Screening tool for sarcopenia (SARC-F) predicts unsatisfactory medical treatment of lower urinary tract symptoms in elderly men aged 75 years or older: a preliminary observational study

Screening tool for sarcopenia (SARC-F) predicts unsatisfactory medical treatment of lower urinary tract symptoms in elderly men aged 75 years or older: a preliminary observational study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Screening tool for sarcopenia (SARC-F) predicts unsatisfactory medical treatment of lower urinary tract symptoms in elderly men aged 75 years or older: a preliminary observational study Naoki Wada, Tsubasa Hatakeyama, Haruka Takagi, Shun Morishita, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4505247/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Oct, 2024 Read the published version in International Urology and Nephrology → Version 1 posted You are reading this latest preprint version Abstract Purpose : We investigated the influence of sarcopenia on treatment outcomes in elderly patients receiving medical therapy for lower urinary tract symptoms (LUTS). Methods : We included male patients with LUTS aged ≥75 years who had not changed their medication for 1 year. Current conditions were estimated using IPSS, overactive bladder symptoms score (OABSS), and screening tool for sarcopenia (SARC-F). SARC-F score of ≧4 was defined as sarcopenia. Results : We included 59 patients in this study, including 16 patients (27.1%) with sarcopenia. IPSS total score, voiding symptom score of IPSS, and IPSS-QOL were significantly higher in the sarcopenia group than the non-sarcopenia group. The non-sarcopenia group had significantly larger PV (40 vs. 20 ml) and higher testosterone levels (497.5 vs. 369 ng/ml) compared with the sarcopenia group. Moderate and severe LUTS (IPSS total ≥8) persisted in 34 patients (57.6%) after medical treatment. Multivariate analysis showed that only SARC-F was a significant factor affecting the IPSS total ≥8 despite medical treatment for 1 year (OR 1.67, 95%CI: 1.13–2.46). Conclusion : Sarcopenia defined by using SARC-F is a significant factor for unsatisfactory medical treatment of LUTS in elderly men aged ≥75 years. elderly lower urinary tract symptoms male SARC-F sarcopenia Figures Figure 1 Figure 2 Introduction In 2007, Japan became a super-aged society, where the population aged ≥65 years accounted for 21.0% of the national population. Several other countries have also become super-aged societies. Frailty is a highly prevalent condition among the elderly patients and has been increasingly considered a crucial public health issue, particularly in the super-aged society. Aging is associated with a progressive loss of skeletal muscle mass (sarcopenia) and function, which causes physical frailty in the elderly [1]. The prevalence of lower urinary tract symptoms (LUTS) also increases with age. The development of LUTS in elderly men is caused by outflow obstruction due to benign prostatic enlargement (BPE), underactive bladder (UAB) due to decreased bladder contractility, and overactive bladder (OAB). For treatment of Male LUTS, pharmacotherapy is very common using alpha-blockers, phosphodiesterase 5 (PDE5) inhibitors, and 5α-reductase inhibitors, particularly for patients with BPE. Furthermore, treatment with anticholinergics or β3 agonists is also effective for OAB symptoms. However, some patients experience persistent moderate to severe symptoms despite the use of these drugs. Some studies have shown an association between sarcopenia and decreased bladder contractility (UAB) [2][3]. Since no effective medication is currently available for UAB, UAB may influence the refractory condition of persistent LUTS. Taking into account the possible association between sarcopenia and UAB, patient groups with sarcopenia may be at risk for developing refractory LUTS. Therefore, we investigated whether sarcopenia affects treatment outcomes in elderly patients receiving medical therapy for LUTS. Methods We have been conducting routine clinical assessments, including interviewing for SARC-F and measuring grip strength, focusing on sarcopenia as well as the assessments of LUTS including IPSS and overactive bladder symptoms score (OABSS). We retrospectively collected the data of male patients with LUTS 1) aged ≥ 75 years, 2) who had not changed their medication for 1 year, 3) who had sufficient cognitive function to complete various questionnaires on their own, and 4) who had complete data as follows. These study patients include those who have refrained from invasive treatments such as transurethral prostatectomy or intravesical injection of botulinum toxin due to advanced age, comorbidities, or poor performance status, as well as those for whom increasing the dosage of OAB medications is challenging due to large residual urine. Specifically, the current study targeted patients whose current medication represents the limit of pharmacotherapy. Patients who had 1) active urinary tract infection, 2) urinary stones, 3) pelvic surgery for prostate cancer or rectal cancer, or 4) insufficient data as follows, were excluded. We surveyed the patient’s basic information, including medications, comorbidities related to lower urinary tract function, height (H), and body weight (BW). As part of routine clinical practice, the following examination items were conducted simultaneously during regular check-up. Current conditions of LUTS were estimated using IPSS [ 4 ] and OABSS [ 5 ]. OABSS is a validated self-assessment questionnaire consisting of four questions on OAB symptoms (Q1: daytime frequency, Q2: nighttime frequency, Q3: urgency, and Q4: urgency incontinence). The voiding symptom score of IPSS was the sum of questions 3 (intermittency), 5 (slow stream), and 6 (straining) of IPSS, and the storage symptom score of IPSS was the sum of questions 2 (increased daytime frequency), 4 (urgency), and 7 (nocturia). IPSS of < 8, 8–19, and ≥ 20 was defined as mild, moderate, and severe, respectively. OABSS of < 6, 6–11, and ≥ 12 was defined as mild, moderate, and severe, respectively. The study patients were screened using SARC-F. Grip strength was measured on both hands using a Smedley-type analog grip strength meter, and the stronger one was adopted. Based on previous reports [ 6 ], SARC-F score of ≧ 4 was defined as having sarcopenia in this study. Prostatic volume (PV) was measured using transabdominal ultrasonography by the same examiner. Appetite and nutrient status were assessed using the Council on Nutrition Appetite Questionnaire (CNAQ), Geriatric Nutritional Risk Index (GNRI), and blood tests, including total protein, albumin (Alb), cholinesterase (ChE), total cholesterol (T-Cho), and lymphocyte count (Lymp). The CNAQ is an eight-item questionnaire originally designed to evaluate appetite and eating behavior [ 7 ]. Each item is rated using a five-point Likert-type scale, with lower scores indicating poorer functions involving that item (score range, 8–40). The CNAQ has been translated into Japanese. The GNRI is a nutritional status indicator that is used to evaluate the risk of malnutrition in elderly patients. It is a simple and accurate screening tool that uses objective factors such as weight, height, and Alb levels. The GNRI was calculated using the following formula: GNRI = (1.489 × Alb (g/L) + (41.7 × BW/ideal BW). Ideal BW = H (cm) -100 ། [(H ། 150)/4]. The primary outcome measure was whether IPSS showed differences based on the presence or absence of sarcopenia, as determined using SARC-F. We also investigated the factors influencing moderate and severe persistent LUTS as the secondary outcome. Due to the difficulty of setting the number of cases in advance because of a preliminary observational study, a post hoc analysis was performed to verify the appropriateness of the sample size. The Wilcoxon signed rank test and square test were used to compare the mean values between the two groups. We estimated the odds ratio for each parameter using logistic regression analysis. Statistical significance was determined at p < 0.05. The institutional review board of Asahikawa Medical University approved this study (No. 23129). Results We included 59 patients (median age, 80 years; IQR, 77–85) in this study, including 16 patients (27.1%) with sarcopenia based on SARC-F. The prevalence of diabetes mellitus and spinal disease (spinal canal stenosis in all) was higher in the sarcopenia group (Table 1 ). Most patients received α1 blocker or tadalafil. Dutasteride and OAB medication (anticholinergics or β3 agonists) were prescribed to 30 (50.8%) and 20 (33.9%) patients, respectively (Table 1 ). The mean grip strength was significantly lower in the sarcopenia group than the non-sarcopenia group (median, 25.5 [IQR, 21.8–30] vs. 30 [IQR, 27.5–35], p < 0.01). The median IPSS total (15 [IQR, 8–18.8] vs. 7 [IQR 5–14], p = 0.03), voiding symptom score (6 [IQR, 4–11] vs. 3 [IQR, 1–8], p = 0.02) and IPSS-QOL (3.5 [IQR, 3–5] vs. 3 [IQR, 2–3], p = 0.02) were significantly higher in the sarcopenia group than the non-sarcopenia group (Table 1 , Fig. 1 ). The non-sarcopenia group had significantly larger PV (median, 40 ml [IQR, 28.5–56.5] vs. 20 ml [IQR, 14.3–35.5], p < 0.01) and higher testosterone levels (median, 497.5 ng/ml [IQR, 376.5–614] vs. 369 ng/ml [IQR, 291–468], p = 0.03) compared with the sarcopenia group (Table 1 , Fig. 2 ), whereas the percentage of patients taking dutasteride tended to be higher in the non-sarcopenia group than the sarcopenia group (58.1% vs. 31.3%, p = 0.07) (Table 1 ). Table 1 Comparison of clinical parameters between patients with and without sarcopenia Whole cohort SARC-F < 4 4 ≦ SARC-F p value No. 59 43 16 Age (years old) 80 (77–85) 80 (77-85.5) 81.5 (76-83.5) 0.96 Height (cm) 163 (160-167.5) 164 (159–168) 163 (162-164.3) 0.96 Weight (kg) 61.9 (56.8–68.0) 60.9 (56.8–67.5) 64.6 (57.6–69.4) 0.66 Body mass index (kg/m 2 ) 23.2 (20.9–25.1) 23 (20.8–24.6) 24.2 (21.8–25.7) 0.64 Grip strength (stronger side: kg) 29 (25–32) 30 (27.5–35) 25.5 (21.8–30) < 0.01 Prostatic volume (ml) 38 (22-52.5) 40 (28.5–56.5) 20 (14.3–35.5) < 0.01 IPSS 10 (6.5–16.5) 7 (5–14) 15 (8-18.8) 0.03 0–7 25 (42.4%) 22 (51.2%) 3 (18.7%) 8–19 25 (42.4%) 16 (37.2%) 9 (56.3%) 20–35 9 (15.2%) 5 (11.6%) 4 (25.0%) 0.07 Voiding symptom score 4 (2–9) 3 (1–8) 6 (4–11) 0.02 Storage symptom score 4 (3–6) 4 (2.5–5.5) 5 (3–7) 0.24 IPSS-QOL 3 (2–4) 3 (2–3) 3.5 (3–5) 0.02 OABSS 4 (3–6) 4 (2.5–5.5) 4 (3.8–6.5) 0.19 0–5 43 (72.9%) 32 (74.4%) 11 (68.8%) 6–11 15 (25.4%) 11 (25.6%) 4 (25.0%) 12–15 1 (1.7%) 0 1 (6.2%) 0.25 CNAQ-J 28 (27–31) 28 (26.5–31) 28 (27-29.5) 0.84 Medication α1 blocker 38 (64.4%) 27 (62.8%) 11 (68.8%) 0.67 PDE5 inhibitor 13 (22.0%) 8 (18.6%) 5 (31.3%) 0.30 5αRI (dutasteride) 30 (50.8%) 25 (58.1%) 5 (31.3%) 0.07 β3 agonist 14 (23.7%) 10 (23.3%) 4 (25.0%) 0.89 Anticholinergic 6 (10.2%) 4 (9.3%) 2 (12.5%) 0.72 Comorbidities Hypertension 21 (35.6%) 16 (37.2%) 5 (31.3%) 0.67 Diabetes mellitus 14 (23.7%) 6 (14.0%) 8 (50.0%) < 0.01 Brain disease 9 (15.3%) 8 (18.6%) 1 (6.3%) 0.24 Spinal disease 5 (8.5%) 1 (2.3%) 4 (25.0%) < 0.01 Laboratory data TP (g/dl) 7.0 (6.8–7.3) 7 (6.9–7.3) 6.95 (6.7–7.1) 0.15 Alb (g/dl) 4.1 (3.9–4.2) 4.1 (3.9–4.2) 4.1 (3.9–4.2) 0.49 ChE (U/L) 275 (236.8-308.8) 274 (250–307) 283.5 (205–323) 0.88 T-Cho (mg/dl) 181 (159–203) 180.5 (164–202) 174.5 (155–204) 0.81 Lymp (×10 3 /µL) 1.57 (1.28–2.06) 1.58 (1.24–2.05) 1.54 (1.33–2.05) 0.84 GNRI 104 (97–108) 103 (97–109) 106 (94–108) 0.88 Testosterone (ng/ml) 473 (343.5-576.5) 497.5 (376.5–614) 369 (291–468) 0.03 SARC-F 2 (1–4) 1 (0–2) 4 (4–5) < 0.01 Mean (IQR) or N (%), Wilcoxon signed ranks test or square test are used. The number of patients in the non-sarcopenia and sarcopenia groups was 43 and 16, respectively. Average IPSS (standard deviation) in each group as the primary outcome were 10.1 (6.6) and 15.0 (7.3), respectively. When calculated using the value of IPSS, the effect size becomes 0.70. When calculating with an effect size of 0.70 and an α error of 0.05, the power (1-β error) was estimated to be 0.75, indicating we had a sufficient sample size to obtain a certain level of statistical reliability. Moderate and severe LUTS (IPSS total ≥ 8) persisted in 34 patients (57.6%) (Table 2 ). The voiding and storage symptoms score of IPSS, IPSS-QOL, OABSS were significantly higher in these 34 patients than those with IPSS < 8. SARC-F score was significantly higher in patients with moderate and severe LUTS (median, 2.5 [IQR, 1–4] vs. 1 [0–2], p = 0.012) (Table 2 ). For logistic regression analysis with the current number of patients, it is appropriate to consider three confounding factors. We conducted multivariate analysis using SARC-F, the presence of comorbidities and PV, which are believed to influence the effectiveness of drug treatment in male patients. Multivariate analysis showed that only SARC-F was a significant factor affecting IPSS total ≥ 8 despite medical treatment for 1 year (OR, 1.67; 95% CI: 1.13–2.46, p = 0.01) (Table 3 ). Table 2 Comparison of clinical parameters between patients with persistent mild and moderate/severe LUTS under medical treatments IPSS < 8 8 ≦ IPSS p value No. 25 34 Age (years old) 81 (78–85) 80 (76–85) 0.92 Height (cm) 165 (160–168) 163 (160–167) 0.66 Weight (kg) 62.3 (58.6–69.7) 59.8 (56.4–67.6) 0.22 Body mass index (kg/m 2 ) 23.3 (22.2–25.8) 22.5 (20.8–24.7) 0.28 Grip strength (stronger side: kg) 30 (25–31) 29.5 (26.3–32) 0.86 Prostatic volume (ml) 35 (22–46) 40 (23–53) 0.76 IPSS 5 (4–7) 15 (12–20) < 0.001 Voiding symptom score 2 (1–2) 8 (6–10) < 0.001 Storage symptom score 3 (2–4) 5.5 (4–7) < 0.001 IPSS-QOL 2 (2–3) 3 (3–4) < 0.001 OABSS 3 (2–4) 4 (3–6) < 0.01 CNAQ-J 29 (27–31) 28 (27–31) 0.92 Medication α1 blocker 15 (60.0%) 23 (67.6%) 0.54 PDE5 inhibitor 5 (20.0%) 8 (23.5%) 0.75 5αRI (dutasteride) 15 (60.0%) 15 (44.1%) 0.23 β3 agonist 3 (12.0%) 11 (32.4%) 0.07 Anticholinergic 2 (8.0%) 4 (11.8%) 0.64 Comorbidities Hypertension 9 (36.0%) 12 (35.3%) 0.96 Diabetes mellitus 7 (28.0%) 7 (20.6%) 0.51 Brain disease 4 (16.0%) 5 (14.7%) 0.89 Spinal disease 1 (4.0%) 4 (11.8%) 0.29 Laboratory data TP (g/dl) 7.1 (6.9–7.4) 7.0 (6.8–7.1) 0.04 Alb (g/dl) 4.1 (3.9–4.2) 4.1 (3.9–4.2) 0.67 ChE (U/L) 277.5 (252.5-315.2) 273 (229.2-307.2) 0.59 T-Cho (mg/dl) 179 (162.8-202.5) 181.5 (157-201.8) 0.92 Lymp (×10 3 /µL) 1.525 (1.35–2.02) 1.59 (1.26–2.07) 0.98 GNRI 104 (96–110) 104 (97–108) 0.38 Testosterone (ng/ml) 473 (303–701) 476.5 (367–542) 0.23 SARC-F 1 (0–2) 2.5 (1–4) 0.012 Mean (IQR) or N (%), Wilcoxon signed ranks test or square test are used. Table 3 Influencing factors for IPSS-total of 8 or higher under medical treatments Odds ratio 95%CI p value Comorbidities 0.58 0.16–2.01 0.39 Prostatic volume 1.01 0.99–1.04 0.36 SARC-F 1.67 1.13–2.46 0.01 Discussion In elderly male patients aged ≥ 75 years with sarcopenia defined by SARC-F, improvement of LUTS, particularly voiding symptoms, was insufficient despite medical treatment. SARC-F was the only significant predictor of persistent moderate to severe LUTS. Thus, the evaluation of sarcopenia by SARC-F may be an indispensable factor when treating LUTS in elderly male patients. Sarcopenia is characterized by the loss of muscle mass, muscular strength, and physical function along with aging, which is induced by age-associated insulin resistance, low-grade inflammation, and oxidative stress [ 1 ][ 8 ]. The diagnosis of sarcopenia is confirmed by measuring the muscle mass in the limbs using a body composition analyzer. Malmstrom and Morley et al. [ 9 ] created a simple screening tool, known as SARC-F, to detect sarcopenia in the elderly population, and its validity has been evaluated in various studies [ 6 ]. In this study, we investigated the correlation between sarcopenia and unsatisfactory medical treatment of LUTS in elderly men using SARC-F instead of measuring limb muscle mass. In the sarcopenia group, no specific indicators of malnutrition were noted in CNAQ-J or GNRI, but grip strength was significantly reduced, and improvement of LUTS was inadequate. LUTS can impair health-related QOL. Although pharmacological treatment is often the mainstay for managing LUTS in men, some invasive treatments may also be necessary for better improvement of symptoms. Some male patients with larger PV failed to obtain sufficient improvement of LUTS despite medical treatment, and surgical interventions, such as transurethral prostatectomy, are often required [ 10 ][ 11 ]. However, in the present study, PV was not a factor associated with persistent LUTS (IPSS ≥ 8) after medical treatment. Only SARC-F could predict unsatisfactory medical treatment in the elderly. Sarcopenia may be a significant negative factor in predicting the effect of medical treatment in elderly patients with LUTS. The relationships between testosterone and PV and between testosterone and sarcopenia have been discussed. Testosterone replacement in castrated animals restores prostatic hyperplasia [ 12 ]. Additionally, castration or androgen deprivation treatments reduce PV [ 13 ]. Testosterone exerts some influence on prostate growth; however, the mechanism by which testosterone influences prostate growth remains unclear. Some studies have failed to demonstrate a correlation between testosterone levels and PV [ 14 ]. Many cross-sectional studies have confirmed significant correlations between testosterone levels and sarcopenia in men [ 15 ][ 16 ]. Testosterone is indirectly associated with muscle metabolism through various cytokines and molecules. Thus, lower testosterone levels could be a risk factor for sarcopenia. In this study, the patients in the non-sarcopenia group (SARC-F < 4) had larger PV and higher testosterone levels than those in the sarcopenia group (SARC-F ≥ 4). More patients in the non-sarcopenia group were taking dutasteride, which can shrink the prostate by inhibiting DHT. A previous study showed that dutasteride could slightly increase testosterone levels [ 17 ]. To analyze mutual relationship among testosterone, dutasteride taking and PV was beyond the scope of the present study. Nevertheless, an interesting correlation was observed between sarcopenia and PV. Only a few studies have reported the relationship between sarcopenia and LUTS, particularly in male patients. Several studies on women have reported an association between sarcopenia-related factors, such as reduced handgrip strength, impaired standing balance, decreased psoas muscle mass, and LUTS (urinary incontinence and OAB) [ 18 ][ 19 ]. Ida et al. showed that in male patients with diabetes, the prevalence of OAB was significantly higher in patients with sarcopenia screened using SARC-F [ 20 ]. Qin et al. reported that low lean mass, a key indicator of muscle mass, strength and function was associated with a higher risk of LUTS in elderly men [ 21 ]. Clinical research has shown a positive correlation between skeletal muscle mass and bladder contractility force in men [ 2 ]. In the present study, the improvement of voiding symptoms was inadequate in the sarcopenia group despite smaller PV than the non-sarcopenia group. It is tempting to speculate that inadequate improvement of voiding symptoms in the sarcopenia group might be caused by decreased bladder contractility (UAB) rather than outflow obstruction. This preliminary observational study has several limitations. First, the sample size was small. However, we believe that our research findings indicate the reliability and statistical significance because the post hoc analysis for sample size accomplished a statistical power of 0.75. SARC-F is a screening tool for sarcopenia and not a tool for the precise diagnosis of sarcopenia. More detailed evaluations using a body composition analyzer are required to explore further information about the relationship between sarcopenia and LUTS. Second, we were unable to assess the severity of LUTS before starting medical treatment. Third, we did not evaluate lower urinary tract function using urodynamic studies including uroflowmetry and pressure-flow study. Without pressure-flow study, it is impossible to evaluate the bladder contractility. Prospective longitudinal studies with a greater number of patients under predetermined criteria for sarcopenia are necessary. Conclusions Sarcopenia screened using SARC-F is a predictive factor for unsatisfactory medical treatment of LUTS in elderly men aged ≥ 75 years. Abbreviations BPE= benign prostatic enlargement CNAQ= council on nutrition appetite questionnaire DHT= dihydrotestosterone GNRI= geriatric nutritional risk index IQR= interquartile range LUTS= lower urinary tract symptoms OAB= overactive bladder OABSS= overactive bladder symptom score PDE= phosphodiesterase PV= prostatic volume UAB= underactive bladder Declarations Acknowledgments We would like to express our gratitude to ENAGO for their English proofreading. Author contribution Naoki Wada: Conceptualization; Data curation; Investigation; Visualization; Writing-original draft, Tsubasa Hatakeyama, Haruka Takagi, Shun Morishita, Ryoken Tsunekawa, Masaya Nagabuchi : Data curation; Investigation; Takeya Kitta: Supervision , Hidehiro Kakizaki: Supervision; Writing—review and editing. Conflict of interest The authors declare no conflict of interest. Funding None Approval of the research protocol by an institutional reviewer board This study was approved by the institutional review board of Asahikawa Medical University (No. 23129). Registry and registration number of the study/trial Not applicable. Data availability statement The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019; 393: 2636-2646. Majima T, Funahashi Y, Matsukawa Y, et al. 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Relationship between the types of urinary incontinence, handgrip strength, and pelvic floor muscle strength in adult women. Neurourol Urodyn. 2021; 40: 1532-1538. Parker-Autry C, Houston DK, Rushing J, et al. Characterizing the Functional Decline of Older Women With Incident Urinary Incontinence. Obstet Gynecol. 2017; 130: 1025-1032. Ida S, Kaneko R, Nagata H, et al. Association between Sarcopenia and Overactive Bladder in Elderly Diabetic Patients. J Nutr Health Aging. 2019; 23: 532-537. Qin Z, Zhao J, Li J, et al. Low lean mass is associated with lower urinary tract symptoms in US men from the 2005-2006 national health and nutrition examination survey dataset. Aging (Albany NY). 2021; 13: 21421-21434. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Oct, 2024 Read the published version in International Urology and Nephrology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4505247","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":311981295,"identity":"f6627c9d-1d01-40cf-b2e1-321db9ec1e74","order_by":0,"name":"Naoki Wada","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYJACCYYKEMnYDBMwABHM+LWcIVkLYxtYI1yRAV5HmUskP7zxc56dPf/s5maDn212DLrtzRsYftQwsJvj0GI5I83YsndbcuKMOwebE3vbkhnMzhwrYOw5xsBs2YBdi8HtBDMJ3m3MCQw3EpsPABn1227kGDDwNjAwGxzApSX9m+TfOfX28kAtB/9uq2cwu//GgPEvXi05ZtK8DYcZNwC1JPNuO8xgdoPHgBmvLfffFFvLHDueuBGoxVj233GgX9IKDssck8DtlzPHN958U1NtL3cj/bHkmzPVDGbHD298+KbGJhlXiGEHQCdJJOOPHWzAjnQto2AUjIJRMEwBAGy/Xen19s5kAAAAAElFTkSuQmCC","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":true,"prefix":"","firstName":"Naoki","middleName":"","lastName":"Wada","suffix":""},{"id":311981296,"identity":"904ae817-1536-42f9-8fbc-913a3b9d1b9e","order_by":1,"name":"Tsubasa Hatakeyama","email":"","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tsubasa","middleName":"","lastName":"Hatakeyama","suffix":""},{"id":311981302,"identity":"5b1d0ac1-81a3-4084-b156-c97deab3fa5d","order_by":2,"name":"Haruka Takagi","email":"","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haruka","middleName":"","lastName":"Takagi","suffix":""},{"id":311981303,"identity":"a9475cab-1acf-44a4-b290-ddd3b25521af","order_by":3,"name":"Shun Morishita","email":"","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shun","middleName":"","lastName":"Morishita","suffix":""},{"id":311981304,"identity":"d78e0a98-348a-4efb-8a96-feb248013df7","order_by":4,"name":"Ryoken Tsunekawa","email":"","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ryoken","middleName":"","lastName":"Tsunekawa","suffix":""},{"id":311981306,"identity":"7b3f856e-7fce-4310-a4af-0a0e2b2214af","order_by":5,"name":"Masaya Nagabuchi","email":"","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Masaya","middleName":"","lastName":"Nagabuchi","suffix":""},{"id":311981310,"identity":"9cf2d002-d376-4474-b0b7-fbcdea1645fc","order_by":6,"name":"Takeya Kitta","email":"","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Takeya","middleName":"","lastName":"Kitta","suffix":""},{"id":311981311,"identity":"66f635a3-3e55-405b-bb91-25abee6f50e6","order_by":7,"name":"Hidehiro Kakizaki","email":"","orcid":"","institution":"Asahikawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hidehiro","middleName":"","lastName":"Kakizaki","suffix":""}],"badges":[],"createdAt":"2024-05-30 22:14:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4505247/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4505247/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11255-024-04233-z","type":"published","date":"2024-10-17T15:58:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58610372,"identity":"3b93efe2-0d52-469b-988b-23d896a9a425","added_by":"auto","created_at":"2024-06-18 22:04:12","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":341987,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of IPSS and OABSS between patients with and without sarcopenia under medical treatment. The IPSS total, voiding symptom score and IPSS-QOL were significantly higher in sarcopenia group than non-sarcopenia group. IPSS-V: voiding symptom score, IPSS-S: storage symptom score, OABSS: overactive bladder symptom score.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4505247/v1/5ee2ac7ec73b6069d49d761f.jpg"},{"id":58609375,"identity":"2783871c-41aa-469f-b88c-bafc4500dc9e","added_by":"auto","created_at":"2024-06-18 21:56:12","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":776693,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of prostatic volume (A) and serum testosterone level (B) between patients with and without sarcopenia. Non-sarcopenia group (SARC-F\u0026lt;4) had larger PV and higher testosterone level compared with sarcopenia group, whereas the percentage of patients taking dutasteride was higher in non-sarcopenia group than sarcopenia group.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4505247/v1/3202f97c1f15964e352ffd24.jpg"},{"id":67149104,"identity":"a1acda96-b0bb-4869-91ce-36f9291f0f6b","added_by":"auto","created_at":"2024-10-21 16:11:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1721685,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4505247/v1/29cfe7f2-349e-4de6-8dcb-dab5c3a09145.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Screening tool for sarcopenia (SARC-F) predicts unsatisfactory medical treatment of lower urinary tract symptoms in elderly men aged 75 years or older: a preliminary observational study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2007, Japan became a super-aged society, where the population aged \u0026ge;65 years accounted for 21.0% of the national population. Several other countries have also become super-aged societies. Frailty is a highly prevalent condition among the elderly patients and has been increasingly considered a crucial public health issue, particularly in the super-aged society. Aging is associated with a progressive loss of skeletal muscle mass (sarcopenia) and function, which causes physical frailty in the elderly [1].\u003c/p\u003e\n\u003cp\u003eThe prevalence of lower urinary tract symptoms (LUTS) also increases with age. The development of LUTS in elderly men is caused by outflow obstruction due to benign prostatic enlargement (BPE), underactive bladder (UAB) due to decreased bladder contractility, and overactive bladder (OAB). For treatment of Male LUTS, pharmacotherapy is very common using alpha-blockers, phosphodiesterase 5 (PDE5) inhibitors, and 5\u0026alpha;-reductase inhibitors, particularly for patients with BPE. Furthermore, treatment with anticholinergics or \u0026beta;3 agonists is also effective for OAB symptoms. However, some patients experience persistent moderate to severe symptoms despite the use of these drugs. Some studies have shown an association between sarcopenia and decreased bladder contractility (UAB) [2][3]. Since no effective medication is currently available for UAB, UAB may influence the refractory condition of persistent LUTS. Taking into account the possible association between sarcopenia and UAB, patient groups with sarcopenia may be at risk for developing refractory LUTS. Therefore, we investigated whether sarcopenia affects treatment outcomes in elderly patients receiving medical therapy for LUTS.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe have been conducting routine clinical assessments, including interviewing for SARC-F and measuring grip strength, focusing on sarcopenia as well as the assessments of LUTS including IPSS and overactive bladder symptoms score (OABSS). We retrospectively collected the data of male patients with LUTS 1) aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years, 2) who had not changed their medication for 1 year, 3) who had sufficient cognitive function to complete various questionnaires on their own, and 4) who had complete data as follows. These study patients include those who have refrained from invasive treatments such as transurethral prostatectomy or intravesical injection of botulinum toxin due to advanced age, comorbidities, or poor performance status, as well as those for whom increasing the dosage of OAB medications is challenging due to large residual urine. Specifically, the current study targeted patients whose current medication represents the limit of pharmacotherapy. Patients who had 1) active urinary tract infection, 2) urinary stones, 3) pelvic surgery for prostate cancer or rectal cancer, or 4) insufficient data as follows, were excluded. We surveyed the patient\u0026rsquo;s basic information, including medications, comorbidities related to lower urinary tract function, height (H), and body weight (BW). As part of routine clinical practice, the following examination items were conducted simultaneously during regular check-up. Current conditions of LUTS were estimated using IPSS [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and OABSS [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. OABSS is a validated self-assessment questionnaire consisting of four questions on OAB symptoms (Q1: daytime frequency, Q2: nighttime frequency, Q3: urgency, and Q4: urgency incontinence). The voiding symptom score of IPSS was the sum of questions 3 (intermittency), 5 (slow stream), and 6 (straining) of IPSS, and the storage symptom score of IPSS was the sum of questions 2 (increased daytime frequency), 4 (urgency), and 7 (nocturia). IPSS of \u0026lt;\u0026thinsp;8, 8\u0026ndash;19, and \u0026ge;\u0026thinsp;20 was defined as mild, moderate, and severe, respectively. OABSS of \u0026lt;\u0026thinsp;6, 6\u0026ndash;11, and \u0026ge;\u0026thinsp;12 was defined as mild, moderate, and severe, respectively. The study patients were screened using SARC-F. Grip strength was measured on both hands using a Smedley-type analog grip strength meter, and the stronger one was adopted. Based on previous reports [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], SARC-F score of ≧\u0026thinsp;4 was defined as having sarcopenia in this study. Prostatic volume (PV) was measured using transabdominal ultrasonography by the same examiner. Appetite and nutrient status were assessed using the Council on Nutrition Appetite Questionnaire (CNAQ), Geriatric Nutritional Risk Index (GNRI), and blood tests, including total protein, albumin (Alb), cholinesterase (ChE), total cholesterol (T-Cho), and lymphocyte count (Lymp). The CNAQ is an eight-item questionnaire originally designed to evaluate appetite and eating behavior [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Each item is rated using a five-point Likert-type scale, with lower scores indicating poorer functions involving that item (score range, 8\u0026ndash;40). The CNAQ has been translated into Japanese. The GNRI is a nutritional status indicator that is used to evaluate the risk of malnutrition in elderly patients. It is a simple and accurate screening tool that uses objective factors such as weight, height, and Alb levels. The GNRI was calculated using the following formula: GNRI = (1.489 \u0026times; Alb (g/L) + (41.7 \u0026times; BW/ideal BW). Ideal BW\u0026thinsp;=\u0026thinsp;H (cm) -100 ། [(H ། 150)/4].\u003c/p\u003e \u003cp\u003eThe primary outcome measure was whether IPSS showed differences based on the presence or absence of sarcopenia, as determined using SARC-F. We also investigated the factors influencing moderate and severe persistent LUTS as the secondary outcome. Due to the difficulty of setting the number of cases in advance because of a preliminary observational study, a post hoc analysis was performed to verify the appropriateness of the sample size. The Wilcoxon signed rank test and square test were used to compare the mean values between the two groups. We estimated the odds ratio for each parameter using logistic regression analysis. Statistical significance was determined at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The institutional review board of Asahikawa Medical University approved this study (No. 23129).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe included 59 patients (median age, 80 years; IQR, 77\u0026ndash;85) in this study, including 16 patients (27.1%) with sarcopenia based on SARC-F. The prevalence of diabetes mellitus and spinal disease (spinal canal stenosis in all) was higher in the sarcopenia group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most patients received α1 blocker or tadalafil. Dutasteride and OAB medication (anticholinergics or β3 agonists) were prescribed to 30 (50.8%) and 20 (33.9%) patients, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean grip strength was significantly lower in the sarcopenia group than the non-sarcopenia group (median, 25.5 [IQR, 21.8\u0026ndash;30] vs. 30 [IQR, 27.5\u0026ndash;35], p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The median IPSS total (15 [IQR, 8\u0026ndash;18.8] vs. 7 [IQR 5\u0026ndash;14], p\u0026thinsp;=\u0026thinsp;0.03), voiding symptom score (6 [IQR, 4\u0026ndash;11] vs. 3 [IQR, 1\u0026ndash;8], p\u0026thinsp;=\u0026thinsp;0.02) and IPSS-QOL (3.5 [IQR, 3\u0026ndash;5] vs. 3 [IQR, 2\u0026ndash;3], p\u0026thinsp;=\u0026thinsp;0.02) were significantly higher in the sarcopenia group than the non-sarcopenia group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The non-sarcopenia group had significantly larger PV (median, 40 ml [IQR, 28.5\u0026ndash;56.5] vs. 20 ml [IQR, 14.3\u0026ndash;35.5], p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and higher testosterone levels (median, 497.5 ng/ml [IQR, 376.5\u0026ndash;614] vs. 369 ng/ml [IQR, 291\u0026ndash;468], p\u0026thinsp;=\u0026thinsp;0.03) compared with the sarcopenia group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), whereas the percentage of patients taking dutasteride tended to be higher in the non-sarcopenia group than the sarcopenia group (58.1% vs. 31.3%, p\u0026thinsp;=\u0026thinsp;0.07) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical parameters between patients with and without sarcopenia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhole cohort\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSARC-F\u0026thinsp;\u0026lt;\u0026thinsp;4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026thinsp;≦\u0026thinsp;SARC-F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years old)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (77\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (77-85.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.5 (76-83.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163 (160-167.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164 (159\u0026ndash;168)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163 (162-164.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.9 (56.8\u0026ndash;68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.9 (56.8\u0026ndash;67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.6 (57.6\u0026ndash;69.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.2 (20.9\u0026ndash;25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (20.8\u0026ndash;24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.2 (21.8\u0026ndash;25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrip strength (stronger side: kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (25\u0026ndash;32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (27.5\u0026ndash;35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.5 (21.8\u0026ndash;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstatic volume (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (22-52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (28.5\u0026ndash;56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (14.3\u0026ndash;35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (6.5\u0026ndash;16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (5\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (8-18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (42.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (18.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (42.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (37.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVoiding symptom score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (4\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStorage symptom score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.5\u0026ndash;5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (3\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-QOL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5 (3\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOABSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.5\u0026ndash;5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (3.8\u0026ndash;6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (72.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (74.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (68.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (25.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (25.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCNAQ-J\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (27\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (26.5\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (27-29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication α1 blocker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (64.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (62.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (68.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDE5 inhibitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5αRI (dutasteride)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (58.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eβ3 agonist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticholinergic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities Hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (37.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrain disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTP (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0 (6.8\u0026ndash;7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (6.9\u0026ndash;7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.95 (6.7\u0026ndash;7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlb (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1 (3.9\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1 (3.9\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1 (3.9\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChE (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e275 (236.8-308.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e274 (250\u0026ndash;307)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e283.5 (205\u0026ndash;323)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT-Cho (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e181 (159\u0026ndash;203)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180.5 (164\u0026ndash;202)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174.5 (155\u0026ndash;204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymp (\u0026times;10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.57 (1.28\u0026ndash;2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.58 (1.24\u0026ndash;2.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.54 (1.33\u0026ndash;2.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGNRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (97\u0026ndash;108)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (97\u0026ndash;109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (94\u0026ndash;108)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTestosterone (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e473 (343.5-576.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e497.5 (376.5\u0026ndash;614)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e369 (291\u0026ndash;468)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSARC-F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMean (IQR) or N (%), Wilcoxon signed ranks test or square test are used.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe number of patients in the non-sarcopenia and sarcopenia groups was 43 and 16, respectively. Average IPSS (standard deviation) in each group as the primary outcome were 10.1 (6.6) and 15.0 (7.3), respectively. When calculated using the value of IPSS, the effect size becomes 0.70. When calculating with an effect size of 0.70 and an α error of 0.05, the power (1-β error) was estimated to be 0.75, indicating we had a sufficient sample size to obtain a certain level of statistical reliability.\u003c/p\u003e \u003cp\u003eModerate and severe LUTS (IPSS total\u0026thinsp;\u0026ge;\u0026thinsp;8) persisted in 34 patients (57.6%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The voiding and storage symptoms score of IPSS, IPSS-QOL, OABSS were significantly higher in these 34 patients than those with IPSS\u0026thinsp;\u0026lt;\u0026thinsp;8. SARC-F score was significantly higher in patients with moderate and severe LUTS (median, 2.5 [IQR, 1\u0026ndash;4] vs. 1 [0\u0026ndash;2], p\u0026thinsp;=\u0026thinsp;0.012) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). For logistic regression analysis with the current number of patients, it is appropriate to consider three confounding factors. We conducted multivariate analysis using SARC-F, the presence of comorbidities and PV, which are believed to influence the effectiveness of drug treatment in male patients. Multivariate analysis showed that only SARC-F was a significant factor affecting IPSS total\u0026thinsp;\u0026ge;\u0026thinsp;8 despite medical treatment for 1 year (OR, 1.67; 95% CI: 1.13\u0026ndash;2.46, p\u0026thinsp;=\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical parameters between patients with persistent mild and moderate/severe LUTS under medical treatments\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIPSS\u0026thinsp;\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;≦\u0026thinsp;IPSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years old)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (78\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (76\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165 (160\u0026ndash;168)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (160\u0026ndash;167)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.3 (58.6\u0026ndash;69.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.8 (56.4\u0026ndash;67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.3 (22.2\u0026ndash;25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.5 (20.8\u0026ndash;24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrip strength (stronger side: kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (25\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.5 (26.3\u0026ndash;32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstatic volume (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (22\u0026ndash;46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (23\u0026ndash;53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (12\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVoiding symptom score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (6\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStorage symptom score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5 (4\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS-QOL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOABSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCNAQ-J\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (27\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (27\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication α1 blocker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDE5 inhibitor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5αRI (dutasteride)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (44.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eβ3 agonist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticholinergic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities Hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrain disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (16.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpinal disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTP (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1 (6.9\u0026ndash;7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0 (6.8\u0026ndash;7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlb (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1 (3.9\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1 (3.9\u0026ndash;4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChE (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e277.5 (252.5-315.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e273 (229.2-307.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT-Cho (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179 (162.8-202.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181.5 (157-201.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymp (\u0026times;10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.525 (1.35\u0026ndash;2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.59 (1.26\u0026ndash;2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGNRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (96\u0026ndash;110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (97\u0026ndash;108)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTestosterone (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e473 (303\u0026ndash;701)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e476.5 (367\u0026ndash;542)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSARC-F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMean (IQR) or N (%), Wilcoxon signed ranks test or square test are used.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfluencing factors for IPSS-total of 8 or higher under medical treatments\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16\u0026ndash;2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstatic volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u0026ndash;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSARC-F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13\u0026ndash;2.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn elderly male patients aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years with sarcopenia defined by SARC-F, improvement of LUTS, particularly voiding symptoms, was insufficient despite medical treatment. SARC-F was the only significant predictor of persistent moderate to severe LUTS. Thus, the evaluation of sarcopenia by SARC-F may be an indispensable factor when treating LUTS in elderly male patients.\u003c/p\u003e \u003cp\u003eSarcopenia is characterized by the loss of muscle mass, muscular strength, and physical function along with aging, which is induced by age-associated insulin resistance, low-grade inflammation, and oxidative stress [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The diagnosis of sarcopenia is confirmed by measuring the muscle mass in the limbs using a body composition analyzer. Malmstrom and Morley et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] created a simple screening tool, known as SARC-F, to detect sarcopenia in the elderly population, and its validity has been evaluated in various studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In this study, we investigated the correlation between sarcopenia and unsatisfactory medical treatment of LUTS in elderly men using SARC-F instead of measuring limb muscle mass. In the sarcopenia group, no specific indicators of malnutrition were noted in CNAQ-J or GNRI, but grip strength was significantly reduced, and improvement of LUTS was inadequate.\u003c/p\u003e \u003cp\u003eLUTS can impair health-related QOL. Although pharmacological treatment is often the mainstay for managing LUTS in men, some invasive treatments may also be necessary for better improvement of symptoms. Some male patients with larger PV failed to obtain sufficient improvement of LUTS despite medical treatment, and surgical interventions, such as transurethral prostatectomy, are often required [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, in the present study, PV was not a factor associated with persistent LUTS (IPSS\u0026thinsp;\u0026ge;\u0026thinsp;8) after medical treatment. Only SARC-F could predict unsatisfactory medical treatment in the elderly. Sarcopenia may be a significant negative factor in predicting the effect of medical treatment in elderly patients with LUTS.\u003c/p\u003e \u003cp\u003eThe relationships between testosterone and PV and between testosterone and sarcopenia have been discussed. Testosterone replacement in castrated animals restores prostatic hyperplasia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, castration or androgen deprivation treatments reduce PV [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Testosterone exerts some influence on prostate growth; however, the mechanism by which testosterone influences prostate growth remains unclear. Some studies have failed to demonstrate a correlation between testosterone levels and PV [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Many cross-sectional studies have confirmed significant correlations between testosterone levels and sarcopenia in men [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e][\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Testosterone is indirectly associated with muscle metabolism through various cytokines and molecules. Thus, lower testosterone levels could be a risk factor for sarcopenia. In this study, the patients in the non-sarcopenia group (SARC-F\u0026thinsp;\u0026lt;\u0026thinsp;4) had larger PV and higher testosterone levels than those in the sarcopenia group (SARC-F\u0026thinsp;\u0026ge;\u0026thinsp;4). More patients in the non-sarcopenia group were taking dutasteride, which can shrink the prostate by inhibiting DHT. A previous study showed that dutasteride could slightly increase testosterone levels [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. To analyze mutual relationship among testosterone, dutasteride taking and PV was beyond the scope of the present study. Nevertheless, an interesting correlation was observed between sarcopenia and PV.\u003c/p\u003e \u003cp\u003eOnly a few studies have reported the relationship between sarcopenia and LUTS, particularly in male patients. Several studies on women have reported an association between sarcopenia-related factors, such as reduced handgrip strength, impaired standing balance, decreased psoas muscle mass, and LUTS (urinary incontinence and OAB) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e][\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Ida et al. showed that in male patients with diabetes, the prevalence of OAB was significantly higher in patients with sarcopenia screened using SARC-F [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Qin et al. reported that low lean mass, a key indicator of muscle mass, strength and function was associated with a higher risk of LUTS in elderly men [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Clinical research has shown a positive correlation between skeletal muscle mass and bladder contractility force in men [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the present study, the improvement of voiding symptoms was inadequate in the sarcopenia group despite smaller PV than the non-sarcopenia group. It is tempting to speculate that inadequate improvement of voiding symptoms in the sarcopenia group might be caused by decreased bladder contractility (UAB) rather than outflow obstruction.\u003c/p\u003e \u003cp\u003eThis preliminary observational study has several limitations. First, the sample size was small. However, we believe that our research findings indicate the reliability and statistical significance because the post hoc analysis for sample size accomplished a statistical power of 0.75. SARC-F is a screening tool for sarcopenia and not a tool for the precise diagnosis of sarcopenia. More detailed evaluations using a body composition analyzer are required to explore further information about the relationship between sarcopenia and LUTS. Second, we were unable to assess the severity of LUTS before starting medical treatment. Third, we did not evaluate lower urinary tract function using urodynamic studies including uroflowmetry and pressure-flow study. Without pressure-flow study, it is impossible to evaluate the bladder contractility. Prospective longitudinal studies with a greater number of patients under predetermined criteria for sarcopenia are necessary.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSarcopenia screened using SARC-F is a predictive factor for unsatisfactory medical treatment of LUTS in elderly men aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBPE= benign prostatic enlargement\u003c/p\u003e\n\u003cp\u003eCNAQ= council on nutrition appetite questionnaire\u003c/p\u003e\n\u003cp\u003eDHT= dihydrotestosterone\u003c/p\u003e\n\u003cp\u003eGNRI= geriatric nutritional risk index\u003c/p\u003e\n\u003cp\u003eIQR= interquartile range\u003c/p\u003e\n\u003cp\u003eLUTS= lower urinary tract symptoms\u003c/p\u003e\n\u003cp\u003eOAB= overactive bladder\u003c/p\u003e\n\u003cp\u003eOABSS= overactive bladder symptom score\u003c/p\u003e\n\u003cp\u003ePDE= phosphodiesterase\u003c/p\u003e\n\u003cp\u003ePV= prostatic volume\u003c/p\u003e\n\u003cp\u003eUAB= underactive bladder\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to ENAGO for their English proofreading.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNaoki Wada:\u0026nbsp;\u003c/strong\u003eConceptualization; Data curation; Investigation; Visualization; Writing-original draft, \u003cstrong\u003eTsubasa Hatakeyama, Haruka Takagi, Shun Morishita, Ryoken Tsunekawa, Masaya Nagabuchi\u003c/strong\u003e: Data curation; Investigation; \u003cstrong\u003eTakeya Kitta:\u0026nbsp;\u003c/strong\u003eSupervision\u003cstrong\u003e, Hidehiro Kakizaki:\u003c/strong\u003e Supervision; Writing\u0026mdash;review and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproval of the research protocol by an institutional reviewer board\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional review board of Asahikawa Medical University (No. 23129).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistry and registration number of the study/trial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019; 393: 2636-2646.\u003c/li\u003e\n\u003cli\u003eMajima T, Funahashi Y, Matsukawa Y, et al. Investigation of the relationship between bladder function and sarcopenia using pressure flow studies in elderly male patients. Neurourol Urodyn. 2019; 38: 1417-1422. \u003c/li\u003e\n\u003cli\u003eWada N, Abe N, Miyauchi K, et al. High-Fat and High-Sucrose Diet Leads to Skeletal Muscle Loss and Bladder Dysfunction in Rat. Res Rep Urol. 2023: 15: 305-313.\u003c/li\u003e\n\u003cli\u003eBarry MJ, Fowler FJ Jr, O\u0026apos;Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992; 148: 1549-1557.\u003c/li\u003e\n\u003cli\u003eHomma Y, Yoshida M, Seki N, et al. Symptom assessment tool for overactive bladder syndrome\u0026mdash;overactive bladder symptom score. Urology. 2006; 68: 318-323.\u003c/li\u003e\n\u003cli\u003eMalmstrom TK, Miller DK, Simonsick EM, et al. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016; 7: 28-36.\u003c/li\u003e\n\u003cli\u003eWilson M.M.G, Thomas D.R, Rubenstein L.Z. et al. Appetite assessment: Simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005; 82, 1074\u0026ndash;1081.\u003c/li\u003e\n\u003cli\u003eDhillon RJ, Hasni S. Pathogenesis and Management of Sarcopenia. Clin Geriatr Med. 2017; 33: 17-26.\u003c/li\u003e\n\u003cli\u003eMalmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013; 14: 531-2.\u003c/li\u003e\n\u003cli\u003eCrawford ED, Wilson SS, McConnell JD, et al. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol. 2006; 175: 1422-6.\u003c/li\u003e\n\u003cli\u003eWada N, Abe N, Miyauchi K, et al. Risk factors for failure of long-term dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement. Int Urol Nephrol. 2022; 54: 31-36.\u003c/li\u003e\n\u003cli\u003eBerry SJ, Coffey DS, Strandberg JD, et al. Effect of age, castration, and testosterone replacement on the development and restoration of canine benign prostatic hyperplasia. Prostate. 1986 ;9: 295-302.\u003c/li\u003e\n\u003cli\u003eNicholson TM, Ricke WA. Androgens and estrogens in benign prostatic hyperplasia: past, present and future. Differentiation. 2011; 82: 184-99.\u003c/li\u003e\n\u003cli\u003eFavilla V, Cimino S, Castelli T, et al. Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia. BJU Int. 2010; 106: 1700-3.\u003c/li\u003e\n\u003cli\u003eShin MJ, Jeon YK, Kim IJ. Testosterone and Sarcopenia. World J Mens Health. 2018; 36: 192-198\u003c/li\u003e\n\u003cli\u003eShigehara K, Kato Y, Izumi K, et al. Relationship between Testosterone and Sarcopenia in Older-Adult Men: A Narrative Review. J Clin Med. 2022; 11: 6202.\u003c/li\u003e\n\u003cli\u003eTraish AM, Krakowsky Y, Doros G, et al. Do 5\u0026alpha;-reductase inhibitors raise circulating serum testosterone levels? A comprehensive review and meta-analysis to explaining paradoxical results. Sex Med Rev. 2019; 7: 95\u0026ndash;114.\u003c/li\u003e\n\u003cli\u003eBag Soytas R, Soytas M, Danacioglu YO, et al. Relationship between the types of urinary incontinence, handgrip strength, and pelvic floor muscle strength in adult women. Neurourol Urodyn. 2021; 40: 1532-1538.\u003c/li\u003e\n\u003cli\u003eParker-Autry C, Houston DK, Rushing J, et al. Characterizing the Functional Decline of Older Women With Incident Urinary Incontinence. Obstet Gynecol. 2017; 130: 1025-1032.\u003c/li\u003e\n\u003cli\u003eIda S, Kaneko R, Nagata H, et al. Association between Sarcopenia and Overactive Bladder in Elderly Diabetic Patients. J Nutr Health Aging. 2019; 23: 532-537.\u003c/li\u003e\n\u003cli\u003eQin Z, Zhao J, Li J, et al. Low lean mass is associated with lower urinary tract symptoms in US men from the 2005-2006 national health and nutrition examination survey dataset. Aging (Albany NY). 2021; 13: 21421-21434.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"elderly, lower urinary tract symptoms, male, SARC-F sarcopenia","lastPublishedDoi":"10.21203/rs.3.rs-4505247/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4505247/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: We investigated the influence of sarcopenia on treatment outcomes in elderly patients receiving medical therapy for lower urinary tract symptoms (LUTS).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We included male patients with LUTS aged ≥75 years who had not changed their medication for 1 year. Current conditions were estimated using IPSS, overactive bladder symptoms score (OABSS), and screening tool for sarcopenia (SARC-F). SARC-F score of ≧4 was defined as sarcopenia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: We included 59 patients in this study, including 16 patients (27.1%) with sarcopenia. IPSS total score, voiding symptom score of IPSS, and IPSS-QOL were significantly higher in the sarcopenia group than the non-sarcopenia group. The non-sarcopenia group had significantly larger PV (40 vs. 20 ml) and higher testosterone levels (497.5 vs. 369 ng/ml) compared with the sarcopenia group. Moderate and severe LUTS (IPSS total ≥8) persisted in 34 patients (57.6%) after medical treatment. Multivariate analysis showed that only SARC-F was a significant factor affecting the IPSS total ≥8 despite medical treatment for 1 year (OR 1.67, 95%CI: 1.13–2.46).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Sarcopenia defined by using SARC-F is a significant factor for unsatisfactory medical treatment of LUTS in elderly men aged ≥75 years.\u003c/p\u003e","manuscriptTitle":"Screening tool for sarcopenia (SARC-F) predicts unsatisfactory medical treatment of lower urinary tract symptoms in elderly men aged 75 years or older: a preliminary observational study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-18 21:56:07","doi":"10.21203/rs.3.rs-4505247/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"959b6a5c-a79f-485b-a4f7-116a7b217b93","owner":[],"postedDate":"June 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T16:05:18+00:00","versionOfRecord":{"articleIdentity":"rs-4505247","link":"https://doi.org/10.1007/s11255-024-04233-z","journal":{"identity":"international-urology-and-nephrology","isVorOnly":false,"title":"International Urology and Nephrology"},"publishedOn":"2024-10-17 15:58:07","publishedOnDateReadable":"October 17th, 2024"},"versionCreatedAt":"2024-06-18 21:56:07","video":"","vorDoi":"10.1007/s11255-024-04233-z","vorDoiUrl":"https://doi.org/10.1007/s11255-024-04233-z","workflowStages":[]},"version":"v1","identity":"rs-4505247","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4505247","identity":"rs-4505247","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}