Analysis Of The Clinical Characteristics Of Diseases With LUTS

BackgroundLower urinary tract symptoms refer to the various abnormal performances in micturition cycle caused by changes of lower urinary tract structure and foundation. In this concept, the bladder function disorders can be better summarized as the damage of urine storage or voiding function.LUTS patients in the world has more than1.9billion and expected will reach2.3billion in2018. Incidence rates of LUTS increase with age, based on LUTS incidence rising in recent years; it will inevitably become a universal disease. With the change of lifestyles and work pressure, prostatitis、interstitial cystitis、urinary tract infection、urinary tract tumors proportion of young patients increases, the trend of younger of the clinical manifestations of these diseases more obvious. LUTS distresses patients and seriously threatens to their life; particularly in the elderly its influence is more in-depth. Urological diseases are becoming a major public health problem. In fact, they increasingly weigh on the economy of a country due to the high direct costs and the consequent significant loss of productivity. With the increase of the incidence of lower urinary tract symptoms and progress of the aging of the age structure, it brings heavy burden to economic and public health just only in the parts of diagnosis and treatment of LUTS diseases.The bladder is "unreliable witness". In addition to the subjective deviation, there are a lot of overlap symptoms between different diseases, and our knowledge about the foundation structure and physiology which start up sensation of the urinary tract is limited. Urodynamic techniques can objectively distinguish between these symptoms and reach appropriate diagnosis, but very few outpatients are conditional and willing to accept the urodynamic examines, so we are not able to conduct the comparative analysis objectively about these diseases because there is lack of urodynamic dates about the common diseases related LUTS.ObjectiveLower urinary tract symptoms of different diseases have their own different characteristics; different disease has different closed correlations with LUTS; even the severity of lower urinary tract symptoms caused by the different stages of the same disease also varies; prevalence of LUTS is very different in different age groups. we conducted a cross-sectional observational survey, and collected relevant clinical dates to study the clinical characteristics of different diseases related LUTS, analyze demographic characteristics of the patient with LUTS, discuss its influence on quality of life, and guide the diagnosis and treatment of diseases related LUTS.Method1、Screening of the research object Outpatients with LUTS from urology of Nan Fang hospital were enrolled from May to June2012. The inclusion criteria:①Male or female, age≥18years;②Patient with any lower urinary tract symptoms;③Patient voluntarily participated in the study and signed an informed consent. The Exclusion criteria:①Patient with obvious mental and/or nervous system disorders; ②Pregnant women, plans to pregnant or lactating women.2%Survey content Selected patients filled out the following information:①General information as age、gender、height、weight, medical history, body mass index (BMI), blood pressure.②visual rating table (symptoms impact on patients’ quality of life):Including urine storage period (Urgency, urinary frequency, nocturia, and urinary incontinence) and voiding period, each option scores0-10, the impact increased with the score increases,0means no effect and10means the largest effect.③International prostate symptom scores(IPSS):The IPSS questionnaire consists of seven urinary symptoms and an urinating quality of life issues, there are0～6grades in each urinary question, the total scores ranges is from0to35.0means non-LUTS symptoms, international prostate symptom scores between1～7means mild degree, between8～19means moderate degree, and20～35means severe degree. Questions1、2、4、7are designed for evaluating irritation, and questions3、5、6are for obstructive symptom. A quality of life rating score is marked0-6points by happy、 satisfied、generally satisfied、ordinary、unhappy、troubled%Terrible status.④Overactive bladder symptom scores (OABSS) and overactive bladder symptom quality of life(OABSS QoL):OABSS is used to evaluate urinating status of patients last week, it consists of4questions, including urinary frequency, nocturia, urgency, urge incontinence. Total scores range0-15points, when question3(urgency) scores2points or more and OABSS total scores3point or more, it can be diagnosed as OAB. Quantitative criteria for severity of OAB:3≤score≤5, mild OAB;6≤score≤11moderate OAB; score≥12, severe OAB. The questions of OABSS QoL include travel or social, work, housework (need special underwear and bedding), sports, psychological and emotional (inhibition, shame, anxiety, etc.), sex life. There are0～6grades in each urinary question:never, rarely, sometimes, most of the time, often, always. The total scores ranges is from0to30points.⑤Physical examination, urinalysis, urine culture, prostate fluid routine inspection, B ultrasound, X-ray, CT, urodynamic and other laboratory examinations help to determine the final diagnosis.3、Diagnosis and treatment process (As shown in figure2-1)4、Statistical analysis SPSS13.0software are used for statistical analysis. x±s stands for average score, T-test is used to compare average scores of two groups, One-way ANOVA is for comparison between the multi-groups; Chi-square test is for rate or Constituent ratio. Spearman correlation analysis is used for the correlation between the relevant factors and LUTS. P<0.05was considered statistically significant.ResultA total of108cases of LUTS are investigated,28patients are diagnosed BPH,25patents are OAB,24are prostatitis,23are urinary tract infection (UTI), and4,2,2patients are diagnosed interstitial Cystitis, ketamine correlation cystitis and stress urinary incontinence respectively. Interstitial cystitis, ketamine cystitis and stress urinary incontinence their respective sample size is too small, there’s too much deviation caused by statistical analysis, so we decided to remove the patients whoever suffered interstitial cystitis, ketamine cystitis or stress urinary incontinence.100patients with LUTS at last were picked up,69of them are male, and31are women. There are61patient were smoker and31are non-smoker. Smoking index wasn’t statisticsed. The average age of the patients with LUTS is (43.1±1.8) years old, there were51patients at18-39years old group (Group A),27patients at40- 59years old group (Group B), and22patients at60years old and above group (Group C). According to One-way ANOVA, the average age of onset of BPH and prostatitis is significant statistical differences with other three diseases respectively. Age of onset of BPH is old, and age of onset of prostatitis is young.IPSS score is the highest in patients with benign prostatic hyperplasia, it scores20.8±7.0points, voiding symptom score is9.4±3.7points, scores of these two aspects are statistically significant difference (P<0.05) with the other three diseases, that means patients with benign prostatic hyperplasia their lower urinary tract symptoms are serious than other diseases, outstanding performance is in obstructive symptoms. The IPSS score of OAB is13.8±3.9points, major scores are from the symptoms of urinary storage period,13.2±3.7points, OAB’s OABSS score is the highest,8.5±2.5points, scores of urinary storage period and OABSS are higher than prostatitis and urinary tract infection (P<0.05), but no significant difference (P>0.05) in patients with benign prostatic hyperplasia. That means symptoms in patients of OAB major perform in the bladder irritation. The IPSS and OABSS scores of Urinary tract infections and prostatitis are both low, these two diseases have no apparent specific performance. Scores of quality of life of patients with LUTS is5.0±0.9points, and the patient feels distressed.Conducting non-parametric statistical analysis between Age groups (Group A, B, C) with prostate symptom classification (mild, moderate, severe), and spearman correlation coefficient was0.562(P<0.01), it shows a significant positive correlation between prostate symptom classification and age. Their correlation is closed. Scores of IPSS score of groups A, B, C are,9.2±3.6points,14.9±6.9points,20.9±6.8points respectively, according to One-way ANOVA, there are significant statistical difference between these three groups (P<0.05). Group C scored significantly higher than the other two groups, and group B was higher than group A, it indicates that the older, the greater the likelihood of severe symptoms of LUTS. Conducting correlation analysis between patient’s age and scores of voiding symptom, we drawn spearman correlation coefficient of0.615, P<0.01. Spearman correlation coefficient between age and scores of storage symptom is0.353, the correlation is not close. Comparison about IPSS quality of life between these three groups, group A was not significant difference with group A (P>0.05), and the same result to group B and C (P>0.05). There exist a statistically significant difference between group A and C (P<0.05).IPSS score of smoking patients and non-smoking patients with were13.5±6.2points,13.1±7.6points, and OABSS score were6.4±2.7points,5.9±3.2points, respectively, storage symptoms score were10.6±3.6points,10.1±4.9points, voiding symptom score were3.0±1.6points,3.1±1.7points; For the part of impacting on quality of life, IPSS quality of life score of smoking patients was5.2±0.8points and OAB quality of life score was14.2±4.3points, non-smoking patients was4.9±0.9points,13.2±4.9points respectively. According to the t-test statistical analysis, there was no significant difference in IPSS, storage period, voiding period, OABSS, quality of life score (P>0.05) between smoking patients and non-smoking patients.ConclusionLUTS is diversity, a variety of urinary tract diseases can trigger LUTS, and different disease has different characteristics of LUTS. LUTS induced by BPH are quite severe regardless irritation or obstruction symptoms, and obstructive symptoms are very prominent and distinct with other diseases. The OAB outstanding performs in the urgency and severe symptoms of urinary frequency; its obstructive symptom is mild. The clinical symptoms of urinary tract infection are not typical, lower urinary tract symptoms is mild, it mainly performs in irritative symptoms. Lower urinary tract symptoms caused by prostatitis are also mild, and have non-specific symptoms, but other symptoms are diversity, not only lower urinary tract symptoms, but also performs as the perineum, and the ejaculatory pain or discomfort, back pain, decreased sexual function and neuropsychiatric symptoms. No clear effect of smoking on lower urinary tract symptoms. Age closely relates with LUTS, older is with higher incidence of LUTS and relatively more severe. LUTS no matter what diseases induce is a threat to the health and quality of life of the patient; we need to pay attention to it.