A national survey of lower urinary tract symptoms in Jordan

Objective To determine the prevalence of lower urinary tract symptoms(LUTS)and their severity population in Jordan.Methods This cross-sectional survey was conducted using a paper-based survey between August and September in 2019.The study was carried out in the health care centers or hospitals in three different regions of Jordan:North(Irbid and Jarash),Middle(Amman,Madaba,Salt,and Zarqa),and South(Karak and Aqaba).Results To estimate the prevalence of LUTS,two definitions were used,including the first definition(presence of any LUTS regardless of the degree of severity)and the second definition(presence of any LUTS that occurs half the time or more).According to the first definition,1038(89.9%)reported LUTS(male:47.3%,female:52.7%),while 763(66.1%)reported LUTS according to the second definition(male:45.6%,female:54.4%).According to the International Prostate Symptom Score characterization,73.9%had nocturia and 62.9%reported daytime increased frequency.Conclusion LUTS are highly prevalent among the Jordanian population,and more than half of them have nocturia or daytime increased frequency as most frequently reported symptoms.

Gender differences of lower urinary tract symptoms in older Chinese Americans

Objective To describe whether or not there are gender differences in lower urinary tract symptoms(LUTS)prevalence and risk factors in community-dwelling older Chinese Americans.Methods We performed a secondary analysis of a prospective cross-sectional population-based survey of Chinese Americans aged 60 years and older between January 2011 and December 2013 in English,Mandarin,Cantonese,Taishanese,or Teochew.A clinical review of systems was used to assess LUTS,which included urinary frequency,urgency,burning and/or pain,blood in urine,and urinary incontinence.Results Of the total 3157 people queried,42%were men and 58%were women.More men reported LUTS compared to women(32.9%vs.28.6%,p=0.01).In a multivariable analysis,female gender(adjusted odds ratio[aOR]0.60,95%confidence interval[CI]0.49-0.73),being married(aOR 0.79,95%CI 0.65-0.97),and smoking(aOR 0.66,95%CI 0.49-0.88)were found to be protective,while traditional Chinese medicine use(aOR 1.51,95%CI 1.28-1.78),heart disease(aOR 1.54,95%CI 1.24-1.91),and anxiety(aOR 1.69,95%CI 1.25-2.28)were most strongly associated with increased odds of LUTS.When examining genders separately,being married was found to be protective only in women.Meanwhile,unique factors found in men were hypertension,heart disease,and practice of Tai Chi.Conclusion In this large population-based study,LUTS were more prevalent in older Chinese American men than women.We also found gender-specific factors that influenced the odds of reporting LUTS;however,traditional Chinese medicine use was the only factor that was shared by both genders.Future longitudinal investigations are needed to elucidate these underlying mechanisms to provide evidence-based and culture-specific guidelines for this rapidly growing population.

Trifecta Outcomes of Screening Detected and Patients with Lower Urinary Tract Symptoms after Open Radical Prostatectomy for Localized Prostate Cancer

Background: Many studies have reported on trifecta outcomes after radical prostatectomy. There is however paucity of studies that compares the trifecta outcome between screen detected and patients presenting with lower urinary symptoms with localized prostate cancer after radical prostatectomy. This study compares the trifecta outcomes between these two groups after an open retropubic radical prostatectomy. Methodology: This is a retrospective study, on the trifecta outcomes (urinary continence, erectile function, and cancer control) of consecutive patients that had open radical retropubic prostatectomy for localized prostate cancer by a single surgeon. Patients were grouped into screen detected and presentation with lower urinary symptoms or retention of urine. The parameters considered were the age of the patients, the total prostate specific antigen (tPSA) at presentation, the clinical T stage, the Gleason score of prostate biopsies, the risk categories using the D’Amico risk groups and the trifecta outcomes after the procedure. Results: In all, 119 patients met the criteria for inclusion. The median follow up was 63.5 months (range 12 - 156 months). Of these 40.3% of the patients were diagnosed through screening with elevated PSA while 59.7% had presented with symptoms of lower urinary tract obstruction. The mean age for the patients was 60.8 ± 6.5 years, median PSA 12.6 ng/ml (IQR 8.6 - 19.7) and median prostate weight of 50.0 (IQR 40.0 - 60 g). The urinary continence rate after the procedure was 93.3%, erection rate of 81.5%, cancer control rate of 71.4% and trifecta achieved in 57.1%. Comparing the screening and the symptomatic cases, the urinary continence rate was 91.7% vrs 94.3%;erectile function rate was 79.2% vrs 83.1%;cancer control 68.8% vrs 73.2% and trifecta achieved in 58.3% vrs 56.3%. There was no statistically significant difference between the two groups in terms of urinary continence p = 0.564, erection function p = 0.588, cancer control p = 0.595, and achieving trifecta p = 0.829. Conclusion: Patients with localized prostate cancer presenting with lower urinary symptoms compared to screen detected patients have similar outcomes in terms of urinary Continence, erectile function, cancer control and trifecta after open radical retropubic prostatectomy.

Common approach to managing lower urinary tract symptoms and erectile dysfunction

The present paper serves as a review of the associations between lower urinary tract symptoms （LUTS） and erectile dysfunction （ED）, with a focus on common and combined pathways for treatment. LUTS and ED are common conditions seen in general urologic practice. Research has started to establish epidemiologic and pathophysiologic links between the two conditions and a strong association confirmed across multiple studies. Men seeking care for one condition should always be interviewed for complaints of the other condition. Proposed common pathways include α-1 adrenergic receptor imbalance, Rho-kinase overactivity, endothelial cell dysfunction and atherosclerosis-induced ischemia. Medical therapy has replaced surgery as the first-line treatment for LUTS in most patients, with the incorporation of α-adrenergic receptor antagonists （α-ARAs） and 5-α-reductase inhibitors （5-ARIs） into everyday practice. Treatment with α-ARAs contributes to some improvement in ED, whereas use of 5-ARIs results in worsened sexual function in some patients. Phosphodiesterase-5 （PDE-5） inhibitors have revolutionized the treatment of ED with a simple oral regimen, and new insights demonstrate a benefit of combined use of PDE-5 inhibitors and α-ARAs. The mechanisms of action of these medications support these observed benefits, and they are being studied in the basic science and clinical settings. In addition, novel mechanisms for therapy have been proposed based on clinical and research observations. The minimally invasive and surgical treatments for LUTS are known to have adverse effects on ejaculatory function, while their effects on erectile function are still debated. Much remains to be investigated, but it is clear that the associations between LUTS and ED lay the foundation for future therapies and possible preventative strategies.

The influence of asymptomatic inflammatory prostatitis on the onset and progression of lower urinary tract symptoms in men with histologic benign prostatic hyperplasia

Benign prostatic hyperplasia(BPH)is a condition that greatly affects the quality of life of middle-aged and elderly men.Histopathologically,hyperplastic changes frequently occur in the prostate tissue of elderly men,the incidence of which has been reported to reach approximately 80% in men in their 70s.In clinical practice,approximately 25% of men with histologic BPH are assumed to experience lower urinary tract symptoms(LUTS)and receive some kind of treatment.In other words,there are some men with histologic BPH who do not exhibit LUTS.For that reason,many factors,such as the change in hormonal environment,the immune or autoimmune response,the alteration of gene expression,and so on,are thought to affect the onset and progression of LUTS in men with histologic BPH.One such factor that has long drawn attention is the presence of asymptomatic histological inflammation,which very often accompanies symptomatic BPH.Recent studies have suggested that asymptomatic histological inflammation causes repeated destruction,healing,and regeneration of the prostate tissue,leading to the enlargement of prostatic nodules,while at the same time causing stromal tissuepredominant remodeling of the prostate tissue,which can increase urination resistance and result in the condition changing from asymptomatic BPH to symptomatic BPH.In future,the biomolecular clarification of the significance of asymptomatic histological inflammation in the prostate tissue could help develop new treatment strategies for BPH accompanied by LUTS.

Effects of obesity on lower urinary tract symptoms in Korean BPH patients

We analyzed the effects of obesity on lower urinary tract symptoms （LUTSs） in Korean benign prostatic hyperplasia （BPH） patients. This is a multicenter, cross-sectional, prospective study conducted in four centers in Korea. A total of 602 men with LUTSs secondary to BPH were included. BPH/LUTSs cases were men aged ≥ 40 years with intemational prostate symptom scores （IPSS） ≥ 8 points. Height, weight and waist circumference were measured. Among the 602 patients, 156 patients had a waist circumference above 90 cm, representing central obesity, and 215 patients had a body mass index above 25 kg m2. Waist circumference was positively correlated with prostate volume （P = 0.034）. Men with waist circumference 〉 90 cm experienced a 1.36-fold increased risk of severe LUTSs （95% CI 0.82-2.41） compared with men with waist circumference ≤ 90 cm. Prostate volume was positively correlated with urgency and nocturia in men with central obesity. In this population of Korean men diagnosed with BPH, central obesity rather than overall obesity seems to be the more important predictor of LUTSs correlated with BPH.

Non-invasive evaluation of lower urinary tract symptoms(LUTS)in men

Lower urinary tract symptoms(LUTS)are common in males over the age of 40 years old and are likely to increase with an aging population.Currently urodynamic studies are the gold standard to determine the aetiology of voiding dysfunction and LUTS.However,due to its invasive nature,a great number of non-invasive ultrasound based investigations have been developed to assess patients with symptomatic LUTS.The clinical application of noninvasive tests could potentially stratify patients who would require more invasive investigations and allow more precise patient directed treatment.A PubMed literature review was performed and we will discuss the non-invasive investigations that have been developed thus far,focusing on bladder wall and detrusor wall thickness(BWT&DWT),ultrasound estimated bladder weight(UEBW)and intravesical prostatic protrusion(IPP).

An open, comparative, multicentre clinical study of combined oral therapy with sildenafil and doxazosin GITS for treating Chinese patients with erectile dysfunction, and lower urinary tract symptoms secondary to benign prostatic hyperplasia

This study sought to investigate the clinical efficacy and safety of combined oral therapy with sildenafil and doxazosin GITS compared to sildenafil monotherapy in treating Chinese patients with erectile dysfunction （ED） and lower urinary tract symptoms secondary to benign prostatic hyperplasia （BPH/LUTS）. The trial was conducted in hospitals in Beijing, Shanghai, Changsha, Wuhan and Guangzhou, five major cities in China. A total of 250 patients diagnosed with ED and BPH/LUTS aged 50-75 years, and who had International Index of Erection Function-5 （IIEF-5） scores ≤ 21 and International Prostate Symptom Score （IPSS） ≥ 10 points, were enrolled and randomly divided into Group A （168 cases; doxazosin GITS 4 mg once daily plus sildenafi125-100 mg on demand） and Group B （82 cases; sildenafi125-100 mg on demand）. Efficacies were evaluated by IIEF-5 and IPSS scores and a quality of life （QoL） questionnaire, and adverse effects were evaluated during the treatment period. There were no statistically significant differences in mean age, and IIEF-5, IPSS and QoL scores pre-treatment between the two groups. After treatment, IIEF-5, IPSS and QoL scores were significantly improved in Group A, while only IIEF-5 scores were significantly improved in Group B compared with pre-treatment. There were no significant differences in side effects between the two groups. The results indicated that combined therapy with sildenafil and doxazosin GITS for the treatment of ED and BPH/LUTS is safe and effective compared to sildenafil monotherapy.

Randomized clinical trial of an ethanol extract of Ganoderma lucidum in men with lower urinary tract symptoms

Aim： To evaluate the safety and efficacy of an extract of Ganoderma lucidum that shows the strongest 5α-reductase inhibitory activity among the extracts of 19 edible and medicinal mushrooms by a double-blind, placebo-controlled, randomized and dose-ranging study in men with lower urinary tract symptoms （LUTS）. Methods： In this trial, we randomly assigned 88 men over the age of 49 years who had slight-to-moderate LUTS to 12 weeks of treatment with G. lucidum extract （6 mg once a day） or placebo. The primary outcome measures were changes in the International Prostate Symptom Score （IPSS） and variables of uroflowmetry. Secondary outcome measures included changes in prostate size, residual urinary volume after voiding, laboratory values and the reported adverse effects. Results： G. lucidum was effective and significantly superior to placebo for improving total IPSS with 2.1 points decreasing at the end of treatment （mean difference, -1.18 points; 95% confidence interval, -1.74 to -0.62; P 〈 0.0001）. No changes were observed with respect to quality of life scores, peak urinary flow, mean urinary flow, residual urine, prostate volume, serum prostate-specific antigen or testosterone levels. Overall treatment was well tolerated with no severe adverse effects. Conclusion： The extract of G. lucidum was well tolerated and improved IPSS scores. These results encouraged a further, large-scale evaluation of phytotherapy for a long duration using the extract of G. lucidum on men with LUTS.

Are age, anthropometry and components of metabolic syndrome-risk factors interrelated with lower urinary tract symptoms in patients with erectile dysfunction？ A prospective study

Aim： To evaluate the effects of metabolic profiles on lower urinary tract symptoms （LUTS） in men with erectile dysfunction （ED）. Methods： A total of 75 impotent men aged 25-75 years old （mean 58.1 years） were included in the study on a prospective basis. Patients were evaluated with a complete history, physical examination, anthropometry and metabolic profiles. LUTS were assessed using the International Prostate Symptom Score （IPSS）. Results： Overall, there was no correlation between the IPSS and continuous parameters. However, when continuous variables were categorized, some parameters were significantly associated with LUTS. Patients with triglyceride level of 150 mg/dL or higher had more severe symptoms than those with tiglyceride levels less than 150 mg/dL （19.4±2.4 vs. 14.3±1.1, P = 0.033）. When 40 mg/dL was chosen as the high-density lipoprotein （HDL）-cholesterol cut-off level, the IPSS was significantly different between the two groups divided by 40 mg/dL （19.4±2.6 for HDL-cholesterol 〈 40 mg/dL vs. 14.4±1.0 for HDL-cholesterol 2 40 mg/dL, P = 0.042）. The area under the receiver operating characteristic curve （AUROCC） of triglyceride was 65.7% （95% confidence interval [CI], 52.6%-82.3%; P = 0.034） for severe LUTS. However, the AUROCC for ＇HDL-cholesterol＇ was not significant （area, 65.4%; 95% CI, 48.2%-82.7%; P = 0.062）. No other factors were determined to be significant in this regard. Conclusion： The results of the present study indicate that some metabolic profiles might influence LUTS in men with ED.

Effect of an extract of Ganoderma lucidum in men with lower urinary tract symptoms： a double-blind, placebo-controlled randomized and dose-ranging study

Aim： To conduct a double-blind, placebo-controlled randomized and dose-ranging study to evaluate the safety and efficacy of the extract of Ganoderma lucidum （G. lucidum） in men with lower urinary tract symptoms （LUTS）. Methods： We enrolled male volunteers （〉 50 years） with an International Prostate Symptom Score （IPSS; questions 1-7） 〉 5 and a prostate-specific antigen （PSA） value 〈 4 ng/mL. Volunteers were randomized into groups of placebo （n = 12）, G. lucidum of 0.6 mg （n = 12）, 6 mg （n = 12） or 60 mg （n = 14）, administered once daily. Efficacy was measured as a change from baseline in IPSS and the peak urine flow rate （Qmax）. Prostate volume and residual urine were estimated by ultrasonography, and blood tests, including PSA levels, were measured at baseline and at the end of the treatment. Results： The overall administration was well tolerated, with no major adverse effects. Statistical significances in the magnitude of changes between the experimental groups were observed at weeks 4 and 8. No changes were observed with respect to Qmax, residual urine, prostate volume or PSA levels. Conclusion： The extract of G. lucidum was well tolerated and an improvement in IPSS was observed. The recommended dose of the extract of G. lucidum is 6 mg in men with LUTS.

The effect of α-blocker therapy on erectile functions in patients with lower urinary tract symptoms due to benign prostate hyperplasia

In this study we aimed to evaluate the impact of doxazosin treatment on erectile functions in patients with lower urinary tract symptoms （LUTS） and having erectile dysfunction （ED） at baseline. Fifty-three patients with LUTS （IPSS score 〉 7） whose maximum flow rate （Qmax） 〈 15 mL s-1 and PSA 〈 4 ng dL^-1 were enrolled in the study. Patients received doxazosin 4 nag once daily for 6 weeks. Subjective efficacy was assessed by IPSS, IPSS- Quality of Life （IPSS-QoL） for LUTS and efficacy was assessed by International Index of Erectile Function （IIEF） for erectile functions at baseline and sixth weeks. The objective efficacy was assessed by Q The patients were classified according to their self reported erectile status： group I had ED and group II did not have ED. At the endpoint, doxazosin significantly improved the total IPSS score （-7.7 ±6.1, P = 0.006）, IPSS-QoL score （-1.5 ± 1.5, P = 0.024） and Qmax （3.2 ± 4.6 mL s^-1, P = 0.002） over baseline. Mean decrease in IPSS and IPSS-QoL scores after the treatment period were 6.9 ＋ 6.4 （P 〈 0.001） and 0.95 4- 1.80 （P 〈 0.05） in group I, whereas 8.2 4- 5.8 （P 〈 0.001） and 1.9 4- 1.1 in group IX （P 〈 0.001）, respectively. Mean changes of Qmax values were 2.3 4- 3.3 mL s^-1 in group I （P 〈 0.05） and 3.7 4- 5.3 mL s-1 in group II （P 〈 0.001）. The improvement of IIEF-EF scores after the treatment period was only significant for group I. The efficacy of a-blocker therapy for LUTS was better by means of symptomatic relief for patients who did not have ED when compared with patients who had ED at baseline. However, slight improvement in erectile functions with a-blocker therapy was only seen in LUTS patients with ED.

The use of antimuscarinics,phosphodiesterase type Ⅴ inhibitors and phytotherapy for lower urinary tract symptoms in men

Besides the mainstay of α-blockers and 5α-reductase inhibitors,other forms of medical therapy complete the armamentarium in the treatment of lower urinary tract symptoms(LUTS)in men.These treatments can target specific symptoms as well as associated symptoms that would affect the quality of life of the patients.Many patients are bothered by storage symptoms,more so than the voiding symptoms.Antimuscarinics are efficacious and safe,provided the patients do not have high post void residual urine.Many patients with LUTS also have erectile dysfunction,and phosphodiesterase type Ⅴ inhibitors are effective in relieving both LUTS as well as erectile dysfunction for such patients.Phytotherapy provides a popular and safe treatment for LUTS,however,the efficacy of the treatment has not been proven in well conducted prospective randomized controlled studies.

Prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: A systematic review and metaanalysis

BACKGROUND Prostate artery embolization(PAE)is a promising minimally invasive therapy that improves lower urinary tract symptoms(LUTS)related to benign prostatic hyperplasia(BPH).Transurethral resection of the prostate(TURP)is the gold standard therapy for LUTS/BPH.AIM To evaluate the efficacy and safety of PAE vs TURP on LUTS related to BPH.METHODS A literature review was performed to identify all published articles on PAE vs TURP for LUTS/BPH.Sources included PubMed,Embase,Cochrane library databases,and Chinese databases before June 2022.A systematic review and meta-analysis were conducted.Outcome measurements were combined by calculating the mean difference with a 95%confidence interval.Statistical analysis was carried out using Review Manager 5.3.RESULTS Eleven studies involving 1070 participants were included.Compared with the TURP group,the PAE group had a similar effect on the International Index of Erectile Function(IPSS)score,Peak urinary flow rate(Qmax),postvoid residual volume(PVR),Prostate volume(PV),prostatic specific antigen(PSA),The International Index of Erectile Function short form(IIEF-5)scores,and erectile dysfunction during 24 mo follow-up.Lower quality of life(QoL)score,lower rate of retrograde ejaculation and shorter hospital stay in the PAE group.There was no participant death in either group.A higher proportion of haematuria,urinary incontinence and urinary stricture was identified in the TURP group.CONCLUSION PAE may be an appropriate option for elderly patients,patients who are not candidates for surgery,and patients who do not want to risk the potential adverse effects of TURP.Studies with large cases and long follow-up time are needed to validate results.

Beyond prostate, beyond surgery and beyond urology: The “3Bs” of managing non-neurogenic male lower urinary tract symptoms

Lower urinary tract symptoms(LUTS),consisting storage,voiding and postmicturition symptoms,is a comprehensive definition involving symptoms that may occur due to several causes.Instead of simply focusing on the enlarged prostate,more attention has to be paid to the entire urinary tract as well as multiple system comorbidities.Therefore,prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required.Based on current literature,this paper proposes the“3Bs”concept for managing non-neurogenic male LUTS,namely,“beyond prostate”,“beyond surgery”and“beyond urology”.The clinical application of the“3Bs”enables urologists to carry out integrated,individualized and precise medical care for each non-neurogenic male LUTS patient.

Association of Increased Urine Brain Derived Neurotrophic Factor with Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia

Urinary brain-derived neurotrophic factor（BDNF）, an ubiquitous neurotrophin, was found to rise in patients with benign prostatic hyperplasia（BPH）. We hypothesized that the urinary level of BDNF could be a potential biomarker for lower urinary tract symptoms（LUTS） in patients with BPH. Totally, 76 patients with BPH-caused LUTS and 32 male control subjects without BPH were enrolled. International Prostate Symptom Score（IPSS） was applied to assess the symptom severity of LUTS. Urodynamic tests were performed for the diagnosis of underlying detrusor overactivity（DO） in the patients with BPH. Urine samples were collected from all subjects. Urinary BDNF levels were measured using enzyme-linked immunosorbent assays and normalized by urinary creatinine（Cr） levels. Seventy-six BPH patients were divided into moderate LUTS group（n=51, 720） according to the IPSS. Of the 76 BPH patients, DO was present in 34（44.7%） according to the urodynamic test. The urinary BDNF/Cr levels were significantly higher in BPH patients with moderate LUTS（8.29±3.635, P〈0.0001） and severe LUTS（11.8±6.44, P〈0.0001） than normal controls（1.71±0.555）. Patients with severe LUTS tended to have higher urinary BDNF/Cr levels than patients with moderate LUTS（11.8±6.44 vs. 8.29±3.635, P=0.000）. The conditions of BPH with LUTS correlated with elevated urinary BDNF levels, and urinary BDNF levels were even higher in BPH-DO patients. The results of this study have provided evidence to suggest that urinary BDNF level test could evaluate the severity of LUTS in BPH patients, and BDNF level can be used as a biomarker

Effect of self-management on lower urinary tract symptoms and life quality of benign prostatic hyperplasia patients

Objective To evaluate the efficacy of self-management to improve the lower urinary tract symptoms ( LUTS) and life quality in benign prostatic

Association of symptomatic late-onset hypogonadism and lower urinary tract symptoms in aging males: a community-based study

Objective:Testosterone deficiency may be a risk factor for lower urinary tract symptoms(LUTS),and there may be a causal ink between the emergence of LUTS and the incidence of late-onset hypogonadism(LOH).We perfomed an epidemiologic study to investigate the association between symptomatic late-onset hypogonadism(SLOH)and LUTS in middle-aged and elderly rural Chinese males.Methods:A total of 965 men completed a questionnaire and underwent a detailed physical examination.The Aging Males'Symptoms(AMS)scale was used to assess SLOH,and the International Prostate Symptom Score(IPSS)questionnaire was used to assess LUTS.Serum reproductive hormone levels of testosterone,sex hormone-binding globulin(SHBG)and luteinizing hormone(LH)were measured.Results:A total of 965 males(mean age:56.34±8.85,range:40-80 years)were recruited for the present study.A total of 20.93%(202/965)were diagnosed with SLOH.A total of 93.16%(899/965)had mild LUTS,5.18%(50/965)had moderate LUTS,and 1.66%(16/965)had severe LUTS.Among SLOH patients,13.40%(27/202)and 3.90%(8/202)had moderate and severe LUTS,respectively.Patients with severe LUTS had increased SHBG and LH compared with those with mild and moderate LUTS(P<0.01).Correlation analysis revealed that the AMS total score was positively correlated with the IPSS score(P<0.05).The prevalence of SLOH was significantly increased with LUTS severity In addition to the known effect of age,the results of mutiple regression analysis also showed that serum LH or SHBG appeared to have a weak link with SLOH and LUTS that requires etiological and biological clarification in our future study.Conclusion:In this cross-sectional analysis of SLOH and LUTS,LUTS severity was significantly associated with hypogonadism symptoms.Additionally,the prevalence of SLOH advanced with increasing LUTS severity.Serum SHBG or LH showed a positive correlation with SLOH and LUTS.

Prostatic Arterial Embolization with Small Sized Particles for the Treatment of Lower Urinary Tract Symptoms Due to Large Benign Prostatic Hyperplasia： Preliminary Results

Background：The clinical failure after prostatic artery embolization （PAE） with conventional particles was relatively high,in treatment for lower urinary tract symptoms （LUTS） due to benign prostatic hyperplasia （BPH）.We reported the results of PAE with combined polyvinyl alcohol particles 50 μm and 100 μm in size as a primary treatment in 24 patients with severe LUTS secondary to large BPH.Methods：From July 2012 to June 2014,we performed PAE in 24 patients （65-85 years,mean 74.5 years） with severe LUTS due to large BPH （≥80 cm^3） and refractory to medical therapy.Embolization was performed using combination of 50 μm and 100 μm in particles size.Clinical follow-up was performed using the International Prostate Symptom Score （IPSS）,quality of life （QoL）,peak urinary floW （Qmax）,postvoid residual （PVR） volume,the International Index of Erectile Function （IIEF）,prostatic specific antigen （PSA）,and prostatic volume measured by magnetic resonance imaging at 1,3,6,and every 6-month thereafter.Technical success was defined when PAE was completed in at least one pelvic side.Clinical success was defined as the improvement of both symptoms and QoL.A Student＇s t-test for paired samples was used.Results：PAE was technically successful in 22 patients （92%）.Bilateral PAE was performed in 19 （86%） patients and unilateral in 3 （14%） patients.Follow-up data were available for 22 patients observed for mean of 14 months.The clinical improvement at 1,3,6,and 12-month was 91%,91%,88%,and 83%,respectively.At 6-month follow-up,the mean IPSS,QoL,PVR,and Qmax were from 27 to 8 （P =0.001）,from 4.5 to 2.0 （P =0.002）,from 140.0 ml to 55.0 ml （P =0.002）,and from 6.0 ml/s to 13.0 ml/s （P =0.001）,respectively.The mean prostate volume decreased from 110 cm3 to 67.0 cm3 （mean reduction of 39.1%;P =0.00 1）.The PSA and IIEF improvements after PAE did not differ from pre-PAE significantly.No major adverse events were noted.Conclusions：The combination of 50μm and 100 μm particles for PAE is a safe and effective treatment method for patients with severe LUTS due to large BPH,which further improves the clinical results of PAE.

Efficacy and safety of combined therapy with terazosin and tolteradine for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia:a prospective study

Background The primary objectives of the treatment for the lower urinary tract symptoms （LUTS） associated with benign prostatic hyperplasia （BPH） are to produce rapid, sustained, and safe improvements in the symptoms that affect the quality of life in the majority of men over 50. In this study, we evaluated the efficacy and safety of the combined therapy with terazosin （α1-adrenergic receptor antagonist） and tolterodine （anticholinergic agent） for LUTS associated with BPH. Methods This combination study included 69 patients diagnosed with LUTS associated with BPH based on the International Prostate Symptom Scores （IPSS）, urinary flow rate, prostate volume, urinary residual, and their serum prostate-specific antigen levels. Initially, 191 patients were treated with terazosin 2 mg once daily for one week. Those patients with continued LUTS after the initial treatment were allocated randomly into two groups： terazosin group （n=-36） in which patients were treated with terazosin 2 mg once daily for six weeks, and combination group （n=33） in which patients were treated with both terazosin 2 mg once daily and tolterodine 2 mg twice daily for 6 weeks. Results The IPSS were significantly improved in both groups after treatment, and the reduction of IPSS in the combination group was significantly greater than that in the terazosin group （P〈0.01）. A decrease in urgency, frequency and nocturia were the main contributory factors causing the reduction of IPSS in the combination group. The differences about the peak urinary flow rate and the residual urine from the baseline values were noted in both groups after treatment but were not significant between the two groups. The incidence of adverse effects in the combination group was higher than that in the terazosin group. As expected the most common adverse effect was mouth dryness which was associated with anticholinergic drugs such as tolterodine. Conclusions Patients with LUTS associated BPH appear the improved IPSS after combined therapy with terazosin and tolterodine. This study, although short term and limited numbers of patients, provides evidence that the combined therapy with terazosin plus tolterodine is a good approach for meeting the objectives of rapid, sustained, and safe improvements in the LUTS associated with BPH. And the profile of patients in this study might be used as the indication of such combined therapy for LUTS associated with BPH without urodynamic evaluation.