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PREDICTIVE FACTORS OF DAILY ACTIVITIES RELATED TO LUTS
549
550
BENIGN PROSTATE HYPERPLASIA: RELATION BETWEEN IPSS, SPI AND QUALITY-OF-LIFE IPSS ITEM SCORES
ACTIGRAPHY: A NEW METHOD TO ASSESS THE IMPACT OF NOCTURIA ON THE BED PARTNER
Perrin P.1, Cucherat M.2, Marionneau N.3, Ruffion A.4, Taïeb C.3
Meadows R.1, Stanley N.2, Venn S.1, Hislop J.1, Dawson J.2, McDonald K.2, Arber S.1
1
Hôpital Lyon Sud, Urology, Pierre Bénite, France, 2Hôpital Lyon Sud, Biostatistic, Lyons, France, 3IRPF, Public Health, Boulogne Billancourt, France, 4Hôpital Lyon Sud, Urology, Lyons, France INTRODUCTION & OBJECTIVES: The International Prostatic Symptom Score (IPSS) evaluates the frequency of symptoms associated with benign prostate hyperplasia, but does not take into account the bothersomeness that they induce. However, this aspect is considered the most important parameter when choosing a treatment strategy. To circumvent this limitation of the IPSS, an 8th question (q8) was added to assess the patient’s overall satisfaction compared to his urinary tract status but does not study in detail the bothersomeness. The SPI score (Symptom Problem Index) evaluates the degree of discomfort associated with each question on the IPSS. Our objective is to determine the relations between IPSS, SPI and quality of life IPSS item (q8) scores. MATERIAL & METHODS: A cohort of 855 male patients with BPH has been monitoring for three years. The IPSS and SPI self-administered questionnaires have been evaluated on the 722 patients with complete data. Relationships between SPI, IPSS and q8 have been investigated through the correlation between those scores and by showing the individual answers dispersion of IPSS and SPI scores when one was fixed. RESULTS: The mean IPSS score was 12.6 +/- 6.4, the mean SPI score was 12.2 +/- 6.5. The correlation coefficient between the IPSS and SPI scores was 0.70; the scores from the 2 rating scales showed a very high variability. The observed IPSS score ranged from 5 to 33 when the corresponding observed SPI score was equal to 14. Similarly, the SPI score varied from 4 to 26 when the corresponding IPSS score was 20. Q8 was also weakly related to SPI (r=0.56). The response to the question on quality of life corresponds to highly varying SPI scores. The SPI score ranged from 2 to 28 points in patients who replied “rather bothered” (score=4) to the question on the quality of life. Question 8 cannot replace the SPI. Patients who replied, “rather bothered” (score=4) to this question had an IPSS score between 4 and 34 points. CONCLUSIONS: IPSS and SPI questionnaires do not collect the same information. The extent of variability between the two scales confirms that one scale cannot be replaced by another. Quality of life question of the IPSS questionnaire isn’t enough to capture all the aspects of bothersomeness explored by the SPI questionnaire. Considering the importance of bothersomeness associated with lower urinary tract symptoms for making the decision about therapy, the joint use of the IPSS and SPI seems appropriate.
1 Surrey University, Sociology, Guildford, Surrey, United Kingdom, 2Surrey University, HPRU, Guildford, United Kingdom
INTRODUCTION & OBJECTIVES: Nocturia, the excessive need to pass urine at night, has been shown to have severe consequences in both the short-term (increased risk of accidents at work, on the road and at home) and the long-term (institutionalisation, increased risk of diabetes, Cardio Vascular disease and death). Acknowledging the seriousness of the condition, we argue that research into nocturia needs to develop in, at least, two ways: Firstly, it is necessary to move away from the subjective tools used to investigate nocturnal voids. Diary data and patient logs, the most common methodologies utilised in this area, have been shown to be susceptible to error and bias. Secondly, there is a need to examine the impact nocturia has on those who share a bed with the sufferer. Many of the consequences listed above are linked directly to the fact that those with the diagnosis experience disturbed sleep. Thus, we argue, that research also needs to empirically investigate whether bed partners are (equally/more) disturbed when the sufferer relocates to void. MATERIAL & METHODS: Reflecting this, this paper reports on our attempts to construct a non-intrusive, objective method to: 1) identify whether a person is asleep or awake at night; 2) investigate the impact this may have on bed partners; and 3) identify whether these wake episodes are associated specifically with a toilet visit. Data come from an Economic and Social Research Council Funded project which seeks to investigate sleep amongst normal, healthy, heterosexual couples aged between 20 and 59 years of age. As part of the project, couples were asked to wear an actiwatch, a small device which objectively measures movement on a minute by minute basis, and also to keep an audio diary record of their sleep for seven consecutive days. RESULTS: In meeting the first objective we applied an algorithm developed elsewhere (Lotjonen et al 2003) to the actigraphy data, predicting, with approximately 81% accuracy, whether a person was awake or asleep during any given epoch. The second objective was met by marking the onset of a wake episode in one person, and then investigating the corresponding partner file to see if the partner was awake either before, during or after this event. Within the 560 nights of data 78 individual toilet visits were noted in the audio diary accounts. Over 90% of these were correctly identified in the actigraphy data as wake episodes. However, although toilet visits did seem to have an identifiable pattern based on length and strength of movement, specifically distinguishing toilet visits from other nocturnal activities was only moderately successful; with the analysis resulting in a number of false positives. CONCLUSIONS: We conclude that actigraphy does enable objectives 1 and 2 to be met and offers the potential to meet objective 3; although a larger data set will be necessary to further define the movement characteristics of a toilet visit.
551 PREDICTIVE FACTORS OF DAILY ACTIVITIES RELATED TO LUTS Marionneau N.1, Perrin P.2, Taïeb C.1 IRPF, Public Health, Boulogne Billancourt, France, 2Lyon Sud Hospital, Urology,
1
Lyons, France INTRODUCTION & OBJECTIVES: Urinary problems secondary to benign prostatic hyperplasia (BPH) are found in 20 to 25% of the population of men over 50 years of age. The severity of lower urinary tract symptoms (LUTS) is assessed by the score obtained on the IPSS. On the other hand, the Symptom Problem Index (SPI) evaluates the degree of discomfort associated with each question on the IPSS. Our objective was to evaluate which of those scales was the best predictive
552 LOWER URINARY TRACT SYMPTOMS: LOCAL ISCHAEMIA ASSESSED BY SONOGRAPHIC FINDINGS AND CORRELATED TO IMPAIRED QUALITY OF LIFE Pinggera G.M.1, Mitterberger M.1, Pallwein L.2, Frauscher F.2, Rehder P.1, Herwig R.1, Gozzi C.1, Bartsch G.1, Strasser H.1 Medical University Innsbruck, Department of Urology, Innsbruck, Austria, 2Medical University Innsbruck, Department of Uroradiology, Innsbruck, Austria
1
INTRODUCTION & OBJECTIVES: Recent studies indicate that local ischemia may play an important role in the development of bladder dysfunction clinically presenting as lower urinary tract symptoms (LUTS). Altered prostatic perfusion has been correlated to filling symptoms in men with prostatic enlargement. On the other hand, blood perfusion measurements in females are still requested to this day. With this in mind, the present study was aimed at relating LUTS in both genders to altered blood perfusion by using an ultrasound investigation.
IPSS is recognised by the WHO as the reference in LUTS frequency evaluation.
MATERIAL & METHODS: A cohort of 110 patients were enrolled in this prospective study with 4 randomised groups: Fifty women (group 1) and 50 age-matched men (group 2) with LUTS were compared to two control groups consisting of five healthy women (group 3) and five healthy men (group 4). All enrolled patients completed the International Prostate Symptom score (IPSS) with quality-of-life assessment (QoL) and a power Doppler ultrasound imaging (PDUS) to determine blood perfusion in the bladder neck as well in male participants in the prostate, respectively. The vascular Resistive Index (RI) was assessed by repeated measurements in at least 3 vessels. The results of the IPSS, quality-of-life score and the assessed Resistive Index (RI) values are reported in table1, expressed as mean values with standard deviations.
However, the frequency of urinary symptoms is not necessary the reason why
RESULTS:
factor of BPH patients’ daily activities discomfort. MATERIAL & METHODS: A cohort of 855 French male patients with BPH was monitored for three years. The IPSS, SPI and BSIA (BPH Symptoms Interferences with Activities) questionnaires were self-administrated at regular time intervals.
patients consult their GP. Regression models and correlation coefficients were
age
IPSS
QoL
RI bladder neck
estimated in order to predict the discomfort in daily activities related to LUTS.
Group 1
70±4
13±3.47
3.2±1.60
0.74±0.08
n.a.
RESULTS: The spearman correlation between daily activities discomfort due to
Group 2
73±5
18.3±4.35
4.5±1.60
0.77±0.04
0.82±0.07
Group 3
69±
3.7±1.4
1.2±1.60
0.62±0.05
n.a.
Group 4
72±
4.8±2.1
2±1.60
0.70±0.06
0.67±0.06
LUTS (BSIA) and LUTS frequency (IPSS) was 0.53. The correlation between daily activities discomfort due to LUTS (BSIA) and bother related to LUTS was 0.65. The correlation between the IPSS and SPI scores was 0.70. CONCLUSIONS: SPI was more predictive of discomfort in daily activities related to LUTS than the IPSS. SPI seems to be an interesting tool to evaluate repercussion on patients’ quality of life. Eur Urol Suppl 2006;5(2):160
RI prostate
Irrespective of the gender, elevated IPSS as well higher QoL scores were found in elderly patients with LUTS compared to age-matched patients without voiding symptoms. Furthermore, in symptomatic patients, a higher RI of the bladder neck in group 1 and of the prostate in group 2, respectively, could be measured by means of PDUS. CONCLUSIONS: RI findings are strictly correlated with the clinical diagnosis in patients suffering from LUTS. Our study suggests that LUTS are related to gender independent chronic ischemia of the bladder neck and additionally from similar alterations of the prostate in men.
550
BENIGN PROSTATE HYPERPLASIA: RELATION BETWEEN IPSS, SPI AND QUALITY-OF-LIFE IPSS ITEM SCORES
ACTIGRAPHY: A NEW METHOD TO ASSESS THE IMPACT OF NOCTURIA ON THE BED PARTNER
Perrin P.1, Cucherat M.2, Marionneau N.3, Ruffion A.4, Taïeb C.3
Meadows R.1, Stanley N.2, Venn S.1, Hislop J.1, Dawson J.2, McDonald K.2, Arber S.1
1
Hôpital Lyon Sud, Urology, Pierre Bénite, France, 2Hôpital Lyon Sud, Biostatistic, Lyons, France, 3IRPF, Public Health, Boulogne Billancourt, France, 4Hôpital Lyon Sud, Urology, Lyons, France INTRODUCTION & OBJECTIVES: The International Prostatic Symptom Score (IPSS) evaluates the frequency of symptoms associated with benign prostate hyperplasia, but does not take into account the bothersomeness that they induce. However, this aspect is considered the most important parameter when choosing a treatment strategy. To circumvent this limitation of the IPSS, an 8th question (q8) was added to assess the patient’s overall satisfaction compared to his urinary tract status but does not study in detail the bothersomeness. The SPI score (Symptom Problem Index) evaluates the degree of discomfort associated with each question on the IPSS. Our objective is to determine the relations between IPSS, SPI and quality of life IPSS item (q8) scores. MATERIAL & METHODS: A cohort of 855 male patients with BPH has been monitoring for three years. The IPSS and SPI self-administered questionnaires have been evaluated on the 722 patients with complete data. Relationships between SPI, IPSS and q8 have been investigated through the correlation between those scores and by showing the individual answers dispersion of IPSS and SPI scores when one was fixed. RESULTS: The mean IPSS score was 12.6 +/- 6.4, the mean SPI score was 12.2 +/- 6.5. The correlation coefficient between the IPSS and SPI scores was 0.70; the scores from the 2 rating scales showed a very high variability. The observed IPSS score ranged from 5 to 33 when the corresponding observed SPI score was equal to 14. Similarly, the SPI score varied from 4 to 26 when the corresponding IPSS score was 20. Q8 was also weakly related to SPI (r=0.56). The response to the question on quality of life corresponds to highly varying SPI scores. The SPI score ranged from 2 to 28 points in patients who replied “rather bothered” (score=4) to the question on the quality of life. Question 8 cannot replace the SPI. Patients who replied, “rather bothered” (score=4) to this question had an IPSS score between 4 and 34 points. CONCLUSIONS: IPSS and SPI questionnaires do not collect the same information. The extent of variability between the two scales confirms that one scale cannot be replaced by another. Quality of life question of the IPSS questionnaire isn’t enough to capture all the aspects of bothersomeness explored by the SPI questionnaire. Considering the importance of bothersomeness associated with lower urinary tract symptoms for making the decision about therapy, the joint use of the IPSS and SPI seems appropriate.
1 Surrey University, Sociology, Guildford, Surrey, United Kingdom, 2Surrey University, HPRU, Guildford, United Kingdom
INTRODUCTION & OBJECTIVES: Nocturia, the excessive need to pass urine at night, has been shown to have severe consequences in both the short-term (increased risk of accidents at work, on the road and at home) and the long-term (institutionalisation, increased risk of diabetes, Cardio Vascular disease and death). Acknowledging the seriousness of the condition, we argue that research into nocturia needs to develop in, at least, two ways: Firstly, it is necessary to move away from the subjective tools used to investigate nocturnal voids. Diary data and patient logs, the most common methodologies utilised in this area, have been shown to be susceptible to error and bias. Secondly, there is a need to examine the impact nocturia has on those who share a bed with the sufferer. Many of the consequences listed above are linked directly to the fact that those with the diagnosis experience disturbed sleep. Thus, we argue, that research also needs to empirically investigate whether bed partners are (equally/more) disturbed when the sufferer relocates to void. MATERIAL & METHODS: Reflecting this, this paper reports on our attempts to construct a non-intrusive, objective method to: 1) identify whether a person is asleep or awake at night; 2) investigate the impact this may have on bed partners; and 3) identify whether these wake episodes are associated specifically with a toilet visit. Data come from an Economic and Social Research Council Funded project which seeks to investigate sleep amongst normal, healthy, heterosexual couples aged between 20 and 59 years of age. As part of the project, couples were asked to wear an actiwatch, a small device which objectively measures movement on a minute by minute basis, and also to keep an audio diary record of their sleep for seven consecutive days. RESULTS: In meeting the first objective we applied an algorithm developed elsewhere (Lotjonen et al 2003) to the actigraphy data, predicting, with approximately 81% accuracy, whether a person was awake or asleep during any given epoch. The second objective was met by marking the onset of a wake episode in one person, and then investigating the corresponding partner file to see if the partner was awake either before, during or after this event. Within the 560 nights of data 78 individual toilet visits were noted in the audio diary accounts. Over 90% of these were correctly identified in the actigraphy data as wake episodes. However, although toilet visits did seem to have an identifiable pattern based on length and strength of movement, specifically distinguishing toilet visits from other nocturnal activities was only moderately successful; with the analysis resulting in a number of false positives. CONCLUSIONS: We conclude that actigraphy does enable objectives 1 and 2 to be met and offers the potential to meet objective 3; although a larger data set will be necessary to further define the movement characteristics of a toilet visit.
551 PREDICTIVE FACTORS OF DAILY ACTIVITIES RELATED TO LUTS Marionneau N.1, Perrin P.2, Taïeb C.1 IRPF, Public Health, Boulogne Billancourt, France, 2Lyon Sud Hospital, Urology,
1
Lyons, France INTRODUCTION & OBJECTIVES: Urinary problems secondary to benign prostatic hyperplasia (BPH) are found in 20 to 25% of the population of men over 50 years of age. The severity of lower urinary tract symptoms (LUTS) is assessed by the score obtained on the IPSS. On the other hand, the Symptom Problem Index (SPI) evaluates the degree of discomfort associated with each question on the IPSS. Our objective was to evaluate which of those scales was the best predictive
552 LOWER URINARY TRACT SYMPTOMS: LOCAL ISCHAEMIA ASSESSED BY SONOGRAPHIC FINDINGS AND CORRELATED TO IMPAIRED QUALITY OF LIFE Pinggera G.M.1, Mitterberger M.1, Pallwein L.2, Frauscher F.2, Rehder P.1, Herwig R.1, Gozzi C.1, Bartsch G.1, Strasser H.1 Medical University Innsbruck, Department of Urology, Innsbruck, Austria, 2Medical University Innsbruck, Department of Uroradiology, Innsbruck, Austria
1
INTRODUCTION & OBJECTIVES: Recent studies indicate that local ischemia may play an important role in the development of bladder dysfunction clinically presenting as lower urinary tract symptoms (LUTS). Altered prostatic perfusion has been correlated to filling symptoms in men with prostatic enlargement. On the other hand, blood perfusion measurements in females are still requested to this day. With this in mind, the present study was aimed at relating LUTS in both genders to altered blood perfusion by using an ultrasound investigation.
IPSS is recognised by the WHO as the reference in LUTS frequency evaluation.
MATERIAL & METHODS: A cohort of 110 patients were enrolled in this prospective study with 4 randomised groups: Fifty women (group 1) and 50 age-matched men (group 2) with LUTS were compared to two control groups consisting of five healthy women (group 3) and five healthy men (group 4). All enrolled patients completed the International Prostate Symptom score (IPSS) with quality-of-life assessment (QoL) and a power Doppler ultrasound imaging (PDUS) to determine blood perfusion in the bladder neck as well in male participants in the prostate, respectively. The vascular Resistive Index (RI) was assessed by repeated measurements in at least 3 vessels. The results of the IPSS, quality-of-life score and the assessed Resistive Index (RI) values are reported in table1, expressed as mean values with standard deviations.
However, the frequency of urinary symptoms is not necessary the reason why
RESULTS:
factor of BPH patients’ daily activities discomfort. MATERIAL & METHODS: A cohort of 855 French male patients with BPH was monitored for three years. The IPSS, SPI and BSIA (BPH Symptoms Interferences with Activities) questionnaires were self-administrated at regular time intervals.
patients consult their GP. Regression models and correlation coefficients were
age
IPSS
QoL
RI bladder neck
estimated in order to predict the discomfort in daily activities related to LUTS.
Group 1
70±4
13±3.47
3.2±1.60
0.74±0.08
n.a.
RESULTS: The spearman correlation between daily activities discomfort due to
Group 2
73±5
18.3±4.35
4.5±1.60
0.77±0.04
0.82±0.07
Group 3
69±
3.7±1.4
1.2±1.60
0.62±0.05
n.a.
Group 4
72±
4.8±2.1
2±1.60
0.70±0.06
0.67±0.06
LUTS (BSIA) and LUTS frequency (IPSS) was 0.53. The correlation between daily activities discomfort due to LUTS (BSIA) and bother related to LUTS was 0.65. The correlation between the IPSS and SPI scores was 0.70. CONCLUSIONS: SPI was more predictive of discomfort in daily activities related to LUTS than the IPSS. SPI seems to be an interesting tool to evaluate repercussion on patients’ quality of life. Eur Urol Suppl 2006;5(2):160
RI prostate
Irrespective of the gender, elevated IPSS as well higher QoL scores were found in elderly patients with LUTS compared to age-matched patients without voiding symptoms. Furthermore, in symptomatic patients, a higher RI of the bladder neck in group 1 and of the prostate in group 2, respectively, could be measured by means of PDUS. CONCLUSIONS: RI findings are strictly correlated with the clinical diagnosis in patients suffering from LUTS. Our study suggests that LUTS are related to gender independent chronic ischemia of the bladder neck and additionally from similar alterations of the prostate in men.