EAU 2023: Male Voiding LUTS: Clinical Issues, Diagnosis, and Medical Treatment

This session discusses a computational fluid dynamic analysis (CFD) of urethral pressure in patients with BPH using the Navier-Stokes equation. In a study, urethra models from patients were used to create a 3D mesh with Ansys fluence software, and simulated boundary conditions based on bladder pressure were applied. Results showed 92.3% accuracy in predicting exit urine flow rate, with nodal funnelling and turbulence leading to a significant loss of bladder degenerative pressure. A wider prostatic release could reduce required blood pressure by 14.9%. Future work aims to streamline the mesh creation process for rendering and estimation.

The relationship between arterial sclerosis and underactive bladder was evaluated in a study involving 192 patients who were divided into four groups. The arterial stiffness was measured using brachial and ankle pulse wave velocity (BAPWV). Results showed that patients with underactive bladder had significantly higher BAPWV compared to the other three groups, with a BAPWV above 1,800 being a risk factor for underactive bladder. In conclusion, arterial sclerosis may be related to underactive bladder etiology.

A study identified the low reporting rates of Bladder Outlet Obstruction (BOO) in patients aged over 40, except those with previous prostate surgery or reports of obstruction, despite its high occurrence. Clinical assessments including total PSA and transrectal ultrasound were conducted. Logistic regression analysis demonstrated that prostate volume and IPSS score had the highest precision in predicting moderate or severe obstruction. A prostate volume of 43ml was identified as the optimal cutoff for identifying high-risk patients, with men over 60 years old and a prostate volume over 43ml having an 84% likelihood of reporting obstruction. In conclusion, physicians should use clinical parameters such as prostate volume and IPSS score to screen patients aged over 40 for bladder outlet obstruction for further investigation.

A randomized clinical trial successfully identified risk factors for poor outcomes following prostate surgery in males and developed three prediction models using clinical data. Surgical success was defined as a reduction of more than three points in IPSS post-surgery. The prediction models included logistic regression, classification tree analysis, and Random Forest analysis based on artificial intelligence. Among the models, the artificial intelligence-based model showed the highest accuracy in predicting surgical outcomes. This tool could serve as a baseline assessment tool for predicting outcomes in prostate surgery patients.

Urodynamics is a current gold standard for diagnosing bladder outlet obstruction considered to be invasive and costly. A novel prostate clinical score based on prostate volume and the maximum flow rate was developed and found to have a sensitivity of 88% for patients with no evidence of obstruction. The study explored significant differences in urodynamic parameters throughout the one-year period, and the clinical process score can be used as an alternative to urodynamics.

The concept of whether using a wearable device to optimize bedtime could improve nocturnal urinary frequency in patients who wake up more than once during the night has gained much attention in recent days. A significant reduction was found in the nocturnal frequency and improved sleep quality suggesting that utilization of a wearable device to optimize bedtime can be an effective intervention for reducing the nocturnal urinary frequency and improving sleep quality.

A study aimed to investigate the impact of bariatric surgery on male patients with lower urinary tract symptoms (LUTS) who were severely obese. The study results showed a significant reduction in body weight and improvement in the total IPSS score for up to five years post-surgery. The improvement was particularly notable in patients with moderate to severe LUTS. Thus, a positive correlation between IPSS improvement and reductions in fat percentage and waist circumference was found. In conclusion, bariatric surgery can provide a consistent and significant improvement in LUTS for morbidly obese male patients.

The effectiveness of clean intermittent catheterization (CIC) was evaluated as an alternative to classic tactics for treating acute urinary retention in patients with benign prostatic hyperplasia. Several advantages such as outpatient treatment, preservation of social and sexual activity, and less catheter-associated urgency was discovered successfully which concludes the CIC as an effective alternative for treating acute urinary retention.

A link between five alpha-reductase inhibitors (5-ARI) and the development of prostate cancer in BPH patients was evaluated by a study that analyzed real-world data from Taiwan, including 17,719 newly diagnosed BPH patients. Among them, 530 patients developed prostate cancer. The results indicated that the use of 5-ARI did not increase the risk of prostate cancer development, but the time interval between the diagnosis of BPH and prostate cancer was shorter in the 5-ARI treatment group. In conclusion, there was no association between 5-ARI usage and increased risk of prostate cancer development in BPH patients.

One of the research projects analyzed the effects of five alpha-reductase inhibitors (ARI) on perioperative and functional outcomes of green light photo vaporization of the prostate. The study utilized the data from the Global Green Light Group database and found that ARI patients had shorter operative times and used less energy. However, postoperative functional outcomes and risks were similar in both the ARI group and the control group. Another study on the cost-effectiveness of alternative treatments for BPH in Singapore using the Markov Model Structure demonstrated that Water Vapor Thermal Therapy (WTT) was incrementally cost-effective for moderate BPH but too expensive for severe BPH patients. Also a comparative study between medical therapy, mist, and traditional surgery for treating BPH found that among the minimally invasive procedures, the prosthetic urethral lift had the lowest complication rate, while WTT had higher procedure complication rates.

A study evaluated the impact of persistent BOO on the bladder function of male BPH patients. It analysed urodynamic profiles of male patients over 40 years old with non-neurogenic BPH who had repeated neurodynamic studies. The study found that bladder function tended to deteriorate over time, with decreased bladder compliance and capacity and increased involuntary detrusor contraction. Thus, active treatment should be considered for patients with confirmed bladder obstruction. 

The study analysed the pathological effects of partial bladder outlet obstruction on detrusor activity and found that early stages of the obstruction may be influenced by oxidative stress and inflammation, which increase the expression of GSA family loss with maximum pressure. As per the study findings, changes in oxidative stress and inflammation could potentially be used as early indicators of the condition.