OBJECTIVETo analyze the parameters of urodynamic tests for patients with type-III B prostatitis and evaluate the significance of the results of urodynamic tests in the choice of therapies for this disease.

METHODSUrodynamic tests were performed for 87 type-III B prostatitis patients aged 22-45 (30.7 ± 8.5) years, who had moderate or severe lower urinary tract symptoms (LUTS) and failed to respond to routine therapy. Different treatments were administered according to the results of urodynamic tests followed by observation of the therapeutic effects.

RESULTSUrodynamic abnormalities were found in 70 of the 87 patients, bladder outlet obstruction in 28 (32.2%), detrusor overactivity in 25 (28.7%), bladder hyperesthesia in 18 (20.7%), low compliance in 10 (11.5%), detrusor-external urethral sphincter dyssynergia in 1 (1.1%), and impaired detrusor contractile function in 1 (1.1%). Treatments achieved obvious effectiveness in 26 cases (29.9%), effectiveness in 51 (58.6%), and no effectiveness in 10 (11.5%).

CONCLUSIONUrodynamic tests contribute significantly to the choice of therapies for type-III B prostatitis patients with moderate or severe LUTS.

Adult ; Humans ; Lower Urinary Tract Symptoms ; physiopathology ; therapy ; Male ; Middle Aged ; Prostatitis ; physiopathology ; therapy ; Urethra ; physiopathology ; Urinary Bladder Neck Obstruction ; physiopathology ; Urinary Bladder, Overactive ; physiopathology ; Urodynamics

We aimed to develop and validate a clinical nomogram predicting bladder outlet obstruction (BOO) solely using routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms (LUTS). A total of 750 eligible patients ≥50 years of age who had previously not responded (International Prostate Symptom Score [IPSS] improvement <4 points) to at least three different kinds of LUTS medications (including a-blocker) for the last 6 months were evaluated as subcohorts for nomogram development (n = 570) and for split-sample validation (n = 180). BOO was defined as Abrams-Griffiths number ≥40, or 20-39.9 with a slope of linear passive urethral resistance ratio >2 cmH₂O ml^-1 s^-1. A stepwise multivariable logistic regression analysis was conducted to determine the predictors of BOO, and b-coefficients of the final model were selected to create a clinical nomogram. The final multivariable logistic regression model showed that age, IPSS, maximum urinary flow rate, postvoid residual volume, total prostate volume, and transitional zone index were significant for predicting BOO; these candidates were used to develop the final nomogram. The discrimination performance of the nomogram was 88.3% (95% CI: 82.7%-93.0%, P < 0.001), and the nomogram was reasonably well-fitted to the ideal line of the calibration plot. Independent split-sample validation revealed 80.9% (95% CI: 75.5%-84.4%, P < 0.001) accuracy. The proposed BOO nomogram based solely on routine clinical parameters was accurate and validated properly. This nomogram may be useful in determining further treatment, primarily focused on prostatic surgery for BOO, without impeding the detection of possible BOO in men with LUTS that is refractory to empirical medications.
Adult ; Aged ; Cohort Studies ; Humans ; Lower Urinary Tract Symptoms/physiopathology* ; Male ; Middle Aged ; Nomograms ; Prostate/pathology* ; ROC Curve ; Reproducibility of Results ; Retrospective Studies ; Urinary Bladder Neck Obstruction/physiopathology* ; Urodynamics

OBJECTIVETo explore the correlation between single acupoints used and the recurrence rate of cystitis among cystitis-prone women receiving acupuncture as a prophylactic treatment.

METHODSIn all, 58 cystitis-prone women were included in the analysis. Customised acupuncture treatments were given twice a week, over 4 weeks. The main effect parameter was the number of cystitis episodes during the 6-month observation time. Residual urine was measured at baseline, 2, 4 and 6 months using portable ultrasound equipment. Sympathetic and vagotone nerve activities were measured by using skin conductance and respiratory sinus arrhythmia, respectively.

RESULTSThe main acupoints used for patients with Kidney (Shen) qi/yang deficiency were Shenshu (BL23), Taixi (KI3), Zhongji (CV3), Sanyinjiao (SP6) and Pangguangshu (BL28), compared with Taichong (LR3), CV3, BL28, Yinlingquan (SP9) and SP6 for Liver (Gan) qi stagnation, and SP6, CV3, BL28, Zusanli (ST36) and SP9 for Spleen (Pi) qi/yang deficiency patients. The combination BL23 and KI3 were used in 16 women, 13 of which were Kidney pattern related patients. When used, the number of symptomatic episodes were reduced to a third compared with what occurred in the 42 women where this combination was not used (3/16 vs. 28/42, P<0.05). BL23 application correlated to a significant reduction in residual urine measured a few days after treatment. Patients with the pattern of Spleen qi/yang deficiency had an initial increase in residual urine after treatments.

CONCLUSIONTreating Kidney pattern related patients with the combination of BL23 and KI3 resulted in far better outcome than other points/combination of points for other Chinese medicine diagnoses. The acupoint SP6 may be less indicated than previously assumed when treating cystitis-prone women prophylactically.

Acupuncture Points ; Acupuncture Therapy ; Cystitis ; physiopathology ; prevention & control ; therapy ; urine ; Female ; Humans ; Recurrence ; Syndrome ; Urinary Tract Infections ; physiopathology ; prevention & control ; therapy ; urine ; Vagus Nerve ; physiopathology

Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction.
Activities of Daily Living ; Aged ; *Aging/physiology/psychology ; Disease Management ; Female ; Humans ; Male ; Prevalence ; *Quality of Life ; Urinary Tract/*physiopathology ; *Urologic Diseases/classification/epidemiology/etiology/physiopathology/psychology/therapy

This study aimed to investigate perceived ejaculatory function/satisfaction before treatment for lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and to identify associations between specific categories of ejaculatory dysfunctions (EjDs) and LUTS. A total of 1574 treatment-naïve men with LUTS/BPH were included in this study. All patients underwent routine evaluation for LUTS/BPH including the International Index of Erectile Function and a 5-item questionnaire developed to assess ejaculatory volume/force/pain/satisfaction/latency time. Patients who had sexual intercourse over the past 4 weeks were classified as sexually active group. A total of 783 patients were categorized as sexually active group. Decreased ejaculatory volume and force were reported by 53.4% and 55.7% of 783 sexually active men, respectively. There was a strong correlation between ejaculatory volume and force. Ejaculatory pain/discomfort, premature ejaculation (PE), and delayed ejaculation (DE) were reported in 41.0%, 16.3%, and 41.4% of the patients, respectively. Over 40.0% of men without decreased ejaculation volume/force were satisfied with ejaculatory function, whereas approximately 6.0% of men with decreased volume/force were satisfied with ejaculatory function. About 30.0% of men with decreased volume/force had orgasmic dysfunction, while approximately 10.0% of men without decreased volume/force did. Decreased ejaculatory volume or force was associated with LUTS severity after adjusting for other influential factors including testosterone level, erectile function, and prostate size on ultrasonography, but PE or DE or ejaculatory pain/discomfort was not. In conclusion, a considerable portion of men with LUTS/BPH appear to have a variety of EjDs. Ejaculatory volume/force and satisfaction/orgasm do not always appear to be concordant. Ejaculatory volume or force is independently associated with LUTS severity, whereas PE or DE or ejaculatory pain/discomfort is not.
Aged ; Coitus ; Ejaculation ; Humans ; Lower Urinary Tract Symptoms/physiopathology* ; Male ; Middle Aged ; Orgasm ; Pain/etiology* ; Personal Satisfaction ; Premature Ejaculation/physiopathology* ; Prostate/diagnostic imaging* ; Prostatic Hyperplasia/physiopathology* ; Sexual Dysfunction, Physiological/physiopathology* ; Surveys and Questionnaires ; Testosterone/blood*

Ketamine is a short-acting anaesthetic agent that has gained popularity as a 'club drug' due to its hallucinogenic effects. Substance abuse should be considered in young adult patients who present with severe debilitating symptoms such as lower urinary tract symptoms, even though the use of controlled substances is rare in Singapore. Although the natural history of disease varies from person to person, a relationship between symptom severity and frequency/dosage of abuse has been established. It is important to be aware of this condition and have a high degree of clinical suspicion to enable early diagnosis and immediate initiation of multidisciplinary and holistic treatment. A delayed diagnosis can lead to irreversible pathological changes and increased morbidity among ketamine abusers.
Adult ; Cystitis ; drug therapy ; Cystoscopy ; Female ; Fluoroscopy ; Humans ; Ketamine ; adverse effects ; Lower Urinary Tract Symptoms ; chemically induced ; Male ; Singapore ; Substance-Related Disorders ; complications ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Tract ; drug effects ; physiopathology ; Young Adult

OBJECTIVETo investigate the incidence of erectile dysfunction (ED) in men with lower urinary tract symptoms (LUTS) and the correlation between LUTS and ED.

METHODSWe enrolled 1 000 men aged 40 - 80 years with regular sex partners, evaluated their erectile function using IIEF-5, and investigated LUTS among them by International Prostate Symptom Score (IPSS). We studied the relationship between ED and LUTS by univariate conditional Logistic regression analysis.

RESULTSLUTS were found in 42.81% of the men investigated (426/995), and ED in 76.18% of the subjects (758/995) and 82.16% of those with LUTS (350/426). Logistic regression analysis revealed a significant relation of ED with aging and LUTS (P < 0.01).

CONCLUSIONThe The incidence of ED is high in men with LUTS and increases with aging and the severity of LUTS.

Adult ; Aged ; Aged, 80 and over ; Erectile Dysfunction ; epidemiology ; physiopathology ; Humans ; Lower Urinary Tract Symptoms ; epidemiology ; Male ; Middle Aged ; Penile Erection ; Prevalence ; Risk Factors

INTRODUCTIONWe prospectively evaluated the staging of benign prostate hyperplasia (BPH) to decide transurethral resection of prostate (TURP) therapeutic modality and the final outcomes in patients with lower urinary tract symptoms (LUTS) suggestive of BPH.

MATERIALS AND METHODSMale patients above 50 years old presented with LUTS suggestive of BPH were included in this study. The initial assessment included the International Prostatic Symptoms Score (IPSS) and the Quality of Life (QOL) index, digital rectal examination (DRE). Transabdominal ultrasound was done to measure the prostate volume, intravesical prostatic protrusion (IPP) and the post void residual (PVR) urine. BPH was classified according to the degree of IPP using grades 1 to 3. The staging of BPH was performed according to the presence or absence of bothersome symptoms (QOL ≥3) and significant obstruction (PVR >100ml). Patients with stage I BPH with no bothersome symptoms and no significant obstruction were generally observed. Those with stage II BPH, bothersome symptoms but no significant obstruction, received pharmacotherapy in the first instance, and were offered TURP if symptoms persisted or worsened. Patients with significant obstruction, persistent PVR >100ml, irrespective of symptoms would be classified as stage III, and were advised to undergo TURP as an option. Lastly, those with stage IV (complications of BPH) were strongly recommended to undergo TURP.

RESULTSA total of 408 patients were recruited in this study and after a mean follow-up of 30 months (range, 6 to 84), 96 (24%) eventually had TURP. Sixteen (13%), 50 (21%), 28 (64%) and 2 (100%) patients who underwent TURP were initially diagnosed as stage I, II, III and IV, respectively. Eighty-seven (91%) of the 96 patients significantly improved to stage I BPH post TURP.

CONCLUSIONSThese results showed that the staging of BPH can assist in the tailoring of treatment for patients with LUTS suggestive of BPH, with good outcome in 91% post TURP.

Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prostatic Hyperplasia ; classification ; diagnostic imaging ; physiopathology ; surgery ; Quality of Life ; Transurethral Resection of Prostate ; Ultrasonography ; Urinary Tract Infections ; etiology

AIMTo describe an unusual symptom of benign prostatic hyperplasia (BPH).

METHODSA patient presented to our urology clinic having experienced post-coital gross hematuria for 2 years. He had not experienced lower urinary tract symptoms (LUTS). A series of examinations were performed to determine the source of bleeding.

RESULTSThe prostate was defined as the active bleeding source responsible for the patient's post-coital hematuria. Endoscopic fulguration did not alleviate the symptom. The use of dutasteride, a dual inhibitor of 5alpha-reductase, solved the problem.

CONCLUSIONThis study reports for the first time that post-coital gross hematuria is one of the clinical presentations of BPH, which can be successfully treated with 5alpha-reductase inhibitor.

5-alpha Reductase Inhibitors ; Azasteroids ; therapeutic use ; Coitus ; physiology ; Dutasteride ; Enzyme Inhibitors ; therapeutic use ; Hematuria ; drug therapy ; etiology ; physiopathology ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; diagnosis ; physiopathology ; Urinary Tract

INTRODUCTIONUrinary tract infections remain one of the most frequently encountered acquired complications in an intensive care unit (ICU). The objective of this study was to determine the incidence, risk factors, microbial sensitivity patterns, and clinical outcomes of patients with UTIs acquired during their admission to an ICU in an acute care hospital in Singapore.

MATERIALS AND METHODSThis was a 14-week prospective study. All ICU patients > or =18 years who remained in the ICU for > or =48 hours were eligible for this study. Patients were reviewed daily and the presence of an ICU-acquired UTI was identified via urinary microscopic examination or culture results. Other data collected included patient demographics, ICU admission criteria, concomitant illnesses, presence of invasive lines, microbial sensitivity and treatment outcomes.

RESULTSThirty-fi ve (13.7%) cases of ICU-acquired UTI occurred in 256 separate ICU admissions. The most common micro-organisms isolated were Candida spp. (34%). Female gender and prior exposure to antibiotics were independent risk factors for developing an ICU-acquired UTI (P <0.01). Both mean length of ICU stay and duration of catheterisation were significantly longer for patients with ICU-acquired UTI (P <0.001). The mortality rate of patients with ICU-acquired UTIs (12.1%) was slightly higher than those without (9.9%).

CONCLUSIONSThe incidence of ICU-acquired UTIs was similar to figures reported for nosocomial UTIs from the previous studies. Significant risk factors for developing an ICU-acquired UTI were female gender and history of antibiotic exposure prior to ICU admission. The insignificant link between ICU-acquired UTI and mortality requires further investigation in larger cohorts.

Adult ; Aged ; Aged, 80 and over ; Cross Infection ; Female ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Prospective Studies ; Risk Factors ; Singapore ; epidemiology ; Urinary Tract Infections ; epidemiology ; etiology ; physiopathology ; Young Adult