LUTS: Lower Urinary Tract Symptoms最新文献_第2页

Transient Receptor Potential Melastatin 8 Contributes to Cystitis-Induced Neuronal Sprouting and Pain Hypersensitivity Through AKT/mTOR Signaling Pathway in Interstitial Cystitis/Bladder Pain Syndrome 瞬时受体电位美司他丁 8 通过 AKT/mTOR 信号通路促进间质性膀胱炎/膀胱疼痛综合征中膀胱炎诱导的神经元萌发和疼痛超敏反应

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-11-11 DOI: 10.1111/luts.12537

Liyang Wu, Ran Chang, Peng Zhang

Objectives

The aim of this study was to investigate the mechanism of TRPM8 in neuroproliferation and pain, as well as the relevance of the Akt/mTOR signaling pathway in mice with IC/BPS.

Methods

The model of IC/BPS was established in wild and TRPM8^−/− mice. The mechanical sensitivity was measured. The number of neurite segments, length of neurites, and density of neurites were all counted. IL-6 and norepinephrine levels were detected by ELISA, Western blot was used to detect protein levels of TRPM8, Akt, p-Akt, mTOR, p-mTOR. Immunofluorescence was used to detect TRPM8 expression and distribution in neurites, neurons, and sensory nerves in mouse bladder tissue.

Results

Pain threshold in the IC/BPS group was decreased, and neurite segments, length, and density were all significantly enhanced when compared to the control group. The parameters in the IC/BPS model + Menthol group were more statistically significant. Neurite number and density were lower in TRPM8 knockout-model mice than in IC/BPS model mice. The expression of TRPM8 and the ratios of p-Akt/Akt and p-mTOR/mTOR rose in the IC/BPS model group. In TRPM8 knockout-model mice, the ratios of p-Akt/Akt and p-mTOR/mTOR were not substantially different from those in the control group. TRPM8 knockout-model mice had considerably lower levels of serum IL-6 and urine norepinephrine than IC/BPS model mice.

Conclusions

TRPM8 can induce pain hypersensitivity and sensory nerve proliferation by activating Akt/mTOR pathway and raising the expression of IL-6 and norepinephrine in IC/BPS models. These findings offer new perspectives on IC/BPS treatment.

研究目的本研究旨在探讨 TRPM8 在 IC/BPS 小鼠神经增殖和疼痛中的作用机制，以及 Akt/mTOR 信号通路的相关性：方法：在野生小鼠和TRPM8-/-小鼠中建立IC/BPS模型。方法：在野生小鼠和TRPM8-/-小鼠中建立IC/BPS模型，测量机械敏感性。方法：在野生小鼠和 TRPM8-/- 小鼠中建立 IC/BPS 模型，测量机械敏感性，计算神经元节段数量、神经元长度和神经元密度。ELISA检测IL-6和去甲肾上腺素的水平，Western印迹检测TRPM8、Akt、p-Akt、mTOR、p-mTOR的蛋白水平。免疫荧光法检测TRPM8在小鼠膀胱组织神经元、神经元和感觉神经中的表达和分布：结果：与对照组相比，IC/BPS 组疼痛阈值降低，神经元节段、长度和密度均明显增加。IC/BPS 模型 + 薄荷醇组的参数在统计学上更为显著。TRPM8基因敲除模型小鼠的神经元数目和密度均低于IC/BPS模型小鼠。IC/BPS模型组中TRPM8的表达以及p-Akt/Akt和p-mTOR/mTOR的比率上升。在TRPM8基因敲除模型小鼠中，p-Akt/Akt和p-mTOR/mTOR的比率与对照组没有实质性差异。TRPM8基因敲除模型小鼠的血清IL-6和尿去甲肾上腺素水平大大低于IC/BPS模型小鼠：结论：在 IC/BPS 模型中，TRPM8 可通过激活 Akt/mTOR 通路并提高 IL-6 和去甲肾上腺素的表达，诱导痛觉过敏和感觉神经增生。这些发现为IC/BPS的治疗提供了新的视角。

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引用次数: 0

Correction to “Preoperative Factors Predicting Poor Therapeutic Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Hyperplasia” 对 "良性前列腺增生症患者前列腺钬激光去核术疗效不佳的术前预测因素 "的更正。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-11-06 DOI: 10.1111/luts.12536

K. Watanabe, A. Otsuka, Y. Kitagawa, et al., “Preoperative Factors Predicting Poor Therapeutic Efficacy of Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Hyperplasia,” Lower Urinary Tract Symptoms 16, no. 4 (2024): e12530, https://doi.org/10.1111/luts.12530.

In the Result section of the Abstract, the second sentence that “Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group” was incorrect. This should have read: “Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR) were lower and the prevalence of OAB was higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group.”

We apologize for this error.

K.Watanabe, A. Otsuka, Y. Kitagawa, et al., "Preoperative Factors Predicting Poor Therapeutic Efficiency of Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Hyperplasia," Lower Urinary Tract Symptoms 16, no.4 (2024): e12530, https://doi.org/10.1111/luts.12530.In 摘要的 "结果 "部分，第二句 "疗效差组的前列腺腔内突出（IPP）、IPSS、IPSS-QOL、排尿后残余尿量（PVR）和膀胱过度活动症（OAB）显著高于疗效好组 "有误。应改为"疗效差组的膀胱内前列腺突出（IPP）、IPSS、IPSS-QOL、排尿后残余尿量（PVR）均低于疗效好组，而膀胱过度活动症的发病率高于疗效好组。"我们对此错误表示歉意。

引用次数: 0

Safety and Effectiveness of Vibegron in Japanese Patients With Overactive Bladder: A Japanese Postmarketing Survey Vibegron 对日本膀胱过度活动症患者的安全性和有效性：日本上市后调查

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-11-05 DOI: 10.1111/luts.12535

Shoko Yoshimura, Hiromitsu Yagi, Kazunori Abe, Masakazu Yamasaki

Objectives

To evaluate the safety and effectiveness of vibegron, a highly selective β₃-adrenoceptor agonist, in Japanese patients with overactive bladder (OAB) in a real-world clinical setting.

Methods

This prospective survey was conducted from August 2019 to July 2023 using a central registration method. Patients newly treated with vibegron for OAB were followed for 12 weeks, and those who continued treatment were observed for up to 52 weeks. Adverse drug reactions (ADRs) and the overall improvement level were assessed, and overactive bladder symptom score (OABSS) and International Prostate Symptom Score-Quality of Life (IPSS QOL) score were collected.

Results

Of the 1848 patients in the safety analysis set, 154 ADRs were reported in 141 patients (7.63%). Common ADRs were increased residual urine volume (1.30%), constipation (1.14%), dysuria and urinary retention (0.97% each), cystitis (0.65%), and dry mouth (0.32%). The incidence of urinary retention-related adverse events (AEs) was higher in male patients, patients ≥ 65 years old, and patients with benign prostatic hyperplasia. The effectiveness rate was 88.8% among the 1561 patients in the effectiveness analysis set. Significant improvement in both OABSS and IPSS QOL scores was observed at all observation periods. The rate of achieving the minimal clinically important change in OABSS total score at the final evaluation was 75.35%. OABSS scores were also significantly reduced in all subgroup analyses.

Conclusions

This survey found no major concerns regarding the safety and effectiveness of vibegron in Japanese OAB patients, except for urinary retention-related AEs. Vibegron is considered to represent a useful drug for treating OAB symptoms in a real-world clinical setting.

目的评估高选择性 β3-肾上腺素受体激动剂维贝琼在实际临床环境中对日本膀胱过度活动症（OAB）患者的安全性和有效性：这项前瞻性调查于 2019 年 8 月至 2023 年 7 月进行，采用中央登记方法。对新接受维贝琼治疗的 OAB 患者进行了为期 12 周的随访，对继续接受治疗的患者进行了长达 52 周的观察。评估药物不良反应（ADRs）和总体改善程度，收集膀胱过度活动症状评分（OABSS）和国际前列腺症状评分-生活质量（IPSS QOL）：在安全性分析组的 1848 名患者中，141 名患者（7.63%）报告了 154 例不良反应。常见的不良反应包括残余尿量增加（1.30%）、便秘（1.14%）、排尿困难和尿潴留（各占 0.97%）、膀胱炎（0.65%）和口干（0.32%）。男性患者、65 岁以上患者和良性前列腺增生患者的尿潴留相关不良事件（AEs）发生率较高。在有效性分析组的 1561 名患者中，有效率为 88.8%。在所有观察期内，OABSS 和 IPSS QOL 评分均有显著改善。在最终评估中，OABSS 总分达到最小临床意义变化的比例为 75.35%。在所有亚组分析中，OABSS 评分也显著降低：这项调查发现，除了与尿潴留相关的 AE 外，日本 OAB 患者对 Vibegron 的安全性和有效性没有重大担忧。在实际临床环境中，Vibegron 被认为是治疗 OAB 症状的有效药物。

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引用次数: 0

Efficacy and Safety of Lemborexant for Insomnia Patients With Nocturia—A Prospective Study 伦博雷沙坦治疗夜尿失眠患者的疗效和安全性--一项前瞻性研究

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-10-10 DOI: 10.1111/luts.12534

Yoshikazu Togo, Yohei Kaizuka, Seiji Nagasawa, Keisuke Kajio, Nobuyuki Kondoh, Keizo Taguchi

Objectives

Nocturia is considered a clinical problem when nocturnal urinary frequency is two or more times. For affected patients, development of depression, falling, and increased mortality rate are matters of concern. The present study investigated the efficacy and safety of lemborexant for insomnia patients with nocturia.

Methods

Insomnia patients (Athens Insomnia Scale [AIS] ≥ 6) who typically awoke twice or more during the night to urinate and were examined at our institutions from June 2021 to December 2022 were enrolled. Each was administrated 5 mg of lemborexant, one tablet, daily for 4 weeks. Total AIS score, nocturia frequency, individual frequency-volume chart findings, and N-QOL score were examined before and after administration.

Results

Of the 37 patients recruited, 5 were excluded, thus 32 were enrolled and subjected to analyses. Following lemborexant therapy, the mean AIS total score was significantly decreased from 11.4 to 7.8 (p < 0.01) as was mean number of nocturia episodes from 3.4 to 2.3 (p < 0.001). Furthermore, the mean single voided urine volume at night was significantly increased from 182.5 to 225.3 mL (p < 0.001)and mean period of undisturbed sleep was significantly extended from 105.3 to 174.8 min (p < 0.001), while mean total N-QOL score was significantly improved from 49.6% to 64.8% (p < 0.001). As for adverse events, mild somnolence was observed in three cases.

Conclusions

Lemborexant may be effective and safe for use in insomniac patients with nocturia.

目的：当夜尿次数达到 2 次或 2 次以上时，夜尿就被视为一种临床问题。对于夜尿症患者来说，抑郁、跌倒和死亡率的增加都是令人担忧的问题。本研究探讨了利眠宁对夜尿症失眠患者的疗效和安全性：方法：选取2021年6月至2022年12月在我院接受检查的失眠患者（雅典失眠量表[AIS]≥6）为研究对象，这些患者通常在夜间醒来两次或两次以上排尿。每人每天服用一片 5 毫克的利眠宁，连续服用 4 周。对用药前后的 AIS 总分、夜尿次数、单次尿量图表结果和 N-QOL 评分进行了检查：结果：在招募的 37 名患者中，有 5 人被排除在外，因此有 32 人被招募并接受了分析。经过伦博雷沙坦治疗后，AIS 总分的平均值从 11.4 显著下降至 7.8（p 结论：伦博雷沙坦可能是一种有效的治疗药物：对于有夜尿症的失眠患者来说，使用伦博雷沙坦可能既有效又安全。

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引用次数: 0

Definition Change and Update of Clinical Guidelines for Interstitial Cystitis and Bladder Pain Syndrome 间质性膀胱炎和膀胱疼痛综合征的定义变更和临床指南更新

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-09-12 DOI: 10.1111/luts.12532

Yukio Homma, Yoshiyuki Akiyama, Jang Hwan Kim, Yao-Chi Chuang, Seong Jin Jeong, En Meng, Takeya Kitta, Jia-Fong Jhang, Akira Furuta, Kyu-Sung Lee, Daichi Maeda

The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.

间质性膀胱炎（IC）和膀胱疼痛综合征（BPS）的临床指南已经修订，更新了我们之前的指南。间质性膀胱炎和膀胱疼痛综合征的症状统称为高敏感性膀胱（HSB）症状，两者几乎没有区别；但是，间质性膀胱炎和膀胱疼痛综合征应被视为不同的疾病。我们将 IC 定义为伴有 Hunner 病变的膀胱疾病，通常伴有 HSB 症状和膀胱炎症；将 BPS 定义为伴有 HSB 症状但无 Hunner 病变和任何可混淆疾病的情况。IC 和 BPS 的病理生理学完全不同。IC 涉及可能由自身免疫引起的免疫性炎症，而 BPS 则与神经源性炎症、外源性物质、尿道缺陷、心理压力和神经亢进等多种因素的相互作用有关。IC 和 BPS 的组织病理学也有所不同。IC 与整个膀胱的严重炎症有关，伴有浆细胞浸润和尿路上皮变性，而 BPS 几乎没有病理变化。治疗应从鉴别诊断 IC 或 BPS 开始，这需要进行膀胱镜检查以确定是否存在 Hunner 病变。虽然 IC 和 BPS 的疼痛治疗方法相同，但患者应根据诊断结果按照算法进行不同的治疗。临床研究也应针对 IC 和 BPS 分别进行设计和分析。

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引用次数: 0

Androgenic Alopecia Is Associated With More Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia 雄激素性脱发与继发于良性前列腺增生症的更严重下尿路症状有关

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-09-12 DOI: 10.1111/luts.12531

Yasar Pazir, Mustafa Kadihasanoglu

Objectives

To evaluate the possible association between androgenic alopecia (AGA) and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Methods

A total of 148 patients aged over 45 with LUTS secondary to BPH were prospectively enrolled in this study. According to the Norwood–Hamilton classification, the patients were divided into two groups: AGA (n = 69) and non-AGA (n = 79). In addition, the cases of AGA were categorized as vertex (n = 39) and frontal baldness (n = 30). The International Prostate Symptom Score (IPSS), uroflowmetry parameters, prostate volume, serum total testosterone (TT), and free and total prostate-specific antigen concentrations of all patients were assessed and compared between the groups. Correlations between the AGA grade and other variables were also investigated.

Results

The serum TT level (354 ± 97.1 vs. 308.6 ± 73.1 ng/dL, p = 0.01), total IPSS (16.1 ± 8.1 vs. 13.4 ± 7.7, p = 0.04), IPSS storage subscore (IPSS-S) (7.1 ± 3.5 vs. 5.8 ± 3.6, p = 0.03), and number of nocturia episodes (2.5 ± 1.4 vs. 1.8 ± 1.4, p < 0.01) were significantly higher in the AGA group than in the non-AGA group. There were no significant differences in any of the parameters between the patients with vertex and frontal baldness. The AGA grade showed a significant positive correlation with the TT level (r = 0.407, p = 0.003), IPSS-S (r = 0.164, p = 0.04), and number of nocturia episodes (r = 0.203, p = 0.015).

Conclusions

This study demonstrated that among patients with LUTS, those with AGA had worse symptoms and higher TT levels compared with those without AGA of similar age. Furthermore, the AGA grade was positively correlated with the TT level and storage symptoms.

目的评估雄激素性脱发（AGA）与继发于良性前列腺增生症（BPH）的下尿路症状（LUTS）之间可能存在的关联。方法本研究前瞻性地纳入了 148 名 45 岁以上、继发于良性前列腺增生症的下尿路症状患者。根据诺伍德-汉密尔顿分类法，患者被分为两组：AGA组（69人）和非AGA组（79人）。此外，AGA病例还分为顶秃病例（39人）和额秃病例（30人）。对所有患者的国际前列腺症状评分（IPSS）、尿流率参数、前列腺体积、血清总睾酮（TT）、游离和总前列腺特异性抗原浓度进行评估，并在各组之间进行比较。此外，还研究了 AGA 分级与其他变量之间的相关性。结果血清 TT 水平（354 ± 97.1 vs. 308.6 ± 73.1 ng/dL，p = 0.01）、总 IPSS（16.1 ± 8.1 vs. 13.4 ± 7.7，p = 0.04）、IPSS 存储子分数（IPSS-S）（7.1 ± 3.5 vs. 5.8 ± 3.6, p = 0.03）和夜尿次数（2.5 ± 1.4 vs. 1.8 ± 1.4, p < 0.01）在 AGA 组明显高于非 AGA 组。顶秃和额秃患者的任何参数均无明显差异。AGA 等级与 TT 水平（r = 0.407，p = 0.003）、IPSS-S（r = 0.164，p = 0.04）和夜尿次数（r = 0.203，p = 0.015）呈显著正相关。结论本研究表明，在 LUTS 患者中，与年龄相仿的非 AGA 患者相比，AGA 患者的症状更严重，TT 水平更高。此外，AGA 等级与 TT 水平和贮积症状呈正相关。

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引用次数: 0

Predictors of Postoperative Urinary Incontinence After Holmium Laser Enucleation of the Prostate (HoLEP) for Surgeons Early in Their Experience 外科医生前列腺钬激光去核术（HoLEP）术后尿失禁的早期预测因素

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-09-12 DOI: 10.1111/luts.12533

Karen M. Doersch, Laena Hines, Timothy D. Campbell, Rajat K. Jain, Scott O. Quarrier

Objectives

To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience.

Methods

Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel–Cox log-rank testing as appropriate.

Results

From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51–93). The median case number was 56 (1–146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (p = 0.01) and shorter enucleation time (p = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel–Cox testing (p = 0.0004).

Conclusions

During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve.

目的评估影响前列腺钬激光去核术（Holmium Laser Enucleation of the prostate，HoLEP）术后尿失禁恢复的因素。方法从前瞻性维护的数据库中评估预定义因素对 HoLEP 术后尿失禁恢复的影响。两位外科医生作为主治医师均实施了少于 150 例 HoLEP。纳入标准为至少有 6 个月尿失禁数据或有尿失禁恢复记录的受试者。每天使用一个或更少的尿垫被定义为尿失禁。统计分析使用 R 和 Prism 进行，包括斯皮尔曼相关性、线性建模和 Mantel-Cox 对数秩检验。结果从 2020 年 12 月到 2023 年 5 月，共有 152 名受试者符合纳入标准，中位年龄为 70 岁（范围：51-93 岁）。病例数中位数为 56 例（1-146 例）。在研究期间，144/152（94.7%）例患者在术后中位数 1.6 个月时恢复了大小便失禁。线性建模显示，年龄较小（p = 0.01）和剜除时间较短（p = 0.001）预示着恢复情况。根据 Mantel-Cox 检验（p = 0.0004），剜除时间少于 100 分钟预示着尿失禁恢复更早。结论在外科医生的 HoLEP 学习曲线中，年龄和去核时间可预测尿失禁的恢复情况。去核时间在 100 分钟以下，预示着尿失禁恢复的速度更快。去核时间与尿失禁恢复之间的关系可能是病例难度的体现，也可能是去核过程中尿道外括约肌受压的结果。这些发现进一步加深了我们对外科医生学习曲线早期 HoLEP 结果的理解。

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引用次数: 0

Holmium laser enucleation of the prostate (HoLEP) in short-circuit outpatient care: Is prostatic volume a limiting factor? 短路门诊中的前列腺钬激光去核术（HoLEP）：前列腺体积是限制因素吗？

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-07-16 DOI: 10.1111/luts.12525

Sánchez Rodríguez Maria, Marco Franco, Roger Freixa Sala, Carlos Gasanz Serrano, Mauro Bernardello Ureta, Ramón Bultó Gonzalvo, Jordi Cervera Alcaide, Carla Casanova García, Mireia García Puche, Maria Segura Alabart, Juan José Areal Calama, Fernando Ágreda Castañeda

Introduction and Objectives

Our goals were to study prostatic volume as a limiting factor after HoLEP surgery with short-circuit outpatient care (4 h) and to define other factors that affect the success of the proposed circuit.

Materials and Methods

An observational analysis and review was performed using a prospective database. Preoperative, intraoperative, and postoperative variables were included for patients who were scheduled for short-circuit outpatient care (SCOC) and who underwent HoLEP between 2020 and 2023. We defined SCOC as a postoperative hospital stay of 4 h. Subjects who required more than 4 h in hospital were categorized as conventional hospital admission (CHA). A descriptive populational study was conducted, expressing the mean using a 95% confidence interval and percentages for the continuous variables. In order to analyze them, we used the Student's t-test for the continuous variables and the chi-squared test for the categorical variables.

Results

Sixty-eight patients were included, 54 of which completed SCOC, which represented a success ratio of 79.5%. The mean age and prostatic volume of the whole cohort were 68.9 (±6.8) years and 79.5 (±29.1) mL, respectively. We found no significant differences in age, prostatic volume, antiplatelet drug use, indwelling bladder catheter, or applied energy among the subjects who completed SCOC and those who required CHA. No patient was presented with a complication of Grade 3 (or higher) in the modified Clavien–Dindo classification. At the six-month follow-up, no differences were observed in the uroflowmetry or International Prostate Symptoms Score variables.

Conclusions

Prostatic volume does not seem to be a limiting factor after undergoing HoLEP with short-circuit outpatient care.

简介和目标：我们的目标是研究前列腺体积作为HoLEP手术后短路门诊护理（4小时）的限制因素，并确定影响拟议电路成功的其他因素：使用前瞻性数据库进行观察分析和回顾。纳入了 2020 年至 2023 年期间计划接受短路门诊护理（SCOC）并接受 HoLEP 的患者的术前、术中和术后变量。我们将 SCOC 定义为术后住院时间不超过 4 小时。我们进行了一项描述性人口研究，使用 95% 的置信区间和百分比来表示连续变量的平均值。为了对其进行分析，我们对连续变量采用了学生 t 检验，对分类变量采用了卡方检验：共纳入 68 名患者，其中 54 人完成了 SCOC，成功率为 79.5%。整个组群的平均年龄和前列腺体积分别为 68.9 (±6.8) 岁和 79.5 (±29.1) mL。我们发现，完成 SCOC 和需要 CHA 的受试者在年龄、前列腺体积、抗血小板药物使用、留置膀胱导尿管或应用能量方面没有明显差异。根据修改后的 Clavien-Dindo 分级，没有患者出现 3 级（或以上）并发症。在六个月的随访中，尿流测量或国际前列腺症状评分变量均未出现差异：结论：前列腺体积似乎并不是接受短路门诊治疗的限制因素。

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引用次数: 0

Preoperative factors predicting poor therapeutic efficacy of holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia 良性前列腺增生症患者前列腺钬激光去核术疗效不佳的术前预测因素。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-07-16 DOI: 10.1111/luts.12530

Kyohei Watanabe, Atsushi Otsuka, Yuichi Kitagawa, Asuka Sano, Ryo Sato, Yuto Matsushita, Hiromitsu Watanabe, Keita Tamura, Daisuke Motoyama, Toshiki Ito, Sanki Takada, Hideaki Miyake

Objectives

We assessed preoperative factors predicting the poor therapeutic efficacy of holmium laser enucleation of the prostate (HoLEP) in benign prostatic hyperplasia (BPH) patients.

Methods

The present study included 159 patients who underwent HoLEP between August 2015 and June 2021 at our institution. Overall therapeutic efficacy was divided into good and poor therapeutic efficacies according to changes in the international prostate symptom score (IPSS), IPSS quality of life (IPSS-QOL), and the maximum urinary flow rate. Patients were divided into good and poor therapeutic efficacy groups based on findings obtained 3 months after HoLEP, and comparative assessments were performed between the two groups.

Results

The therapeutic efficacy of HoLEP was poor in 53 (33.3%) out of 159 patients. Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group. A multivariable analysis of several factors identified the preoperative presence of OAB and short IPP as independent risk factors for the poor therapeutic efficacy of HoLEP. When treatment efficacy was divided according to risk factors, poor therapeutic efficacy was observed in only 14% of patients with prolonged IPP and the absence of OAB.

Conclusions

The therapeutic efficacy of HoLEP may be poor in patients with OAB and short IPP, resulting in the significant deterioration of lower urinary tract symptoms. Accordingly, it is important to consider the presence or absence of OAB and IPP measurements when selecting indications for HoLEP.

研究目的我们评估了良性前列腺增生症（BPH）患者接受前列腺钬激光去核术（HoLEP）疗效不佳的术前预测因素：本研究纳入了2015年8月至2021年6月期间在我院接受HoLEP术的159例患者。根据国际前列腺症状评分（IPSS）、IPSS生活质量（IPSS-QOL）和最大尿流率的变化，将总体疗效分为疗效好和疗效差。根据HoLEP术后3个月的结果将患者分为疗效好和疗效差两组，并对两组进行比较评估：结果：159 名患者中有 53 人（33.3%）的 HoLEP 疗效不佳。疗效差组的膀胱内前列腺突出（IPP）、IPSS、IPSS-QOL、排尿后残余尿量（PVR）和膀胱过度活动症（OAB）明显高于疗效好组。对多个因素进行的多变量分析表明，术前存在膀胱过度活动症和IPP短是导致HoLEP疗效不佳的独立风险因素。根据风险因素对疗效进行划分后发现，只有14%的患者IPP时间长且无OAB，疗效较差：结论：对于 OAB 和 IPP 较短的患者，HoLEP 的疗效可能较差，导致下尿路症状明显恶化。因此，在选择 HoLEP 的适应症时，必须考虑是否存在 OAB 和 IPP 测量值。

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引用次数: 0

Efficacy and safety of Vibegron for the treatment of residual overactive bladder symptoms after laser vaporization of the prostate: A single-center prospective randomized controlled trial (VAPOR TRIAL) Vibegron 治疗前列腺激光汽化术后残余膀胱过度活动症状的有效性和安全性：单中心前瞻性随机对照试验（VAPOR TRIAL）。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-07-02 DOI: 10.1111/luts.12529

Narihito Seki, Hiroyuki Masaoka, Yoohyun Song, Takashi Dejima, Yoshiaki Sato, Shotaro Maeda

Objectives

This study aimed to evaluate the efficacy and safety of Vibegron for the treatment of residual overactive bladder (OAB) symptoms after laser vaporization of the prostate (photo-selective vaporization of the prostate, contact laser vaporization of the prostate, and thulium laser vaporization).

Methods

This randomized, open-label, parallel-group, single-center superiority trial with a 12-week observation (jRCTs071190040) enrolled male patients with OAB aged 40 years or older who had undergone laser vaporization of the prostate for not less than 12 weeks and not more than 1 year earlier. Patients were allocated to receive Vibegron 50 mg once daily or follow-up without treatment for 12 weeks.

Results

Forty-seven patients were enrolled between January 2020 and March 2023. The median age (interquartile range) was 75.5 (72.5–78.5) years for the Vibegron group and 76.5 (71.0–81.0) years for the control group. The intergroup difference in the mean change (95% confidence interval) in the 24-hour urinary frequency at 12 weeks after randomization was −3.66 (−4.99, −2.33), with a significant decrease for the Vibegron group. The Overactive Bladder Symptom Score, International Prostate Symptom Score, IPSS storage score, and Overactive Bladder Questionnaire score significantly improved for the Vibegron group. Voided volume per micturition also increased for the Vibegron group.

Conclusions

The administration of 50 mg of Vibegron once daily for 12 weeks showed significant improvement compared with follow-up without treatment in bladder storage (OAB) symptoms after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia.

研究目的本研究旨在评估Vibegron治疗前列腺激光汽化术（光选择性前列腺汽化术、接触式前列腺激光汽化术和铥激光汽化术）后残留膀胱过度活动症（OAB）症状的有效性和安全性：这项随机、开放标签、平行组、单中心优效试验（jRCTs071190040）的观察期为12周，招募了年龄在40岁或40岁以上、接受过不少于12周且不超过1年的前列腺激光汽化术的男性OAB患者。患者被分配接受每天一次、每次 50 毫克的 Vibegron 治疗或为期 12 周的无治疗随访：47名患者于2020年1月至2023年3月期间入组。Vibegron组的中位年龄（四分位数间距）为75.5（72.5-78.5）岁，对照组为76.5（71.0-81.0）岁。随机分组 12 周后，24 小时尿频的平均变化（95% 置信区间）的组间差异为-3.66（-4.99，-2.33），Vibegron 组显著下降。Vibegron组的膀胱过度活动症状评分、国际前列腺症状评分、IPSS贮存评分和膀胱过度活动问卷评分均有显著改善。Vibegron组每次排尿量也有所增加：结论：在对有症状的良性前列腺增生症进行前列腺激光汽化术后，与不进行治疗的随访相比，每天服用一次 50 毫克的维贝琼，持续 12 周后，膀胱储尿（OAB）症状有了明显改善。

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引用次数: 0