Ji-Yeon Han

The Long-term Effect of Alfuzosin in Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostate Hyperplasia: Evaluation of Voiding and Storage Function With Respect to Bladder Outlet Obstruction Grade and Contractility

OBJECTIVES To evaluate the efficacy of alfuzosin treatment on voiding and storage in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) with respect to bladder outlet obstruction and contractility. METHODS A 12-month, multicenter, observational, prospective study was conducted at four university hospitals in Korea. Patients were divided into four groups: group 1 (bladder outlet obstruction index (BOOI) ≥20, bladder contractility index (BCI) ≥100), group 2 (BOOI ≥20, BCI <100), group 3 (BOOI <20, BCI ≥100), and group 4 (BOOI <20, BCI <100), with respect to BOOI and BCI evaluated by pressure-flow study. Treatment efficacy was analyzed by validated symptom scores. RESULTS Two-hundred thirty-two men with LUTS/BPH were enrolled, and 165 (41, 50, 30, and 44 in groups 1-4, respectively) were followed to the end of the study. After 12 months of alfuzosin treatment, all International Prostate Symptom Score (IPSS) parameters improved in all four groups. Mean improvement in IPSS subscore for voiding was 4.0 points in group 1, 5.5 points in group 2, 5.5 points in group 3, and 3.0 points in group 4. Change in IPSS subscore for storage was 2.5 points in group 1, 3.6 points in group 2, 2.9 points in group 3, and 1.8 points in group 4. There was no difference among four groups in improvements seen in storage or voiding IPSS subscore. International Continence Society male questionnaire scores significantly improved in all four groups with no between-group differences. CONCLUSIONS Alfuzosin treatment in men with LUTS indicative of BPH effectively improved voiding and storage symptoms regardless of BOOI or BCI.

Prescription pattern of oxybutynin ER in patients with overactive bladder in real life practice: a multicentre, open‐label, prospective observational study

Aims of study:  To investigate the prescription pattern and dose distribution of the antimuscarinic agent oxybutynin extended release (ER) in patients with overactive bladder (OAB) in actual clinical practice.

Most Bothersome Symptom and Symptom Specific Goal Achievement in Patients With Benign Prostatic Obstruction: A Prospective Open Label Study

PURPOSE We evaluated symptom specific goal achievement, and the correlations between goal achievement and traditional outcome measures after pharmacological therapy in patients with benign prostatic obstruction. MATERIALS AND METHODS Men 50 years old or older with lower urinary tract symptoms secondary to benign prostatic obstruction and International Prostate Symptom Score 8 or greater were enrolled and treated with 10 mg alfuzosin XL for 12 months. Before treatment, face-to-face interviews were conducted to identify the single most bothersome symptoms and to set treatment goals for the symptoms in individual patients. After treatment, patients described perceptions of goal achievement using a 5-point Likert scale. Changes in International Prostate Symptom Score/quality of life score, International Continence Society male short form questionnaire, 3-day voiding diary and uroflowmetry parameters were analyzed to evaluate the correlations between goal achievement and traditional outcome measures. RESULTS Of 108 most bothersome symptoms slow stream (26.9%) was the most frequently reported followed by increased daytime frequency (21.3%) and nocturia (19.4%). After treatment the median score of goal achievement was 3 points with no significant difference among most bothersome symptoms. Changes in quality of life score (correlation coefficient -0.247, p=0.020) and maximal flow rate (correlation coefficient 0.254, p=0.021) were correlated with goal achievement. For men with most bothersome symptoms of storage, changes in the number of micturition and urgency episodes per 24 hours were correlated with goal achievement. For men with most bothersome symptoms of voiding the International Prostate Symptom Score voiding score was correlated with goal achievement. CONCLUSIONS Assessing goal achievement for most bothersome symptoms can be a useful outcome measure in patients with benign prostatic obstruction with heterogeneous symptoms or goals reflecting change in quality of life.

A Long-Term Study of the Effects of the Tension-Free Vaginal Tape Procedure for Female Stress Urinary Incontinence on Voiding, Storage, and Patient Satisfaction: A Post-Hoc Analysis

Purpose We assessed the long-term effects of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) on voiding, storage, and patient satisfaction. Materials and Methods This retrospective study examined the records of 134 patients who had undergone the TVT procedure for SUI and were followed up for more than 5 years. Voiding function was evaluated by measuring maximum urinary flow rate (MFR), post-void residual urine volume (PVR), and storage function by using a voiding diary. Patients were asked to describe their satisfaction with the operation. Results MFR was lower at 1 month compared with the preoperative level, but had recovered to preoperative levels by 5 years postoperatively. However, some patients with >50%, 25-50%, and <25% decreases in the MFR at 1 month postoperatively showed a decrease in the MFR of >50% at 5 years. PVR increased over the 5 postoperative years. Of the patients with urgency and urgency incontinence, 43.8% and 48.1% showed improvement, respectively, whereas new patients developed postoperatively. Thus, the total number of patients with urgency or urgency incontinence remained similar over the 5 years. In those with a changed voiding pattern, patient satisfaction was negatively affected by de novo urgency and urgency incontinence and decreased MFR. Conclusions Any obstructive effect of the TVT procedure diminished over time in most patients, although a decrease in the MFR was sustained in some patients. With regard to overactive bladder symptoms, some patients were cured and some patients complained of de novo symptoms. The most major factor affecting patient satisfaction was de novo urgency.

Management of Recurrent or Persistent Stress Urinary Incontinence after Mid‐urethral Sling

The mid‐urethral sling (MUS) procedure is the most common treatment modality for women with stress urinary incontinence (SUI). Although this procedure is highly successful, 5–20% of patients undergoing MUS experience persistent or recurrent SUI, regarded as surgical failure. However, little is known about methods to evaluate and manage patients who fail MUS procedures. The surgical options in these patients include bulking agent injection, shortening of pre‐implanted tape, pubovaginal sling and repeat MUS. Of these secondary procedures, repeat MUS is the most widely studied, although this has been limited to small case series without long‐term follow‐up. Repeat MUS for prior MUS failure has shown relatively good success rates, ranging from 55 to 90%, with better outcomes obtained using the retropubic rather than the transobturator route. Persistent or recurrent SUI may also be successfully managed with less invasive techniques, such as tape shortening and periurethral injection of a bulking agent. Transurethral injection therapy for primary SUI has shown success rates of more than 65% at 1 year; however, these decreased significantly thereafter to around 30% at long‐term follow‐up. Since the optimal management of recurrent or persistent SUI after MUS has not yet been established, long‐term, prospective, randomized trials are warranted.

Patient Reported Goal Achievement Following the Midurethral Sling Procedure for Female Stress Urinary Incontinence

Objectives: Patient perspective is very important for evaluating surgical outcomes. We investigated patient reported goal achievement, overall satisfaction and objective outcome following the midurethral sling (MUS) procedure for female stress urinary incontinence (SUI).