in 70-79 years of age group respectively. And the average score of storage urinary symptoms in each group was 1.20,1.66,2.24,2.57,3.20; average score of voiding symptoms was 1.28,2.14,2.54,2.76,3.59; average score of the quality of life (QoL) was 1.78±1.42,1.84±0.30,1.89±1.04,2.03±1.08,2.07±1.92 respectively. The incidence of LUTS in different age groups was correlated with age (x2=70.46, P<0.005). IPSS total score, voiding symptom score and storage symptoms score were positively correlated with QoL score, in which storage symptoms had a more impact on the quality of life than voiding symptoms.Conclusions:LUTS are relatively widespread in adult healthy males more than 30 years of age. The incidence of LUTS and symptom scores increase with age. The more severe symptoms of LUTS, the greater impact on QoL, in which storage symptoms have a greater impact on QoL than voiding symptoms (The correlation coefficient between the storage symptom score, voiding symptom score and QoL are r=0.966(P<0.05), r=0.931(P<0.05), respectively)Objective:To explore the clinical characteristics of LUTS suggestive of BPH and their impact on patients'quality of life(QoL).Methods:548 patients with BPH were enrolled from July 2003 to October 2009 and their clinical data were studied retrospectively. Data on International Prostate Symptom Questionnaire Score (IPSS), a self-designed nocturia symptom score sheet and sexual function questionnaire (MSF-4) filled out by patients when they hospitalized was anlyzed.Results:548 cases of patients with LUTS, moderate (8-19 points) accounted for 24.8% and severe (20-35 points) accounted for 75.2%. LUTS and its individual symptoms were positively associated with age, but less relevant, which were also positively correlated with QoL. Among the individual urinary symptoms, nocturnal score(Q7) correlated most with QoL, followed by dribbling urine (Q1), inability to urinate (Q5). 28.6%(157/548) of patients considered nocturnal as the greatest impact on their QoL, mainly affecting their sleep (NQ5), followed by fatigue and decreased attention in next day (NQ1),worring about the impact on family or partner's sleep (NQ6). The Spearman rank correlation analysis showed that there was a positive correlation between IPSS and MSF-4 score (P<0.0001), in which nocturia, dysuria, and urinary frequency were the serious urinary symptoms that affected sexual function of patients (r=0.20648,020635,0.18861). Conclusion:LUTS seriously affect QoL of patients with BPH, including the impact on sexual function.More attention on the further study of BPH patients with nocturia should be paid in order to reduce its disturbance of patients'sleep and life.Objective:To explore the relationship between different clinical factors and lower urinary tract symptoms (LUTS) suggestive of benign prostate hyperplasia (BPH), in order to understand the impact of the risk factors on BPH related LUTS.Methods:548 patients with BPH were enrolled from July 2003 to Octorber 2009 and their clinical data were studied retrospectively. The impact of various clinical factors such as age, medical history, maximum urinary flow rate (Qmax), total prostate volume, transition zone volume, transition zone index, total PSA, f/tPSA and prostatic inflammation on IPSS scores were analyzed, and multiple liner regression analysis was also conducted.Results:Among all the clinical factors mentioned above, age, transition zone volume, Qmax, PSA and prostatic inflammation had a significant impact on the IPSS score. IPSS scores increased significantly with the increase of age and transitional zone volume, while IPSS scores increased significantly with the reduction in Qmax (P<0.05). IPSS scores were significantly higher in the group of PSA≥4ng/ml than that of PSA<4ng/ml (P<0.05), however, there was no difference between the group of PSA range of 4-10ng/ml and that of PSA≥10ng/ml (P<0.05). Patients with prostate inflammation had much higher IPSS score than those patients without prostate inflammation (P<0.05). Further analysis by multiple liner regression found that Qmax and prostate tissue inflammation were closely correlated with the IPSS score among all the possible risk factors (β=-0.807,5.736;P<0.001).Conclusion:This study shows that prostate tissue inflammation and Qmax have a remarkable impact on the severity of LUTS, and other clinical factors such as patient's age, transition zone volume and PSA value have a limited impact on the severity of LUTS suggestive of BPH as no significance is found after multiple liner regression analysis.Objective:Acute retention of urine (AUR) is a common urological condition that often needs an emergence management. One of the most common causes of acute urinary retention is benign prostatic hyperplasia (BPH) which is a common disease in aging male population. This study attempts to explore the risk factors of AUR ocurred in BPH patients, thus reasonable preventative measures are taken for the treatment of BPH patients.Methods:Total 548 patients with BPH were enrolled from Jul 2003 to Oct 2009 and their clinical data were studied retrospectively. Clinical data such as patient's age, medical history, IPSS and QoL score, Qmax, residual urine volume, prostate volume, transition zone volume, transition zone index, tPSA and fPSA, and PSAD was analyzed statistically.Results:In 548 cases of BPH patients involved in the investigation, development of AUR was found in 164 cases (29.9%), not in 384 cases (70.1%). Patient's age, IPSS score, Qmax, residual urine volume, prostate volume, transition zone volume, tPSA and fPSA including f/tPSA, and PSAD were significantly different in two groups (P<0.05), while there was no significant difference in the disease duration and transition zone index between the two groups. Further Multivariate Logistic regression analysis showed that symptom severity, residual urine volume, tPSA, and Qmax were the most risk factors for predicting the development of AUR.Conclusions:BPH patient's age, IPSS score, Qmax, residual urine volume, prostate volume, transition zone volume, tPSA and fPSA, and PSAD are likely to increase the risk of AUR, in which symptom severity, Qmax, residual urine volume and total PSA are the most significant predictors for acute retention.Objective:To analyze the clinical characteristics of benign prostate hyperplasia (BPH) with prostate inflammation,and to investigate the relationship between inflammation and lower urinary tract symptoms (LUTS) suggestive of BPH and the possible role of inflammation in the progression of BPH.Methods:From July 2003 to Octorber 2009,548 patients diagnosed with BPH were enrolled in this study, and several items including age, history, IPSS, volume of prostate, prostatic-specific antigen (PSA) and related parameter, Qmax, acute urinary retention (AUR) and the way of treatment were analyzed.Results:504 cases (91.97%) were identified as prostatitis, and those patients'history (62.10±45.21) were longer and their scores of IPSS/QoL (26.07±7.1.3/4.7±0.5) were higher than that of patients without prostatitis. The total volume of prostate and transitional zone were 63.37±40.81cm3 and 32.77±25.69 cm3 respectively in patients with BPH combined with prostatitis, which were larger than those of the patients without prostatitis. Patients with prostatitis felt more uncomfortable about voiding symptoms than the other group.Their maximum flow rate (5.75±5.37ml/s) were decreased and risk of AUR were increased, and the proportion of BPH-related surgery were higher. On the other hand, there were no significant differences about patients'age, tPSA, fPSA, f/tPSA and PSAD between two groups.Conclusion:Prostatitis in benign prostatic hyperplasia is very common. LUTS may be aggravated by the existence of inflammation in benign prostatic hyperplasia, and the inflammation may increase the risk in occurrence of AUR and BPH-related surgery. Prostate inflammation may be an important factor in occurrence and progression of LUTS suggestive of BPH.Objective:To compare the surgical efficacy and safety of transurethral Plasma Kinetic Resection of the Prostate (PKRP) and transurethral vaporization resection of the prostate (TUVRP), so as to provide the best choice of the treatment for LUTS suggestive of benign prostatic hyperplasia (BPH).Methods:The clinical data of 341 patients with BPH treated by PKRP and TUVRP from July 2003 to October 2009 in our hospital was analyzed retrospectively, and the operative time, intraoperative blood loss and blood transfusion, post-operative bladder irrigation and catheter extubation time, IPSS, QoL, and Qmax between the two groups were compared.Result:The operations were completed successfully in all patients and no significant intraoperative complications occurred. The operation time (96.60±52.05min), post-operative washing time (2.62±0.99 days) of TUVRP group (193 cases) were longer than that (84.96±28.93min) (2.32±1.33 days) of PKRP group (148 cases) (P<0.05). No significant difference was found between two groups in the intraoperative blood loss, blood transfusion, catheter removal time, hospitalization time (P>0.05). IPSS, QoL, Qmax of TUVRP group were 8.38±5.86min,1.87±1.46min, 17.98±7.33ml/s, that of PKRP group were 7.86±5.87 min,2.09±2.12min, 16.77±9.69ml/s,these indicators of both groups improved significantly than that before surgery, (P<0.05). The storage and voiding symptom score of TUVRP group and PKRP group were 4.99±3.10,3.44±3.80 and 5.00±2.96min,2.26±2.98 points, which improved significantly than those before surgery (P<0.05). There was no significant difference existed between this two groups in parameters improvement of IPSS, including storage symptom score and voiding symptom score, QoL and Qmax (P>0.05).Conclusions:The post-operation results of TUVRP and PKRP improve remarkably compared with preoperation, and both are safe and effective methods for the treatment of LUTS suggestive of benign prostatic hyperplasia. PKRP is better on the operation time and the postoperative irrigating time than TUVRP in this study, however, there is no significant difference between the two groups in intraoperative blood loss and blood transfusion, catheter removal time, hospitalization time, IPSS and QoL score, Qmax. PKRP seems to be faster than TUVRP in cutting efficiency, but this two procedures have similar effects on the short term efficacy such as improving LUTS.