THE MINIMAL IMPORTANT DIFFERENCE (MID) ABOUT THE INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS)

THE MINIMAL IMPORTANT DIFFERENCE (MID) ABOUT THE INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS)

233 THE MINIMAL IMPORTANT DIFFERENCE (MID) ABOUT THE INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS) 5XᚑRQ $1, De La Taille A.2, Delmas V.2, Coulange C...

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233 THE MINIMAL IMPORTANT DIFFERENCE (MID) ABOUT THE INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS) 5XᚑRQ $1, De La Taille A.2, Delmas V.2, Coulange C., Tostain J.4, Ferrière J.M.5, Saussine C.6, Perrin P.1 Hospices Civils de Lyon, Lyon, France, 2Assistance Publique Paris, Paris, France, Assistance Publique Marseille, Marseille, France, 4CHU St Etienne, St Etienne, France, 5CHU Bordeaux, Bordeaux, France, 6CHU Strasbourg, Strasbourg, France

1

Introduction & Objectives: MID is the smallest change that is perceived by the patient. It serves DVDEULGJHEHWZHHQDVLJQLᚏFDQWVWDWLVWLFDOGLᚎHUHQFHDQGDPHDQLQJIXOFOLQLFDOGLᚎHUHQFHIRU the patient. The aim of the study is to estimate the MID associated with the variation of IPSS for LUTS. Material & Methods: We present the results of a prospective multi-centric validation study. We studied 150 consecutives patients treated for LUTS associated with BPH. The treatments included drugs, minimally invasive devices, and surgery. We have related the change in the ,366DWPRQWKVWRDJOREDOUDWLQJVFDOHRIFKDQJHPDGHRIFDWHJRULHVZRUVHVWDEOHVOLJKW moderate and marked improvement. Results: IPSS

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234 IMPACT OF NOCTURIA ON SLEEP EFFICIENCY IN PATIENTS WITH BENIGN PROSTATIC HYPERTROPHY: A 2007 PROSPECTIVE SURVEY IN FRANCE Chartier-Kastler E.1, Leger D.2, Montauban V., Comet D.4, Haab F.5 3LWL«6DOS¬WULªUH0HGLFDO&HQWUH'HSWRI8URORJ\3DULV)UDQFH 2Hôtel-Dieu Hospital, Sleep Centre, Paris, France, Astellas Pharma, Medical, Levallois - Perret, France, 4Axonal, Medical, Nanterre, France, Tenon Hospital, Dept. of Urology, Paris, France

1

5

Introduction & Objectives: 7R DVVHVV VOHHS HᚑFLHQF\ LQ SDWLHQWV SUHVHQWLQJ ZLWK QRFWXULD DQG symptomatic benign prostatic hypertrophy (BPH). Material & Methods: 7KLVSURVSHFWLYHVXUYH\ZDVFDUULHGRXWLQ)UDQFHIURP-DQXDU\WR$SULOE\ XURORJLVWV$WRWDORISDWLHQWVFRQVXOWLQJIRU%3+ZLWKุQRFWXULDHSLVRGHVSHUKZHUHDVVHVVHG PHDQs6'DJHs\HDUV%3+KLVWRU\RIRYHU\HDULQRIFDVHVDQGRYHU\HDUVLQ PHDQ,366VFRUHsV\PSWRPVHYHULW\PLOG PRGHUDWH VHYHUH  3DWLHQWV used a sleep diary to record the previous night’s total sleep period (TSP), total sleep time (TST) and QXPEHURIDZDNHQLQJV6OHHSHᚑFLHQF\ZDVH[SUHVVHGDVWKH767763SHUFHQWDJHUDWLRUHSUHVHQWLQJ WKHWRWDODPRXQWRIDFWXDOVOHHSEHWZHHQLQLWLDOVOHHSRQVHWDQGᚏQDODZDNHQLQJ Results: RIWKHSDWLHQWVVXᚎHUHGIURPFKURQLFLQVRPQLDFRQVLGHUHGDVSULPDU\LQVRPQLD LQ RIFDVHV RUUHODWHGWRHLWKHU%3+  RUVQRULQJVOHHSDSQRHD  7KHPHDQVOHHSHᚑFLHQF\ LQGH[ ZDV s DQG DSSHDUHG WR EH VLJQLᚏFDQWO\ ORZHU LQ %3+UHODWHG LQVRPQLD 6LJQLᚏFDQWO\ ORZHU VOHHS HᚑFLHQF\ LQGH[ YDOXHV ZHUH REVHUYHG DV WKH VHYHULW\ RI WKH %3+ V\PSWRPV LQFUHDVHG s IRU PLOGO\ V\PSWRPDWLF %3+ YV s IRU VHYHUHO\ V\PSWRPDWLF %3+ 3  7DEOHVOHHSHᚑFLHQF\QXPEHURIDZDNHQLQJVDQGIUHTXHQF\RIFKURQLFLQVRPQLDDVDIXQFWLRQRIWKH number of nocturnal micturitions: Nocturia (number of 2(n=545) micturitions) 6OHHSHᚑFLHQF\ s Ps6' Number of s DZDNHQLQJV Ps6' Chronic insomnia ? 422(78.6%) No 115(21.4%) Yes >[email protected] &KLt>[email protected] .UXVNDO:DOOLV

Conclusions: The mean absolute MID can EHHVWLPDWHGDURXQGSRLQWVRQWKH,366 scale. It is related to the baseline IPSS and converted in percentage of decrease related to baseline it corresponds to 15 % decrease. These results are similar to those presented by M. Barry1. 1. Barry MJ et al J Urol. 154: 1770-4, 1995.

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Conclusions: Insomnia is frequent in patients presenting with BPH-related lower urinary tract symptoms /876 DQGLVPDLQO\VHFRQGDU\WRWKHVH/8767KHUHLVDVLJQLᚏFDQWFRUUHODWLRQEHWZHHQWKHIUHTXHQF\ of nocturia and the severity of insomnia.

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IS PROSTATIC ENLARGEMENT ASSOCIATED WITH HYPERINSULINEMIA AND INSULIN RESISTANCE IN ELDERLY MEN?

IS THE OBSTRUCTIVE UROPATHY A SEQUENCE OF VASCULAR DISORDERS IN PATIENTS WITH BPH?

Cho K.S.1, Hong S.J.1, Koo K.1, Ham W.S.1, Park S.Y.1, Lee Y.H.1, Park S.J.1, Park K.K.1, Choi Y.D.1, Kwon S.W.2

Hambaryan A.1, Bratchikov O.1, Zheleznov A.F.1, Badalyan R.2

Yonsei University College of Medicine, Dept. of Urology, Seoul, South Korea, 2Pochon Cha University College of Medicine, Dept. of Urology, Pochon, South Korea 1

Introduction & Objectives: The etiology of benign prostatic hyperplasia is multifactorial and is known to be related to metabolic syndrome, characterized by hyperinsulinemia and insulin resistance. We evaluated the relationship between insulin parameters and prostate volume parameters in elderly men. We evaluated the relationship between insulin and prostate volume parameters in elderly men. Material & Methods: Four hundred and eighty-eight patients participated in this prospective study. Study population was limited to men aged between 60 and 90. We checked relevant medical and surgical history, and measured anthrophometric SDUDPHWHUV IDVWLQJ EORRG VXJDU VHUXP LQVXOLQ DQG VHUXP FKROHVWHURO SURᚏOHV Prostate volume parameters such as total prostate (TP) volume and transitional zone (TZ) volume were determined by transrectal ultrasonography. Insulin resistance was assessed by homeostasis model assessment (HOMA), and annual TP and TZ growth rates were calculated. The relationship between insulin parameters and prostate volume parameters was evaluated using linear regression analysis.

1 Kursk State Medical University, Dept. of Urology, Kursk, Russia, 2National Institute of Health, Dept. of Urology, Yerevan, Armenia

Introduction & Objectives: Benign prostate enlargement (BPE) and vascular diseases are both common in ageing men. The aim of this study was to determine the role of concomitant vascular disorder in BPE progression and development of obstructive uropathy (OU). Material & Methods: A case-control study of 168 patients (hospitalized from January 2001 to May 2007) with diagnosed BPE, complicated by obstructive uropathy was performed. The inclusion criteria were bilateral retention of upper urinary tract, chronic urinary retention (residual urine more than 200ml) and ischuria paradoxa. Group of 105 patients with BPE, without obstructive uropathy complications served as a control group. Patients’ evaluation data included: LUTS assessment (by IPSS), digital rectal examination, urinary tract ultrasound, urinalysis, serum creatinine level. Cardiologists’ assessment records were considered for diagnosing of concomitant vascular disorder. Exclusion criteria were bilateral urolithiasis, beforehand drained XULQDU\ WUDFW QHXURORJLFDO SDWKRORJ\ ZLWK SHOYLF RUJDQVಬ DᚎHFWLRQ 7KH GDWD ZHUH analyzed by StatSoft Statistica 6.0 software.

Results: 0HDQDJHZDVs\HDUV73YROXPH7=YROXPHDQQXDO73JURZWK UDWHDQGDQQXDO7=JURZWKUDWHZDVsP/sP/sP/\HDUV DQGsP/\HDUVUHVSHFWLYHO\6HUXPLQVXOLQOHYHOZDVZHDNO\FRUUHODWHGZLWK TP volume (R2=0.027, p<0.001), TZ volume (R2=0.021, p=0.001), annual TP growth rate (R2 S DQGDQQXDO7=JURZWKUDWH 52=0.024, p=0.001). Similarly, insulin resistance was weakly associated with TP volume (R2=0.020, p=0.002), TZ volume (R2=0.014, p=0.008), annual TP growth rate (R2=0.024, p=0.001), and annual TZ growth rate (R2=0.129, p=0.004).

Results: %RWKJURXSVGLGQRWGLᚎHUE\SDWLHQWVಬDJH sYVsS   %HWZHHQWKHWZRJURXSVWKHUHZDVQRVLJQLᚏFDQWGLᚎHUHQFHLQPHDQSURVWDWHYROXPH s sS  DQGSUHVHQFHRILQWUDYHVLFDOSURVWDWHJURZWK    S   ([SUHVVLRQ RI FOLQLFDO FRPSRQHQWV RI PHWDEROLF V\QGURPH 06  (atherosclerosis, diabetes mellitus-II, hypertension) estimated by logistic regression LVVLJQLᚏFDQWO\PRUHSURQRXQFHGLQWKHJURXSZLWKREVWUXFWLYHXURSDWK\ S  $PRQJ 06 FRPSRQHQWV WKH PRVW VLJQLᚏFDQW GLᚎHUHQFH EHWZHHQ JURXSV KDV atherosclerosis (coronary, aortal, cerebral, lower extremities). No correlation between prostate volume and presence of MS components was found (p>0,05).

Conclusions: Hyperinsulinemia and increased serum insulin had statistically VLJQLᚏFDQW DVVRFLDWLRQ ZLWK SURVWDWH YROXPH DQG DQQXDO SURVWDWH JURZWK UDWH EXW WKHLUFRHᚑFLHQWRIGHWHUPLQDWLRQ52 was very low. Therefore, the relationship between insulin and prostate volume parameters is still uncertain in elderly men over sixty. A larger longitudinal study, with other possible etiologies considered, is needed to elucidate the impact of hyperinsulinemia and insulin resistance on prostate growth.

Conclusions: 3DWLHQWV ZLWK %3( FRPSOLFDWHG E\ 28 DUH PRUH RIWHQ DᚎHFWHG E\ concomitant vascular pathology, in comparison to patients with uncomplicated BPE. $JH SURVWDWH YROXPH DQG JURZWK SDWWHUQ GR QRW DᚎHFW WKH SURJUHVVLRQ RI 28 2XU results support the hypothesis that vascular pathology plays an important role in the development of OU in patients with BPE.

Eur Urol Suppl 2008;7(3):129