- Email: [email protected]
UP-02.006 Correlation of the Visual Prostate Symptom Score (VPSS) and International Prostate Symptom Score (IPSS) with Uroflow Parameters in Men Presenting with Lower Urinary Tract Symptoms
UNMODERATED POSTER SESSIONS
who had urethrograms and 6 patients who had urodynamic studies for incontinence. The significant findings were: 55% of the PSA were within normal limits and 53/303 (17.49%) were ⬎20ng/ml. 50/303 (16.5%) were 4-10ng/ml and 33/303 (10.8%) 10-20ng/ml. 22/61 (36%) of prostate biopsies were adenocarcinomas,and 39(64%) were BPH. Of the patients with adenocarcinomas of the prostate, 4/22(18%) had Gleason scores 2-4;11/22 (50%) Gleason 5-6 and 7/22(31.8%) had Gleason 7-10. 120 patients required cystourethroscopy of whom 61% had normal findings. The abnormal findings were bulbar urethral stricture, bladder neck stenosis and prostatitis. Conclusions: Lower urinary tract evaluation using facilities and indications in line with recommended gold standard practice presents no unique limitations in Nigeria. The findings from this study are interesting from the results of prostatic disease evaluation. The incidence of likely metastatic prostate cancer as suggested by PSA ⬎20ng/ml was just about 17.49%; about 25-30% of detected prostate cancers from PSA testing and biopsy could be organ confined and suitable for appropriate treatment suggesting a shift in mindset and attitude towards investigation, diagnosis and treatment of prostate cancer in Nigeria.
UP-02.004 Risk Factor Analysis of Patients’ Dissatisfaction After Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia Fukumoto K, Yokoyama T, Ohira S, Hara R, Fujii T, Jo Y, Miyaji Y, Nagai A Kawasaki Medical School, Kurashiki, Japan Introduction and Objective: We investigated the risk factor of patients’ dissatisfaction after holmium laser enucleation of the prostate (HoLEP) for patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Materials and Methods: Among the patients who had HoLEP for LUTS at our institution between October 2007 and September 2010, we reviewed the records of 128 patients with follow-up for at least 3 months after surgery. The patients were divided into two groups: group A (27 patients) with International Prostate Symptom Score (IPSS) ⱖ12 or quality of life (QOL) index ⱖ4, and group B (101 patients) with IPSS ⬍12 or QOL index ⬍4 at 3 months after HoLEP. We defined group
A as a dissatisfaction group and investigated the difference of mean age, IPSS, QOL index, Overactive Bladder Symptom Score (OABSS), maximum flow rate (Qmax), post-void residual urine volume (PVR), prostate specific antigen (PSA), and prostate volume between two groups. Results: There were no significant difference between two groups in the age (72.3 years old vs. 71.2 years old), IPSS (23.9 vs. 20.6), QOL index (5.2 vs. 5.0), OABSS (6.35 vs. 6.43), Qmax (6.77 ml/s vs. 6.89 ml/s), PVR (117.8 ml vs. 121.9 ml/s), and prostate volume (52.4 ml vs. 58.4 ml), except for PSA (6.08 ng/ml vs. 6.92 ng/ml) before surgery. Statistically significant difference (p⬍0.05) were found in the OABSS (7.81 vs. 4.01), Qmax (12.7 ml/s vs. 17.1 ml/s), and PVR (29.9 ml vs. 16.8 ml) after 3 months surgery between two groups. Conclusions: Although the baseline backgrounds were similar between two groups, the patients who remained OAB symptoms, slow stream, and more PVR after surgery were less satisfied than the other patients. In this study we did not performed pressure flow study in every patient and could not find prospective risk factor of post operative dissatisfaction. We assume that the risk factor of surgical treatment failure depends on preoperative bladder malfunction such as weak detrusor or/and detrusor overactivity. We should carefully consider performing a urodynamic study before choosing surgical treatment.
UP-02.005 Preferences with Regard to Position During Digital Rectal Examination and Perceptions of Pain During and After Digital Rectal Examination Among Men with Lower Urinary Tract Symptoms Van der Walt C, Heyns C Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa Introduction and Objective: The aims of this study were to determine the position for digital rectal examination (DRE) preferred by men with lower urinary tract symptoms (LUTS) and to assess patient perceptions of pain prior to and after DRE. Materials and Methods: Men with LUTS were requested to indicate on a pictogram their preferred position during DRE, and to indicate on a 10-point pictogram scale how much pain they anticipated prior to DRE and how much pain they had experienced during DRE. The proto-
UROLOGY 78 (Supplement 3A), September 2011
col was approved by the institutional ethics committee and written informed consent was obtained. Statistical analysis was performed using Student’s-t and Fisher’s exact tests (p⬍0.05 statistically significant). Results: A total of 80 men, mean age 63 (range 33 to 85) years, were evaluated August 2009 through August 2010. The patient’s preferred position for DRE was left lateral in 58%, supine 22%, standing 15% and knee-chest 5%. The position used during DRE was supine in 83% and left lateral in 17%. Mean pre-DRE pain score was 3.3 (range 0-10) and mean post-DRE score was 0.94 (range 0-8) (p⬍0.0001). There was a significant correlation between pre- and post-DRE scores (p⫽0.01). Comparing men with educational grade 0-7 vs those with educational grade ⬎10 there was no difference in mean pre-DRE score (3.58 vs 3.27) but the post-DRE score was lower (0.54 vs 1.27, p⫽0.073). Comparing the patients who underwent DRE in the preferred vs non-preferred position there was no significant difference between pre- and post-DRE scores (3.46 vs 0.93, and 3.23 vs 0.94, respectively). Comparing men aged ⱕ60 vs ⱖ70 years there was no significant difference between pre-DRE (3.32 vs 3.10) or post-DRE scores (0.87 vs 0.62). Conclusion: The majority of men preferred to undergo DRE in the left lateral or supine position. Patients’ expectation of pain prior to DRE was quite low (3.3/ 10) and the post-DRE perception of pain was 3 times lower than anticipated by the patient. Pain perception was not significantly associated with age or DRE in the preferred vs non-preferred position, but patients with lower educational level had slightly lower post-DRE pain.
UP-02.006 Correlation of the Visual Prostate Symptom Score (VPSS) and International Prostate Symptom Score (IPSS) with Uroflow Parameters in Men Presenting with Lower Urinary Tract Symptoms Van der Walt C, Heyns C, Groeneveld A, Edlin R, Van Vuuren S Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa Introduction and Objective: The international prostate symptom score (IPSS) to assess lower urinary tract symptoms (LUTS) was designed to be self-administered by the patient and requires a high degree of literacy, which is problematic in developing countries with low literacy
S261
UNMODERATED POSTER SESSIONS
levels. We have devised a visual prostate symptom score (VPSS) using pictograms to evaluate three IPSS questions (Q2 - urinary frequency, Q7 - nocturia and Q5 weak stream ⫽ Q1-3 in the VPSS, respectively) and the IPSS quality of life (QoL) question. In a previous analysis we showed that the VPSS correlated significantly with the IPSS and could be completed without assistance by a greater proportion of men with limited education. The aim of this study was to compare the correlation of the IPSS and VPSS with uroflow parameters. Materials and Methods: The IPSS and VPSS were completed by 96 men (mean age 64 years) presenting with LUTS. Peak (Qmax) and average (Qave) urinary flow rates and voided volumes (VV) were measured using a Urodyn 1000 flowmeter, and post-void residual (PVR) urine was measured with ultrasonography. Statistical analysis was performed using Pearson’s correlation test. Results: See table 1. Conclusion: In this study cohort total VPSS showed a better correlation with Qmax and Qave than total IPSS. The VPSS pictogram to assess the force of the urinary stream (VPSS Q3) showed a statistically significant correlation with Qmax, Qave, VV and PVR, whereas IPSS Q5 did
UP-02.007, Figure 1. The patterns of frequency of vibration in the prostatic urethra.
not show a significant correlation with any of these parameters. Both VPSS and IPSS questions assessing frequency and nocturia showed significant correlations with Qmax and Qave.
UP-02.007 Urethral Vibration Under Irrigation: A Possible Parameter for Estimating Urethral Flexibility Horiuchi K1, Ishii T1, Naya Y2, Yamanishi T3, Nakada T4, Igarashi T1 1 Dept. of Medical System Engneering,Faculty of Engineering, Chiba University, Chiba, 2Dept. of Urology, Teikyo University Chiba Medical Center, Chiba, 3Dept. of Urology, Dokkyo Medical
UP-02.006, Table 1. Variables IPSS total vs Qmax VPSS total vs Qmax IPSS total vs Qave VPSS total vs Qave IPSS QoL vs Qmax VPSS QoL vs Qmax IPSS QoL vs Qave VPSS QoL vs Qave Weak stream IPSS Q5 vs Qmax VPSS Q3 vs Qmax IPSS Q5 vs Qave VPSS Q3 vs Qave IPSS Q5 vs VV VPSS Q3 vs VV IPSS Q5 vs PVR VPSS Q3 vs PVR Frequency IPSS Q2 vs Qmax VPSS Q1 vs Qmax IPSS Q2 vs Qave VPSS Q1 vs Qave Nocturia IPSS Q7 vs Qmax VPSS Q2 vs Qmax IPSS Q7 vs Qave VPSS Q2 vs Qave
S262
Correlation coefficient (r) ⫺ 0.2804 ⫺ 0.4208 ⫺ 0.2897 ⫺ 0.4141 ⫺0.0752 ⫺0.04182 ⫺0.1095 ⫺0.09728
p-value 0.007 ⬍0.0001 0.005 ⬍0.0001 0.502 0.691 0.296 0.354
⫺ 0.1101 ⫺ 0.3696 ⫺0.08981 ⫺0.3402 ⫺0.1011 ⫺0.2459 ⫹0.1983 ⫹0.2603
0.294 0.0003 0.392 0.008 0.335 0.018 0.057 0.012
⫺ 0.2350 ⫺ 0.3287 ⫺0.2720 ⫺0.3092
0.023 0.001 0.008 0.003
⫺ 0.2714 ⫺ 0.2830 ⫺0.2765 ⫺0.2958
0.009 0.006 0.008 0.004
University, Mibu, 4Dept. of Urology, Kurimoto Chuo Hospital, Japan Introduction and Objective: Urethral flexibility plays important role for continence mechanism and voiding function. In SIU2010, we reported a method for estimating the urethral flexibility through detecting urethral vibration from cystourethroscopic video images under intermittent irrigation. Here we studied its possibility to be one of parameters to assess status of the urethra by comparing patterns vibration in patients with or without voiding dysfunction. Materials and Methods: Between June 2009 and March 2011, we recorded cystourethroscopic video images in 8 male and 5 female patients scheduled for transurethral surgeries. Three of six male patients had BPH, two had BOO, and one young patient without voiding dysfunction had impacted stone in the prostatic urethra. All five female patients had severe voiding dysfunction. The video images are recorded using conventional cystourethroscope fixed to the distal end of the prostatic urethra in male and at the external sphincter in female patients under intermittent irrigation of isotonic water with water pressure set at 80cmH2O. The patterns of the frequencies of the vibration were detected by matching template images to the original video frames. Results: The vibration of the urethral wall during irrigation could be detected in every direction of the urethra in each patient. The distribution of peaks of frequencies were contradictory in patients with voiding dysfunction, BPH or BOO, and without voiding dysfunction. Difference in pattern of frequency was prominent at the 8kHz of bandwidth zone (arrow in the figure) including female patients. Conclusion: Though the number of the patients was small, present study implies urethral vibration could be a parameter in estimating urethral function in patients with voiding dysfunction.
UROLOGY 78 (Supplement 3A), September 2011
who had urethrograms and 6 patients who had urodynamic studies for incontinence. The significant findings were: 55% of the PSA were within normal limits and 53/303 (17.49%) were ⬎20ng/ml. 50/303 (16.5%) were 4-10ng/ml and 33/303 (10.8%) 10-20ng/ml. 22/61 (36%) of prostate biopsies were adenocarcinomas,and 39(64%) were BPH. Of the patients with adenocarcinomas of the prostate, 4/22(18%) had Gleason scores 2-4;11/22 (50%) Gleason 5-6 and 7/22(31.8%) had Gleason 7-10. 120 patients required cystourethroscopy of whom 61% had normal findings. The abnormal findings were bulbar urethral stricture, bladder neck stenosis and prostatitis. Conclusions: Lower urinary tract evaluation using facilities and indications in line with recommended gold standard practice presents no unique limitations in Nigeria. The findings from this study are interesting from the results of prostatic disease evaluation. The incidence of likely metastatic prostate cancer as suggested by PSA ⬎20ng/ml was just about 17.49%; about 25-30% of detected prostate cancers from PSA testing and biopsy could be organ confined and suitable for appropriate treatment suggesting a shift in mindset and attitude towards investigation, diagnosis and treatment of prostate cancer in Nigeria.
UP-02.004 Risk Factor Analysis of Patients’ Dissatisfaction After Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia Fukumoto K, Yokoyama T, Ohira S, Hara R, Fujii T, Jo Y, Miyaji Y, Nagai A Kawasaki Medical School, Kurashiki, Japan Introduction and Objective: We investigated the risk factor of patients’ dissatisfaction after holmium laser enucleation of the prostate (HoLEP) for patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Materials and Methods: Among the patients who had HoLEP for LUTS at our institution between October 2007 and September 2010, we reviewed the records of 128 patients with follow-up for at least 3 months after surgery. The patients were divided into two groups: group A (27 patients) with International Prostate Symptom Score (IPSS) ⱖ12 or quality of life (QOL) index ⱖ4, and group B (101 patients) with IPSS ⬍12 or QOL index ⬍4 at 3 months after HoLEP. We defined group
A as a dissatisfaction group and investigated the difference of mean age, IPSS, QOL index, Overactive Bladder Symptom Score (OABSS), maximum flow rate (Qmax), post-void residual urine volume (PVR), prostate specific antigen (PSA), and prostate volume between two groups. Results: There were no significant difference between two groups in the age (72.3 years old vs. 71.2 years old), IPSS (23.9 vs. 20.6), QOL index (5.2 vs. 5.0), OABSS (6.35 vs. 6.43), Qmax (6.77 ml/s vs. 6.89 ml/s), PVR (117.8 ml vs. 121.9 ml/s), and prostate volume (52.4 ml vs. 58.4 ml), except for PSA (6.08 ng/ml vs. 6.92 ng/ml) before surgery. Statistically significant difference (p⬍0.05) were found in the OABSS (7.81 vs. 4.01), Qmax (12.7 ml/s vs. 17.1 ml/s), and PVR (29.9 ml vs. 16.8 ml) after 3 months surgery between two groups. Conclusions: Although the baseline backgrounds were similar between two groups, the patients who remained OAB symptoms, slow stream, and more PVR after surgery were less satisfied than the other patients. In this study we did not performed pressure flow study in every patient and could not find prospective risk factor of post operative dissatisfaction. We assume that the risk factor of surgical treatment failure depends on preoperative bladder malfunction such as weak detrusor or/and detrusor overactivity. We should carefully consider performing a urodynamic study before choosing surgical treatment.
UP-02.005 Preferences with Regard to Position During Digital Rectal Examination and Perceptions of Pain During and After Digital Rectal Examination Among Men with Lower Urinary Tract Symptoms Van der Walt C, Heyns C Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa Introduction and Objective: The aims of this study were to determine the position for digital rectal examination (DRE) preferred by men with lower urinary tract symptoms (LUTS) and to assess patient perceptions of pain prior to and after DRE. Materials and Methods: Men with LUTS were requested to indicate on a pictogram their preferred position during DRE, and to indicate on a 10-point pictogram scale how much pain they anticipated prior to DRE and how much pain they had experienced during DRE. The proto-
UROLOGY 78 (Supplement 3A), September 2011
col was approved by the institutional ethics committee and written informed consent was obtained. Statistical analysis was performed using Student’s-t and Fisher’s exact tests (p⬍0.05 statistically significant). Results: A total of 80 men, mean age 63 (range 33 to 85) years, were evaluated August 2009 through August 2010. The patient’s preferred position for DRE was left lateral in 58%, supine 22%, standing 15% and knee-chest 5%. The position used during DRE was supine in 83% and left lateral in 17%. Mean pre-DRE pain score was 3.3 (range 0-10) and mean post-DRE score was 0.94 (range 0-8) (p⬍0.0001). There was a significant correlation between pre- and post-DRE scores (p⫽0.01). Comparing men with educational grade 0-7 vs those with educational grade ⬎10 there was no difference in mean pre-DRE score (3.58 vs 3.27) but the post-DRE score was lower (0.54 vs 1.27, p⫽0.073). Comparing the patients who underwent DRE in the preferred vs non-preferred position there was no significant difference between pre- and post-DRE scores (3.46 vs 0.93, and 3.23 vs 0.94, respectively). Comparing men aged ⱕ60 vs ⱖ70 years there was no significant difference between pre-DRE (3.32 vs 3.10) or post-DRE scores (0.87 vs 0.62). Conclusion: The majority of men preferred to undergo DRE in the left lateral or supine position. Patients’ expectation of pain prior to DRE was quite low (3.3/ 10) and the post-DRE perception of pain was 3 times lower than anticipated by the patient. Pain perception was not significantly associated with age or DRE in the preferred vs non-preferred position, but patients with lower educational level had slightly lower post-DRE pain.
UP-02.006 Correlation of the Visual Prostate Symptom Score (VPSS) and International Prostate Symptom Score (IPSS) with Uroflow Parameters in Men Presenting with Lower Urinary Tract Symptoms Van der Walt C, Heyns C, Groeneveld A, Edlin R, Van Vuuren S Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa Introduction and Objective: The international prostate symptom score (IPSS) to assess lower urinary tract symptoms (LUTS) was designed to be self-administered by the patient and requires a high degree of literacy, which is problematic in developing countries with low literacy
S261
UNMODERATED POSTER SESSIONS
levels. We have devised a visual prostate symptom score (VPSS) using pictograms to evaluate three IPSS questions (Q2 - urinary frequency, Q7 - nocturia and Q5 weak stream ⫽ Q1-3 in the VPSS, respectively) and the IPSS quality of life (QoL) question. In a previous analysis we showed that the VPSS correlated significantly with the IPSS and could be completed without assistance by a greater proportion of men with limited education. The aim of this study was to compare the correlation of the IPSS and VPSS with uroflow parameters. Materials and Methods: The IPSS and VPSS were completed by 96 men (mean age 64 years) presenting with LUTS. Peak (Qmax) and average (Qave) urinary flow rates and voided volumes (VV) were measured using a Urodyn 1000 flowmeter, and post-void residual (PVR) urine was measured with ultrasonography. Statistical analysis was performed using Pearson’s correlation test. Results: See table 1. Conclusion: In this study cohort total VPSS showed a better correlation with Qmax and Qave than total IPSS. The VPSS pictogram to assess the force of the urinary stream (VPSS Q3) showed a statistically significant correlation with Qmax, Qave, VV and PVR, whereas IPSS Q5 did
UP-02.007, Figure 1. The patterns of frequency of vibration in the prostatic urethra.
not show a significant correlation with any of these parameters. Both VPSS and IPSS questions assessing frequency and nocturia showed significant correlations with Qmax and Qave.
UP-02.007 Urethral Vibration Under Irrigation: A Possible Parameter for Estimating Urethral Flexibility Horiuchi K1, Ishii T1, Naya Y2, Yamanishi T3, Nakada T4, Igarashi T1 1 Dept. of Medical System Engneering,Faculty of Engineering, Chiba University, Chiba, 2Dept. of Urology, Teikyo University Chiba Medical Center, Chiba, 3Dept. of Urology, Dokkyo Medical
UP-02.006, Table 1. Variables IPSS total vs Qmax VPSS total vs Qmax IPSS total vs Qave VPSS total vs Qave IPSS QoL vs Qmax VPSS QoL vs Qmax IPSS QoL vs Qave VPSS QoL vs Qave Weak stream IPSS Q5 vs Qmax VPSS Q3 vs Qmax IPSS Q5 vs Qave VPSS Q3 vs Qave IPSS Q5 vs VV VPSS Q3 vs VV IPSS Q5 vs PVR VPSS Q3 vs PVR Frequency IPSS Q2 vs Qmax VPSS Q1 vs Qmax IPSS Q2 vs Qave VPSS Q1 vs Qave Nocturia IPSS Q7 vs Qmax VPSS Q2 vs Qmax IPSS Q7 vs Qave VPSS Q2 vs Qave
S262
Correlation coefficient (r) ⫺ 0.2804 ⫺ 0.4208 ⫺ 0.2897 ⫺ 0.4141 ⫺0.0752 ⫺0.04182 ⫺0.1095 ⫺0.09728
p-value 0.007 ⬍0.0001 0.005 ⬍0.0001 0.502 0.691 0.296 0.354
⫺ 0.1101 ⫺ 0.3696 ⫺0.08981 ⫺0.3402 ⫺0.1011 ⫺0.2459 ⫹0.1983 ⫹0.2603
0.294 0.0003 0.392 0.008 0.335 0.018 0.057 0.012
⫺ 0.2350 ⫺ 0.3287 ⫺0.2720 ⫺0.3092
0.023 0.001 0.008 0.003
⫺ 0.2714 ⫺ 0.2830 ⫺0.2765 ⫺0.2958
0.009 0.006 0.008 0.004
University, Mibu, 4Dept. of Urology, Kurimoto Chuo Hospital, Japan Introduction and Objective: Urethral flexibility plays important role for continence mechanism and voiding function. In SIU2010, we reported a method for estimating the urethral flexibility through detecting urethral vibration from cystourethroscopic video images under intermittent irrigation. Here we studied its possibility to be one of parameters to assess status of the urethra by comparing patterns vibration in patients with or without voiding dysfunction. Materials and Methods: Between June 2009 and March 2011, we recorded cystourethroscopic video images in 8 male and 5 female patients scheduled for transurethral surgeries. Three of six male patients had BPH, two had BOO, and one young patient without voiding dysfunction had impacted stone in the prostatic urethra. All five female patients had severe voiding dysfunction. The video images are recorded using conventional cystourethroscope fixed to the distal end of the prostatic urethra in male and at the external sphincter in female patients under intermittent irrigation of isotonic water with water pressure set at 80cmH2O. The patterns of the frequencies of the vibration were detected by matching template images to the original video frames. Results: The vibration of the urethral wall during irrigation could be detected in every direction of the urethra in each patient. The distribution of peaks of frequencies were contradictory in patients with voiding dysfunction, BPH or BOO, and without voiding dysfunction. Difference in pattern of frequency was prominent at the 8kHz of bandwidth zone (arrow in the figure) including female patients. Conclusion: Though the number of the patients was small, present study implies urethral vibration could be a parameter in estimating urethral function in patients with voiding dysfunction.
UROLOGY 78 (Supplement 3A), September 2011