J.K. Kwon

Seasonal Variation of Urinary Symptoms in Korean Men with Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia

Purpose To examine seasonal variations in urinary symptoms in Korean men with lower urinary tract symptoms and benign prostatic hyperplasia (LUTS/BPH). Materials and Methods Records were obtained from a consecutive database of LUTS/BPH patients from March 2010 to February 2014. A total of 1,185 patients were suitable for analysis. The International Prostate Symptom Score (IPSS), uroflowmetric parameters, prostate volume-related parameters, and serum prostate-specific antigen levels were evaluated. Results Based on the month during which they were examined, patients were categorized into cold, hot, or intermediate season groups. The IPSS score was significantly different between the cold and the hot season groups (17.3±6.9 vs. 16.1±7.4, respectively; p=0.020). Storage symptom scores were significantly aggravated in the cold (6.8±3.3; p=0.030) and intermediate groups (6.9±3.5; p=0.032) compared with the hot season group (6.3±3.4), with this observation primarily driven by the individual scores for frequency and urgency. Quality of life (QOL) scores were worse in the cold compared with the hot season group (4.0±1.1 vs. 3.8±1.1, respectively; p=0.012). There were also significant differences between the cold and hot season groups in voided volume (278.7±148.5 vs. 255.9±145.1, respectively; p=0.034) and postvoid residual volume (26.4±37.6 vs. 32.2±41.0, respectively; p=0.039). Conclusions Different urinary symptoms and uroflowmetric parameters were associated with changes in seasons. QOL and IPSS parameters might be worse in cold weather seasons compared with hot weather seasons.

Simple Modification of the Bladder Outlet Obstruction Index for Better Prediction of Endoscopically-Proven Prostatic Obstruction: A Preliminary Study

Purpose The bladder outlet obstruction index (BOOI), also known as the Abrams-Griffiths (AG) number, is the most widely used index for predicting BOO. However, the obstructed prostatic urethra determined by the BOOI is often inconsistent with endoscopically-proven obstruction. We assessed abdominal straining pattern as a novel parameter for improving the prediction of BOO. Materials and Methods We retrospectively reviewed the pressure-flow studies (PFS) and cystourethroscopy in 176 BPH/LUTS patients who were unresponsive to medical therapy. During PFS, some groups of patients tried to urinate with abdominal straining, which can increases intravesical pressure and underestimate BOOI theoretically. Accordingly, the modified BOOI was defined as (PdetQmax+ΔPabd)-2Qmax. Results Ultimately, 130 patients were eligible for the analysis. In PFS, ΔPabd (PabdQmax-initial Pabd) was 11.81±13.04 cmH2O, and it was 0–9 cmH2O in 75 (57.7%), 10–19 cmH2O in 23 (17.7%) and ≥20 cmH2O in 32 (24.6%) patients. An endoscopically obstructed prostatic urethra in 92 patients was correctly determined in 47 patients (51.1%) by the original BOOI versus 72 patients (78.3%) based on the modified BOOI. Meanwhile, an “unobstructed” urethra according to the original BOOI was present in 11 patients (12.0%), whereas according to the modified BOOI, only 2 (2.1%) would be labeled as “unobstructed”. In receiver operating characteristic curves, the area under the curve was 0.906 using the modified BOOI number versus 0.849 in the original BOOI (p<0.05). Conclusions The change in abdominal pressure was correlated with endoscopically-proven obstruction. Our simple modification of the BOOI on the basis of this finding better predicted bladder outlet obstruction and, therefore, should be considered when evaluating BOO in patients with LUTS/BPH.

Is Periurethral Calcification Associated With Urinary Flow Rate and Symptom Severity in Men With Lower Urinary Tract Symptoms-Benign Prostatic Hyperplasia? A Retrospective Review

OBJECTIVE To evaluate the association of periurethral calcification (PUC) with urine flow rate and symptom severity in men with lower urinary tract symptoms-benign prostatic hyperplasia (LUTS-BPH). METHODS The records of 1199 LUTS-BPH patients were obtained from a prospectively maintained database of men on their first visit from April 2010 to April 2013. Patients with incomplete data or comorbidities affecting voiding function were excluded. The degree of PUC was scored by evaluating the ratio of the calcified urethra to the entire prostatic urethra on the midsagittal plane of a transrectal ultrasonogram. The relationships between prostate-related parameters, International Prostate Symptom Score (IPSS), and uroflowmetric parameters were evaluated. RESULTS A total of 1030 patients were eligible for final analysis. There were 654 patients (63.5%) with no PUC, 233 (22.6%) with mild PUC, and 143 (13.9%) with moderate to severe PUC. The total IPSS was 16.21 ± 7.29, 17.74 ± 7.77, and 17.75 ± 7.60 in no, mild, and moderate to severe PUC groups, respectively (P = .007), whereas peak urinary flow rate (Qmax) was 15.05 ± 7.59, 13.62 ± 6.68, and 12.20 ± 6.39 mL/s, respectively (P <.001). In an age-adjusted partial correlation test, PUC significantly associated with total IPSS, the storage symptom score, and Qmax (P <.05). Multivariate analysis revealed that PUC independently associated with Qmax (P = .012), total IPSS (P = .042), and the storage symptom score (P = .018) but not with postvoid residue, the voiding symptom score, or the postmicturition symptom score. CONCLUSION PUC is independently associated with Qmax and urinary symptoms indirectly advocating for the recent idea that periurethral fibrosis and stiffness could cause LUTS-BPH in men.

MP84-06 TERTIARY REFERRAL HOSPITAL EXPERIENCES OF MEN PRESENTING WITH PAINLESS POST-COITAL GROSS HEMATURIA AND A SUGGESTION FOR TENTATIVE MANAGEMENT ALGORITHM

to baseline assessment of erectile function. These findings suggest that despite the known association between select comorbid conditions, medications, and ED, the presence of these conditions does not result in a more rapid deterioration in erectile function over time compared to cases with no comorbid conditions. This information provides a significant addition to our current understanding of the natural history of ED progression.

Clinical Significance of Periurethral Calcification According to the Location in Men With Lower Urinary Tract Symptoms and a Small Prostate Volume

Purpose To assess the impact of periurethral calcification (PUC) according to its location on uroflowmetric parameters and urinary symptoms in patients with small prostate volume (PV). Methods Records were obtained from a prospectively maintained database of first-visit men with lower urinary tract symptoms (LUTS). Patients whose PV was >30 mL were excluded to elucidate more clearly the impact of PUC on LUTS. A total of 539 patients were enrolled in the study. The prostatic urethra was examined by transrectal ultrasonography for PUC, and the location of PUC was divided into 3 areas (proximal, mid, and distal). Results The characteristics according to the location of PUC were compared using a 1-way analysis of variance test. The Total International Prostate Symptom Score (IPSS), postmicturition symptoms, and overactive bladder symptom score (OABSS) differed significantly among the groups. In the propensity score matching analysis, the proximal- and distal-PUC groups did not have a significantly different urinary flow rate or symptom score when compared to their matched control groups. However, the mid-PUC group had significantly worse urinary symptoms than its matched control group (total IPSS [P=0.001], voiding symptoms [P=0.002], storage symptoms [P=0.041], and OABSS [P=0.015]). The peak urinary flow rate was also lower in the mid-PUC group with borderline significance (P=0.082). On multivariate linear regression analysis, mid-PUC was independently associated with IPSS and OABSS (P=0.035 and P=0.011, respectively). Conclusions Only mid-PUC was associated with symptom severity in men with LUTS and a small PV. Our findings suggest that mid-PUC could be a potential causal factor of LUTS, and the midportion of the prostatic urethra might play a pivotal role in the process of micturition.