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.

Endoscopic full-thickness plication along with argon plasma coagulation for treatment of proton pump inhibitor dependent gastroesophageal reflux disease

BACKGROUND Most endoscopic anti-reflux interventions for gastroesophageal reflux disease(GERD)management are technically challenging to practice with inadequate data to support it utility.Therefore,this study was carried to evaluate the effectiveness and safety newer endoscopic full-thickness fundoplication(EFTP)device along with Argon Plasma Coagulation to treat individuals with GERD.AIM To evaluate the effectiveness and safety newer EFTP device along with Argon Plasma Coagulation to treat individuals with GERD.METHODS This study was a single-center comparative analysis conducted on patients treated at a Noble Institute of Gastroenterology,Ahmedabad,hospital between 2020 and 2022.The research aimed to retrospectively analyze patient data on GERD symptoms and proton pump inhibitor(PPI)dependence who underwent EFTP using the GERD-X system along with argon plasma coagulation(APC).The primary endpoint was the mean change in the total gastroesophageal reflux disease health-related quality of life(GERD-HRQL)score compared to the baseline measurement at the 3-month follow-up.Secondary endpoints encompassed enhancements in the overall GERD-HRQL score,improvements in GERD symptom scores at the 3 and changes in PPI usage at the 3 and 12-month time points.RESULTS In this study,patients most were in Hill Class II,and over half had ineffective esophageal motility.Following the EFTP procedure,there were significant improvements in heartburn and regurgitation scores,as well as GERDHRQL scores(P<0.001).PPI use significantly decreased,with 82.6%not needing PPIs or prokinetics at end of 1 year.No significant adverse events related to the procedures were observed in either group.CONCLUSION The EFTP along with APC procedure shows promise in addressing GERD symptoms and improving patients'quality of life,particularly for suitable candidates.Moreover,the application of a lone clip with APC yielded superior outcomes and exhibited greater cost-effectiveness.

The Self-Administered International Prostate Symptoms Score (IPSS) Questionnaire of Kosovo Men with Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) has been a major health problem for aging males because of its related symptoms and complications. Although it is not a life-threatening condition, BPH has an adverse effect on a patient’s quality of life, as manifested in community and clinical trials. Aim: The aim of the study was the perception of patients in their symptomatology by comparing the place of residence and quality of life in living with HBP using the IPSS questionnaire. Materials and Methods: This was a prospectively designed study conducted at University Clinical Centre of Kosovo—Urology Clinic. The study was conducted from October 2020 to January 2021. The study in criteria was as follows: all patients who presented to the urology outpatient clinic with BPH, Lower Urinary Tract Symptoms (LUTS) and aged > 40 years. The exclusion criteria included the following cases: patients with uncontrolled diabetes (prostate-specific antigen > 4 ng/dL);patients with a history of transurethral resection of the prostate. Results: This study was carried out on 100 consecutive patients with HBP and LUTS attending. The largest proportion of patients 51% was in the 46 - 55 age group. Most patients were between 45 - 65 years of 51%. The largest number of them (52%) was with severe symptoms and 41% of them were with moderate symptoms. Comparing the three levels of IPSS and the quality of life of patients with HBP and LUTS, when asked how they would feel if they still had problems with urination, 22% said they felt upset, analyzing the categorization of patients according to IPSS: mild symptoms were Mean/SD (1.71. ± 1.113), moderate symptoms (2.9 ± 1.49) and severe symptoms (4.31 ± 1.27) p < 0.156. Statistical reliability of 64% p < 0.000 was in patients where they were interested in learning about any invasive option that would allow them to discontinue medication for LUTS. Conclusion: The IPSS is a valid instrument to assess the impact of BPH symptoms on health and quality of life due to urinary symptoms.

Psychological Nursing Combined with Biofeedback to Promote the Rehabilitation of Patients with Anxiety Disorders

Objective:To explore the effect of psychological nursing combined with biofeedback on the rehabilitation of patients with anxiety disorders.Methods:100 patients with anxiety disorders in our hospital from January to December 2021 were randomly divided into two groups:control group(n=50)and study group(n=50).The control group was given routine nursing,while the study group was given psychological nursing combined with biofeedback.The changes of self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,symptom score,and quality of life of the two groups were compared before and after nursing.Results:Before nursing,there was no significant difference in the scores of SAS and SDS between the two groups,but after nursing,the scores of SAS and SDS in the study group were lower than those in the control group,and the degree of improvement in the study group was higher than that of the control group.Before nursing,there was no significant difference in the scores of symptoms between the two groups(P>0.05),but after nursing,the scores of stress,crying spells,tremor,and general discomfort in the study group were lower than those of the control group(P<0.05).Besides,before nursing,there was no significant difference in the quality of life between the two groups(P>0.05),but after nursing,the scores of physical function,psychological activity,social ability,and material life in the study group were higher than those in the control group(P<0.05).Moreover,the degree of improvement after nursing in the study group was better than that of the control group.Conclusion:Psychological nursing combined with biofeedback to promote the rehabilitation of patients with anxiety disorders effectively improves the negative emotion of patients,reduces stress,depression,tremor,and general discomfort,and improve the overall quality of life.Therefore,it is worth further popularization.

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.

Is there a correlation between the outcome of transurethral resection of prostate and preoperative degree of bladder outlet obstruction？

To compare the impact of transurethral resection of prostate （TURP） on symptom scores and maximal flow rates （Qmax） in patients with equivocal bladder outlet obstruction （BOO） and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index （BOO1） greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score （IPSS）, uroflowmetry, post-void residual volume （PVR） check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive （IPSSO） and irritative （IPSSI） subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients＇ symptoms should be considered in deciding treatment modality.

Difference in symptom manifestation between postmenopausal and premenopausal women in acute uncomplicated cystitis:A multi-institutional pilot study

Objectives:We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy.Materials and methods:This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020.After registration,we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score(CLSS)questionnaire.Results:After treatment,pyuria disappeared in 60 of the 66 patients(14 premenopausal and 46 postmenopausal).The CLSS total score(range)changed from 13(3-29)to 4(0-18)with a significant improvement in all CLSS items.At baseline,nocturia,urgency,and urgency incontinence were more prominent in postmenopausal women than in premenopausal women.In contrast,baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women.After treatment,the CLSS total score was still higher in postmenopausal women,as reflected by the relatively higher scores for nocturia and urgency,irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups.Conclusions:Our results suggest that if storage symptoms persist,they should be carefully interpreted according to menopausal status.

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

Eye reflux:an ocular extraesophageal manifestation of gastric reflux

AIM： To suspect laryngopharyngeal reflux（LPR） in patients with ocular surface disease（OSD）. METHODS： The present study evaluated a group of subjects with OSD assessing the Ocular Surface Disease Index（OSDI） and the Reflux Symptom Index（RSI） to detect patients with suspected LPR and define a possible relationship between tests.RESULTS： Two hundred and ninety subjects（175 females, mean age： 60.41±15.68y） were consecutively visited at ophthalmologist offices. One hundred and one（34%） patients had pathological RSI（〉13） and consequently a suspected LPR.CONCLUSION： The current study shows that suspected LPR may be common（34%） in patients with OSD and a suspected LPR may be considered in OSD patients when RSI score is 〉13 and OSDI score is 〉42.

Menorrhagia and Uterine Volume Associated with Lower Urinary Tract Symptoms in Patients with Adenomyosis

Background： Adenomyosis is a gynecological disorder with symptoms most presenting as dysmenorrhea and heavy menstrual bleeding. However, the presence of lower urinary tract symptoms （LUTS） among women with adenomyosis remains unclear. This study was designed to determine the prevalence of LUTS and factors related to the severity of these symptoms in this population. Methods： From July 2016 to November 2016, a total of 298 untreated symptomatic adenomyosis patients and 280 age-matched controls were enrolled. Demographics, LUTS, pain symptoms, ultrasouographic uterine size, and serum CA125 level were recorded. LUTS were evaluated using the International Prostate Symptom Score （IPSS） questionnaire. Factors related to the severity of LUTS were detected using the logistic regression analysis presented as odds ratio （OR） and 95% confidence interval （CI）. Results： Compared with the control group, patients with adenomyosis had a greater IPSS total （4 [2-8] vs. 2 [0-3], Z = -8.159, P 〈 0.001 ）, IPSS storage （2 [1-4] vs. [[0 2], Z = -7.361 [P 〈 0.001）, and I PSS voiding （2 [0-4] vs. 0 [0-1], Z = -7.[94, P 〈 0.001）. Of the patients with adenomyosis, 30.2% had moderate-to-severe lower urinary tract symptoms （IPSS 〉8）. The most prevalent LUTS were daytime frequency （40.9%）, lbllowed by nocturia （24.8%）, weak stream （24.2%）, and incomplete emptying （23.5%）. In study group, patients with an IPSS total score ≥8 had higher proportion of menorrhagia （51.1% vs. 30.8%, χ2 = 11. 162 P = 0.025） and larger uterine volumes （183.3 [109.8-273.8] cm3 vs. 148.5 [96.4-262.7] cm3, Z=- 1.441, P = 0.150） compared to patients with an IPSS total score 〈8. On multivariate logistic regression analysis, patients with menorrhagia were associated with an increased risk of an IPSS total score 〉8 （OR： 2.309, 95% CI： 1.310-4.070, P= 0.004）, an IPSS storage subscore 〉4 （OR： 2.422, 95% CI： 1.395-4.206, P= 0.002）, and an IPSS voiding subscore 〉5 （OR： 1.971, 95% （CI： 1.176-3.302, p= 0.010）. However, patients with uterine volume more than 180 cm3 had more than 2-fold risk of bearing IPSS total score ≥8 （OR： 2.437, 95% CI： 1.381-4.300, P = 0.002）, 1PSS storage subscore 〉4 （OR： 2.486, 95% CI： 1.433-4.314, P =0.001）, and IPSS voiding subscore ≥5 （OR： 2.700, 95% （CI： 1.485-4.908, P=0.001）. Conclusions： Lower urinary tract synaptoms are prevalent in patients with symptomatic adenomyosis and greatly affect patients＇ quality of life. Menorrhagia and large uterine volume could be potential risk factors that increase the occurrence of moderate-to-severe LUTS.

Overactive bladder symptom score to evaluate efficacy of solifenacin for the treatment of overactive bladder symptoms

Background Overactive bladder （OAB） is a series of symptoms with high prevalence in elderly people.This study was conducted using the overactive bladder symptom score （OABSS） to evaluate the efficacy of solifenacin succinate for the treatment of OAB.Methods This was a prospective,multicenter,single-arm,12-week study that enrolled 241 OAB patients.The patients received 5-10 mg/day solifenacin.Changes in OABSS,symptoms from voiding diary,perception of bladder condition （PPBC） score,international prostate symptom score （IPSS） and quality of life （QOL） were evaluated at weeks 0,4,and 12.The relationship between OABSS and PPBC score or parameters of voiding diary was also evaluated.Results At baseline,the mean OABSS for all patients was 9.41±2.40,and was reduced significantly at week 12 （-3.76 points; 61.21％,P ＜0.0001）.The OABSS subscore,PPBC score,IPSS,and QOL were also significantly reduced during the study （P ＜0.0001）.The overall incidence of adverse events was 19.91％ （44 cases）.The gastrointestinal system was the most commonly affected （11.31％）.Around 5.88％ of the cases had adverse events related to the genitourinary system.There was a strong correlation between OABSS and urinary symptoms that was recorded in the 3-day voiding dairy.Conclusions We showed that solifenacin was clinically effective for relieving OAB symptoms,considering the balance between efficacy,patients＇ well-being,and tolerability.OABSS integrates four OAB symptoms into a single score and can be a useful tool for research and clinical practice.

Relationship between lower urinary tract symptoms and objective measures of benign prostatic hyperplasia： a Chinese survey

Background The enlarged prostate leads to obstruction and lower urinary tract symptoms （LUTS）, which comprise frequency, urgency, weak stream, straining and nocturia. This study was conducted in a large series of patients to evaluate the relationship between LUTS as stipulated in the International Prostate Symptom Score （IPSS） and the objective parameters related to benign prostatic hyperplasia （BPH）.Methods We enrolled 1295 BPH patients from seven centers. The patients were either at first diagnosis of BPH or had discontinued medical treatment for at least 3 months. Those with several other diseases that may be potential risk factors affecting urinary symptoms were excluded from the study. Age, IPSS, prostate volume, peak flow rate, urine volume and post-voiding residual urine volume were measured. The relationship between IPSS and objective parameters were quantified by means of Spearman correlation coefficients. The differences in these parameters between the groups with mild, moderate or severe symptoms were also evaluated.Results Statistically significant correlations were found between IPSS and objective parameters by means of Spearman correlation coefficients. When the patients were divided into three groups with different severities of symptoms, there were significant differences in peak flow rate, urine volume, prostate volume, residue urine volume and quality of life, whereas average age and prostate-specific antigen levels were similar. However, there was evident overlap of these parameters between the groups. The same results were found when the irritative or obstructive subscore of IPSS was considered. Conclusions The correlation between objective parameters of BPH and LUTS is significant. However, it is hard to predict the severity of symptoms by these parameters.

The epidemiology of anal incontinence and symptom severity scoring

For many patients,anal incontinence(AI)is a devastating condition that can lead to social isolation and loss of independence,contributing to a substantial economic health burden,not only for the individual but also for the allocation of healthcare resources.Its prevalence is underestimated because of poor patient reporting,with many unrecorded but symptomatic cases residing in nursing homes.Endosonography has improved our understanding of the incidence of post-obstetric sphincter tears that are potentially suitable for repair and those cases resulting from anorectal surgery,most notably after fistula and hemorrhoid operations.The clinical scoring systems assessing the severity of AI are discussed in this review,along with their limitations.Improvements in the standardization of these scales will advance our understanding of treatment response in an era where the therapeutic options have multiplied and will permit a better comparison between specific therapies.

Clinical Observation of the Hot and Humid Compress Therapy of Traditional Chinese Medicine in the Treatment of Qi Stagnation and Blood Stasis Type of Lumbar Disc Herniation

Background: Although a number of studies have reported that the hot and humid compress from traditional Chinese medicine (TCM) is effective in treating lumbar disc herniation (LDH) with qi stagnation and blood stasis, clinical evidence is limited. Objective: The purpose of this study is to provide high-quality evidence to support the effectiveness of the traditional Chinese hot and humid compress in the treatment of LDH with qi stagnation and blood stasis. Methods: From October 2021 to November 2023, 86 patients with LDH of qi stagnation and blood stasis type were recruited in our hospital and divided into a control (n = 43) and an observation group (n = 43) according to the random number table method. The control group was given routine clinical treatment, and the observation group was treated with the hot and humid compress therapy for two weeks. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, TCM syndrome score, serum interleukin-6 (IL-6), serum interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were observed and compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated. Results: After treatment, the VAS score, TCM symptom score, and serum IL-6, IL-1β, and TNF-α levels decreased in both groups (P P P P P Conclusions: The hot and humid compress of traditional Chinese medicine can effectively relieve pain, restore lumbar function, improve TCM syndromes, reduce the level of inflammatory factors, and have a curative effect in treating LDH.