Storage (irritative) and voiding (obstructive) symptoms as predictors of benign prostatic hyperplasia progression and related outcomes. The effect of benign lower urinary tract symptoms on subsequent prostate cancer testing and diagnosis. Self-management for men with lower urinary tract symptoms Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia: Combined Treatment with Fesoterodine Fumarate Extended-Release and Tamsulosin - A Prospective Study Which clinical risk factors determine a pathological urodynamic evaluation in patients with multiple sclerosis? an analysis of 100 prospective cases Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years. Natural history of prostatism: risk factors for acute urinary retention. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: a prospective study Self management for men with lower urinary tract symptoms: randomised controlled trial Effect of Improvement in Lower Urinary Tract Symptoms on Sexual Function in Men: Tamsulosin Monotherapy vs. Combination Therapy of Tamsulosin and Solifenacin Urinary and Bowel Symptoms in Men with and without Prostate Cancer: Results from an Observational Study in the Stockholm Area Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. Update on AUA guideline on the management of benign prostatic hyperplasia. Eliciting preferences for drug treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women. Analysis of the results obtained with a new phytotherapeutic association for LUTS versus control. [corrected].
OBJECTIVES To assess the utility of voiding and filling symptom subscores in predicting features of benign prostatic hyperplasia ( BPH ) progression , including acute urinary retention ( AUR ) and prostate surgery . METHODS The Proscar Long-term Efficacy and Safety Study ( PLESS ) was a 4-year study design ed to evaluate the effects of finasteride versus placebo in men with lower urinary tract symptoms ( LUTS ) , clinical evidence of BPH , and no evidence of prostate cancer . A self-administered question naire was employed to quantify LUTS at baseline . Receiver operating characteristics ( ROC ) curves were used to assess baseline characteristics from patients treated with placebo as predictors of outcomes . The characteristics assessed included the overall symptom score ( Quasi-AUA SI ) , separate voiding and filling subscores , prostate volume ( PV ) and serum prostate-specific antigen ( PSA ) levels . RESULTS PV and PSA were superior to the symptom scores at predicting episodes of spontaneous AUR and all types of AUR . The Quasi-AUA SI and the filling and voiding subscores were effective at predicting progression to surgery ; however , PSA was more effective at predicting this outcome . To better evaluate symptoms as predictors of surgery , patients who experienced a preceding episode of AUR were excluded from the surgery analysis . In the absence of preceding AUR , the best predictors of future surgery were the Quasi-AUA SI and the filling subscore . CONCLUSIONS Among men with LUTS , clinical BPH and no history of AUR , the overall symptom score and storage subscore are useful parameters to aid clinicians in identifying patients at risk for future prostate surgery . PV and PSA were the best predictors of AUR , while PSA was the best predictor of prostate surgery ( for all indications ) BACKGROUND Lower urinary tract symptoms ( LUTS ) are common and have been associated with the subsequent diagnosis of prostate cancer ( PCa ) in population cohorts . OBJECTIVE To determine whether the association between LUTS and PCa is due to the intensity of PCa testing after LUTS diagnosis . DESIGN , SETTING , AND PARTICIPANTS We prospect ively followed a representative , population -based cohort of 1922 men , aged 40 - 79 yr , from 1990 until 2010 with interviews , question naires , and abstract ing of medical records for prostate outcomes . Men were excluded if they had a previous prostate biopsy or PCa diagnosis .  Self-reported LUTS was defined as an American Urological Association symptom index score > 7 ( n=621 ) . Men treated for LUTS ( n=168 ) were identified from review of medical records and /or self report . Median follow-up was 11.8 yr ( interquartile range : 10.7 - 12.3 ) . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations between self-reported LUTS , or treatment for LUTS , and risk of subsequent prostate biopsy and PCa were estimated using Cox proportional hazard models . RESULTS AND LIMITATIONS Fifty-five percent of eligible men enrolled in the study . Men treated for LUTS were more likely to undergo a prostate biopsy ( hazard ratio [ HR ] : 2.4 ; 95 % confidence interval [ CI ] , 1.7 - 3.3 ) . Men younger than 65 yr who were treated for LUTS were more likely to be diagnosed with PCa ( HR : 2.3 , 95 % CI , 1.5 - 3.5 ) , while men aged > 65 yr were not ( HR : 0.89 , 95 % CI , 0.35 - 1.9 ) . Men with self-reported LUTS were not more likely to be biopsied or diagnosed with PCa . Neither definition of LUTS was associated with subsequent intermediate- to high-risk cancer . The study is limited by lack of histologic or prostate-specific antigen level data for the cohort . CONCLUSIONS These results indicate that a possible cause of the association between LUTS and PCa is increased diagnostic intensity among men whose LUTS come to the attention of physicians . Increased symptoms themselves were not associated with intensity of testing or diagnosis Treatment for men with lower urinary tract symptoms ( LUTS ) has developed into a “ cascade ” that escalates from watchful waiting through medical treatment to surgery . Self-management can help men to adopt lifestyle and behavioral modifications that will avoid or delay an escalation in treatment and reduce symptoms . Although many of these interventions are advised to men with LUTS , it is usually in a nonst and ardized and un systematic way . Recent work in this area has defined a self-management program for men with uncomplicated LUTS using formal methods and assessed its effectiveness in a r and omized controlled trial . Self-management significantly reduced the frequency of escalation through the treatment cascade and reduced urinary symptoms ( as effective as medication ) , suggesting that self-management could be considered as first-line treatment for men with LUTS OBJECTIVE Estimate the prevalence of urinary incontinence ( UI ) , overactive bladder ( OAB ) , and other lower urinary tract symptoms ( LUTS ) among men and women in five countries using the 2002 International Continence Society ( ICS ) definitions . METHODS This population -based , cross-sectional survey was conducted between April and December 2005 in Canada , Germany , Italy , Sweden , and the United Kingdom using computer-assisted telephone interviews .  A r and om sample of men and women aged > /= 18 yr residing in the five countries and who were representative of the general population s in these countries was selected . Using 2002 ICS definitions , the prevalence estimates of storage , voiding , and postmicturition LUTS were calculated . Data were stratified by country , age cohort , and gender . RESULTS A total of 19,165 individuals agreed to participate ; 64.3 % reported at least one LUTS . Nocturia was the most prevalent LUTS ( men , 48.6 % ; women , 54.5 % ) . The prevalence of storage LUTS ( men , 51.3 % ; women , 59.2 % ) was greater than that for voiding ( men , 25.7 % ; women , 19.5 % ) and postmicturition ( men , 16.9 % ; women , 14.2 % ) symptoms combined . The overall prevalence of OAB was 11.8 % ; rates were similar in men and women and increased with age . OAB was more prevalent than all types of UI combined ( 9.4 % ) . CONCLUSIONS The EPIC study is the largest population -based survey to assess prevalence rates of OAB , UI , and other LUTS in five countries . To date , this is the first study to evaluate these symptoms simultaneously using the 2002 ICS definitions . The results indicate that these symptoms are highly prevalent in the countries surveyed Objective : To evaluate the efficacy and safety of fesoterodine extended-release ( ER ) plus tamsulosin in men with lower urinary tract symptoms ( LUTS ) associated with benign prostatic hyperplasia ( BPH ) . Patients and Methods : Men aged ≥50 years , with LUTS , prostate volume ≤60 ml and International Prostate Symptom Score ( IPSS ) ≥13 were enrolled in this study . 173 consecutive patients were treated initially with tamsulosin ( 0.4 mg ) for 1 week . At the second visit , 47 patients out of the sample of 173 who were still experiencing inconvenient LUTS were r and omized into two groups . The first group received a therapy with tamsulosin and fesoterodine combination ( group 1 , n = 24 ) while the second continued the therapy with the single administration of tamsulosin ( group 2 , n = 23 ) for an additional 4-week period . Results : There was no statistically significant difference in age , prostate volume , Qmax , and postvoid residual urine between the two groups . A statistical significance appeared in the combination group regarding the storage and the total IPSS values among the second and third visits ( 10.5 ± 1.4 to 8.5 ± 1.3 and 16.1 ± 1.8 to 13.7 ± 1.5 respectively ) . Conclusion : Regarding bothersome LUTS and storage symptoms  , fesoterodine ER and tamsulosin combination was significantly more effective than the single administration of tamsulosin Background Urinary tract symptoms are an underestimated problem in multiple sclerosis ( MS ) . Objective Hundred urodynamics of MS patients have been evaluated prospect ively . Design , setting and participants In an inpatient rehabilitation , all persons with MS who also suffered from urinary tract symptoms received a voiding diary , post-void sonography and an urodynamic examination according to International Continence-Society-St and ard . Results and limitations Between 10/2009 and 3/2011 , 100 patients ( 79 women ; 21 men ; mean EDSS , 4.52 ± 2.26 ) were examined who had primary progressive MS ( 9 × ) , relapsing – remitting MS ( 41 × ) , secondary progressive MS ( 43 × ) and CIS ( 1 × ) . The  mean duration of MS was 10.26 ± 10.09 years and mean duration of LUTS , 6.9 ± 7.75 years . Urodynamic testing showed normal findings in 22 patients , detrusor overactivity in 7 , increased bladder sensation without detrusor overactivity in 21 , detrusor – sphincter dyssynergia in 26 , detrusor hypocontractility in 12 , detrusor acontractility in 4 and unclear diagnosis in 8 patients . Statistically significant risk factors for pathological urodynamic findings were as follows : wheelchair dependency , use of more than one incontinence pad per day and a MS type other than relapsing – remitting . Conclusions The urodynamic investigation at h and showed urinary tract dysfunction in 78 of 100 MS patients with lower urinary tract symptoms ( LUTS ) . The long latency between the occurrence of MS and /or the beginning of LUTS and the first neuro-urological evaluation indicates a deficit in treatment . Beyond national guidelines , all MS patients should at regular intervals be question ed about LUTS and receive urodynamic assessment especially according to the presented risk profile OBJECTIVES We analyzed the prevalence and characteristics of  lower urinary tract symptoms ( LUTS ) in community-dwelling men aged 80 years and older . METHODS We administered the American Urological Association Symptom Index ( AUA-SI ) by mail to 291 surviving community-dwelling male participants in the Rancho Bernardo Study , a prospect i ve , community-based study of aging . We compared the prevalence , severity , and types of LUTS occurring in men who were > or = 80 years to those < 80 years . RESULTS The mean age was 74.6 years ( st and ard deviation [ SD ] 8.9 , range 48.3 - 97.1 ) . One third of the respondents were > or = 80 years . The mean total AUA-SI score increased steadily by decade of life ( P-trend = .002 ) . The prevalence of LUTS was 70 % in men > or = 80 years and 56 % in men < 80 years ( P = .03 ) . Men > or = 80 years had significantly higher mean total AUA-SI ( P = .05 ) and were more likely to complain of incomplete emptying ( odds ratio [ OR ] 2.12 , 95 % confidence interval [ CI ] 1.06 - 4.18 , P = .02 ) , frequency ( OR 1.83 , 95 % CI 1.00 - 3.31 , P = .03 ) , urgency ( OR 1.76 , 95 % CI 0.96 - 3.20 , P = .05 ) , and weak stream ( OR 1.78 , 95 % CI 1.01 - 3.12 , P = .03 ) . CONCLUSIONS In this cohort of community-dwelling men , prevalence and severity of LUTS increased into the 10th decade of life . Compared to younger men , men > or = 80 years were more likely to complain of incomplete emptying , frequency , urgency , and weak stream . Further studies of LUTS in older men are needed to better delineate these associations PURPOSE We determined the occurrence of and risk factors for acute urinary retention in the community setting . MATERIAL S AND METHODS A cohort of 2,115 men 40 to 79 years old was r and omly selected from an enumeration of the Olmsted County , Minnesota population ( 55 % response rate ) . Participants completed a previously vali date d baseline question naire that assessed symptom severity , and voided into a portable urometer to measure peak urinary flow rates . A 25 % r and om sub sample underwent transrectal sonographic imaging of the prostate to determine prostate volume . Followup was performed through a retrospective review of community medical records to determine the occurrence of acute urinary retention in the subsequent 4 years . RESULTS During the 8,344 person-years of followup 57 men had a first episode of acute urinary retention ( incidence 6.8/1,000 person-years , 95 % confidence interval [ CI ] 5.2 , 8.9 ) . Among men with no to mild symptoms ( American Urological Association symptom index score 7 or less ) the incidence of acute urinary retention increased from 2.6/1,000 person-years among men 40 to 49 years old to 9.3/1,000 person-years among men 70 to 79 years old . By contrast , rates increased from 3.0/1,000 person-years for men 40 to 49 years old to 34.7/1,000 person-years among men 70 to 79 years old among men with moderate to severe symptoms ( American Urological Association symptom index score greater than 7 ) . Men with depressed peak urinary flow rate ( less than 12 ml . per second ) were at 4 times the risk of acute urinary retention compared with men with urinary flow rates greater than 12 ml . per second ( 95 % CI 2.3 , 6.6 ) . Men with an enlarged prostate ( greater than 30 ml . ) experienced a 3-fold increase in risk ( 95 % CI 1.0 , 9.0 , p = 0.04 ) . CONCLUSIONS Lower urinary tract symptoms , depressed peak urinary flow rates , enlarged prostates and older age are associated with an increased risk of acute urinary retention in community dwelling men . These findings may help to identify men at increased risk of acute urinary retention in whom closer evaluation may be warranted Study design : A prospect i ve study . Objectives : To investigate the risk factors predicting upper urinary tract ( UUT ) deterioration in patients with spinal cord injury ( SCI ) . Setting : Beijing , China . Methods : We review ed the medical records and UUT imaging studies of 112 patients , with a mean follow-up of 2 years . Variables evaluated for possible influence on UUTs included patient age , gender and educational background ; injury level and completeness ; bladder management method ; and the presence of adverse outcomes such as recurrent urinary tract infections and bladder stones . Video urodynamic data were also review ed . Total renal function was assessed by serum creatinine . UUT abnormalities were assessed by renal ultrasound or magnetic resonance imaging . Results : Lumbosacral spinal cord lesions likely contribute to UUT deterioration . UUT abnormalities were present in 23 patients ( 65.7 % ) in a spontaneous voiding group , 10 patients ( 20 % ) in a clean intermittent catheterization group , 15 patients ( 78.9 % ) in an indwelling urethral catheterization group and 7 patients ( 87.5 % ) in a suprapubic Foley catheterization group ( P<0.001 ) . When dividing bladder management method into two groups , catheter-free ( spontaneous and intermittent voiding ) and indwelling catheter ( urethral and suprapubic catheterization ) , there was UUT dysfunction in 33 patients ( 38.3 % ) and 22 patients ( 81.5 % ) , respectively ( P<0.001 ) . Conclusions : Lumbosacral SCI and chronic indwelling urethral and suprapubic catheterization were predictors of UUT deterioration Objective To evaluate the effectiveness of self management as a first line intervention for men with lower urinary tract symptoms . Design R and omised controlled trial . Setting A teaching hospital and a district general hospital in London . Participants 140 men ( mean age 63 ( SD 10.7 ) years ) , recruited between January 2003 and April 2004 , referred by general practitioners to urological outpatient departments with uncomplicated lower urinary tract symptoms . Interventions Self management and st and ard care ( n=73 ) or st and ard care alone ( n=67 ) . The self management group took part in three small group sessions comprising education , lifestyle advice , and training in problem solving and goal setting skills . Main outcome measures The primary outcome measure was treatment failure measured at 3 , 6 , and 12 months . Symptom severity ( international prostate symptom score ; higher scores represent a poorer outcome ) was used as a secondary outcome . Results At three months , treatment failure had occurred in 7 ( 10 % ) of the self management group and in 27 ( 42 % ) of the st and ard care group ( difference=32 % , 95 % confidence interval 18 % to 46 % ) . Corresponding differences in the frequency of treatment failure were 42 % ( 27 % to 57 % ) at six months and 48 % ( 32 % to 64 % ) at 12 months . At three months , the mean international prostate symptom score was 10.7 in the self management group and 16.4 in the st and ard care group ( difference=5.7 , 3.7 to 7.7 ) . Corresponding differences in score were 6.5 ( 4.3 to 8.7 ) at six months and 5.1 ( 2.7 to 7.6 ) at 12 months . Conclusions Self management significantly reduced the frequency of treatment failure and reduced urinary symptoms . Because of the large observed benefit of self management , the results of this study support the case for a large multicentre trial to confirm whether self management could be considered as first line treatment for men with lower urinary tract symptoms . Trial registration National Research Register N0263115137 ; Clinical trials NCT00270309 Purpose To evaluate how much the improvement of lower urinary tract symptoms ( LUTS ) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function . Material s and Methods A total of 187 patients were enrolled in this study . Patients were r and omly assigned to receive either tamsulosin 0.2 mg ( group A ) or tamsulosin 0.2 mg and solifenacin 5 mg ( group B ) . At 4 weeks and 12 weeks , the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 ( IIEF5 ) , International Prostate Symptom Score ( IPSS ) , Overactive Bladder Symptom Score ( OABSS ) question naire , uroflowmetry , and bladder scan . Results Both groups A and B showed statistically significant improvements in IPSS , OABSS , and quality of life ( QoL ) . Group A showed improved maximum flow rate , mean flow rate , and residual urine volume by time . Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time . The IIEF5 score was not improved in either group . In group A , the IIEF5 score dropped from 13.66±4.97 to 11.93±6.14 after 12 weeks ( p=0.072 ) . Group B showed a decline in the IIEF5 score from 13.19±5.91 to 12.45±6.38 ( p=0.299 ) . Although group B showed a relatively smaller decrease in the IIEF5 score , the difference between the two groups was not significant ( p=0.696 ) . Conclusions Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function Objectives : To investigate the prevalence of urinary and bowel symptoms in population -based groups of men with and without prostate cancer . Methods : A self-administered question naire , assessing 5 urinary and 3 bowel symptoms , was sent to the 431 men diagnosed as having prostate cancer in the Stockholm area in 1992 who were still alive in October 1993 and to 435 r and omly selected control subjects with an age distribution matching men with newly diagnosed prostate cancer in the same area . The results were evaluated as ratios of proportions . Results : Among the prostate cancer patients , all urinary and bowel symptoms assessed were more common and the risk of having the various symptoms was 1.3–4.5 times that of the controls . The risks of having leakage of urine after radical prostatectomy and bowel urgency after external beam radiation therapy were fourfold when compared with the control group . We noted an increased risk ratio of proportions of leakage of faeces after radical prostatectomy and this risk was significantly increased when men with any of 11 specified diseases were excluded from the analysis to reduce confounding . Conclusions : Prostate cancer and its treatment affects urinary and bowel functions . The increased risk of having leakage of faeces after radical prostatectomy may be a chance phenomenon due to few patients subjected to surgery , but warrants further investigation PURPOSE We evaluated the correlation of lower urinary tract symptoms suggestive of detrusor instability with urodynamic findings in men . MATERIAL S AND METHODS Enrolled in our prospect i ve study were 160 consecutive neurologically intact men referred for urodynamic evaluation of persistent lower urinary tract symptoms . All patients had storage symptoms suggestive of detrusor instability . Patients were further clinical ly categorized according to the chief complaint of urge incontinence , frequency and urgency , nocturia or difficult voiding . The clinical and urodynamic diagnosis in all patients as well as specific urodynamic characteristics of those with detrusor instability were analyzed according to the these 4 clinical categories . RESULTS Mean patient age was 61 + /- 15 years . The chief complaint was urge incontinence in 28 cases ( 17 % ) , frequency and urgency in 57 ( 36 % ) , nocturia in 30 ( 19 % ) and difficult voiding in 45 ( 28 % ) . Detrusor instability was diagnosed in 68 cases ( 43 % ) . A higher incidence of detrusor instability was associated with urge incontinence than with the other clinical categories ( 75 % versus 36 % , p < 0.01 ) . Of the patients 109 ( 68 % ) had bladder outlet obstruction , including 50 ( 46 % ) with concomitant detrusor instability . The prevalence of bladder outlet obstruction was similar in all patients regardless of the chief complaint . All other urodynamic diagnoses were also similar in the 4 clinical categories . The mean bladder volume at which involuntary detrusor contractions occurred were lower in patients with urge incontinence and frequency and urgency than in those with nocturia and difficult voiding ( 277.1 + /- 149.4 and 267.7 + /- 221.7 versus 346.7 + /- 204.6 and 306.2 + /- 192.1 ml . , respectively , not statistically significant , p = 0.07 ) . CONCLUSIONS Detrusor instability and bladder outlet obstruction are common in men with lower urinary tract symptoms . The symptom of urge incontinence strongly correlated with detrusor instability . Other lower urinary tract symptoms did not correlate well with any urodynamic findings . Therefore , we believe that an accurate urodynamic diagnosis may enable focused and more efficient management of lower urinary tract symptoms in men PURPOSE To revise the 2003 version of the American Urological Association 's ( AUA ) Guideline on the management of benign prostatic hyperplasia ( BPH ) . MATERIAL S AND METHODS From MEDLINE ® search es of English language publications ( January 1999 through February 2008 ) using relevant MeSH terms , articles concerning the management of the index patient , a male ≥45 years of age who is consulting a healthcare provider for lower urinary tract symptoms ( LUTS ) were identified . Qualitative analysis of the evidence was performed . Selected studies were stratified by design , comparator , follow-up interval , and intensity of intervention , and meta-analyses ( quantitative synthesis ) of outcomes of r and omized controlled trials were planned . Guideline statements were drafted by an appointed expert Panel based on the evidence . RESULTS The studies varied as to patient selection ; r and omization ; blinding mechanism ; run-in periods ; patient demographics , comorbidities , prostate characteristics and symptoms ; drug doses ; other intervention characteristics ; comparators ; rigor and intervals of follow-up ; trial duration and timing ; suspected lack of applicability to current US practice ; and techniques of outcomes measurement . These variations affected the quality of the evidence review ed making formal meta- analysis impractical or futile . Instead , the Panel and extractors review ed the data in a systematic fashion and without statistical rigor . Diagnosis and treatment algorithms were adopted from the 2005 International Consultation of Urologic Diseases . Guideline statements concerning pharmacotherapies , watchful waiting , surgical options and minimally invasive procedures were either up date d or newly drafted , peer review ed and approved by AUA Board of Directors . CONCLUSIONS New pharmacotherapies and technologies have emerged which have impacted treatment algorithms . The management of LUTS/BPH continues to evolve PURPOSE There are 2 main medical preparations available for lower urinary tract symptoms result ing from benign prostatic hyperplasia ( BPH ) . Choosing between an alpha-blocker and a 5alpha-reductase inhibitor requires trade-offs between their attributes or characteristics . We investigated the relative importance of and trade-offs between the attributes of the 5alpha-reductase inhibitor dutasteride and alpha-blockers in community dwelling men using a vali date d technique . MATERIAL S AND METHODS A discrete choice experiment was administered to 211 men older than 40 years who were r and omly selected from the general United Kingdom population . Attributes investigated in the discrete choice experiment were time to symptom improvement , sexual and nonsexual side effects , the risks of acute urinary retention ( AUR ) and surgery , cost and prostate size decrease . Using regression analysis the relative importance of these attributes , the trade-offs that men are willing to make between these attributes and the willingness to pay for each attribute were estimated . RESULTS All attributes were important to respondents . The most important attribute was side effects . The least preferred side effects was impotence , followed by decreased libido and dizziness . Respondents were willing to wait 13 , 2 and 8 months longer for symptom improvement in exchange for decreased prostate size , and the risks of AUR and surgery , respectively . Men reporting moderate symptoms were less concerned about sexual side effects , time to symptom improvement and the risk of AUR compared with men reporting mild symptoms . CONCLUSIONS Given the attribute levels of BPH medical treatment , overall community dwelling men preferred the 5alpha-reductase inhibitor over alpha-blockers . In the interests of shared decision making it is important to consider the importance of eliciting the preferences of patients with BPH BACKGROUND Female urinary incontinence ( UI ) , overactive bladder ( OAB ) , and other lower urinary tract symptoms ( LUTS ) are highly prevalent conditions with a profound influence on well-being and quality of life . There are a few studies describing progression as well as remission , in the short term , of UI in the general population as well as in selected groups ; at present , there are very few population -based studies describing the natural course of other LUTS in the same women , and there are no long-term longitudinal studies . OBJECTIVE To describe the prevalence of UI , OAB , and other LUTS in the same women studied prospect ively over time and , thus , to assess possible progression or regression . DESIGN , SETTING , AND PARTICIPANTS A longitudinal population -based study was performed in one primary health care district in the city of Gothenburg , Sweden . The participants were a sample of women aged > or = 20 yr who were r and omly selected from the Swedish National Population Register , assessed in 1991 ( n=2911 ) , and available for re assessment in 2007 ( n=1408 ) . METHODS A self-administered postal question naire regarding UI , OAB , and other LUTS was returned by 77 % of the contacted women in 1991 . The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal question naire . RESULTS AND LIMITATIONS In 2007 , 1081 of the available 1408 women responded to the question naire ( 77 % ) . The overall prevalence of UI , OAB , nocturia , and daytime micturition frequency of eight or more times per day increased by 13 % , 9 % , 20 % ( p<0.001 ) , and 3 % ( p<0.05 ) , respectively , from 1991 to 2007 . The incidence of UI and OAB were 21 % and 20 % , respectively , and the corresponding remission rates were 34 % and 43 % , respectively . Women with OAB symptoms were classified as OAB dry or OAB wet , depending on the presence or absence of concomitant UI . The prevalence of OAB dry did not differ between the two assessment occasions ( 11 % and 10 % , respectively ) , but the prevalence of OAB wet increased from 6 % to 16 % ( p<0.001 ) . CONCLUSIONS UI and other LUTS constitute dynamic conditions . In this study , there was a marked overall increase in the prevalence of UI , OAB , and nocturia in the same women from 1991 to 2007 . Both incidence and remission of most symptoms were considerable INTRODUCTION Benign prostatic hypertrophy ( BPH ) is a common disease whose frequency has risen throughout the world in concomitance with the increase in life expectancy . BPH causes voiding disturbances known by the acronym LUTS ( lower urinary tract symptoms ) , which heavily influence the quality of life in the elderly . The treatment for LUTS is mainly divided into medical and surgical , the latter usually represented by prostate ablation . Medical therapy includes synthetic molecules that interfere with the hormonal control of BPH or act on the bladder neck tonus , as well as natural remedies based on plant extracts from Serenoa Repens and /or Urtica Dioica . MATERIAL AND METHODS Two groups of patients who were c and i date s for surgery for BPH-induced LUTS , were r and omly recruited in a six-month trial aim ed at comparing outcome of treatment with a new combination of plants extracts ( Pluvio ® ) , which differs from the previous ones in that it also contains avocado and soya oil , as well as a high dose of Urtica Dioica , with no therapy . Age , IPSS score , maximal uroflow , prostate volume , PSA , free-to-total PSA ratio , post voiding residual urine and number of nocturia episodes were recorded and statistically evaluated using a NCSS 60 ® program . RESULT A marked benefit in terms of quality of life , measured by IPSS score , uroflow , residual urine and nocturia , was observed in the treated group compared to controls . PSA and prostate volume were not significantly affected . No noteworthy adverse events were observed . CONCLUSIONS The new phytotherapeutic combination evaluated in the present study would seem to be highly effective for the treatment of LUTS in BPH patients and does not have negative side effects . Its use could therefore be strongly advocated in this setting
Studies revealed both structural and functional alterations in bladders from patients with LUTS symptoms or animals with experimentally induced bladder dysfunction .
In particular , the urothelium and the suburothelial space , containing afferent nerve fibres and interstitial cells , have been found to form a functional unit that is essential in the process of bladder function .
Various imbalances within this suburothelial complex have been identified as significant contributors to the generation of storage LUTS , along with potential abnormalities of central function
CONTEXT The focus of clinical underst and ing and management of male storage lower urinary tract symptoms ( LUTS ) has shifted from the prostate to the bladder .
This is mirrored by an increasing body of experimental evidence suggesting that the bladder is the central organ in the pathogenesis of LUTS .
OBJECTIVE A systematic review of the literature available on pathophysiologic aspects of storage LUTS .