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Purpose To evaluate the significance of preoperative and follow-up neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for recurrence in patients with non-metastatic clear cell renal cell carcinoma (NMCCRCC). Materials and methods We retrospectively reviewed the medical records of 309 patients with NMCCRCC who underwent radical or partial nephrectomy. The prognostic significance of various clinicopathological variables, preoperative NLR (pNLR) and PLR (pPLR), and NLR and PLR at recurrence or quasi-recurrence (rNLR and rPLR) for recurrence-free survival (RFS) was analyzed. Results At mean follow-up of 93 months, 44 patients (14.2%) developed recurrence. In the univariate analysis, clinical presentation, tumor size, pathologic tumor stage, Fuhrman grade, pNLR, pPLR and rNLR were significant prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as continuous variables, tumor size, pathologic tumor stage and pPLR were independent prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as dichotomous variables, tumor size, pathologic tumor stage, Fuhrman grade and pNLR ≥1.7 were independent prognostic factors for RFS. In multivariate analyses using rNLR and rPLR, only tumor size and pathologic tumor stage were independent prognostic factors for RFS. In a subset of patients with recurrence or at least 42 months follow-up without recurrence, rNLR ≥1.9 was significantly associated with worse RFS, albeit without independent significance. Conclusions pNLR and pPLR are independent prognostic factors for RFS in patients with NMCCRCC. We propose that postoperative follow-up NLR of 1.9 and higher with one or more adverse clinicopathological factors should prompt radiologic evaluation for possible metastasis.

Purpose With a rapidly aging population in Korea, the number of patients with lower urinary tract symptoms is increasing. Therefore, it is important to determine the current extent of incontinence among Korean women to establish future plans. We attempted to create reference materials for organizing public relations and educational activities by investigating the effect of age on incontinence and quality of life in women. Materials and methods The participants comprised women aged 30 years and older who visited a tertiary center for health screening from September 1 to October 31, 2016. The survey included a questionnaire consisting of 12 questions that took approximately 10 minutes to complete. We analyzed the responses and assessed the prevalence of the disease and its rate of recognition. Results A total of 509 women completed the survey. Irrespective of age, 76.8% of all respondents were aware of urinary incontinence (UI) and 57.4% of the women exhibited lower urinary tract symptoms. The most prevalent symptom was UI (45.8%), and the incidence rates of stress and urge UI were identified as 33.6% and 12.2%, respectively. Only 8.0% of the women had visited a hospital; 38.3% had awaited spontaneous symptom improvement. Many participants (61.2%) answered that a urology clinic is suitable for treating UI, while 58.9% chose a gynecology clinic. Conclusions Our study showed that more than 75% of women are aware of UI, but their perception of the disease mechanism and treatment options was low. We suggest that continuous education and publicity are necessary.

INTRODUCTION AND OBJECTIVE:Programmed death 1 (PD-1) and programmed death-ligand 1 (PD-L1) are potential new targets for the treatment of prostate cancer (PC) and their expression in prostatectomy ...

Purpose To compare the clinical efficacy of anticholinergics for managing diabetes mellitus-associated overactive bladder (DM OAB) versus idiopathic overactive bladder (OAB) in Korean women. Methods We conducted a multicenter, prospective, parallel-group, open-label, 12-week study. Women (20–65 years old) with OAB symptoms for over 3 months were assigned to the DM OAB and idiopathic OAB groups. Changes in the Overactive Bladder Symptom Score (OABSS), urgency, urinary urgency incontinence, nocturia, daytime frequency according to a voiding diary, uroflowmetry, and postvoid residual urine volume (PVR) at the first visit (V1), week 4 (V2), and week 12 (V3) were compared. Results No significant difference was found between the baseline patient characteristics of the DM OAB and idiopathic OAB groups. Treatment with solifenacin was associated with improvements in urgency, urinary urgency incontinence, nocturia, frequency according to a voiding diary, and the total OABSS between V1 and V2 and between V1 and V3. Moreover, a significant improvement in urgency and urge incontinence was found between V2 and V3 in the DM OAB group. However, no significant changes were found in any other parameters. There were no significant differences between the DM OAB group and the idiopathic OAB group except for urgency and urge incontinence at V2 (3.71 vs. 2.28 and 0.47 vs. 0.32, respectively). Conclusions The patients who received solifenacin demonstrated improved urgency, urinary urgency incontinence, nocturia, frequency according to a voiding diary, and total OABSS. Management with solifenacin was equally effective for both DM-related OAB and idiopathic OAB.

Purpose: To determine changes in autonomic nervous system activity after treatment in men with lower urinary tract symptoms (LUTS), we evaluated changes in patients' symptoms, uroflowmetry, and heart rate variability (HRV) after treatment with alpha-blockers for 12 weeks. Materials and Methods: Ninety-five men who had LUTS (International Prostate Symptom Score [IPSS] ≥8) were included in this study. We divided them into two groups on the basis of a low frequency/high frequency (LF/HF) ratio of 1.6. After treatment with Xatral XL (Handok Inc., Korea) 10 mg for 3 months, we rechecked their IPSS, uroflowmetry, HRV and compared these with the baseline measurements. Results: Fifty-four men were assigned to the low LF/HF group (group A: LF/HF ≤1.6) and 41 men to the high LF/HF group (group B: LF/HF >1.6). At baseline and 12 weeks, none of the parameters differed significantly between the groups except for HF, which is one of the parameters of HRV. IPSS, the IPSS-voiding subscore, and the IPSS-storage subscore decreased and maximal uroflow increased significantly after 12 weeks of treatment. Whereas the baseline LF/HF ratio increased from 0.89±0.407 to 1.80±1.804 after treatment in group A, it decreased from 3.93±5.471 to 1.79±1.153 in group B. Conclusions: The efficacies of Xatral XL were clear in both groups. We found that the LF/HF ratio in the two groups merged to a value of approximately 1.79 after treatment. We suggest that this could be a clue to the importance of balance in autonomic nervous system activity in men with LUTS.

Purpose Complaints from spinal cord injury (SCI) patients are typically related to physical disability affecting activities of daily life. However, difficulties with voiding and defecation and/or sexual function can also be major concerns. The general population and even physicians are generally unaware of these complaints; therefore, this study focuses on surveying SCI patients regarding challenges that are faced in daily life. Methods A questionnaire was administered randomly and anonymously to SCI patients who visited the Korea Spinal Cord Injury Association and several rehabilitation hospitals in the Republic of Korea in 2013. All participants gave their consent prior to filling out the questionnaire. Results A total of 299 patients answered the questionnaire; the male to female ratio was 5.8:1 and common vectors for injury were motor vehicle accidents, industrial accidents, and falling down. Of the 169 patients who answered the 'most troublesome' and 'wish would improve' complaints questionnaire properly, urinary problems were most common, specifically incontinence and urinary tract infection. Among all patients, 67% were using clean intermittent catheterization, 63% were taking voiding-related medications, 83% had sexual desires, and among the 122 patients who did not have offspring, 27% had future plans for children. Conclusions From this questionnaire, we discovered that SCI patients in the South Korea suffer not only from physical disability but also many other quality-of-life-related problems. When managing SCI patients, physicians should show greater concern and educate patients about problems related to voiding and sexual activity, rather than just physical disability.

Purpose To evaluate the categories of nocturia and relationships with the international prostate symptom score (IPSS) in Korean men with lower urinary tract symptoms (LUTS) accompanying nocturia. Materials and methods Five hundred twenty-one male patients from five different hospitals, aged ≥18 years, were included. The 3-day frequency volume chart was used to identify nocturia. We also used the IPSS and The International Consultation on Incontinence Modular Questionnaire-Nocturia (ICIQ-N) module to verify the correlation between nocturia and quality of life. Results The distribution of nocturia events varied from 1 to 11, and 2 nocturia events were most prevalent (48.4%). Across the various numbers of nocturia events, the mean age, first sleep period, functional bladder capacity (FBC), nocturnal polyuria index (NPI), nocturia index (NI), predicted number of nightly voids, and nocturnal bladder capacity index (NBCI) were statistically different. Patients with pure nocturnal polyuria showed different night lengths, nocturnal urine volume, FBC, NPI, NI, and predicted number of nightly voids than those without nocturnal polyuria. Patients with severely reduced NBCI were prominent in the IPSS >20 group, and the degree of vexation increased with the number of nocturia events. The IPSS storage symptom score and ICIQ-N symptom score positively correlated with nocturia events. Conclusions In Korean male LUTS patients with nocturia, mixed-type nocturia was prominent, and patients with a high IPSS had a much poorer sleep quality than those with a low IPSS.

OBJECTIVES To analyse actual long-term medical treatment of benign prostatic hyperplasia (BPH) and compare the incurred cost with that of patients with BPH who underwent early surgery. PATIENTS AND METHODS Patients who were first diagnosed with BPH from 1 January 2008 to 31 December 2010 were identified using the Clinical Data Warehouse. Hospital billing data generated by the electronic hospital management system were collected until December 2015. For outpatient care, only procedures, materials and drugs directly related to the management of BPH were selected for the analysis. For inpatient care, all procedures, materials and drugs ordered on dates with continuity with BPH surgery date were included. The primary endpoint of the study was the total treatment-related direct costs of patients undergoing a long-term curative medical therapy for BPH (Group 1), which was arbitrarily defined as any medical therapy including a 5α-reductase inhibitor with a minimum medication possession ratio of 0.5 during ≥5 consecutive years, or ≥1 year until BPH surgery due to medical therapy failure. In all, 70 patients who underwent BPH surgery at

To evaluate the efficacy and safety of silodosin on nocturia in patients with benign prostatic hyperplasia (BPH).This was a 12-week, single-arm, open-label, prospective, multicenter study. The study included men aged 50 years or older with nocturia (≥2 events/night) based on a voiding diary, an International Prostate Symptom Score (IPSS) ≥8, and a quality of life score ≥3. Enrolled patients received 8 mg of silodosin once daily for 12 weeks. We evaluated changes in the mean number of nocturia episodes (using a voiding diary) from baseline to the final assessment. Safety assessments included the rate of adverse events and adverse drug reactions.There were 118 patients included in the safety evaluation analysis, and 112 patients in the full analysis set group. The number of nocturia episodes decreased significantly after 12 weeks of treatment with silodosin (-1.12 ± 1.05, P.0001). The secondary efficacy variables, including IPSS, overactive bladder symptom score and International Consultation on Incontinence Questionnaire-Nocturia score, also improved with treatment (P.0001). There were abnormal drug reactions in 11.8% of patients. The most common adverse drug reaction was an ejaculatory disorder (7.6%). There were no significant adverse drug reactions reported.Silodosin was found to be safe and effective in the treatment of nocturia in patients with BPH.

Purpose In this study, we compared the treatment outcomes for an α-blocker between 2 groups of men, one with high sympathetic activity (HSA) and another with low sympathetic activity (LSA) or normal sympathetic activity. Methods A total of 159 men (≥50 years of age) with lower urinary tract symptoms resulting from benign prostatic hyperplasia were analyzed. We assigned patients to groups according to their sympathetic activity, which was evaluated by heart ratevariability measurements. HSA was defined as a low frequency/high frequency ratio greater than 1.6. All patients received 10mg of alfuzosin once a day for 12 weeks. The primary end point was a change in the total International Prostate SymptomScore (IPSS) at 12 weeks from baseline. Results Sixty-seven men were assigned to the HSA group and 92 men were assigned to the LSA group. The baseline characteristics were not significantly different between the 2 groups, and the response to alfuzosin was good in both groups. Themean total IPSS change was not different between the groups. Both groups were not significantly different with respect to the changes in maximal flow rate, IPSS voiding or storage symptom subscores, quality of life, and rates of adverse drug events. TheHSA group showed a similar willingness to continue treatment compared to the LSA group, although their treatment satisfaction rating was lower. Conclusions The therapeutic effects of alfuzosin did not differ in regards to the differences in sympathetic activity, but treatment satisfaction ratings were lower in the HSA group.

Purpose The aims of this study were to investigate the efficacy of combining the systematized behavioral modification program (SBMP) with desmopressin therapy and to compare this with desmopressin monotherapy in the treatment of nocturnal polyuria (NPU). Methods Patients were randomized at 8 centers to receive desmopressin monotherapy (group A) or combination therapy, comprising desmopressin and the SBMP (group B). Nocturia was defined as an average of 2 or more nightly voids. The primary endpoint was a change in the mean number of nocturnal voids from baseline during the 3-month treatment period. The secondary endpoints were changes in the bladder diary parameters and questionnaires scores, and improvements in self-perception for nocturia. Results A total of 200 patients were screened and 76 were excluded from the study, because they failed the screening process. A total of 124 patients were randomized to receive treatment, with group A comprising 68 patients and group B comprising 56 patients. The patients' characteristics were similar between the groups. Nocturnal voids showed a greater decline in group B (-1.5) compared with group A (-1.2), a difference that was not statistically significant. Significant differences were observed between groups A and B with respect to the NPU index (0.37 vs. 0.29, P=0.028), the change in the maximal bladder capacity (-41.3 mL vs. 13.3 mL, P

Purpose Nationwide database regarding stress urinary incontinence (SUI) is important for evaluating treatment patterns for SUI and for establishing appropriate national policies regarding SUI management. The purpose of this present study was to investigate surgical treatment patterns for women with SUI and analyze the current status of SUI management in Korea by using a nationwide database. Methods Data used for investigating the surgical trends and changes in Korea were retrieved from the Health Insurance Review & Assessment Service from 2008 to 2011. Results The number of surgical cases of SUI decreased continuously from 2008 to 2011. The proportion of transvaginal surgery using a midurethral sling increased continuously. Sling procedures were most commonly performed for women in their 40s followed by women in their 50s. Transvaginal surgery using a single sling or a readjustable sling was performed from 5.6% to 6.1%, which showed no significant change in the number of surgical cases. Conclusions There is a growing need for an appropriate national welfare policy and budget to care for aged and super-aged women in Korea. The early detection and intervention of silent SUI should be actively considered as an important preventive strategy to improve the quality of life in younger women.

PURPOSE To investigate whether hospitalization influences serum prostate-specific antigen (PSA) values. MATERIALS AND METHODS Transrectal ultrasound-guided prostate biopsies were performed for detecting prostate cancer in 2,017 patients between February 2001 and April 2011 at Ajou University Hospital. Of those patients, 416 patients who were hospitalized for prostate biopsies, whose serum PSA values were measured at the outpatient department within 1 month of admission and also just after admission, and who had negative prostate biopsy results were included in the present study. We retrospectively reviewed the data of the 416 patients and compared the serum PSA values measured in the outpatient department with those measured during hospitalization. RESULTS Among all 416 patients, the interval between the two PSA measurements was 22.2 days (range, 3 to 30 days) and the prostate size measured by transrectal ultrasonography was 53.63 mL (range, 12.8 to 197.9 mL). Among all patients, mean serum PSA levels measured during hospitalization were significantly lower than those measured in the outpatient department (6.69 ng/mL vs. 8.01 ng/mL, p

Introduction Urinary incontinence (UI) and Alzheimer's disease (AD) are common in the elderly population and have increased rapidly in recent decades. This study aimed to evaluate the prevalence of UI and determine the neuropsychological characteristics of patients with AD and UI. Methods A total of 464 patients with probable AD were recruited, and the prevalence and type of UI were evaluated. Neuropsychological evaluation was assessed using the Mini-Mental Status Examination, Clinical Dementia Rating, Clinical Dementia Rating-Sum of Boxes, Global Deterioration Scale, Barthel Activities of Daily Living and Instrumental Activities of Daily Living. Results The prevalence of UI in patients with AD was 24.8% (men 29.6%, women 23.0%). The two most common types of UI were urge incontinence (44.3%) and functional incontinence (25.3%). UI in patients with Alzheimer's disease was statistically significantly associated with Clinical Dementia Rating-Sum of Boxes (OR 1.56, 95% CI 1.21–2.01) and Barthel Activities of Daily Living (OR 1.34, 95%CI 1.22–1.47) after adjustment for different covariates. Discussion UI commonly occurred in patients with AD. The Clinical Dementia Rating-Sum of Boxes and Barthel Activities of Daily Living could be potential predictors for UI in patients with AD.

Objectives The aim of this study was to evaluate the pattern of tailoring and efficacy of several types of pharmacotherapy in male LUTS. Methods Prospectively 404 male subjects were included who were over 40 years old, had at least 3 months symptom duration, and 12 or higher international prostate symptom score (IPSS). Subjects were treated with several types of pharmacotherapy for 6 months and were evaluated with IPSS/QoL at every follow-up. Subjects were subdivided into storage (44%), nocturia (18.5%), and voiding symptom (37.5%) groups according to the most bothersome symptom. Results At 6 months, 188 subjects (46.5%) completed the study. The mean age was 64.2±8.5 years, and symptom duration was 30.6±32.6 months. PSA was 2.98±7.96 ng/mL, and prostate size was 32.8±14.2 cc. IPSS continually decreased from baseline (18.7) to last follow-up (10.8). Combination therapy increased from 33.0% to 52.7% at last follow-up (P=.006). However, there was no difference of IPSS changes between combination and monotherapy groups (P>.05). Only antimuscarinic prescription significantly increased from 15.4% to 28.2% (P=.004). Mean number of visits to the clinic was 3.6±1.3 and the number of treatment changes was 0.31±0.47. The nocturia (0.47±0.51) group changed treatment more than voiding group (0.21±0.41, P=.003). However, the voiding group (−9.4) had significantly more improvement than e storage (−6.4) and nocturia (−7.8) groups (P=.011). Conclusions Male LUTS continually improved over 6 months with customised treatment. Pharmacotherapy for male LUTS should be tailored by symptom type and alteration of symptoms during treatment.

The objective was to investigate the expression of endothelial nitric oxide synthase (eNOS) and phosphodiesterase (PDE) 5 in vaginal tissue of premenopausal women experiencing stress urinary incontinence (SUI) with and without sexual dysfunction. Women presenting for treatment of SUI were screened using the Female Sexual Function Index (FSFI) and 10 were selected who met the criteria for female sexual dysfunction (FSD) and 10 asymptomatic controls. Vaginal tissue specimens were obtained from those premenopausal women aged ≥40 years who had had sexual activity ≥2 times every month for the last 6 months and who were scheduled to undergo surgery for SUI. FSD criteria was FSFI scores

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a common disease in the United States, with more than 20% prevalence.MetShasbeenshown tohavedetrimental effectson thebladder, including significant lower urinary tract symptoms (LUTS), decreased quality of life, and detrusor underactivity (DU). However, the progression and mechanism of disease are poorly understood. A large animal model for diabetic bladder dysfunction was developed with Ossabaw pigs. It is hypothesized thatMetSaffects thebladder in theOssabawmetabolicpigandpossibly humans by causing DU over time, contributing to LUTS. METHODS: A group of 11 Ossabaw pigs underwent dietary modification consisting of a hypercaloric, atherogenic diet for 10months to induce MetS. This cohort was compared to a group of 5 lean pigs. Urodynamic studies were performed at 7 and 10 months after randomization. Bladder pressure and compliance were used to define detrusor underactivity. RESULTS: MetS was confirmed between the two groups by demonstrating increased body weight in the MetS animals, increased systolic and diastolic blood pressure, fasting serum glucose, total cholesterol, but not triglycerides (Table 1). Eleven Metabolic pigs demonstrated decreased bladder pressure at maximum capacity (28.2 4.6 vs. 63.8 6.5 cmH2O, p1⁄40.001) and increased compliance (67.1 7.9 vs. 22.2 3.2 cc/cmH2O, p

Objectives: The aim of this study was to compare the efficacy of low (0.2 mg) and intermediate (0.4 mg) dose tamsulosin in treating lower urinary tract symptoms (LUTS). Methods: Patients were treated with low-dose tamsulosin for an initial run-in period of 12 weeks, then divided into two groups based on their clinical improvement. Patients were measured for objective parameters of peak flow rate and postvoid residual urine volume, as well as subjective symptom scores and perceived patient benefit of treatment. The items were then integrated as the LUTS Outcome Score to determine dose increase or maintenance. Overall outcome was determined at 36 weeks. Results: One hundred and seventy-four patients were enrolled and started on 0.2 mg tamsulosin treatment. One hundred and fifty-five patients completed the 36-week study. Sixty patients required dose increase to 0.4 mg at the 12th week. Baseline characteristics showed that a patient who would benefit from 0.4 mg dosage had higher age, daytime frequency, and lower peak urine flow rate. Patients receiving both 0.2 and 0.04 mg both showed improved clinical outcome measures. Higher improvement was found in voiding component symptom scores and urine flow rate improvement in patients receiving an increased dose. Conclusion: Both low- and intermediate-dose tamsulosin are effective treatment regimens. Increasing from low to intermediate dose should follow assessment of both objective and subjective improvements.

To determine and compare autonomic dysfunction in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).The subjects were 30-60 years old and had no known systemic disease. Electrocardiographic signals in the patients in the resting state were obtained from 59 patients with CP/CPPS (age 46.5 ± 7.02 years) and 94 healthy subjects (age 48.4 ± 5.96 years), and heart rate variability parameters were compared.The standard deviation of the N-N interval (P.001), square root of the mean squared differences of the successive N-N intervals (P = .004), total power (P = .004), very low frequency (P = .012), and high frequency (P.001) were lower in the patients with CP/CPPS. However, no significant differences were found in the low frequency and low frequency/high frequency ratios.Patients with CP/CPPS exhibited lower heart rate variability parameters compared with normal controls, with the exception of low frequency and low frequency/high frequency ratios. Possible differences in autonomic nervous system between those with CP/CPPS and normal healthy subjects could exist and autonomic dysfunction might be 1 of the causes that aggravates CP/CPPS.

Testosterone deficiency is associated with late-onset hypogonadism. Micronutrients including copper (Cu) and zinc (Zn) influence testosterone synthesis. The association between micronutrient concentrations in hair tissue and serum testosterone was studied in Korean men. The subjects were 88 men 40-60 years of age who visited the health promotion center and an outpatient clinic of family medicine at a university hospital from March 2006 to February 2008. Population sociological features of the subjects were acquired by self-administered surveys and interview, height and weight were measured, serum total testosterone was determined in the morning, and Cu and Zn were quantified from hair tissue collected in the morning. Subjects with normal testosterone group had a significantly higher Zn level compared to low testosterone group (P = 0.003). Significant negative correlations were evident between total testosterone and Cu level (r = -0.252, P = 0.022), and the Cu/Zn ratio (r = -0.288, P = 0.008). Normal testosterone is associated with a higher Zn level. Decreased serum testosterone is significantly associated with a high level of Cu and elevated Cu/Zn ratio in hair tissue.

Purpose The objective of this study is to investigate alteration of autonomic nervous system (ANS) activity in patients suffering from erectile dysfunction (ED) by comparing parameters of heart rate variability (HRV) between men with ED and healthy subjects. Methods A retrospective review was performed on 40 ED patients (mean age, 46.0±8.49 years) without any disease and 180 healthy control people (mean age, 44.4±7.83 years) without ED in our institution from June 2008 to July 2010. And electrocardiographic signals were obtained to measure HRV parameters for both patients and controls in a resting state. Results For the time domain analysis, square root of the mean differences between successive RR intervals (RMSSD) representing parasympathetic activity was lower in patients than controls although P-value was not statistically significant (P=0.060). For the frequency domain analysis, high frequency (HF) representing parasympathetic activity was lower in patients than controls (P=0.232) and low frequency (LF) representing mainly sympathetic activity was higher in patients than controls (P=0.416). Lastly, LF/HF ratio reflecting sympathetic/parasympathetic activity ratio was statistically higher in patients than controls (P=0.027). Conclusions Patients with ED exhibited different HRV parameters compared with normal controls. This suggests that the patients with ED may have some kind of imbalance in the ANS and it may be possible that general imbalance of the ANS is one of the causes of ED. Thus, HRV analysis may give valuable diagnostic information and serve as a rapid screening tool to evaluate altered ANS activity in patients with ED.

To identify the difference in autonomic nervous dysfunction activity in men between voiding symptom-predominant lower urinary tract symptoms (LUTS) and storage symptom-predominant LUTS.A total of 39 men with LUTS (mean age 56.9 +/- 8.96 years) and 23 healthy men (mean age 57.0 +/- 1.76 years) were included in the present study. Seven questions numbered Q1 to Q7 in the order of appearance in International Prostate Symptom Score were divided into 2 clusters: one with Q1, Q3, Q5, and Q6 and the other with Q2, Q4, and Q7, representing voiding and storage symptoms, respectively. Patients were divided into either voiding symptom-predominant group, if mean voiding symptom score, defined as (Q1 + Q3 + Q5 + Q6)/4, is bigger than mean storage symptom score, defined as (Q2 +Q4 + Q7)/3, or storage symptom-predominant group otherwise. We measured and compared parameters of heart rate variability between men with LUTS and healthy normal subjects. We also compared heart rate variability of men between storage symptom-predominant LUTS and voiding symptom-predominant LUTS.On frequency domain analysis, there was evidence of decreased high frequency (HF) in patients with LUTS (P.05). In comparison of autonomic nervous dysfunction activity in LUTS patients, men with voiding symptom-predominant LUTS had relatively increased ratio of low frequency and HF than what was observed in men with storage symptom-predominant LUTS.Patients with LUTS exhibited decreased HF indicated that they may have had some disease or imbalance in the autonomic nervous system, which may distinguish LUTS patients from healthy men. Also, patients with voiding symptom-predominant LUTS had relatively increased sympathetic activity than storage symptom-predominant LUTS patients.

INTRODUCTION AND OBJECTIVES: Chronic pelvic pain afflicts millions of patients in the U.S., yet underlying disease mechanisms remain unclear. We recently reported that E. coli strains exhibit diverse pain phenotypes in a murine urinary tract infection model that were subject to modulation via the GI tract, including a chronic pelvic pain phenotype reminiscent of interstitial cystitis/bladder pain syndrome (IC). Thus, we hypothesized that flora of the GI and/or reproductive tracts modulate IC symptoms and characterized the IC microbiome. METHODS: The NIDDK-sponsored Multi-Disciplinary Approaches toChronicPelvicPainNetwork (MAPP) isacomprehensiveeffort to characterize IC and other chronic pelvic pain syndromes. Female IC patients and controls were recruited into this study from individuals already participating in MAPP at Northwestern University for analyses of fecal and vaginal flora, and a second cohort was recruited that included non-MAPP participants. Stool and vaginal swabs from the introitus, mid-vagina, and posterior fornix were obtained and processed according to the Human Microbiome Project Manual of Procedures. Duplicate samples were cultured under anaerobic conditions. Purified DNA samples were subjected to 16S rDNA sequence and metagenome sequence analyses. RESULTS: Random forest analyses identified statistically significant features that discriminated IC patients from controls. Consistent with differences in microbiomes, oral gavage of anaerobic cultures from IC patients and controls into mice differentially modulated pelvic pain. CONCLUSIONS: These preliminary studies suggest that chronic pelvic pain is associated with an altered fecal microbiome in IC patients. Moreover, specific taxa may modulate IC symptoms and represent novel biomarkers for diagnosis.

Dry mouth is among the most common side effects of antimuscarinic therapy. This study evaluated the drug-related change in dry mouth after the solifenacin treatment and the impact of dry mouth on the drug efficacy against overactive bladder syndrome (OAB).OAB patients (n = 331) were enrolled in a prospective, multicenter, 8-week observational study of solifenacin treatment. Participants were20 years of age and presented with OAB symptoms for ≥3 months, a total overactive bladder symptom score (OABSS) of ≥3, and an urgency score of ≥2. Primary endpoints were changes in dry mouth according to baseline dry mouth status using Xerostomia Inventory (XI) and the effect of dry mouth to the drug efficacy according to improvements in the OABSS.Three hundred and thirty-three patients were initially screened for the study, with 331 actually enrolled. One hundred and ninety-four patients completed the study. Mean total XI scores increased by 2.8 points in the entire patient population, with larger increases for patients stratified into the non-dry mouth group (NDG) versus the dry mouth group (DG) (4.0 vs. 1.9, p = 0.015) at study baseline. Mean total OABSSs decreased by 3.2 points, with no significant differences between the NDG and the DG (-3.4 vs. -3.0 points, p = 0.578). The dry mouth aggravated in 71 patients (29.2 %) (NDG 30.1 % and DG 27.1 %), but only 10/331 individuals (3.0 %) stopped medication due to xerostomia. Dry mouth progressed in approximately 30 % of the OAB patients, regardless of its presence before solifenacin treatment. However, OAB symptoms were well relieved by solifenacin, and the adverse influence of dry mouth on drug persistence was low.

Objective To evaluate the efficacy, complications, and managements of the readjustable midurethral sling (Remeex system) for the treatment of recurrent stress urinary incontinence (SUI) after previous anti-incontinence surgeries or intrinsic sphincter deficiency (ISD). Methods Between March 2008 and February 2012, 102 women, who presented with previous failed surgery or ISD, were treated with the Remeex system at 4 different institutions. We retrospectively reviewed medical history, physical examination, urodynamic study, postvoiding residual volume, and/or 1-hour pad test of the patients. Surgical outcomes were evaluated using the Severity Index for Urinary Incontinence. The degree of patient satisfaction was assessed, and all complications were classified according to the modified Clavien classification system. Results After a mean follow-up of 27.6 months (range, 14-56 months), 91 patients (89.2%) were cured and 6 patients (5.9%) were improved. The patient's satisfaction rate was 87.2% (89 of 102 patients). Overall, 41 patients (40.2%) experienced 53 complications; 15 patients (14.7%) presented de novo urgency, which was properly managed with anticholinergics, and 14 patients (13.7%) underwent delayed sling readjustment for recurrent SUI (n = 13) and urinary retention (n = 1) during follow-up. Among 6 patients (5.9%) with wound infection, 4 patients were successfully treated by daily dressing with antibiotics, and 2 patients underwent removal of the Remeex system owing to intractable infection. Most complications were classified as grade 1 (54.8%) or 2 (15.1%) and were successfully treated with minimal conservative measures. Conclusion The Remeex system is a valuable adjunct for recurrent SUI after previous anti-incontinence surgeries or ISD, considering most complications are Clavien grade I or II.

Summary Objectives To evaluate the dose–response relationship of tarafenacin, an antimuscarinic agent in development phase, for efficacy and safety, at daily doses of 0.2 and 0.4 mg for the treatment of overactive bladder (OAB) Patients and methods This multicentre, placebo-controlled, randomised, double-blind, phase 2b study was conducted. Patients were randomised to tarafenacin 0.2 mg, tarafenacin 0.4 mg or placebo daily for 12 weeks. Adult patients with OAB for at least 6 months, with an average of ≥ 8 micturitions per day and ≥ 3 incontinence episodes or a total of ≥ 6 urgency episodes per 3 days were enrolled. The primary objective was to compare the mean changes in the number of micturitions per 24 h of the two doses of tarafenacin compared with placebo from baseline to 12 weeks after treatment. Results A total of 334 patients were screened, of whom 235 patients were randomised. The mean decrease in the number of micturitions per 24 h from baseline to 12 weeks was statistically higher in the tarafenacin 0.4 mg group (−2.43 ± 2.21 times per day, p = 0.033) and non-statistically significant in the tarafenacin 0.2 mg group (−1.92 ± 2.45 times per day, p = 0.393) when compared with the placebo group (−1.77 ± 2.95 times per day). There were no statistically significant differences in the mean change of urgency episodes per 24 h among three groups. The most common adverse event was dry mouth. There were no significant differences in blurred vision and constipation compared with placebo. Conclusions Tarafenacin 0.4 mg decreased the number of micturitions in patients with OAB after 12 weeks compared with placebo, and the dose–response relationship of tarafenacin 0.2 and 0.4 mg was confirmed. Both dose levels of tarafenacin were well tolerated.

Urinary incontinence (UI) and Alzheimer's disease (AD) are common in the elderly population and have increased rapidly in recent decades. This study aimed to evaluate the prevalence of UI and determine the neuropsychological characteristics of patients with AD and UI.A total of 464 patients with probable AD were recruited, and the prevalence and type of UI were evaluated. Neuropsychological evaluation was assessed using the Mini-Mental Status Examination, Clinical Dementia Rating, Clinical Dementia Rating-Sum of Boxes, Global Deterioration Scale, Barthel Activities of Daily Living and Instrumental Activities of Daily Living.The prevalence of UI in patients with AD was 24.8% (men 29.6%, women 23.0%). The two most common types of UI were urge incontinence (44.3%) and functional incontinence (25.3%). UI in patients with Alzheimer's disease was statistically significantly associated with Clinical Dementia Rating-Sum of Boxes (OR 1.56, 95% CI 1.21-2.01) and Barthel Activities of Daily Living (OR 1.34, 95%CI 1.22-1.47) after adjustment for different covariates.UI commonly occurred in patients with AD. The Clinical Dementia Rating-Sum of Boxes and Barthel Activities of Daily Living could be potential predictors for UI in patients with AD.