The Effect Of Pelvic Floor Muscle Training Alone Or In Combination With Electrostimulation In The Treatment Of Sexual Dysfunction In Women With Multiple Sclerosis.

Sexual dysfunction (SD) affects up to 80% of multiple sclerosis (MS) patients and pelvic floor muscles (PFMs) play an important role in the sexual function of these patients. The objective of this paper is to evaluate the impact of a rehabilitation program to treat lower urinary tract symptoms on SD of women with MS. Thirty MS women were randomly allocated to one of three groups: pelvic floor muscle training (PFMT) with electromyographic (EMG) biofeedback and sham neuromuscular electrostimulation (NMES) (Group I), PFMT with EMG biofeedback and intravaginal NMES (Group II), and PFMT with EMG biofeedback and transcutaneous tibial nerve stimulation (TTNS) (Group III). Assessments, before and after the treatment, included: PFM function, PFM tone, flexibility of the vaginal opening and ability to relax the PFMs, and the Female Sexual Function Index (FSFI) questionnaire. After treatment, all groups showed improvements in all domains of the PERFECT scheme. PFM tone and flexibility of the vaginal opening was lower after the intervention only for Group II. All groups improved in arousal, lubrication, satisfaction and total score domains of the FSFI questionnaire. This study indicates that PFMT alone or in combination with intravaginal NMES or TTNS contributes to the improvement of SD.

Long-Term Effect of Early Postoperative Pelvic Floor Biofeedback on Continence in Men Undergoing Radical Prostatectomy: A Prospective, Randomized, Controlled Trial

Purpose: The impact of pelvic floor muscle training on the recovery of urinary continence after radical prostatectomy is still controversial. We tested the effectiveness of biofeedback-pelvic floor muscle training in improving urinary incontinence in the 12 months following radical prostatectomy. Materials and Methods: A total of 73 patients who underwent radical prostatectomy were randomized to a treatment group (36) receiving biofeedback-pelvic floor muscle training once a week for 3 months as well as home exercises or a control group (37). Patients were evaluated 1, 3, 6 and 12 months postoperatively. Continence was defined as the use of 1 pad or less daily and incontinence severity was measured by the 24-hour pad test. Incontinence symptoms and quality of life were assessed with the International Continence Society male Short Form questionnaire and the Incontinence Impact Questionnaire. Pelvic floor muscle strength was evaluated with the Oxford score. Results: A total of 54 patients (26 pelvic floor muscle training and 28 controls) completed the trial. Duration of incontinence was shorter in the treatment group. At postoperative month 12, 25 (96.15%) patients in the treatment group and 21 (75.0%) in the control group were continent (p = 0.028). The absolute risk reduction was 21.2% (95% CI 3.45-38.81) and the relative risk of recovering continence was 1.28 (95% CI 1.02-1.69). The number needed to treat was 5 (95% CI 2.6-28.6). Overall there were significant changes in both groups in terms of incontinence symptoms, lower urinary tract symptoms, quality of life and pelvic floor muscle strength (p <0.0001). Conclusions: Early biofeedback-pelvic floor muscle training not only hastens the recovery of urinary continence after radical prostatectomy but allows for significant improvements in the severity of incontinence, voiding symptoms and pelvic floor muscle strength 12 months postoperatively.

Is the ultrasound-estimated bladder weight a reliable method for evaluating bladder outlet obstruction?

OBJECTIVE To evaluate the correlation between ultrasound-estimated bladder weight (UEBW) in patients with different degrees of bladder outlet obstruction (BOO). METHODS We evaluated 50 consecutive non-neurogenic male patients with lower urinary tract symptoms (LUTS) referred to urodynamic study (UDS). All patients self-answered the International Prostate Score Symptoms (IPSS) questionnaire. After the UDS, the bladder was filled with 150 mL to determine UEBW. Patients with a bladder capacity under 150 mL, a previous history of prostate surgery or pelvic irradiation, an IPSS score <8, a bladder stone or urinary tract infection were excluded. After a pressure-flow study, the Schafer linear passive urethral resistance relation nomogram was plotted to determine the grade of obstruction: Grades I-II/VI were defined as mild obstruction, Grades III-IV/VI as moderate obstruction, and Grades V-VI/VI as severe obstruction. RESULTS The UEBW was 51.7 +/- 26.9, 54.1 +/- 30.0 and 54.8 +/- 28.2 in patients with mild, moderate and severe BOO, respectively (P = 0.130). The UEBW allowed us to define four groups: (i) UEBW < 35 g; (ii) 35 g <= UEBW < 50 g; (iii) 50 g <= UEBW < 70 g; and (4) UEBW >= 70 g. We did not find any differences in age, prostate weight, IPSS, PVR, cystometric bladder capacity, presence of detrusor overactive and degree of obstruction in the aforementioned groups. CONCLUSION Despite the fact that some studies have emphasized the value of UEBW as an efficient non-invasive method for evaluating lower urinary tract obstruction, our study suggests that UEBW does not present any individual correlation with LUTS or objective measurements of BOO.

The prevalence of erectile dysfunction among Brazilian men screened for prostate cancer

OBJECTIVE To determine the prevalence of erectile dysfunction (ED) in a large cohort of Brazilian men who were screened for prostate cancer, and to determine risk factors in this population, as there are large cultural differences among countries in reporting the frequency of ED, and it is likely that the prevalence of ED among men screened for prostate cancer cannot be generally applied across countries. SUBJECTS AND METHODS The analysis focused on the baseline characteristics of 1008 consecutive South American men from Brazil with no known prostate disease who had routine screening for prostate cancer by urologists. The variables analysed were patient age, urinary symptoms, patient health-related quality of life (HRQL), prostate-specific antigen (PSA) levels, prostate volume and erectile function. To assess lower urinary tract symptoms (LUTS) and HRQL, we used the American Urological Association symptom score and its appended eighth question, respectively. Benign prostatic hyperplasia was defined as a prostate volume of > 30 g. Sexual function was assessed using the five-item version of the International Index of Erectile Function questionnaire. Thus, ED was considered to absent for scores of 22-25, mild for 17-21, mild to moderate for 12-16, moderate for 8-11, or severe for 5-7. Obesity was defined by calculating the body mass index (BMI), and categorized as underweight (< 18.5 kg/m

Voiding Dysfunction in Patients With Parkinson`s Disease: Impact of Neurological Impairment and Clinical Parameters

Aims: We assessed the lower urinary tract symptoms (LUTS) of patients with Parkinson`s disease (PD) and their association with different clinical parameters. Methods: We prospectively evaluated 110 patients (84 men), with a mean age of 61.8 +/- 9.6 years. Mean duration of the disease was 12.3 +/- 7.2 years. Neurological impairment was assessed by the Hoehn-Yahr and the Unified Parkinson Disease Rating scales. LUTS were assessed by the International Continence Society questionnaire. We evaluated the impact of age, PD duration, neurological impairment, gender, and use of anti-Parkinsonian drugs on the voiding function. Results: On multivariate analysis, voiding dysfunction increased with the neurological impairment, but not with patient`s age or disease duration. Quality of life (QOL) was affected by the severity of LUTS, and the symptoms with the worst impact were frequency and nocturia. Sixty-three (57.2%) patients were symptomatic. They did not differ with the asymptomatic as to age and disease duration, but had more severe neurological impairment. No impact on LUTS was associated with the use of levodopa, anticholinergics, and dopamine receptor agonists. Men and women were similarly affected by urinary symptoms. Conclusions: The severity of the neurological disease is the only predictive factor for the occurrence of voiding dysfunction, which affects men and women alike. Neztrourol. Urodynam. 28.510-515, 2009. (C) 2009 Wiley-Liss, Inc.

Braquiterapia prostática: morbilidade urinária e sexual

RESUMO: Objectivos 1. Avaliar a morbilidade urinária e sexual secundária à braquiterapia prostática com implante de I125. 2. Avaliar a influência da hormonoterapia neoadjuvante e adjuvante na morbilidade urinária e sexual secundária à braquiterapia(I125). 3. Avaliar a influência da associação da radioterapia externa na morbilidade urinária e sexual secundária à braquiterapia(I125). 4. Avaliar a morbilidade urinária dos doentes com contra-indicação relativa (próstatas volumosas, IPSS elevado).Material e métodos De Setembro de 2000 a Dezembro de 2004 foram recrutados 204 doentes com o diagnóstico de carcinoma da próstata localizado (T1 e T2) ou localmente avançado (T3) e expectativa de vida superior a 10 anos. Foram submetidos a braquiterapia, com implante transperineal de Iodo 125 (I125) em monoterapia ou combinada com hormonoterapia e/ou radioterapia externa (tratamento trimodal). Definiram-se diversos sub-grupos de pacientes, consoante algumas características habitualmente referidas como factores de risco para a morbilidade do tratamento de braquiterapia prostática, com o objectivo de analisar a sua influência sobre a morbilidade urinária e sexual: Grupo 1: Braquiterapia em monoterapia (MONO) versus braquiterapia associada a radioterapia externa (BCOMB) Grupo 2: Próstatas volumosas (>50ml) versus próstatas não volumosas (<50ml)Grupo 3: Braquiterapia associada a hormonoterapia (HORM) versus braquiterapia sem hormonoterapia (NHORM)Grupo 4: IPSS elevado versus IPSS baixo Avaliou-se a evolução do IPSS, QoL, taxa de RTU-P e retenção urinária pós implante, e evolução do BSFI durante todo o período de seguimento. Resultados Grupo 1: Para o grupo MONO o IPSS iniciou-se com 7.1, sofreu agravamento para 16.1 e 15.9 ao primeiro e terceiro meses. Aos 12 meses, o IPSS desceu para 10.1 enquanto que, aos 18 e 24 meses, o IPSS foi de 7.3 e 5.8. O grupo BCOMB iniciou com IPSS de 9.4. Sofreu agravamento ligeiro e pouco acentuado até aos 6 meses (IPSS de 14). A evolução do IPSS foi, então, flutuante com IPSS de 5.9 aos 12 meses e 9.5 aos 18 meses. Aos 24 meses apresentava IPSS de 6.7. A taxa de retenção urinária (6.4% e 0%) e de RTU-P (2.0% e 0%) foram semelhantes nos grupos MONO e BCOMB, respectivamente (p=0.375 e p=1). A evolução da qualidade das erecções foi semelhante nos dois grupos excepto aos 6 meses em que MONO apresentou o valor 6 e BCOMB 3.7 (p=0.029). A percentagem de doentes potentes foi significativamente inferior nos primeiros 6 meses após a braquiterapia para o grupo BCOMB relativamente ao grupo MONO: 36%–74%; 33%–73%; 33%–75%. Após os 6 meses os grupos foram homogéneos. Grupo 2: O IPSS evoluiu nas próstatas <50ml e >50ml de 7–9 para 15-19 ao primeiro mês e 15-18 ao 3.º mês. Apenas ao primeiro mês é que as diferenças no IPSS foram significativas (p=0.061). Após o 3.º mês os dois grupos foram semelhantes: IPSS de 8 e 12 ao 12.º mês e 5.7 e 6 ao 24.º mês. As taxas de retenção urinária e de RTU-P foram semelhantes (p=0.054 e p=0.286) Grupo 3: A evolução do IPSS, taxas de retenção urinária e de RTU-P foram sobreponíveis em ambos os grupos. A evolução da líbido, erecções, percentagem de doentes potentes, ejaculação, incómodo e satisfação foi significativamente inferior no grupo HORM relativamente ao grupo N HORM apenas ao primeiro mês (valores de p<0.0001; <0.0001; < 0.0001; 0.009 e 0.002 respectivamente) Grupo 4: A evolução do IPSS nos doentes com IPSS elevado foi a seguinte: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M) A evolução do IPSS nos doentes com IPSS baixo foi a seguinte: 5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M) As taxas de RTU-P (2.8% e 0%) e retenção urinária (5.1% e 5.9%) foram semelhantes em ambos os grupos de doentes (p=1). Conclusões 1. A radioterapia intersticial da próstata com implante transperineal e ecoguiado de Iodo 125 é frequentemente acompanhada de morbilidade urinária transitória e de intensidade moderada. A Morbilidade consiste em sintomatologia do aparelho urinário baixo (“LUTS – lower urinary tract symptoms”) que, na maioria dos doentes, sofre um agravamento máximo do primeiro ao 3.º mês. Segue-se uma melhoria ligeira até ao 6.º mês que é mais acentuada daí em diante. Por volta do 12.º e 18.º mês, a maior parte dos doentes apresenta sintomatologia urinária muito semelhante à que apresentava antes do tratamento. Após o 18.º mês, os doentes mantêm uma melhoria da sintomatologia urinária para além da que apresentavam previamente ao implante. As taxas de retenção urinária e de ressecção transuretral prostática após o implante de braquiterapia são muito baixas, inferiores a 10%. 2. A associação da braquiterapia prostática com radioterapia externa adjuvante influencia a evolução da sintomatologia urinária: o aparecimento da sintomatologia urinária é mais lento, demorando 6 meses a atingir o seu valor máximo que, por sua vez, é de intensidade menos acentuada do que quando a braquiterapia é utilizada em monoterapia. 3. O volume prostático superior a 50 ml não influencia a morbilidade urinária. 4. A terapêutica hormonal, neoadjuvante e adjuvante, não influencia a sintomatologia urinária. 5. Os doentes com sintomatologia urinária prévia muito acentuada não sofrem agravamento da referida sintomatologia. Pelo contrário, apresentam uma melhoria de sintomas urinários desde o primeiro mês, e que se mantém ao longo dos 24 meses de seguimento, apresentando, no final deste período, sintomatologia urinária ligeira e muito inferior à que apresentavam antes do implante. As taxas de retenção urinária e RTU-P após a braquiterapia são semelhantes às que ocorrem nos doentes assintomáticos previamente ao implante. 6. A vida sexual está preservada, em mais de 70% dos casos, ao fim dos 24 meses de seguimento. No entanto, imediatamente após o primeiro mês de seguimento, ocorre uma diminuição ligeira da qualidade das erecções que se mantém, sem melhoria ou agravamento, durante todo o período de seguimento. A hormonoterapia afecta todos os parâmetros da vida sexual, embora de forma apenas temporária. Após a suspensão da terapêutica hormonal este grupo de doentes recupera a actividade sexual e apresenta-se idêntico ao grupo de doentes que não foram sujeitos a essa terapêutica.----------------ABSTRACT: Objectives 1. To assess urinary and sexual morbility after prostatic brachytherapy with the implant of I125 seeds. 2. To assess the influence of neoadjuvant and adjuvant hormone therapy in urinary and sexual morbility after prostatic brachytherapy with the implant of I125 seeds. 3. To assess the effects, on urinary and sexual morbility, of associating external radiotherapy after prostatic brachytherapy with the implant of I125 seeds. 4. To assess the urinary morbility in patients with relative contraindications (voluminous prostates, high IPSS). Material and Methods From September, 2000 to December, 2004 a total of 204 patients were recruited with a diagnosis of localized (T1 and T2) or locally advanced (T3) carcinoma of the prostate and a life expectancy in excess of 10 years. The patients underwent brachytherapy with transperineal seed implant of iodine (I125) as a monotherapy or in combination with hormone therapy and/or external radiotherapy (trimodal treatment). With the aim of evaluating the treatment’s influence on urinary and sexual morbility, a number of patient sub-groups were defined in accordance with certain characteristics normally mentioned as morbility risk factors for prostatic brachytherapy treatment: Group 1: Brachytherapy as monotherapy (MONO) versus brachytherapy in combination with external radiotherapy (BCOMB) Group 2: Voluminous prostates (>50ml) versus non- voluminous prostates (<50ml) Group 3: Brachytherapy in combination with hormone therapy (HORM) versus brachytherapy without hormone therapy (NHORM)Group 4: High IPSS versus a low IPSS. The evolution of the IPSS, QoL, TURP rate and post-implant urinary retention as well as the BSFI were assessed throughout the entire follow-up period. Results Group 1: For the MONO group the IPSS began at 7.1, and then rose to 16.1 and 15.9 in the first and third months, respectively. At month 12, the IPSS had dropped to 10.1 and at month 18 and 24 the IPSS was registered at 7.3 and 5.8, respectively. The BCOMB group started out with an IPSS of 9.4. It underwent a slight and little-significant rise until month 6 (IPSS at 14). The evolution of the IPSS then began to fluctuate from an IPSS of 5.9 at month 12 and 9.5 at month 18. At month 24 we registered an IPSS of 6.7. The urinary retention rate (6.4% and 0%) and TURP rate (2.0% e 0%) were similar to those of the MONO and BCOMB groups, respectively (p=0.375 and p=1). The evolution regarding the quality of erections was similar for the two groups except at 6 months when the MONO group displayed a value of 6 and the BCOMB group 3.7 (p=0.029). The percentage of sexually potent patients was significantly lower in the first six months after brachytherapy for the BCOMB group when compared with the MONO group: 36%–74%; 33%–73%; 33%–75%. After six months, the results became more consistent. Group 2: IPSS results evolved in <50ml and >50ml prostates from 7–9 to 15-19 in the first month and from 15-18 after the third month. It was only in the first month that the differences in the IPSS were significant (p=0.061). After the third month, the two groups displayed similar outcomes: IPSS 8 and 12 at month 12 and 5.7 and 6 at month 24. Urinary retention and TURP rates were similar (p=0.054 e p=0.286). Group 3: IPSS evolution and rates of urinary retention and TURP were identical in both groups. Figures regarding libido, erections, percentage of sexually potent patients, ejaculation, discomfort and sexual satisfaction were always significantly lower for the HORM group, when compared to the NHORM group in the first month only (values of p<0.0001; <0.0001; <0.0001; 0.009 e 0.002, respectively). Group 4: IPSS evolution in patients with a high IPSS was as follows: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M) IPSS evolution in patients with a low IPSS was as follows: 5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M)TURP rates (2.8% e 0%) and those for urinary retention (5.1% e 5.9%) were similar in both patient groups (p=1). Conclusions 1. Interstitial radiotherapy of the prostate with transperineal, ultrasound-guided implant of Iodine-125 seeds is often followed by transitory urinary morbility of moderate intensity. The morbility involves symptoms of the lower urinary tract which, in most cases are at their worst from the first to the third months. There is a slight improvement up to the sixth month, at which point improvement becomes more accentuated. Around months 12 or 18, most patients display urinary symptoms that are very similar to those noted before treatment. After month 18, patients’ urinary symptoms continue to improve past the point they displayed prior to the implant. Urinary retention rates and those for transurethral resection of the prostate are very low (below 10%), after brachytherapy seed implant. 2. The combination of prostatic brachytherapy and adjuvant external radiotherapy affects the evolution of urinary symptoms: the appearance of urinary symptoms is much slower, taking six months to peak, and is less intense than when brachytherapy is employed as the only means of treatment. 3. The fact that the prostate displays a volume greater than 50 ml does not influence urinary morbility. 4. Neoadjuvant and adjuvant hormone therapy do not influence urinary symptomology. 5. Patients with severe, preexisting symptoms of the urinary tract do not experience a worsening of those symptoms. On the contrary, they exhibit an improvement in urinary symptoms as of the first month. This improvement continues for the 24 months, after which patients display symptoms of the urinary tract that are slight and a noticeable improvement over the urinary complaints registered before the implant. Urinary retention and TURP rates subsequent to brachytherapy are similar to those registered for asymptomatic patients. 6. The patient’s sexual performance is maintained in more than 70% of the cases, as noted after 24 months of follow-up. However, immediately after the first follow-up month there is a lessening in the quality of erections that continues, without improving or worsening, for the whole follow-up period. Hormone therapy affects all the parameters of sexual performance, albeit temporarily. After suspending hormone therapy, this group recovered with regard to sexual performance, and showed itself to be identical to the group of patients that had not undergone hormone therapy.-------------------RESUMÉ:Objectives 1. Évaluer la morbilité urinaire et sexuelle après la realisation la curiethérapie de la prostate avec implant de I125. 2. Évaluer l’ influence de la thérapie hormonale néoadjuvante et adjuvante en ce qui concerne la morbilité urinaire et sexuelle après la réalisation de la curiethérapie (I125). 3. Évaluer l’influence de l’association de la radiothérapie externe dans la morbilité urinaire et sexuelle après la réalisation de la curiethérapie (I125). 4. Évaluer la morbilité urinaire des malades avec des contre indications relatives (prostates volumineuses, IPSS élevé). Matériel et méthodologie De Septembre 2000 à Décembre 2004, on a recruté 204 patients ayant pour diagnostique un carcinome de la prostate localisé (T1 et T2) ou localement avancé (T3) et dont l’expectative de vie était de plus de 10 ans. Ils ont été soumis au traitement de la curiethérapie avec l’implantation transpérinéal de l’iode 125 (I125) en monothérapie ou en traitement combiné avec une thérapie hormonale et/ou radiothérapie externe (traitement trimodale). Il y a eu plusieurs sous-catégories de patients, et cela dépend de quelques caractéristiques normalement considérées comme des facteurs à risque en ce qui concerne la morbilité du traitement de la curiethérapie de la prostate, et l’objective étant d’analyser son influence sur la morbilité urinaire et sexuelle. Groupe 1: Curiethérapie en traitement unique (MONO) par rapport à la curiethérapie associée au traitement externe (BCOMB). Groupe 2: Prostates volumineuses (>50ml) par rapport au prostates qui ne sont pas volumineuses (<50ml). Groupe 3: Curiethérapie associée au traitement hormonale (HORM) par rapport à la curiethérapie sans traitement hormonale (NHORM). Groupe 4: IPSS élevé par rapport au IPSS diminué. Nous avons évalué l’evolution du IPSS, Qualité de vie, le taux de RTU-P et la retention de l’urine après l’implant, BSFI pendant toute la période du traitement. Résultats Groupe 1: Pour le groupe MONO l’IPSS a commençé avec un taux de 7.1, et les patients ont souffert d’un empirement allant jusqu’à 16.1 et 15.9 pendant le premier et le troisième mois. 12 mois après l’IPSS diminua jusqu’à 10.1 À 18 mois le taux fût de 7.3 et à 24 mois il diminua encore jusqu’à atteindre 5.8. Le groupe BCOMB commença avec un taux d’IPSS de 9.4. Ils souffrirent un empirement légér et peu accentué jusqu’aux 6 premiers mois (IPSS de 14). L’évolution de l’IPSS était fluctuante allant de 5.9 à 12 mois et 9.5 à 18 mois. À 24 mois, l’IPSS était de 6.7. Le taux de retention de l’urine (6.4% et 0%) et de la RTU-P (2.0% et 0%) étaient simmilaires dans les groupes MONO et BCOMB respectivement (p=0.375 et p=1). L’ évolution de la qualité des érections fût semblable dans les 2 groupes excepté le groupe MONO qui présenta une valeure de 6 à 6 mois et le groupe BCOMB qui présenta une valeure de 3.7 (p=0.029). Le pourcentage des malades sexuellement puissants a été significativement inférieur pendant les 6 premiers mois depuis la curiethérapie pour le groupe BCOMB si on le compare au groupe MONO: 36%–74%; 33%–73%; 33%–75%. Après cette période, les groupes eûrent des résultats homogénes. Groupe 2: L’ IPSS a évolué dans les prostates <50ml et >50ml de 7–9 jusqu’à 15-19 pendant le premier mois et jusqu’à 15-18 au 3ème mois. C’est seulement pendant le premier mois que les différences de l’IPSS ont été significatives (p=0.061). Après le 3ème mois les deux groupes ont eu des résultats semblables: IPSS 8 et 12 à 12.º mois et 5.7 et 6 à 24.º mois. Le taux de retention de l’urine et de la RTU-P ont été simmilaires (p=0.054 e p=0.286). Groupe 3: L’evolution de l’ IPSS, les taux de retention de l’urine et de la RTU-P pourraient se surposer pour les deux groupes. L’évolution de la libido, des érections, le pourcentage des malades sexuellements puissants, l’incommodité et la satisfaction ont été toujours significativement infériures dans le groupe HORM par rapport au groupe NHORM dès le premier mois (valeurs de p <0.0001; <0.0001; < 0.0001; 0.009 et 0.002 respectivement) Groupe 4: L’évolution de l’ IPSS pour les malades ayant un IPSS élevé fût ainsi: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M)L’évolution de l’ IPSS pour les malades ayant un IPSS diminué fût ainsi:5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M) Le taux de RTU-P (2.8% e 0%) et de retention de l’urine (5.1% et 5.9%) ont été semblables dans les 2 groupes de malades (p=1). Conclusions 1. La radiothérapie interstitielle de la prostate avec implant transpérinéal de l’iode 125 est fréquamment acompagnée d’une morbilité urinaire transitoire et d’intensité modérée. La morbilité consiste d’une symptomatologie de l’apparéil urinaire inférieure qui, dans la plupart des malades, empire gravement du premier au troisième mois. La situation s’améliore légèrement jusqu’au 6ème mois, l’amélioration étant plus accentuée à partir de là. Autour du 12ème jusqu’au 18ème mois, la majorité des malades présente une symptomatologie urinaire qui se ressemble beaucoup à celle qu’ils avaient avant le traitement. Après le 18ème mois l’amélioration de la symptomatologie urinaire est constante par rapport à celle qu’ils présentaient avant l’implant. Le taux de retention de l’urine et de RTU-P après l’implant de la curiethérapie sont très basses, au dessus de 10%. 2. L’association de la curiethérapie de la prostate avec la radiothérapie externe adjuvante a une influence sur l’évolution de la symptomatologie urinaire: l’apparition des symptômes est plus lente, prenant jusqu’à 6 mois pour atteindre son niveau maximum, qui à son tour, a une intensité moins accentuée que lorsque la curiethérapie est utilisée en monothérapie. 3. Le volume de la prostate supérieure à 50 ml n’a pas d’influence sur la morbilité urinaire. 4. La thérapie hormonale, néoadjuvante et adjuvante, n’a pas d’influence sur la symptomatologie urinaire. 5. Les malades ayant une symptomatologie urinaire préalable et très accentuée ne souffrent pas d’empirement de leur situation. Au contraire, ils présentent une amélioration des symptômes urinaires à partir du premier mois et ceci se maintient tout au long des 24 mois que dure le traitement, ayant à la fin de cette période une symptomatologie urinaire légère et beaucoup plus basse que celle qu’ils présentaient avant l’implant. Le taux de retention de l’urine et de la RTU-P après la curiethérapie est simmilaire à celui que les malades qui n’ont pas de symptômes présentent avant l’implant. 6. La vie sexuelle est préservée dans plus du 70% des cas à la fin de la période de traitement (24 mois). Entretemps, immédiatement après le premier mois d’étude, on note une légère diminution de la qualité des érections qui se maintient sans amélioration ou empirement tout au long du traitement. Le traitement à base d’hormones affecte tous les paramètres de la vie sexuelle, mais de façon temporaire. Après la suspension de la thérapie hormonale ce groupe de malades récupère l’activité sexuelle et se présente de façon égale au groupe de malades qui n’ont pas été soumis à ce traitement.

Prostatic Arterial Embolization to Treat Benign Prostatic Hyperplasia

PURPOSE: To evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Fifteen patients (age range, 62-82 years; mean age, 74.1 y) with symptomatic BPH after failure of medical treatment were selected for PAE with nonspherical 200-μm polyvinyl alcohol particles. The procedure was performed by a single femoral approach. Technical success was considered when selective prostatic arterial catheterization and embolization was achieved on at least one pelvic side. RESULTS: PAE was technically successful in 14 of the 15 patients (93.3%). There was a mean follow-up of 7.9 months (range, 3-12 months). International Prostate Symptom Score decreased a mean of 6.5 points (P = .005), quality of life improved 1.14 points (P = .065), International Index of Erectile Function increased 1.7 points (P = .063), and peak urinary flow increased 3.85 mL/sec (P = .015). There was a mean prostate-specific antigen reduction of 2.27 ng/mL (P = .072) and a mean prostate volume decrease of 26.5 mL (P = .0001) by ultrasound and 28.9 mL (P = .008) by magnetic resonance imaging. There was one major complication (a 1.5-cm(2) ischemic area of the bladder wall) and four clinical failures (28.6%). CONCLUSIONS: In this small group of patients, PAE was a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, associated with a reduction in prostate volume.

Voiding dysfunction and urodynamic abnormalities in elderly patients

Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in elderly men and women. With the progressive aging of the population, it is important to understand common micturitional disorders that may occur in this population. Most urinary problems in the elderly are multifactorial in origin, demanding a comprehensive assessment of the lower urinary tract organs, functional impairments, and concurrent medical diseases. Urodynamics is a highly valuable tool in the investigation of elderly patients with lower urinary tract symptoms. Urodynamic tests are not always necessary, being indicated after excluding potentially reversible conditions outside the urinary tract that may be causing or contributing to the symptoms. Although urodynamic tests may reveal common diagnoses such as bladder outlet obstruction and stress urinary incontinence in the elderly population, findings such as detrusor overactivity and impaired detrusor contractility are common and have important prognostic and therapeutic implications. The purpose of this article is to describe common urologic problems in the elderly and review the indications for and clinical aspects of urodynamic studies in these conditions.

Intérêt d'une Consultation spécialisée multidisciplinaire en neuro-urologie et urologie fonctionnelle [Benefit of a specialized multidisciplinary clinic in neuro-urology and functional urology].

Functional disorders encounter for a large amount of the medical activity, including in urology. The decreased quality of life due to lower urinary tract symptoms requires a prompt management, with primary assessment undergone in community. Referral to a specialist is required when simple management has failed, and whenever any of these coexists: hematuria, recurrent urinary infection, and neurological condition. The specialized clinic in neurourology and functional urology aim at further investigating the underlying disorder responsible for the urinary symptoms and preventing urinary tract complications. A multidisciplinary team is the key to accurately assess patients with regards to their bother and handicap, therefore offering the most appropriate conservative, medical or surgical management.

National Audit of Continence Care

The first National Audit of Continence Care for Older People, sponsored by the HealthcareCommission, was published in November 2005. The results from that audit generated muchinterest and harnessed an impetus for change. This report presents the results from the 3rdround of the organisational and clinical National Audit of Continence Care which examined thestructure and provision of care for people with lower urinary tract symptoms and incontinence,and faecal incontinence in primary care, secondary care and care homes in England, Walesand Northern Ireland, and compared this to current national guidelines.Well organised services,based upon national guidelines have been shown to deliver higher quality care to patients. Asjudged by the national guidelines however, this round of audit shows there is still considerablevariation in both the organisation of services and the way they deliver care to patients.

Testostérone et prostate [Testosterone and prostate].

Age related testosterone deficiency syndrome may occur with other diseases of the elderly men, as prostate diseases. The relationship between testosterone and prostate has been widely studied the last 10 years, with the increased use of testosterone replacement therapy. The traditional belief that testosterone administration causes prostate cancer growth has been challenged by recent studies. To date, nothing has been found to support the evidence that restoring testosterone levels within physiological range increases the incidence of prostate cancer in hypogonadic patients. In these patients, testosterone replacement therapy does not seem to worsen lower urinary tract symptoms.

Sphenoid sinus metastasis as the presenting manifestation of a prostatic adenocarcinoma: case report and overview of the literature.

Although a metastatic presentation of an occult prostatic adenocarcinoma is not uncommon, the majority of these patients present with bone metastasis affecting the axial skeleton. Cranial metastases to the paranasal sinuses are extremely rare. A 56-year-old man presented with loss of vision and numbness of the right side of the face. Computed tomography (CT) scan and cranial magnetic resonance imaging (MRI) revealed a mass invading the sphenoid sinus. The patient underwent surgery to remove the lesion, and the histopathological examination suggested metastasis of an adenocarcinoma, with positive staining to prostatic specific antigen (PSA). However, serum PSA was 4 ng/mL, and the patient did not report any lower urinary tract symptoms or bone pain. Transrectal ultrasound-guided biopsy revealed prostatic adenocarcinomas with a Gleason score of 8 [4 + 4]. The subsequent treatment consisted of radiotherapy and androgen deprivation, followed by first- and second-line chemotherapy (docetaxel and cabazitaxel) when the disease progressed. The patient achieved a good response with the last cycle of cabazitaxel and after a 5-year followup is currently alive. Cranial metastases of prostate adenocarcinoma are rare, and there is currently no standard treatment for these patients. Whenever possible, surgery combined with radiotherapy and hormonotherapy is the recommended option.

Alpha1-adrenoceptors are required for normal male sexual function.

BACKGROUND AND PURPOSE: Alpha(1)-adrenoceptor antagonists are extensively used in the treatment of hypertension and lower urinary tract symptoms associated with benign prostatic hyperplasia. Among the side effects, ejaculatory dysfunction occurs more frequently with drugs that are relatively selective for alpha(1A)-adrenoceptors compared with other drugs of this class. This suggests that alpha(1A)-adrenoceptors may contribute to ejaculation. However, this has not been studied at the molecular level. EXPERIMENTAL APPROACH: The physiological contribution of each alpha(1)-adrenoceptor subtype was characterized using alpha(1)-adrenoceptor subtype-selective knockout (KO) mice (alpha(1A)-, alpha(1B)- and alpha(1D)-AR KO mice) since the subtype-specific drugs available are only moderately selective. We analysed the role of alpha(1)-adrenoceptors in the blood pressure and vascular response as well as ejaculation by determining these variables in alpha(1)-adrenoceptor subtype-selective KO mice and in mice with all their alpha(1)-adrenoceptor subtypes deleted (alpha(1)-AR triple-KO mice). KEY RESULTS: The pregnancy rate was reduced by 50% in alpha(1A)-adrenoceptor KO mice, and this reduction was dramatically enhanced in alpha(1)-adrenoceptor triple-KO mice. Contractile tension of the vas deferens in response to noradrenaline was markedly decreased in alpha(1A)-adrenoceptor KO mice, and this contraction was completely abolished in alpha(1)-adrenoceptor triple-KO mice. This attenuation of contractility was also observed in the electrically stimulated vas deferens. CONCLUSIONS AND IMPLICATIONS: These results demonstrate that alpha(1)-adrenoceptors, particularly alpha(1A)-adrenoceptors, are required for normal contractility of the vas deferens and consequent sperm ejaculation as well as having a function in fertility.

Increased prevalence of bladder and intestinal dysfunction in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is predominantly characterized by a progressive loss of motor function. While autonomic dysfunction has been described in ALS, little is known about the prevalence of lower urinary tract symptoms (LUTS) and intestinal dysfunction. We investigated disease severity, LUTS and intestinal dysfunction in 43 patients with ALS attending our outpatient department applying the ALS functional rating scale, the International Consultation on Incontinence Modular Questionnaire, the Urinary Distress Inventory and the Cleveland Clinic Incontinence Score. Results were compared to the German population of a cross-sectional study assessing LUTS in the healthy population, the EPIC study. Results showed that urinary incontinence was increased in patients with ALS aged ≥ 60 years compared to the EPIC cohort (female: 50%/19% (ALS/EPIC), p = 0.026; male: 36%/11% (ALS/EPIC), p = 0.002). No difference was seen at 40-59 years of age. Urge incontinence was the predominant presentation (73% of symptoms). A high symptom burden was stated (ICIQ-SF quality of life subscore 5.5/10). Intake of muscle relaxants and anticholinergics was associated with both urinary incontinence and severity of symptoms. Furthermore, a high prevalence of constipation (46%), but not stool incontinence (9%), was noted. In conclusion, the increased prevalence of urge incontinence and high symptom burden imply that in patients with ALS, LUTS should be increasingly investigated for.

Relación entre síntomas urinarios bajos y calidad de vida antes y después de la RTUP

Determinar el impacto en la calidad de vida de los pacientes con STUB dados por HPB en el Hospital de la Samaritana y Hospital universitario mayor MEDERI, que son llevados a resección transuretral de próstata y definir cual es la relación de dicho impacto con la severidad de los síntomas antes y después del tratamiento. Métodos: Se incluyeron 72 pacientes con síntomas de tracto urinario bajo dados por crecimiento prostático que fueron llevados a resección transuretral de próstata. Se realizo medición de síntomas urinarios según el IPSS y medición de calidad de vida según el cuestionario índice de impacto BPH (BII) antes de la cirugía y 3 meses luego de la misma. Resultados: Se realizó análisis de correlación entre los síntomas del IPSS y el BII antes de la resección transuretral de próstata y 3 meses después de la misma, encontrándose una correlación significativa entre las dos escalas en ambos momentos. Se realizó un modelo de regresión con las variables de las 2 escalas utilizadas, encontrando que antes de la cirugía los síntomas que deterioran más la calidad de vida son chorro débil, nicturia y frecuencia y los síntomas que al mejorar luego de la cirugía, mejoran la calidad de vida son intermitencia, chorro débil y pujo. Conclusión: Existe una correlación entre la escala IPSS y el índice de calidad de vida BII en los pacientes con STUB que van a ser llevados a RTUP antes y después de la intervención; por lo que el BII podría ser una herramienta para la evaluación inicial y para el seguimiento de los pacientes que son llevados a resección transuretral de próstata .