Interventional procedure overview of image-guided transperineal laser ablation (TPLA) for treating lower urinary tract symptoms caused by benign prostatic hyperplasia
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Outcome measures
The main outcomes included ejaculatory function (assessed by the MSHQ-EjD),erectile function (assessed by IIEF-5), symptom relief (assessed by IPSS), maximum urinary flow rate (Qmax), PVR urine volume, PV, QOL and complications. Some of the measures used are detailed in the following paragraphs.
MSHQ-EjD
The MSHQ is a 25-item self-administered questionnaire that includes questions on erection, ejaculation, desire and satisfaction. It is particularly useful to investigate ejaculatory disorders. The ejaculation dysfunction domain includes 7 questions scored from 0 to 5, with higher scores representing better function. A total MSHQ-EjD score in the range of 28 to 35 represents good ejaculatory function, scores of 22 to 27 represent average ejaculatory function, and a score less than 22 is used to diagnose ejaculatory dysfunction. The MSHQ-EjD short form is an abridged version that was developed and validated for assessing ejaculatory dysfunction. This includes 2 domains: ejaculatory function (3 items -completeness of ejaculation, strength of ejaculation and volume of semen on ejaculation) and bother or satisfaction (1 item). Each question is scored 0 to 5, with higher scores indicating better ejaculatory function.
IIEF-15
The IIEF is a 15-item PROM questionnaire used to assess sexual function in men in 5 domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Each domain has its own score range and lower scores represent greater dysfunction:
erectile function score: range 0 to 30 (scores of 24 or less represent increasing dysfunction)
orgasmic function score: range 0 to 10 (scores of 8 or less represent increasing dysfunction)
sexual desire score: range 0 to 10 (scores of 8 or less represent increasing dysfunction)
intercourse satisfaction score: range 0 to 15 (scores of 12 or less represent increasing dysfunction)
overall satisfaction score: range 0 to 10 (scores of 8 or less represent increasing dysfunction).
IPSS
The IPSS is a validated questionnaire often used to assess symptoms of BPH (it is also referred to as the American Urological Association BPH Symptom Score Index). It includes questions on incomplete bladder emptying, frequency, intermittency and urgency of urination, weak urine stream, straining to urinate and nocturia. Higher scores represent worse symptoms. In general, an IPSS symptom score of 0 to 7 indicates mild symptoms, 8 to 19 indicates moderate symptoms and 20 to 35 indicates severe symptoms. An additional question asks the person how they feel about their BPH symptoms, and the response yields a score for quality of life (ranging from 0 to 6, with 0 representing 'delighted' and 6 representing 'terrible').
Qmax
In uroflowmetry, Q refers to the volume of fluid expelled by the urethra per unit time (flow rate). Qmax is the maximum measured value of the flow rate after correction for artefacts. It decreases with age and voided volume. A low Qmax value is commonly a sign of obstruction.
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