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Finazzi Agrò E, Rosato E, Wagg A, Sinha S, Fede Spicchiale C, Serati M, Mancini V, de Rijk M, Tarcan T, Wein A, Abrams P, Bou Kheir G. How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1. Neurourol Urodyn 2024; 43:1261-1271. [PMID: 38178627 DOI: 10.1002/nau.25377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. OBJECTIVES The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. METHODS A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment. RESULTS AND CONCLUSIONS The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Rosato
- School of specialization in Urology, Policlinico Tor Vergata University Hospital, University of Rome Tor Vergata and Urology Unit, Rome, Italy
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | - Maurizio Serati
- Department Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Varese, Italy
| | - Vito Mancini
- Urology and renal transplantation Unit, Urinary incontinence center, Policlinico di Foggia Hospital and University of Foggia, Foggia, Italy
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Tufan Tarcan
- Marmara University School of Medicine, Istanbul, Turkey and Koç University School of Medicine, Istanbul, Turkey
| | - Alan Wein
- University of Miami Miller School of Medicine, Desai Sethi Institute of Urology, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Xu Z, Elrashidy RA, Li B, Liu G. Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases. Front Med (Lausanne) 2022; 9:812967. [PMID: 35360727 PMCID: PMC8960172 DOI: 10.3389/fmed.2022.812967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Aging and major chronic diseases are risk factors for lower urinary tract symptoms (LUTS). On the other hand, oxidative stress (OS) is one of the fundamental mechanisms of aging and the development of chronic diseases. Therefore, OS might be a candidate mechanism linking these two clinical entities. This article aims to summarize the studies on the prevalence of LUTS, the role of OS in aging and chronic diseases, and the potential mechanisms supporting the putative link. A comprehensive literature search was performed to identify recent reports investigating LUTS and OS in major chronic diseases. In addition, studies on the impact of OS on the lower urinary tract, including bladder, urethra, and prostate, were collected and summarized. Many studies showed LUTS are prevalent in aging and major chronic diseases, including obesity, metabolic syndrome, diabetes, cardiovascular disease, hypertension, obstructive sleep apnea, autoimmune diseases, Alzheimer’s disease, and Parkinson’s disease. At the same time, OS is a key component in the pathogenesis of those chronic diseases and conditions. Recent studies also provided evidence that exacerbated OS can cause functional and/or structural changes in the bladder, urethra, and prostate, leading to LUTS. The reviewed data support the concept that OS is involved in multiple risk factors-associated LUTS, although further studies are needed to confirm the causative relationship. The specific ROS/RNS and corresponding reactions/pathways involved in chronic diseases and associated LUTS should be identified in the future and could serve as therapeutic targets.
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Affiliation(s)
- Zhenqun Xu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Rania A. Elrashidy
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Bo Li
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- *Correspondence: Guiming Liu,
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Kim JK, Lee YG, Han K, Han JH. Obesity, metabolic health, and urological disorders in adults: a nationwide population-based study. Sci Rep 2021; 11:8687. [PMID: 33888807 PMCID: PMC8062508 DOI: 10.1038/s41598-021-88165-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/30/2021] [Indexed: 12/25/2022] Open
Abstract
We evaluate the risks of various urological disorders that require treatments according to obesity and metabolic health status using a nationwide dataset of the Korean population. 3,969,788 patients who had undergone health examinations were enrolled. Participants were classified as “obese” (O) or “non-obese” (NO) using a BMI cut-off of 25 kg/m2. People who developed ≥ 1 metabolic disease component in the index year were considered “metabolically unhealthy” (MU), while those with none were considered “metabolically healthy” (MH). There were classified into the MHNO, MUNO, MHO, and MUO group. In BPH, chronic renal disease, neurogenic bladder, any medication related to voiding dysfunction, alpha-blocker, and antidiuretics, age and gender-adjusted hazard ratio (HR) was highest in MUO, but higher in MUNO than in MHO. In stress incontinence, prostate surgery, and 5alpha-reductase, HR increased in the order of MUNO, MHO, and MUO. In prostatitis, anti-incontinence surgery, and cystocele repair, HR was higher in MHO than MUNO and MUO. In cystitis, cystostomy, and anticholinergics, HR was higher in MUNO and MUO than MHO. In conclusion, obesity and metabolic health were individually or collaboratively involved in urological disorders related to voiding dysfunction. Metabolic healthy obesity needs to be distinguished in the diagnosis and treatment of urological disorders.
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Affiliation(s)
- Jong Keun Kim
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
| | - Young Goo Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-Ro, Dongjak-gu, Seoul, 06978, Republic of Korea
| | - Jun Hyun Han
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea.
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Szabó L, Szabó J, Vidor E. A drop of self-confidence program about urinary incontinence. Neurourol Urodyn 2021; 40:978-985. [PMID: 33527446 DOI: 10.1002/nau.24621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/07/2022]
Abstract
AIM The aim of our study was to find and map untreated incontinence patients through general practitioner (GP) practices. METHODS General practitioners and their assistants participated in the program (Group A). GPs of all the country were involved in a representative manner. The process of the program was preparing the education program, praxis involvement, participant education, a population screening, and by questionnaire by medical staff. In Group B urological outpatients clinics participated. RESULTS A total of 2761 GPs, 3015 nurses, and 110 specialists participated in the program between 2011 and 2019. The population participating in the program was 162,871, 86% women and 14% men. The age range was 18-96. 68% had urinary incontinence (UI), 76% of patients had stress, and 49% had urge incontinence. Incontinence is very high (98%) among bedridden patients. On average, 20% had very little information, 40% had little information, 33% had enough information about incontinence, and 7% thought they knew everything about it. 41% reported diabetes mellitus, 33% had frequent cough and sneezing, 31% obesity as a risk factor. 30% of incontinent patients did not go to the GP and 66% to the specialist. 34% of patients who were at GPs received no information, 34% of the patients received symptomatic, and 30% did not receive treatment from the GP. CONCLUSION The incidence of UI is similar to that in other countries. Patient recognition care is similar, perhaps worse. The findings of this study clearly indicate that harmful physical and psychosocial effects of UI are significant and require attention of the healthcare system.
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Affiliation(s)
- László Szabó
- Hungarian Continence Society, Budapest, Hungary.,Department of Family Care Methodology, Semmelweis University, Budapest, Hungary.,Department of Directorate, Heim Pál National Pediatric Institute, Budapest, Hungary
| | - János Szabó
- National Institute for Primary Care, Budapest, Hungary
| | - Eszter Vidor
- VMkomm Communication Consultancy Office, Budapest, Hungary
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[EVALUATING THE RELATIONSHIP BETWEEN LOWER URINARY TRACT SYMPTOMS AND ENDOTHELIAL FUNCTION USING FLOW-MEDIATED DILATION, AND THE EFFECTS OF TADALAFIL]. Nihon Hinyokika Gakkai Zasshi 2021; 111:1-8. [PMID: 33473089 DOI: 10.5980/jpnjurol.111.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objective) Recently, lower urinary tract symptoms (LUTS) were reported to be associated with endothelial dysfunction. Endothelial function is non-invasively measured by flow-mediated dilation (FMD). As tadalafil has the potential to improve atherosclerosis, we evaluated the relationship between LUTS and endothelial function using FMD, and the effects of tadalafil. (Patients and methods) We conducted FMD examinations for a total of 122 males, and analyzed its association with IPSS, OABSS, and cardiovascular risks. Furthermore, 21 BPH patients received 5 mg of tadalafil per day for one year. We defined the Low FMD group as FMD < 3.9% and the Control group as other values, and compared the effects of tadalafil between groups. (Results) In the 122 male patients, FMD was negatively correlated with nocturia and OABSS. Patients with hypertension or coronary artery disease had a lower FMD than those without.In the tadalafil administration study, the Low FMD group achieved greater improvement of IPSS, OABSS and FMD than the Control group. (Conclusion) FMD examination revealed that endothelial dysfunction is closely associated with LUTS in males, and that tadalafil is effective for patients with endothelial dysfunction.
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Everaert K, Hervé F, Bower W, Djurhuus JC, Dmochowski R, Fine N, Wein A, Wyndaele M, Weiss J. How can we develop a more clinically useful and robust algorithm for diagnosing and treating nocturia? ICI-RS 2017. Neurourol Urodyn 2019; 37:S46-S59. [PMID: 30133785 DOI: 10.1002/nau.23569] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/26/2018] [Indexed: 12/15/2022]
Abstract
AIMS Nocturia, or waking up at night to void, is a highly prevalent and bothersome symptom. Currently, there is a lack of clear and consistent recommendations regarding evaluation and management of nocturia. The aim of this report is to discuss how to fill the gaps in our knowledge in order to develop a practical patient-oriented diagnostic and therapeutic algorithm for nocturia. METHODS This paper is a report of the presentations and subsequent discussion of a Think Tank session at the annual International Consultation on Incontinence Research Society (ICI-RS) in June 2017 in Bristol. RESULTS AND CONCLUSION Further investigations are needed to better understand the pathophysiology of nocturia, to allow improvement in diagnosis, and to optimize treatment by increasing efficacy and reducing adverse events. Patient-oriented practical guidelines on nocturia are needed to help clinicians from different disciplines diagnose and treat nocturia.
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Affiliation(s)
- Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - François Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Wendy Bower
- Faculty of Medicine, Department of Medicine and Community Care, Melbourne Health, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
| | - Jens C Djurhuus
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennesse
| | - Noam Fine
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York
| | - Alan Wein
- Department of Urology, Perelman School of Medicine-University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michel Wyndaele
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Jeffrey Weiss
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York
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Abstract
PURPOSE Lower urinary tract symptoms are prevalent and burdensome, yet methods to enhance diagnosis and appropriately guide therapies are lacking. We systematically reviewed the literature for human studies of biomarkers associated with lower urinary tract symptoms. MATERIALS AND METHODS PubMed®, EMBASE® and Web of Science® were searched from inception to February 13, 2018. Articles were included if they were in English, performed in benign urological populations without neurological disorders or interstitial cystitis/bladder pain syndrome, and assessed a biomarker's association with or ability to predict specific lower urinary tract symptoms or urological conditions. Bioinformatic pathway analyses were conducted to determine whether individual biomarkers associated with symptoms are present in unifying pathways. RESULTS Of 6,150 citations identified 125 met the inclusion criteria. Most studies (93.6%) assessed biomarkers at 1 time point and were cross-sectional in nature. Few studies adjusted for potentially confounding clinical variables or assessed biomarkers in an individual over time. No individual biomarkers are currently validated as diagnostic tools for lower urinary tract symptoms. Compared to controls, pathway analyses identified multiple immune response pathways that were enriched in overactive bladder syndrome and cell migration/cytoskeleton remodeling pathways that were enriched in female stress incontinence. CONCLUSIONS Major deficiencies in the existing biomarker literature include poor reproducibility of laboratory data, unclear classification of patients with lower urinary tract symptoms and lack of adjustment for clinical covariates. Despite these limitations we identified multiple putative pathways in which panels of biological markers need further research.
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Song QX, Zhang Y, Ye X, Xue W, Xu C, Xu J, Abrams P, Sun Y. Current status and progression of lower urinary tract symptoms in Chinese male patients: the protocol and rationale for a nationwide, hospital-based, prospective, multicentre study. BMJ Open 2019; 9:e028378. [PMID: 31562145 PMCID: PMC6773293 DOI: 10.1136/bmjopen-2018-028378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION It has become increasingly evident that the male lower urinary tract symptoms (LUTS) may not only be caused by abnormalities in one or more components of the lower urinary tract, but also be secondary to a range of systemic disorders. The primary aim of this study is to evaluate the features of urological and systemic disorders among middle-aged and elderly male LUTS patients in China. The second aim is to investigate the changes of both conditions after interventions through a 2-year prospective follow-up. METHODS AND ANALYSIS This nationwide, hospital-based, multicentre cohort study was designed and initiated by the Prostatic Obstruction Investigation Team which is an international multidisciplinary academic group focusing on the management of male LUTS. An expectation of 11 500 eligible subjects from 23 authorised urological centres across the mainland of China will be recruited with a baseline assessment and data collection. Subsequently, subjects will undergo a follow-up for 24 months having been prescribed with oral medications or after being selected for prostate surgery based on the standard practice of each institution as well as the clinician's own experience. All statistical analysis will be performed using SAS V.9.4 and R package. ETHICS AND DISSEMINATION This study has received ethical approval from the Ethics Committee Boards of Shanghai Changhai Hospital (CHEC2017-244). The results will be reported at scientific conferences and be published on peer-reviewed journals. TRIAL REGISTRATION NCT03394651.
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Affiliation(s)
- Qi-Xiang Song
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Yi Zhang
- Department of Military Health Service, Naval Medical University, Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Jing Xu
- Department of Nephrology, Changhai Hospital, Shanghai, China
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Shanghai, China
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Macoska JA, Wang Z, Virta J, Zacharias N, Bjorling DE. Inhibition of the CXCL12/CXCR4 axis prevents periurethral collagen accumulation and lower urinary tract dysfunction in vivo. Prostate 2019; 79:757-767. [PMID: 30811623 PMCID: PMC7269149 DOI: 10.1002/pros.23781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several studies show that prostatic fibrosis is associated with male lower urinary tract dysfunction (LUTD). Development of fibrosis is typically attributed to signaling through the transforming growth factor β (TGF-β) pathway, but our laboratory has demonstrated that in vitro treatment of human prostatic fibroblasts with the C-X-C motif chemokine ligand 12 (CXCL12) chemokine stimulates myofibroblast phenoconversion and that CXCL12 has the capacity to activate profibrotic pathways in these cells in a TGF-β-independent manner. We have previously reported that feeding mice high-fat diet (HFD) results in obesity, type II diabetes, increased prostatic fibrosis, and urinary voiding dysfunction. The purpose of this study was to test the hypothesis that in vivo blockade of the CXCL12/CXCR4 axis would inhibit the development of fibrosis-mediated LUTD in HFD-fed mice. METHODS Two-month-old male senescence-accelerated mouse prone-6 mice were fed either a HFD or low-fat diet (LFD) for 8 months. Half of each dietary group were given constant access to normal water or water that contained the C-X-C chemokine receptor type 4 (CXCR4; CXCL12 receptor) antagonist CXCR4AIII. At the conclusion of the study, mice were weighed, subjected to oral glucose tolerance testing and cystometry, and lower urinary tract tissues collected and assessed for collagen content. RESULTS HFD-fed mice became significantly obese, insulin resistant, and hyperglycemic, consistent with acquisition of metabolic syndrome, compared with LFD-fed mice. Anesthetized cystometry demonstrated that HFD-fed mice experienced significantly longer intercontractile intervals and greater functional bladder capacity than LFD-fed mice. Immunohistochemistry demonstrated high levels of CXCR4 and CXCR7 staining in mouse prostate epithelial and stromal cells. Picrosirius red staining indicated significantly greater periurethral collagen deposition in the prostates of HFD than LFD-fed mice. Treatment with the CXCR4 antagonist CXCR4AIII did not affect acquisition of metabolic syndrome but did reduce both urinary voiding dysfunction and periurethral prostate collagen accumulation. CONCLUSIONS This is the first study to report that obesity-induced lower urinary tract fibrosis and voiding dysfunction can be repressed by antagonizing the activity of the CXCR4 chemokine receptor in vivo. These data suggest that targeting the CXCL12/CXCR4 signaling pathway may be a clinical option for the prevention or treatment of human male LUTD.
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Affiliation(s)
- Jill A. Macoska
- Center for Personalized Cancer Therapy, The University of Massachusetts Boston, Boston, Massachusetts
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
| | - Zunyi Wang
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
- School of Veterinary Medicine, The University of Wisconsin Madison, Madison, Wisconsin
| | - Johanna Virta
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
- School of Veterinary Medicine, The University of Wisconsin Madison, Madison, Wisconsin
| | - Nicholas Zacharias
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
- School of Veterinary Medicine, The University of Wisconsin Madison, Madison, Wisconsin
| | - Dale E. Bjorling
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
- School of Veterinary Medicine, The University of Wisconsin Madison, Madison, Wisconsin
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Song Q, Abrams P, Sun Y. Beyond prostate, beyond surgery and beyond urology: The "3Bs" of managing non-neurogenic male lower urinary tract symptoms. Asian J Urol 2019; 6:169-173. [PMID: 31061803 PMCID: PMC6488681 DOI: 10.1016/j.ajur.2017.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/16/2017] [Accepted: 08/30/2017] [Indexed: 12/14/2022] Open
Abstract
Lower urinary tract symptoms (LUTS), consisting storage, voiding and post-micturition symptoms, is a comprehensive definition involving symptoms that may occur due to several causes. Instead of simply focusing on the enlarged prostate, more attention has to be paid to the entire urinary tract as well as multiple system comorbidities. Therefore, prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required. Based on current literature, this paper proposes the "3Bs" concept for managing non-neurogenic male LUTS, namely, "beyond prostate", "beyond surgery" and "beyond urology". The clinical application of the "3Bs" enables urologists to carry out integrated, individualized and precise medical care for each non-neurogenic male LUTS patient.
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Affiliation(s)
- Qixiang Song
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Helfand BT, Andreev VP, Siddiqui NY, Liu G, Erickson BA, Helmuth ME, Lutgendorf SK, Lai HH, Kirkali Z. A Novel Proteomics Approach to Identify Serum and Urinary Biomarkers and Pathways that Associate with Lower Urinary Tract Symptoms in Men and Women: Pilot Results of the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) Study. Urology 2019; 129:35-42. [PMID: 30922973 DOI: 10.1016/j.urology.2019.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/15/2019] [Accepted: 03/16/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To assess the feasibility of a novel proteomics approach to identify biomarkers associated with lower urinary tract symptoms (LUTS) within serum and urine, because many clinical factors contribute to LUTS in men and women. These factors confound clinicians' abilities to reliably evaluate and treat LUTS. Previous studies identified candidate LUTS biomarkers, but none are clinically utilized. METHODS Eighteen male and 18 female symptoms of lower urinary tract dysfunction research network (LURN) observational cohort study participants with LUTS (measured on the LUTS Tool questionnaire) were randomly selected. Twelve male and 12 female controls with minimal or no LUTS were recruited and matched for clinico-demographic characteristics. The SomaScan Assay (SomaLogic) was used to measure the abundance of 1305 proteins contained within urine and serum. Statistical analyses were performed to evaluate reproducibility of assays, compare protein abundances, and estimate effect size. RESULTS SomaScan assay results were more reproducible in serum than in urine. Within serum, there were many more differentially abundant proteins between cases and controls in males than in females. An enrichment/pathway analysis of the affected proteins in male and female subjects demonstrated that the enriched Gene Ontology processes were related to prostate morphogenesis in men and growth and inflammation in women. CONCLUSION The pilot study results support that the etiology and pathophysiologic mechanisms underlying LUTS may be sex-specific. While further studies involving larger numbers of subjects are warranted, our results support the feasibility of a novel proteomic approach to identify biomarkers for diagnostic classification of LUTS.
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Affiliation(s)
| | | | - Nazema Y Siddiqui
- Urogynecology & Reconstructive Pelvic Surgery, Duke University, Durham NC
| | - Gang Liu
- Arbor Research Collaborative for Health, Ann Arbor MI
| | | | | | | | - H Henry Lai
- Washington University School of Medicine, St. Louis, MO
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD
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Everaert K, Hervé F, Bosch R, Dmochowski R, Drake M, Hashim H, Chapple C, Van Kerrebroeck P, Mourad S, Abrams P, Wein A. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn 2019; 38:478-498. [PMID: 30779378 DOI: 10.1002/nau.23939] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Patients with nocturia have to face many hurdles before being diagnosed and treated properly. The aim of this paper is to: summarize the nocturia patient pathway, explore how nocturia is diagnosed and treated in the real world and use the Delphi method to develop a practical algorithm with a focus on what steps need to be taken before prescribing desmopressin. METHODS Evidence comes from existing guidelines (Google, PubMed), International Consultation on Incontinence-Research Society (ICI-RS) 2017, prescribing information and a Delphi panel (3 rounds). The International Continence Society initiated this study, the authors represent the ICI-RS, European Association of Urology, and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). RESULTS Diagnostic packages: consensus on, history taking for all causalities, intake diary (fluid, food) and bladder diary, not for its duration. Pelvic (women) or rectal (men) examination, prostate-specific antigen, serum sodium check (SSC), renal function, endocrine screening: when judged necessary. Timing or empty stomach when SSC is not important. Therapeutic packages: the safe candidates for desmopressin can be phenotyped as no polydipsia, heart/kidney failure, severe leg edema or obstructive sleep apnea syndrome. Lifestyle interventions may be useful. Initiating desmopressin: risk management consensus on three clinical pictures. Follow-up of desmopressin therapy: there was consensus on SSC day 3 to 7, and at 1 month. Stop therapy if SSC is <130 mmol/L regardless of symptoms. Stop if SSC is 130 to 135 mmol/L with symptoms of hyponatremia. CONCLUSION A summary of the nocturia patient pathway across different medical specialists is useful in the visualization and phenotyping of patients for diagnosis and therapy. By summarizing basic knowledge of desmopressin, we aim to ease its initiation and shorten the patient journey for nocturia.
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Affiliation(s)
- Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Francois Hervé
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Ruud Bosch
- Urology Department, UMC Utrecht, Utrecht, The Netherlands
| | - Roger Dmochowski
- Urology Department, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus Drake
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Hashim Hashim
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Christopher Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, United Kingdom
| | | | - Sherif Mourad
- Urology Department, Ain Shams University, Cairo, Egypt
| | - Paul Abrams
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Alan Wein
- Urology Department, University of Philadelphia, Philadelphia, Pennsylvania
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Mitsui T, Kira S, Ihara T, Sawada N, Nakagomi H, Miyamoto T, Shimura H, Yokomichi H, Takeda M. Metabolomics Approach to Male Lower Urinary Tract Symptoms: Identification of Possible Biomarkers and Potential Targets for New Treatments. J Urol 2018; 199:1312-1318. [DOI: 10.1016/j.juro.2017.11.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Takahiko Mitsui
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Satoru Kira
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Tatsuya Ihara
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Norifumi Sawada
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Nakagomi
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Tatsuya Miyamoto
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Shimura
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Masayuki Takeda
- Departments of Urology and Health Sciences (HY), Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
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Vaughan CP, Markland AD, Smith PP, Burgio KL, Kuchel GA. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome. J Am Geriatr Soc 2018; 66:773-782. [PMID: 29205261 PMCID: PMC5906179 DOI: 10.1111/jgs.15157] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside-to-Bench research conference, entitled "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome," October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm disturbance, and urinary incontinence-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions. The conference provided a forum for discussing current epidemiology, basic science, and clinical and translational research on urinary incontinence in older adults; for identifying gaps in knowledge; and for developing a research agenda to inform future investigative efforts. The conference also promoted networking involving emerging researchers and thought leaders in the field of incontinence, aging, and other fields of research, as well as National Institutes of Health program personnel.
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Affiliation(s)
- Camille P Vaughan
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Phillip P Smith
- Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - Kathryn L Burgio
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
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Sönmez MG, Göğer YE, Ecer G, Atıcı A, Özkent MS, Öztürk A. Effects of urine alkalinization with sodium bicarbonate orally on lower urinary tract symptoms in female patients: a pilot study. Int Urogynecol J 2017; 29:1029-1033. [PMID: 28975365 DOI: 10.1007/s00192-017-3492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In this study, we planned to explore the effects of sodium bicarbonate orally (NaHCO3) treatment on female patients with lower urinary tract symptoms (LUTS) who have acidic urine pH values (<6). METHODS NaHCO3 was given orally to 33 female patients for 4 weeks at a dose of 2 × 4 g/day. Laboratory values, bladder diary, the Patient Perception of Bladder Condition Score (PPBC), Patient Perception of Intensity of Urgency Scale (PPIUS), Overactive Bladder-Validated 8-question Awareness tool (OAB-V8), Pelvic Pain and Urgency & Frequency Patient Symptom Scale tests (PUFSS), and the King's Health Questionnaire (KHQ) scores before and after treatment were compared. RESULTS A significant increase was detected in urine pH values measured after treatment (5.31 ± 0.52 to 7.2 ± 0.66, p < 0.001), but not in blood pH values (7.369 ± 0.33 to 7.384 ± 0.28, p = 0.14). After treatment, a significant decrease was detected in daily frequency, nocturia, urgency, and urge incontinence prevalence (p < 0.001,p = 0.003, p < 0.001, p = 0.002, respectively) and PPBC, PPIUS, PUFSS, and OAB-V8 symptom scores (p = 0.004, p = 0.002, p < 0.001, p < 0.001, respectively). A significant decrease was detected in all KHQ subunit scores. CONCLUSION Urine alkalinization with NaHCO3 orally in female patients with LUTS and acidic urine pH has a significant level of positive effects on symptoms and symptom scores. Our results show that this new treatment modality-which is inexpensive, easy to use, and has a low side-effect profile is effective in this chronic patient group.
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Affiliation(s)
- Mehmet Giray Sönmez
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey.
| | - Yunus Emre Göğer
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey
| | - Gökhan Ecer
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey
| | - Ahmet Atıcı
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey
| | - Mehmet Serkan Özkent
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey
| | - Ahmet Öztürk
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, 42080, Konya, Turkey
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17
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Gacci M, Vignozzi L, Corona G, Serni S, Maggi M. Reply to Jae Heon Kim's Letter to the Editor re: Mauro Gacci, Giovanni Corona, Arcangelo Sebastianelli, et al. Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis. Eur Urol 2016;70:788-96. Eur Urol 2016; 71:e119-e120. [PMID: 27816298 DOI: 10.1016/j.eururo.2016.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
| | - Linda Vignozzi
- Andrology Unit, University of Florence, Careggi Hospital, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Mario Maggi
- Andrology Unit, University of Florence, Careggi Hospital, Florence, Italy
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Varella LRD, Bezerra da Silva R, Eugênia de Oliveira MC, Melo PHA, Maranhão TMDO, Micussi MTABC. Assessment of lower urinary tract symptoms in different stages of menopause. J Phys Ther Sci 2016; 28:3116-3121. [PMID: 27942131 PMCID: PMC5140811 DOI: 10.1589/jpts.28.3116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/21/2016] [Indexed: 01/04/2023] Open
Abstract
[Purpose] To assess lower urinary tract symptoms in different stages of menopause and the quality of life of females with incontinence. [Subjects and Methods] The sample consisted of 302 females, aged between 40 and 56 years, divided into three groups: PRE (n= 81), PERI (n= 108) and POST (n= 113). This was a cross-sectional, analytical, observational study. Data were collected by assessment chart and conducting the International Consultation on Incontinence Questionnaire-Short Form. [Results] Most of the women had less than 10 years of schooling and were married. In PERI and POST menopause, the most frequent lower urinary tract symptoms were urinary urgency and stress incontinence. The PRE group did not exhibit nocturia, urge incontinence or urinary urgency, and had the lowest symptoms frequency. In the three stages, stress incontinence was the most prevalent symptom. Of the three menopause stages, PERI had a greater impact on urinary incontinence according to the International Consultation on Incontinence Questionnaire. [Conclusion] The presence of lower urinary tract symptoms can vary across the different stages of menopause and the urinary incontinence was the most frequent complaint. Moreover, it was observed that quality of life was more affected in the perimenopause stage.
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