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      Changes in Nocturia after Photoselective Vaporization of the Prostate for Patients with Benign Prostatic Hyperplasia

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          Abstract

          Purpose

          To investigate changes in nocturia and predictive factors for improvement after photoselective vaporization of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH).

          Materials and Methods

          A total of 103 patients who complained of nocturia of ≥2 times per night on baseline frequency-volume chart (FVC) and who underwent PVP were included in this retrospective study. All patients underwent a preoperative evaluation for BPH including multichannel video urodynamics. The efficacy of the PVP was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score (IPSS) and FVC. Subjective and objective improvement of nocturia were defined as a reduction of ≥50% in nocturnal frequency compared with baseline on the IPSS and FVC, respectively.

          Results

          As shown by the IPSS and FVC, nocturia was significantly reduced starting from 1 month after PVP. The percentage of patients with improvement in nocturia was 20.0%, 20.7%, 36.2%, and 27.9% on the IPSS, and 30.1%, 48.6%, 52.2%, and 54.5% on the FVC at 1, 3, 6, and 12 months after PVP, respectively. None of the baseline parameters, including the presence or absence of nocturnal polyuria (NPU), reduced nocturnal bladder capacity (NBC), and detrusor overactivity (DO), were associated with improvement of nocturia.

          Conclusions

          Nocturnal frequency was significantly reduced from the early postoperative period after PVP. Improvement in nocturia after PVP was not affected by baseline nocturnal frequency, the presence or absence of preoperative NPU, or reduced NBC or DO on baseline urodynamics.

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          Most cited references25

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          Subjective sleep characteristics of 1,485 males and females aged 50-93: effects of sex and age, and factors related to self-evaluated quality of sleep.

          This epidemiologic study cross-sectionally examined the effects of sex and age on subjective characteristics of sleep and the factors related to self-evaluated sleep quality in a Dutch noninstitutionalized elderly population. 1,692 sleep questionnaires were mailed to all attenders of the general practice serving Krimpen aan de Lek, The Netherlands, aged 50 or over. Both target population and responders (1,485 subjects) were virtually representative of the Dutch population regarding sex and age (50 +) characteristics. Overall, females reported significantly poorer quality of sleep, longer sleep latencies, more nighttime awakenings, less frequent napping, and more frequent use of sedative-hypnotic drugs when compared to males. Additionally, there was a female predominance in the prevalence of disturbed sleep onset and sleep maintenance, whereas a male predominance was observed in the prevalence of excessive daytime sleepiness. Across subjects, a significant age-related increment was found for sleep latency time and time spent in bed. The number of nighttime awakenings increased significantly with age only in males. No significant correlations were found between health status and sex, age, or subjective sleep quality. The most frequently reported causes of disturbed sleep onset and sleep maintenance were worries and nocturia, respectively. Subjective quality of sleep was mostly associated with self-estimated sleep latency. Our findings extend those of previous epidemiologic studies reporting that sleep disorders are common in the general elderly population. Future studies should further elucidate the nature and extent of geriatric sleep disorders to satisfy the increasing need for its accurate diagnosis and treatment.
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            Nocturia: a risk factor for falls in the elderly.

            To determine if nocturia is a risk factor for reported falls and bone fractures in older persons. Cross-sectional study comparing falls in men and women with and without nocturia. Longitudinal health screening program of ambulatory elderly participants. Participants included 988 (65.5%) women and 520 (34.5%) men who had completed their tenth annual visit to the program. Reported falls in the past year and reported bone fractures in the past 5 years. Participants who reported nocturia at least twice during the night were at significantly greater risk to report falls (Odds Ratio = 1.84; 95% CI = 1.05-3.22), and the risk increased in subjects reporting more than three nocturia events (Odds Ratio = 2.15; 95% CI = 1.04-4.44). The significant increase in falls reported by nocturia participants did not result in an increase in reported bone fractures in the past 5 years (P < 0.4360). Nocturia is an important risk factor for falls in ambulatory elderly persons. Preventive measures should be taken to decrease nocturia events and to decrease the risk of falling during these nocturia events.
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              Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes.

              We present long-term observations on photoselective vaporization of the prostate in a prospectively studied cohort of men with obstructive benign prostatic hyperplasia. Obstructive benign prostatic hyperplasia in 94 men was treated with transurethral near contact vaporization with potassium-titanyl-phosphate laser with the patient under general or spinal anesthesia. Baseline characteristics, perioperative data, postoperative outcomes and adverse events were recorded. Mean prostate volume was 45 ml (range 13 to 136). Mean lasing time was 47 minutes (range 10 to 99), and there was minimal blood loss and no evidence of fluid absorption. All 94 men were outpatients and all but 1 became catheter-free in less than 24 hours. Baseline mean American Urological Association symptom index score was 22, quality of life score 4.5, peak urinary flow rate 7.8 ml per second and post-void residual urine volume 197 ml. After surgery percentage changes from baseline in mean values of these parameters, reflecting significant (p <0.0001) improvement at 1, 2, 3 and 5 years, ranged from 83% to 88%, 86% to 90%, 170% to 252% and 76% to 89%, respectively. Complications were mild, and included transient dysuria (6%), delayed hematuria (3%), bladder neck contracture (2%) and 2-day retention (1%). No patient had incontinence or newly developed impotence, but up to 26% of the sexually active men experienced retrograde ejaculation. Postoperatively, low stage prostate cancer was detected in 5% of the patients. : Despite limitations our long-term experience and the literature suggest that significant improvements in symptomatic and urodynamic outcomes of photo-selective vaporization of the prostate are achievable and sustainable.
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                Author and article information

                Journal
                Korean J Urol
                KJU
                Korean Journal of Urology
                The Korean Urological Association
                2005-6737
                2005-6745
                August 2010
                18 August 2010
                : 51
                : 8
                : 531-536
                Affiliations
                Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
                [1 ]Department of Urology, Dongguk University, College of Medicine, Seoul, Korea.
                Author notes
                Corresponding Author: Jae-Seung Paick. Department of Urology, Seoul National University College of Medicine, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. TEL: +82-2-2072-2422, FAX: +82-2-742-4665, jspaick@ 123456snu.ac.kr
                Article
                10.4111/kju.2010.51.8.531
                2924556
                20733958
                849da281-3dd3-4901-8701-db05fb5a4746
                Copyright © The Korean Urological Association, 2010

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 May 2010
                : 16 July 2010
                Categories
                Original Article
                Voiding Dysfunction

                Urology
                laser therapy,nocturia,prostatic hyperplasia
                Urology
                laser therapy, nocturia, prostatic hyperplasia

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