Therapeutic interventions to urologic chronic pelvic pain syndrome and UPOINT system for clinical phenotyping: How far are we?

The assessment and management of urologic chronic pelvic pain syndrome (UCPPS), is controversial. It is classified by voiding symptoms, pelvic pain, and bladder pain, which is weekly treated, weekly understood, and bothersome. In the aspect of clinical efforts and research to help people with this syndrome have been hampered by the deficiency of a widely reliable, accepted, and a valuable tool to evaluate the patient symptoms and quality of life (QoL) impact. However, the etiology comes into sight is multifactorial, and available treatment options have been imprecise considerably in present years. We compiled the published literature on the assessment of the syndrome, a tentative role of pharmacological and non-pharmacological (conservative, alternative, and invasive therapy) interventions in eradicating the disease as well as improving symptoms. The previously published literature on animal models has established the association of immune systems in the etiology, pathogenesis, and progression of the disease. The UPOINT system for clinical phenotyping of UCPPS patients has six predefined domains that direct multimodal therapy, which would lead to significant symptom improvement in the medical field. The narrative review aims to scrutinize the fluctuating scientist’s views on the evaluation of patient and multimodal treatment of the UPOINT system.

Nocturnal polyuria in men performing uroflowmetry for lower urinary tract symptoms

Purpose: To assess the prevalence of nocturnal polyuria (NP) in males performing uroflowmetry (UF) for lower urinary tract symptoms (LUTS), the impact of NP on UF outcomes, and bladder emptying, the association between NP and LUTS. Materials and methods: Men scheduled for UF were recruited in two Centres. Data collected were medical history, IPSS, UF, post-void residual urine volume (PVR), 3-day frequency-volume charts (FVC). The NP index was used to assess NP with a threshold of ≥ 33%. The relationship between NP and patient’s aging was assessed. Results: 162 patients were included in the analysis. Mean age was 70.95 ± 8.04 years. The prevalence of NP was 54.9% (89/162). 110 (68%) patients reported nocturia, and among these, NP was documented in 76 (69%). Nocturia was found in 85% (76/89) of the population with NP. Total IPSS score, IPSS items #1, #2 and #7 showed a significant difference in men with NP compared with those without. Maximum flow rate and PVR did not significantly change comparing men with or without NP. Mean voiding volume (VV) of the night-time micturitions was significantly higher in men with NP compared to those without NP (532.1 ± 275.6 ml vs 175 ± 168.7 ml respectively, p < 0001), while mean VV day-time micturitions and mean VV at UF did not change between groups.Conclusions: NP had a high prevalence in men with LUTS performing UF. Aged males were more commonly affected by NP. Data demonstrated a strong relationship between NP and nocturia and increased urinary frequency while voiding symptoms were poorly related to NP.

A Brunn’s cyst as a cause of bladder outlet obstruction: a case report

A Brunn’s cyst in the proximity of the bladder neck is a rare cause of bladder outlet obstruction. This case study concerns a 45-year-old male presenting with bladder outlet obstruction secondary to a Brunn’s cyst. A provisional diagnosis of Brunn’s cyst was based on ultrasonography, CT scan and cystoscopic examination which indicated a cystic lesion at the bladder neck. Transurethral resection of the cyst was performed with successful resolution of the obstructive voiding symptoms. The final diagnosis of this case based on the pathology is a Brunn’s cyst.

The importance of physiotherapy in the puerperium

The gestational period promotes changes in the woman's body, so that the baby can develop in a healthy way in the uterus. These transformations can interfere in a woman's daily life. Physiotherapy promotes re-education of the abdominal muscles, analgesia in the perineum region, restoration of gastrointestinal function, in addition to helping them with psychological changes. To verify the benefits of physiotherapy in the puerperium. A non-systematic review of the literature was carried out, through randomized clinical trials, published between 1999 and 2018. The search involved the databases PubMed, MEDLINE, SciELO, LILACS and PEDro. The following keywords were used: postpartum physiotherapy. 6 RCTs were included. There was a significant decrease in pain in the treatment group in four studies, increase in strength of the pelvic floor muscles (PFM) and decrease in urinary incontinence in two studies, but 3 postpartum women presented voiding symptoms; in another study, there was a decrease in the score related to anal incontinence; in another study, immediate physiotherapy after delivery reduced abdominal diastasis. Postpartum physiotherapy, through an exercise program, contributes to pain reduction, increase in pelvic floor strength, decrease in urinary incontinence, anal incontinence and abdominal diastasis.

Homoeopathic treatment for lower urinary tract symptoms in men with benign prostatic hyperplasia: an open randomized multicentric placebo controlled clinical trial

Background: Benign Prostatic Hyperplasia (BPH) associated with Lower Urinary Tract Symptoms (LUTS) is the most common condition in ageing men. The epidemiological studies estimate that 90% of men between 45 and 80 years of age suffer some type of LUTS.1 There is paucity of such epidemiological data from India but one study reports the prevalence of BPH among rural elderly of India as 11.8%2. Although LUTS secondary to BPH (LUTS/BPH) is not often a life-threatening condition, the impact of LUTS/BPH and its complications on Quality of Life (QoL) can be significant and should not be underestimated.3 When the effect of BPH-associated LUTS on QoL was studied in a number of community-based populations, for many, the most important motivations for seeking treatment were the severity and the degree of bother associated with the symptoms.4LUTS include storage and/or voiding disturbances common in ageing men. Although voiding symptoms are most common, storage symptoms responsible for daytime frequency, urgency and nocturia interfere the most with life activities. Homoeopathic constitutional treatment is useful in the treatment of a constellation of symptoms due to BPH and LUTS. Along with constitutional medicine homoeopathic practitioners are using organ medicines having special affinity for prostate and urinary bladder with good results. Traditionally the primary goal of treatment is to alleviate bothersome LUTS that result from prostatic enlargement. The literature review indicates that both homoeopathic constitutional medicines as well as organ specific remedies show positive results in relieving the symptoms of BPH but the study was not randomized and there was no control group to show its efficacy. In this backdrop the present study was undertaken to evaluate the storage and voiding symptoms of men having BPH through an internationally validated scale IPSS and the role of homoeopathic intervention, both constitutional and organ remedies on LUTS due to BPH and QoL of the patient. Objectives: The primary objective was to compare the changes in IPSS (International Prostate Symptom Score) within the three groups enrolled for the study (Constitutional remedy/Constitutional + Organ remedy/Placebo). The secondary objectives were to compare the changes in Prostate volume, Post Void Residual Urine (PVRU), Uroflowmetry and in WHOQOL-BREF.5 Material and Methods: The study was done in an open randomized placebo controlled setting at five research centers under Central Council for Research in Homoeopathy. The patients in the age group of 50-80 years presenting with the symptoms of incomplete emptying, frequency, intermittency, urgency, weak stream, straining and nocturia were screened from the general OPD as per ICD-10 Classification Code N40.0 following the predefined inclusion and exclusion criteria. A consultant Urologist was appointed at each center to screen and follow up the enrolled cases. The participants who qualified the inclusion criteria were enrolled in the study after obtaining the ‘Informed Written Consent’. It was a three armed randomized clinical trial where Intervention was administered as per the randomization chart for three groups i.e. homoeopathic constitutional medicine in LM potency (Group 1), homoeopathic constitutional medicine in LM potency with organ remedy in mother tincture and 3X (Group 2) and placebo (Group 3) in 2:2:1 ratio. The patients were followed for six months and the outcome of intervention was assessed monthly for IPSS (Primary objective) and at third and sixth month for prostate volume, post void residual urine, Qmax and Qavg, PSA and WHOQOL-BREF, (Secondary objectives). Internationally validated scales (IPSS &WHOQOL-BREF) were used to assess the outcome. Primary safety endpoint was any adverse event which may be life threatening, requires prolonged hospital stay, results in significant disability, an injury, accident or any other important medical event. 474 patients were screened and 252 patients were enrolled in the study. The analysis of these patients as per protocol and as per intention to treat was carried out using repeated measures ANOVA and paired T test. Results: Out of 254 patients enrolled in the study (HC=103, HC + O = 102 and Placebo = 49), 152 were analyzed as per protocol (HC=71, HC + O = 53 and Placebo = 28) as they completed a follow up period of 6 months whereas, 241 patients were analyzed as per ITT (HC=101, HC + O = 92 and Placebo = 48). 13 patients were excluded from analysis for reasons such as protocol violation and incomplete baseline information. There was statistically significant improvement in all the seven components of IPSS, WHOQOL- BREF and Q max values of uroflowmetry in both per protocol as well as ITT analysis. Discussion: Results from this trial will help in constructing treatment strategy for BPH patients with lower urinary tract symptoms to enable them to make an informed decision about available alternatives for the management of LUTS in BPH. The limitation of the study was that it was not blinded. The inhibition for not making it blinded was the use of mother tinctures of organ specific medicines in liquids of different colors and odours which could not be blinded. Pragmatic trial with longer follow up and a parallel arm comprising of conventional treatment may be undertaken in future to compare their role on LUTS due to BPH on pathological and pathophysiological parameters such as prostatic volume and post void residual urine. Trial Registration: Clinical Trial Registry - India: CTRI/2012/05/002649.

Lower Urinary Tract Symptoms (LUTS) Related to COVID-19: Review Article

The pandemic of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or Coronavirus Disease 2019 (COVID-19) is still ongoing. The outbreak of this new emerging contagious disease has impacted a wide range of sectors including health and economics. Much information about COVID-19 has been discovered by many laboratories, and action taken in various ways as quickly as possible to inhibit the outbreak. It was found that COVID-19 is a ribonucleic acid virus (RNA virus) that can cause infection among humans. Moreover, it can mutate and spread contagiously mainly through the respiratory system. The most common symptoms are cough and fever. Many patients could develop to either pneumonitis or respiratory failure. The SARS-CoV-2 virus can infect various organs, the main infections being in lungs and rectum. In these cases, many laboratories can isolate the virus from oropharyngeal and nasopharyngeal swab and then apply the reverse transcription polymerase chain reaction (RT-PCR) test to identify the COVID-19 virus. Many of the viral infections can cause cystitis by immunologic response. There is a study that showed the SARS-CoV-2 virus could be isolated from the urine sample. The patients had significant changes in urinary storage for frequency, urgency, and urinary incontinence during infected period, which improved after the disease resolved. Moreover, there is a study that reported that the COVID-19 patients who had the International Prostate Symptom Score (IPSS) scores of 20 to 35 had significantly longer hospital stays, more frequent intensive care requirements, and higher mortality rates. Therefore, physician and medical personnel should be aware of the irritative voiding symptoms that might be the presenting symptoms of COVID-19. Furthermore, as many studies have shown that the virus can be excreted in urine, thus, the virus could be contagious via urinary contamination. Keywords: COVID-19; LUTS, Lower urinary tract symptoms; Viral cystitis

Population-Based Study of Prevalence, Bother and Behavior Related to Treatment for Lower Urinary Tract Symptoms and Overactive Bladder among Polish Neurogenic Patients

Background: The aim of this study was to perform a cross-sectional study of Polish neurogenic patients to measure, at the population level, the prevalence, bother and behavior associated with treatment for lower urinary tract symptoms (LUTS) and overactive bladder (OAB). Methods: This epidemiological study was based on data from LUTS POLAND, a computer-assisted and population-representative telephone survey. Participants were classified by age, sex and place of residence. Results: LUTS POLAND includes 6005 completed interviews, of which 1166 (19.4%) were for individuals who had ever received any treatment by neurologists and/or neurosurgeons. Among these neurogenic participants, LUTS prevalence was 72.3%, statistically higher than for non-neurogenic respondents. At the population level, neurogenic patients had about a 20% higher risk for LUTS presence than non-neurogenic participants (relative risk: 1.17–1.21). LUTS prevalence did not differ between men and women. Frequency was the most common of the LUTS. Forty percent of neurogenic respondents described having more than one LUTS subtype (i.e., storage, voiding, and/or post-micturition symptom subtype), and more than 50% of respondents reported OAB symptoms. Both storage and voiding symptoms were bothersome, and many neurogenic individuals (42.3–51.0%) expressed anxiety about bladder function affecting quality of life. Only one-third (34.9–36.6%) of neurogenic participants had sought treatment for their LUTS, and the majority of such individuals received and maintained treatment. Conclusions: LUTS and OAB symptoms were highly prevalent and bothersome among Polish neurogenic patients at the population level. Because the scale of seeking treatment for LUTS was low, Polish neurogenic patients may not be adequately informed about multiple effects of LUTS and OAB.

COMPARAȚIA METODELOR DE TRATAMENT AL LITIAZEI RENOURETERALE PRIN URETEROSCOPIE LASER HOLMIUM ȘI LITOTRIȚIE EXTRACORPOREALĂ CU UNDE DE ȘOC (ESWL)

In contemporary era the urologists have several options for treating reno uretheral stones in the range of 5- 20mm. Of that range, this study makes a comparison between ESWL and ureteroscopic holmium laser lithotripsy in the treatment of reno uretheral stones. Acording of that ureteroscopy and ESWL such as a methods of treatment are invasive procedures, still there is controversy which of them is more acceptable for treating reno ureteral stones disease. Generally, the total cost, the procedural time and analgesia requirements and were noticeably variant. Additionally, gross hematuria and renal colic were more frequent with ESWL procedure, while the voiding symptoms show more frequency with ureteroscopy procedure.