Benign Prostatic Enlargement, the International Prostate Symptoms Score and a Review of Other Symptom Scores

Benign prostatic hyperplasia (BPH) is the most common benign prostate disease in elderly men, and its incidence increases with age and is associated with lower urinary tract symptoms (LUTS). The international prostate symptoms score (IPSS) is the most common symptom score used to assess LUTS even though other symptom scores exist. This study aims to evaluate the LUTS of patients secondary to BPH presenting to the urology clinic of UPTH using the IPSS and to review other scoring systems. Materials and Methods: This was a prospective hospital based descriptive cross-sectional study carried out in University of Port Harcourt Teaching Hospital (UPTH). All adult male patients with LUTS secondary to BPE were given an IPSS questionnaire to fill. Another IPSS questionnaire was filled by the patient assisted by the researcher. The data were collated using Microsoft Excel 2016 version and they were analyzed using SPSS version 20. Results were presented in tables. Results: Sixty-nine (69%) patients had at least secondary level of education. Sixty-four (64%) could complete their questionnaire without any aid. The mean IPSS was 22.13 ± 6.34 as most patients presented with severe symptoms. The mean Quality of Life score was 4.60 ± 1.38. There was a significant positive correlation between Quality of Life and IPSS. Conclusion: A level of literacy is needed to complete the questionnaire. Most patients in our study presented late with severe symptoms and significant level of bother. Nocturia was the worst symptom.

Relationship between serum sex hormones levels and degree of benign prostate hyperplasia in Chinese aging men

Benign prostatic hyperplasia （BPH） is one of the most common medical conditions in middle aged and older men. This study investigated the relationship between serum levels of sex hormones and measures of BPH in the aging male population of China. Prostate symptoms were assessed as part of a free health screening program for men ~40 years of age. The examination included digital rectal examination, determination of serum prostate-specific antigen levels, International Prostate Symptom Score （IPSS） and transrectal ultrasonography. Serum levels of total testosterone （TT）, sex hormone binding globulin （SHBG）, free testosterone （FT）, luteinizing hormone （LH）, follicle-stimulating hormone （FSH）, prolactin （PRL） and estradiol （E2） were evaluated. The men also completed a health and demographics questionnaire and received a detailed physical examination. The final study population consisted of 949 men with a mean age of 58.9 years. Pearson correlation analysis indicated that there were significant correlations between age and levels of all sex hormones except TT, and between age and prostate volume （PV; r=0.243; P〈0.01） or IPSS （r=0.263; P〈0.01）. Additional significant correlations were found between IPSS and serum levels of LH （r=0. 112; P〈0.01） and FSH （r=0.074; P〈0.05）, but there were no significant correlations between sex hormone levels and PV. Multivariate linear regression analysis showed significant correlations between age and body mass index （BMI） with PV （P〈0.0001）. In addition, there was a significant correlation between age and PV with IPSS （P〈0.0001）. Serum sex hormone levels did not correlate with PV or IPSS. The effects of endocrine changes on measures of BPH in aging men require further investigation in longitudinal and multicenter studies that include oatients with all severities of BPH.

Relationship between age and prostate size

In a community-based study, the relationship between age and human prostate size was investigated in a population of men between the ages of 40 and 70 years to determine the normal prostate increase curve equation. One thousand male volunteers were randomly recruited from the Shanghai community, and the length, width, height, volume of the transition zone （TZ） and the whole prostates were measured by transrectal ultrasound （TRUS）. Each volunteer was evaluated bythe International Prostate Symptom Score （IPSS）. Among those who completed the examination, the mean prostate parameters were all positively associated with increased age. There were statistically significant differences between each age group （P〈O.05）. The mean transition zone volume （TZV） had a higher increase rate with age than the mean total prostate volume （TPV）, indicating that the enlargement of the TZ contributed the most to the increase in TPV. While all prostate parameters were positively correlated with the IPSS, the strongest correlation was associated with the TZ length （TZL） and TZV. The growth curve equations for prostate width, height and length were also positively associated with increasing

Efficacy of Bladder Neck Incision (BNI) Versus Transurethral Resection of Prostate (TURP) in Management of Benign Prostatic Hyperplasia (BPH) Causing Obstruction: A Randomised Controlled Study

Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.

不同严重程度前列腺增生尿道周围前列腺组织SWE及其与IPSS相关性分析

目的探究不同严重程度前列腺增生尿道周围前列腺组织SWE及其与IPSS相关性分析。方法选取2016年9月至2017年9月恩施市中心医院诊治的良性前列腺增生的76例患者作为研究对象。同时,选取20例健康志愿者为正常组,对所有患者进行IPSS评分,根据评分将患者分为轻度、中度、严重3组,然后对患者进行直肠超声检查(TRUS),通过计算得出患者前列腺重量,根据重量将患者分成A组、B组、C组、D组,最后进行实时剪切波弹性成像(SWE),比较各组尿道周围前列腺组织弹性模量差异,评价每组间弹性模量与前列腺重量、IPSS评分严重程度、患者年龄的相关性。结果经过对不同重量的前列腺尿道周围组织弹性模量对比分析,四组患者上部A区、上部B区、中部A区、中部B区、下部A区组间差异均无统计学意义(均P>0.05),下部B区组织弹性模量随着患者前列腺重量的增加而增加,差异具有统计学意义(P<0.05);经过对不同严重程度的前列腺尿道周围组织弹性模量对比分析,不同部位的尿道周围组织弹性模量随着前列腺增生的严重程度的升高而增加,差异具有统计学意义(P<0.05);经过对不同年龄的前列腺尿道周围组织弹性模量对比分析,尿道周围组织弹性模量随着前列腺增生患者的年龄的增加而增加,差异具有统计学意义(P<0.05);经过相关性分析,前列腺的重量与IPSS呈正相关(r=0.354,P 0.05);前列腺增生尿道周围组织弹性模量与IPSS呈正相关,上部A区(r=0.740,P<0.01)、上部B区(r=0.863,P<0.01)、中部A区(r=0.792,P<0.01)、中部B区(r=0.835,P<0.01)、下部A区(r=0.761,P<0.01)、下部B区(r=0.862,P<0.01);前列腺增生尿道周围组织弹性模量与患者年龄呈正相关(r=0.613,P<0.05)。结论前列腺尿道周围组织弹性模量与前列腺增生严重程度、患者年龄呈正相关,因此SWE可以用做无创评估患者前列腺增生严重程度的方法。

前列腺体积与IPSS的关系

目的:了解前列腺体积、腺体突入膀胱的距离与IPSS的关系。方法:对181例男子作经腹B超测量前列腺的体积、腺体突入膀胱的距离及回顾性IPSS问卷调查。结果:随前列腺体积及腺体突入膀胱距离增大,IPSS评分增加(P<0.05及P<0.01)。结论:IPSS评分结合前列腺体积及腺体突入膀胱的距离对评价前列腺增生患者症状的严重程度、选择治疗方法和评价治疗效果有重要的临床价值。

可视前列腺症状评分在良性前列腺增生症中的临床应用

目的分析新型可视前列腺症状评分(VPSS)与国际前列腺症状评分(IPSS)及最大尿流率(Qmax)的相关性,评估VPSS对良性前列腺增生症(BPH)症状严重程度及临床应用的价值。方法门诊选取274位良性前列腺增生症患者进行IPSS和VPSS评分,VPSS包括Q1(尿频)、Q2(夜尿)、Q3(尿线症状)和Q4(生活质量)4个问题,分别统计每个问题的得分及总分,并测量患者最大尿流率(Qmax)和平均尿流率(Qave),运用χ2检验、Spearman相关性分析、LSD多重检验、SNK检验及Mantel-Haenszel检验等进行统计学分析。结果完成VPSS评分用时显著少于IPSS评分(84svs.187s,P<0.001),VPSS总分、Q3、Q4与Qmax之间存在明显的负相关(r=-0.552,P<0.000 1;r=-0.633,P<0.000 1;r=-0.553,P<0.000 1);Q3、Q4与VPSS总分之间存在明显的正相关(r=0.716,P<0.000 1;r=0.799,P<0.000 1)。Q3的分组中,各组间存在显著性差异(P<0.000 1);Qmax≤15mL/s的百分率明显与VPSS Q3得分呈线性递增关系。结论 VPSS与IPSS、Qmax间存在明显相关性,而在良性前列腺增生症患者的下尿路症状评估中,VPSS较IPSS更适合不同教育程度的患者,尤其是受教育程度及读写能力较低的患者。

针刺配合艾灸治疗前列腺增生临床观察

目的观察针刺配合艾灸治疗前列腺增生的临床疗效。方法将60例前列腺增生患者随机分为两组,治疗组30例,对照组30例。治疗组采用针刺配合艾灸,对照组口服晶珠前列癃闭通胶囊。治疗3个疗程后,对比两组疗效及治疗前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿量(RUV)变化情况。结果治疗组总有效率为93.3%,对照组总有效率为66.7%,两组比较差异有统计学意义(P<0.01);两组治疗前后IPSS评分、QOL评分、Qmax、RUV比较差异均有统计学意义(P<0.05)。结论治疗组与对照组比较能够明显改善患者IPSS、QOL评分和Qmax及减少RUV,证明针刺配合艾灸治疗前列腺增生有良好的疗效。

癃闭舒胶囊治疗前列腺增生症的临床观察

上海市静安区中心医院等五家医院泌尿科对“癃闭舒胶囊”治疗中老年男性良性前列腺增生症的有效性和安全性进行临床验证，观察治疗１３８例结果：国际前列腺症状评分（ＩＰＳＳ）、残余尿测定与最大尿流率（ＭＦＲ）获显著改善的患者分别为８２例（共１３８例）、４６例（共１２９例）和３３例（共１３６例），改善率分别为５９４２％、３５６６％和２４２６％。１３８例用药前后的肝。

45岁以上男性下尿路症状与残余尿量相关性调查

目的探讨下尿路症状与残余尿量之间的相关性。方法采用IPSS问卷调查45岁以上男性人群中下尿路症状,同时经腹部B超测量残余尿量。结果1256例调查对象中,552人具有下尿路症状,其中64.7%有轻度下尿路症状,33.9%有中度下尿路症状,1.4%有重度下尿路症状。残余尿量总体均值为37.69±99.195ml,各年龄组残余尿量总体差异有统计学意义(P=0.001)。下尿路症状评分与残余尿量轻度相关(r=0.303,P<0.001),排尿困扰问题评分与残余尿量相关性轻微(r=0.099,P=0.027)。结论成年男性人群随年龄增长,下尿路症状逐渐加重,而残余尿量增加不明显。残余尿量可引起下尿路症状,但其相关性不密切。

中老年男性下尿路症状调查及危险因素分析

目的探讨中老年男性下尿路症状(LUTS)的特征及危险因素。方法采用便利抽样方法抽取1 019例50岁以上男性,使用国际前列腺症状评分表进行问卷调查,并提取其部分体检数据。结果中老年男性下尿路症状(IPSS≥8分)患病率为48.0%。回归分析显示:年龄>65岁、空腹血糖>6.16 mmol/L、低密度脂蛋白>3.36 mmol/L、体质量指数>24为下尿路症状的独立危险因素(均P<0.01)。结论中老年男性年龄越大,下尿路症状越严重,生活质量越差。需加强中老年男性下尿路症状的筛查及宣教工作,指导其减少高脂肪高糖食物的摄入,适当锻炼,保持合适体质量,以延缓下尿路症状的发生及进展,提高其生活质量。

猪苓汤合当归芍药散治疗前列腺增生的临床疗效观察

【目的】观察猪苓汤合当归芍药散加减治疗湿热瘀阻型良性前列腺增生(BPH)的临床疗效。【方法】将80例湿热瘀阻型BPH患者随机分为对照组和试验组,每组各40例。对照组给予常规西药(坦索罗辛联合非那雄胺)治疗,试验组在对照组常规西药的基础上加用猪苓汤合当归芍药散加减治疗,疗程为4周。观察2组患者治疗前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)和中医证候积分的变化情况。【结果】治疗前,2组患者的IPSS评分、QOL评分和中医证候积分比较,差异均无统计学意义(P>0.05)。治疗后,2组患者的IPSS评分、QOL评分和中医证候积分均较治疗前明显降低(P<0.01),且试验组的降低作用均明显优于对照组,差异均有统计学意义(P<0.01)。【结论】猪苓汤合当归芍药散加减治疗湿热瘀阻型BPH患者疗效确切,可有效改善患者的临床症状和生活质量,其疗效优于单纯西药治疗。

北京远郊中老年农民勃起功能调查及影响因素分析

目的调查北京远郊区农村中老年男性的勃起功能状况并探讨其相关影响因素。方法随机选择北京远郊密云地区4个村的>55岁的男性167例作为研究对象。通过当面咨询和问卷调查,收集年龄,结婚年龄,身高,体重,腰围,臀围,吸烟,饮酒和秃顶等一般资料,填写国际前列腺症状评分(IPSS),国际勃起功能评分5(IIEF-5)评分表,检测总和游离前列腺特异性抗原(tPSA和fPSA)。调查各年龄组的勃起功能障碍发生比例,应用Kruskal-Wallis秩和检验和Logistic回归分析进行统计分析。结果轻度、中度和重度勃起功能障碍(ED)在研究人群中的比例分别为40%、30%和42%。秩和检验发现年龄越大,中度和重度的ED患者的比例越高。单因素和多因素logistic回归分析,发现年龄、体重指数、IPSS和f/t(fPSA/tPSA)等均对ED有明显的影响。结论年龄和IPSS评分是影响ED的独立危险因素,而f/t和BMI是其保护因素。

普乐安片治疗良性前列腺增生的临床疗效及其与疗程关系研究

目的探讨普乐安片治疗良性前列腺增生的临床疗效及其与疗程关系。方法良性前列腺增生患者共260例,随机分为治疗组和对照组,每组各130例,治疗组服用普乐安片,4片/次,每天3次,对照组服用安慰剂,4片/次,每天3次,疗程为90 d。观察并记录治疗前及治疗30、60、90 d后的国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量、前列腺体积等指标变化。结果与治疗前相比,治疗组服药30 d后,IPSS平均下降了6.94分,QOL平均下降了0.61分,单次残余尿量平均减少5.96 mL,改变均有统计学意义(P<0.05),前列腺体积差异无统计学意义(P>0.05)。随治疗疗程的延长,其症状有进一步改善的趋势。治疗组和对照组均未发生药物不良反应。结论普乐安片能有效改善良性前列腺增生患者的临床症状。