Rural/urban status was not associated with significantly increased adjusted odds of either recognised or unrecognised LUTS/BPH.

Background Cardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of massive transfusion following injury suggest that the ratios of administered plasma and platelets (PLT) to red blood cells (RBCs) affect mortality. The Red Cell Storage Duration Study (RECESS) was a large randomized trial of the effect of RBC storage duration in patients undergoing complex cardiac surgery. Data from that study was analyzed retrospectively to investigate the association between blood components ratios used in massively transfused patients and subsequent clinical outcomes. Methods Massive transfusion in subjects enrolled in RECESS was defined as those who had ≥6 RBC units or ≥8 total blood components. For plasma, high ratio was defined as ≥1 plasma unit:1 RBC unit. For PLT transfusion, high ratio was defined as ≥0.2 PLT doses:1 RBC unit; PLT dose was defined as one apheresis PLT or 5 whole blood PLT equivalents. The clinical outcomes analyzed were mortality and the change in the Multiple Organ Dysfunction Score (Δ MODS) comparing the pre-operative score to the highest composite score through the earliest of death, discharge or day 7. These outcomes were compared between patients transfused with high and low ratios of plasma to RBCs, and also PLT to RBCs. Linear and Cox regression were used to explore relationships between predictors and continuous outcomes (ICU length of stay, 7-day ΔMODS, 28-day ΔMODS, hemoglobin, creatinine and total bilirubin) and time to event outcomes (all-cause mortality at postoperative day 2, 7, and 28), respectively. Results 324 out of 1098 RECESS subjects met the definition of massive transfusion. In those receiving high plasma:RBC ratio, the mean (SE) 7-and 28-day ΔMODS was 1.24 (0.45) and 1.26 (0.56) points lower, (p=0.007 and p=0.024), respectively, than in patients receiving lower ratios. In patients receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day ΔMODS were 1.55 (0.53) and 1.49 (0.65) points lower (p=0.004 and p=0.022) respectively. Subjects who received low ratio plasma:RBC transfusion had excess 7-day mortality compared to those who received high ratio (7.2% vs 1.7%, respectively, p=0.0318), which remained significant at 28 days (p=0.035). The ratio of PLT:RBCs was not associated with differences in mortality. The mean (SE) hemoglobin level on day 2 was 0.36 (0.15) g/L lower in the high plasma group for the entire cohort (p=0.016). It was also 0.62 (0.24) g/L lower in the high platelet group for those in the long blood storage group (p=0.009). However, these changes are unlikely to be clinically significant. Conclusion This analysis found that in complex cardiac surgery patients who received massive transfusion, there was an association between the composition of blood products used and clinical outcomes. Specifically, there was less organ dysfunction in those who received high ratio transfusions (plasma:RBC and PLT:RBCs), and lower mortality in those who received high ratio plasma:RBC transfusions.

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SUMMARYLittle is known about how total testosterone and estradiol-17b influence lower urinary tract symptoms (LUTS) in men with benign prostatic hypertrophy (BPH). We analyzed data from a subset of men aged ≥18 years randomized to tadalafil 5 mg once-daily or placebo who had ≥6 month history of LUTS and an International Prostate Symptom Score (IPSS)≥13 enrolled in one of three randomized, placebo-controlled tadalafil clinical trials (N = 958). Three specific aims were addressed, as follows: (i) To characterize enrolled men by treatment randomization and testosterone level; (ii) to assess cross-sectional associations of estradiol-17b, testosterone, and LUTS prior to treatment with tadalafil; and, (iii) to assess longitudinal associations between baseline estradiol-17b and testosterone and improvements or worsening of LUTS during a 12-week period of tadalafil or placebo administration. LUTS were assessed by total IPSS, IPSS voiding sub-score (IPSS-V) and IPSS storage sub-score (IPSS-S) for cross-sectional analyses, and change in total IPSS (DIPSS), DIPSS-V, and DIPSS-S between baseline and 12-week visit for longitudinal analyses. Correlation analyses and linear regression examined associations. Baseline testosterone was not significantly associated with IPSS. In contrast, estradiol-17b was inversely correlated with IPSS (r = À0.08; p < 0.05) and IPSS-S (r = À0.14; p < 0.05). Tadalafil treatment resulted in greater IPSS improvements in men with lower baseline estradiol-17b versus those with higher baseline estradiol-17b. Lower baseline estradiol-17b was significantly associated with modestly improved DIPSS-V (p = 0.04) and Dtotal IPSS (p = 0.05) but not with DIPSS-S, following treatment which may substantiate the role of bladder dysfunction because of nerve and smooth muscle changes in the bladder in addition to benign prostatic enlargement in LUTS. Circulating baseline testosterone did not predict DIPSS. Men with lower baseline estradiol17b levels showed greater responsiveness to tadalafil 5 mg treatment than those with higher baseline estradiol-17b levels when responsiveness was measured using total IPSS and IPSS-V.