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Al-Zoubi RM, Alwani M, Aboumarzouk OM, Elaarag M, Al-Qudimat AR, Ojha L, Yassin A. Updates on androgen replacement therapy and lower urinary tract symptoms: a narrative review. Aging Male 2022; 25:234-241. [PMID: 36066424 DOI: 10.1080/13685538.2022.2118253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are caused by higher tension at the bladder neck level (due to fibrosis or stiffness) or benign prostatic hyperplasia, which causes static obstruction of the bladder outlet. Both forms cause a group of symptoms such as hesitancy, intermittency, weak stream, nocturia, urine frequency, and urgency. Additionally, LUTS (obstructive or irritative symptoms) are common in elderly men with hypogonadism, identified as the reduced testes capability in producing sex steroids and sperm, and are categorized as testosterone deficiency. Even though the mode of action (MoA) of testosterone therapy (TTh) on hypogonadal men needs more researched and understanding, the effectiveness of TTh in the development of male genital organs has been reported in several studies. This review shows the latest updates of TTh in LUTS including potential adverse effects, advantages, and disadvantages.
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Affiliation(s)
- Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, QU-Health, College of Health Sciences, Qatar University, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Mustafa Alwani
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Omar M Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Science, College of Medicine, Qatar University, Doha, Qatar
- Department of Surgery, School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow, UK
| | - Mai Elaarag
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad R Al-Qudimat
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Laxmi Ojha
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Aksam Yassin
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine and Health Sciences, Dresden International University, Dresden, Germany
- Department of Surgery, Division of Urology/Andrology, Hamad Medical Corporation, Doha, Qatar
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Bang WJ, Kim H, Oh CY, Jo JK, Cho JS, Shim M. Clinical significance of prostate volume and testosterone reduction on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy. Sci Rep 2022; 12:18535. [PMID: 36323749 PMCID: PMC9630373 DOI: 10.1038/s41598-022-21963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
To investigate the effect of both prostate volume and serum testosterone changes on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy. A total of 167 patients who received androgen deprivation therapy for prostate cancer treatment from January 2010 to August 2020 were enrolled in this retrospective study. Changes in the International Prostate Symptom Score (IPSS) in the patient groups stratified by prostate volume and the amount of testosterone reduction were assessed every 4 weeks until 12 weeks after androgen deprivation therapy initiation. Longitudinal mixed models were used to assess the adjusted effects of prostate volume and testosterone reduction on IPSS change. All mean values of IPSS-total score (IPSS-total), voiding subscore (IPSS-vs), and storage subscore (IPSS-ss) significantly decreased from baseline to week 12 in both patients with small (< 33 mL) and large (≥ 33 mL) prostates. The mean values of IPSS-total, IPSS-vs, and IPSS-ss similarly decreased in patients with large prostate with a baseline IPSS-total of ≥ 13. However, in those with small prostate, IPSS-ss specifically remained unchanged, while IPSS-total and IPSS-vs significantly decreased. In addition, only in patients with small prostate (< 33 mL), patients with lesser testosterone reduction (< Δ400 ng/dL) showed greater improvement in IPSS-ss by 7.5% compared with those with greater testosterone reduction (≥ Δ400 ng/dL). In conclusion, although androgen deprivation therapy generally improves lower urinary tract symptoms, it may worsen specifically storage symptoms in patients with relatively small prostate and greater testosterone reduction. Our finding suggests that testosterone may influence lower urinary tract symptoms in these patients.
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Affiliation(s)
- Woo Jin Bang
- grid.488421.30000000404154154Department of Urology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068 South Korea
| | - Hwanik Kim
- grid.488421.30000000404154154Department of Urology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068 South Korea
| | - Cheol Young Oh
- grid.488421.30000000404154154Department of Urology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068 South Korea
| | - Jung Ki Jo
- grid.49606.3d0000 0001 1364 9317Department of Urology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jin Seon Cho
- grid.488421.30000000404154154Department of Urology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068 South Korea
| | - Myungsun Shim
- grid.488421.30000000404154154Department of Urology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068 South Korea
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Al-Zoubi RM, Yassin AA, Alwani M, Al-Qudimat A, Aboumarzouk OM, Zarour A, Al Ansari A. A systematic review on the latest developments in testosterone therapy: Innovations, advances, and paradigm shifts. Arab J Urol 2021; 19:370-375. [PMID: 34552788 PMCID: PMC8451690 DOI: 10.1080/2090598x.2021.1959260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives To review the latest innovations and advances in testosterone treatments including their advantages and disadvantages and to address important issues in testosterone therapy (TTh). Methods This review was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-analyses guidelines. The PubMed, MEDLINE, Scopus and Cochrane databases were searched using specifically related key words. The identified studies were screened for inclusion criteria that included studies discussing one of the four objectives of the systematic review: 1) cut–off references, 2) prevention/remission of type II diabetes mellitus (T2DM), 3) duration of treatment, and 4) prostate, lower urinary tract symptoms, prostate health, or cancer. The search was limited to the past 15 years. Any studies were not written in English were excluded. Results The initial literature search retrieved 393 studies. After screening four studies were removed due to duplication, 360 studies were further excluded after reviewing the title, abstract or the whole manuscript due to different exclusion criteria or being not focussed on the objective. Finally, 29 studies were included in the review. One study discussed the cut–off value, four studies discussed the effect of testosterone replacement therapy (TRT) on the control of T2DM, four studies on duration of TRT, and 20 studies discussed the effects of TRT on the prostate Conclusions Numerous studies have demonstrated the benefits of TTh in overtly hypogonadal men. There are several possible administration routes for testosterone treatment. Each approach has advantages and disadvantages, and the choice of the method of TRT will often be determined by patient preference or co-medication (no intramuscular injections in patients under coumarin or similar anticoagulants). Although new developments are promising, it seems that among the available treatments, only transdermal gel delivery and long-acting injectable testosterone undecanoate provide pharmacokinetic behaviour that gives a steady state level within a physiological range.
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Affiliation(s)
- Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Aksam A Yassin
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,Department of Surgery, Division of Urology/Andrology, Hamad Medical Corporation, Doha, Qatar.,Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
| | - Mustafa Alwani
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Al-Qudimat
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Omar M Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Zarour
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Correlation Between Testosterone Replacement Treatment and Lower Urinary Tract Symptoms. Int Neurourol J 2021; 25:12-22. [PMID: 33504130 PMCID: PMC8022167 DOI: 10.5213/inj.2040234.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/21/2020] [Indexed: 01/23/2023] Open
Abstract
Lower urinary tract symptoms (LUTS) are a cluster of voiding symptoms, such as weak stream, hesitancy, intermittency, urinary frequency, urgency, and nocturia. LUTS are frequent in elderly men and it considered the ultimate clinical symptoms of benign prostatic hyperplasia. With aging, male hypogonadism is increased which is defined as decreased ability of the testes to produce sperm and sex steroids because of a pituitary/hypothalamic, or testicular deficiency. In academic andrology associations, the term "male hypogonadism" is commonly used to categorize testosterone deficiency. Testosterone deficiency syndrome (TDS) is defined as a decrease in serum testosterone accompanied by symptoms such as libido decrease, depressive disorder, erectile dysfunction, and fatigue. Although the mechanism about testosterone-replacement therapy (TRT) effects on men with hypogonadism is not yet identified, TRT has been shown to effectively relieve the symptoms of TDS as well as LUTS by several studies. Although the present review demonstrates the effectiveness and safety of TRT in men with TDS by prior studies, future large scale of clinical trials should be conducted to present more high-quality evidence to clinicians and patients.
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Li SY, Zhao YL, Yang YF, Wang X, Nie M, Wu XY, Mao JF. Metabolic Effects of Testosterone Replacement Therapy in Patients with Type 2 Diabetes Mellitus or Metabolic Syndrome: A Meta-Analysis. Int J Endocrinol 2020; 2020:4732021. [PMID: 33061966 PMCID: PMC7545471 DOI: 10.1155/2020/4732021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/29/2020] [Accepted: 09/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Testosterone replacement therapy (TRT) is commonly used for the treatment of hypogonadism in men, which is often associated with type 2 diabetes mellitus (T2DM) and metabolic syndrome (Mets). Recent compiling evidence shows that TRT has beneficial metabolic effects on these patients. OBJECTIVE A meta-analysis has been conducted to evaluate the effects of TRT on cardiovascular metabolic factors. METHODS We conducted a systemic search on PubMed, Embase, Cochrane Library, Wanfang, and CNKI and selected randomized controlled trials (RCTs) to include. The efficacy of TRT on glycemia, insulin sensitivity, lipid profile, and body weight was meta-analyzed by Review Manager. RESULTS A total of 18 RCTs, containing 1415 patients (767 in TRT and 648 in control), were enrolled for the meta-analysis. The results showed that TRT could reduce HbA1c (MD = -0.67, 95% CI -1.35, -0.19, and P=0.006) and improve HOMA-IR (homeostatic model assessment of insulin resistance) (SMD = -1.94, 95% CI -2.65, -1.23, and P < 0.0001). TRT could also decrease low-density lipoprotein (SMD = -0.50, 95% CI -0.82, -0.90, and P=0.002) and triglycerides (MD = -0.64, 95% CI -0.91, -0.36, and P < 0.0001). In addition, TRT could reduce body weight by 3.91 kg (MD = -3.91, 95% CI -4.14, -3.69, and P < 0.00001) and waist circumference by 2.8 cm (MD -2.80, 95% CI -4.38, -1.21 and P=0.0005). Erectile dysfunction (measured by IIEF-5) did not improve, while aging-related symptoms (measured by AMS scores) significantly improved. CONCLUSIONS TRT improves glycemic control, insulin sensitivity, and lipid parameters in hypogonadism patients with T2DM and MetS, partially through reducing central obesity.
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Affiliation(s)
- Shu-ying Li
- Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Division of Endocrinology, Beijing 100730, China
| | - Ya-ling Zhao
- Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Division of Endocrinology, Beijing 100730, China
| | - Yu-fan Yang
- Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Division of Endocrinology, Beijing 100730, China
| | - Xi Wang
- Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Division of Endocrinology, Beijing 100730, China
| | - Min Nie
- Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Division of Endocrinology, Beijing 100730, China
| | - Xue-yan Wu
- Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Division of Endocrinology, Beijing 100730, China
| | - Jiang-feng Mao
- Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Division of Endocrinology, Beijing 100730, China
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Yang TK, Chang CC, Chang HC, Yang HJ, Huang KH. Factors Associated with Bothersome Lower Urinary Tract Symptoms in Middle-Aged Men Receiving Health Checkup. Sci Rep 2019; 9:901. [PMID: 30696907 PMCID: PMC6351592 DOI: 10.1038/s41598-018-37605-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022] Open
Abstract
The prospective study is to investigate the associations between serum testosterone levels and LUTS among middle-aged men ≥40 years receiving health check-up. Lower urinary tract symptoms were evaluated by the self-administered International Prostate Symptom Score questionnaire. Serum prostate specific antigen and total testosterone level were checked in all subjects. A total of 1752 men were enrolled into the study. The mean age was 55.6 ± 9.7 years. All study subjects were stratified into low, medium and high testosterone levels by two cut-off, 3.0 and 4.11 ng/mL. We found that testosterone levels were significantly associated with metabolic syndrome and body fat components. Compared to those with low testosterone levels, subjects with high and medium testosterone had a significantly higher IPSS (5.84 ± 5.55 vs 6.71 ± 5.68 and 6.34 ± 5.66, p = 0.032) and storage score (2.76 ± 2.29 vs 3.20 ± 2.49 and 2.90 ± 2.49; p = 0.009), and a more moderate/severe LUTS (IPSS ≧ 8) (26.5% vs 35.7% and 29.9%; p = 0.002). Multivariate analyses showed that high vs low testosterone levels (OR, 1.76; 95% CI, 1.26–2.45) and prostate volume ≧25 vs <25 mL (OR, 1.38; 95% CI, 1.04–1.82) significantly associated with the presence of moderate/severe LUTS. Pearson correlation analyses showed significantly positive correlations between testosterone level and IPSS in whole study sample (Pearson correlation coefficient, 0.066; p < 0.01) and in the subgroup of moderate/severe LUTS (Pearson correlation coefficient, 0.038; p < 0.05). In conclusion, high testosterone and prostate volume adversely impacted LUTS in our target population.
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Affiliation(s)
- Teng-Kai Yang
- Department of Surgery, Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chih Chang
- The Interdisciplinary Nanoscience Centre, Aarhus University, Aarhus, Denmark
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Ju Yang
- Department of Surgery, Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
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Grzesiak K, Rył A, Baranowska-Bosiacka I, Rotter I, Dołęgowska B, Słojewski M, Sipak-Szmigiel O, Ratajczak W, Lubkowska A, Metryka E, Piasecka M, Laszczyńska M. Comparison between selected hormone and protein levels in serum and prostate tissue homogenates in men with benign prostatic hyperplasia and metabolic disorders. Clin Interv Aging 2018; 13:1375-1382. [PMID: 30122909 PMCID: PMC6080669 DOI: 10.2147/cia.s168146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose The purpose of the study was to assess the relationship between changes in the levels of selected hormones in serum and prostate tissue homogenate in regard to metabolic disorders in patients with diagnosed, surgically treated benign prostatic hyperplasia (BPH). Patients and methods The study involved a group of 154 men with a diagnosis of BPH with metabolic syndrome (MetS) and without MetS. The serum levels of the hormones – total testosterone, free testosterone, insulin, dehydroepiandrosterone sulfate, estradiol, luteinizing hormone, sex hormone binding globulin (SHBG), and insulin-like growth factor-1 (IGF-1) – were determined using the ELISA method. Prostate tissue sections obtained from the patients during transurethral resection of the prostate were frozen in liquid nitrogen. We determined the levels of the same hormones. Results There was a statistically significant difference between the groups in terms of serum SHBG levels, but not in the prostate tissue SHBG levels. A similar relationship was observed in regard to IGF-1, the serum levels of which were significantly higher in patients with MetS. MetS had an effect on the ratio of hormone levels in serum to their levels in the prostate tissue. Correlations between the levels of biochemical parameters and the levels of hormones in serum and the prostate tissue of BPH patients with and without MetS demonstrate that serum SHBG levels correlated weakly with waist size and triglyceride levels. Conclusion The occurrence of MetS in BPH patients was associated with changes in the levels of hormones and proteins. These changes, however, were not always equivalent to changes in the levels of these parameters in prostate tissue. It should also be mentioned that MetS in BPH patients had an influence on a quantitative balance between the levels of SHBG in serum and prostate tissue.
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Affiliation(s)
- Katarzyna Grzesiak
- Department of Histology and Developmental Biology, Pomeranian Medical University, Szczecin, Poland
| | - Aleksandra Rył
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland,
| | | | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland,
| | - Barbara Dołęgowska
- Department of Laboratory Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Olimpia Sipak-Szmigiel
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University, Szczecin, Poland
| | - Weronika Ratajczak
- Department of Histology and Developmental Biology, Pomeranian Medical University, Szczecin, Poland
| | - Anna Lubkowska
- Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Emilia Metryka
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Małgorzata Piasecka
- Department of Histology and Developmental Biology, Pomeranian Medical University, Szczecin, Poland
| | - Maria Laszczyńska
- Department of Histology and Developmental Biology, Pomeranian Medical University, Szczecin, Poland
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Traish AM, Johansen V. Impact of Testosterone Deficiency and Testosterone Therapy on Lower Urinary Tract Symptoms in Men with Metabolic Syndrome. World J Mens Health 2018; 36:199-222. [PMID: 30079638 PMCID: PMC6119850 DOI: 10.5534/wjmh.180032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 12/11/2022] Open
Abstract
Lower urinary tract function is modulated by neural, vascular and urethral and bladder structural elements. The pathophysiological mechanisms of lower urinary tract symptoms (LUTS) encompass prostate enlargement, alterations in urethra histological structure bladder fibrosis and alterations in pelvic neuronal and vascular networks, The complex pathophysiological relationship between testosterone (T) deficiency (TD) and the constellations LUTS, and metabolic dysfunction manifested in the metabolic syndrome (Met S) remains poorly understood. TD has emerged as one the potential targets by which Met S may contribute to the onset and development as well as worsening of LUTS. Because it has been recognized that treatment of men with Met S with T therapy ameliorates Met S components, it is postulated that T therapy may represent a therapeutic target in improving LUTS. Furthermore, the effect of TD on the prostate remains unclear, and often debatable. It is believed that T exclusively promotes prostate growth, however recent evidence has strongly contradicted this belief. The true relationship between benign prostatic hyperplasia, TD, and LUTS remains elusive and further research will be required to clarify the role of T in both benign prostatic hypertrophy (BPH) and LUTS as a whole. Although there is conflicting evidence about the benefits of T therapy in men with BPH and LUTS, the current body of literature supports the safety of using this therapy in men with enlarged prostate. As the population afflicted with obesity epidemic continues to age, the number of men suffering from Met S and LUTS together is expected to increase.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, MA, USA.
| | - Vanessa Johansen
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
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Inoue S, Mizushima T, Miyamoto H. Role of the androgen receptor in urothelial cancer. Mol Cell Endocrinol 2018; 465:73-81. [PMID: 28652170 DOI: 10.1016/j.mce.2017.06.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 12/22/2022]
Abstract
Men have had a substantially higher risk of developing bladder cancer than women. This has prompted research on androgen-mediated androgen receptor (AR) signaling in urothelial cancer. Indeed, increasing preclinical evidence indicates that AR activation correlates with the promotion of urothelial carcinogenesis and tumor outgrowth. In this article, we summarize and discuss available data suggesting the involvement of androgens and the AR pathway in the development and progression of urothelial cancer. Although precise mechanisms for the functions of AR and related signals in urothelial cells remain far from being fully understood, current observations may offer effective chemopreventive and therapeutic approaches for urothelial cancer. Clinical application of various anti-AR therapies available for AR-dependent prostate cancer to urothelial cancer patients is thus anticipated.
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Affiliation(s)
- Satoshi Inoue
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Taichi Mizushima
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Hiroshi Miyamoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
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Badawi JK, Bosch R, Djurhuus JC, Hanna-Mitchell AT. Is testosterone important in LUT function in men and women? ICI-RS 2015. Neurourol Urodyn 2017; 36:859-862. [PMID: 28444714 DOI: 10.1002/nau.23041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/02/2016] [Indexed: 12/20/2022]
Abstract
AIM This review article is a collaborative report based upon the Authors' presentations and Group discussion on the role of testosterone (T) in the male and female lower urinary tract (LUT) which took place at the 6th International Consultation on Incontinence Research Society's (ICI-RS) annual meeting, in Bristol, UK (September 8-10, 2015). METHODS It comprises overviews and opinions on both the current state of knowledge of the role of T in LUT function and dysfunction in both sexes. RESULTS Results from animal studies suggest that T treatment may be beneficial for disorders of the LUT in women including urinary incontinence and pelvic organ prolapse. The need for clinical studies to evaluate the effect of T treatment in peri- and post-menopausal women, taking into account the type of applied androgen, the application form, timing and dosage, is especially emphasized. In males, findings on the impact of T on the male external urethral sphincter underscores that there is still much to learn about its role in male LUT physiology. The important topic of the use of T therapy in the treatment of enuresis in the young, both sexes, is also discussed. The importance of understanding the steroidogenic pathways linking T with estradiol is discussed as being of paramount importance in researching the unique actions of T in the LUT. CONCLUSION The overall conclusion is that further research into the role of T in LUT function and dysfunction across genders and age groups (young to old) is extremely important. Neurourol. Urodynam. 36:859-862, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jasmin Katrin Badawi
- Department of Urology, University Hospital Mannheim, Medical Faculty of the Ruprechts-Karls-University of Heidelberg, Mannheim, Germany
| | - Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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Allen S, Aghajanyan I. Use of thermobalancing therapy in ageing male with benign prostatic hyperplasia with a focus on etiology and pathophysiology. Aging Male 2017; 20:28-32. [PMID: 27960590 DOI: 10.1080/13685538.2016.1247151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION We investigated if "thermobalancing" therapy (TT), using Dr Allen's therapeutic device (DATD) in men with benign prostatic hyperplasia (BPH), can aid in understanding the etiology and pathophysiology of BPH. METHODS We compared urinary and other parameters of BPH patients who received TT over 6 months (treatment group) with those of healthy volunteers who had not received the treatment (control group). Dynamics of symptoms and indicators in each group were evaluated in comparison with their data at the beginning and end of the study. Parameters were the International Prostate Symptom Score (IPSS) for urinary symptoms and quality of life (QoL), ultrasound measurement of prostate volume (PV) and uroflowmetry (maximum flow rate, Qmax). TT effectiveness was examined in 124 men with BPH and PV <60 mL. We also investigated the data of five patients with BPH and PV >60 mL. RESULTS TT decreased urinary symptoms and PV, increased Qmax and improved QoL in men with BPH, PV <60 mL, and in men with BPH, PV >60 mL. CONCLUSIONS The present study demonstrated that TT is effective for BPH, suggesting that blood circulation plays a crucial role in its cause. The continuous heat exposure that does not exceed the normal body temperature terminates the trigger of BPH development, "micro-focus" of hypothermia, and the following spontaneous expansion of capillaries. TT could be considered to be a useful tool in BPH treatment.
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Affiliation(s)
- Simon Allen
- a Fine Treatment , Oxford , United Kingdom of Great Britain and Northern Ireland and
| | - Ivan Aghajanyan
- b Urology, Yerevan State Medical University Named after Mkhitar Heratsi , Yerevan , Armenia
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Kosilov K, Loparev S, Kuzina I, Shakirova O, Zhuravskaya N, Lobodenko A. The effective tool for self-assessment of adherence to treatment in patients with benign prostatic obstruction and overactive bladder symptoms. Aging Male 2017; 20:39-44. [PMID: 28074677 DOI: 10.1080/13685538.2016.1247435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Study of validity of the Medication Adherence Self-Report Inventory (MASRI) for use in clinical practice to treat patients with benign prostatic obstruction (BPO) accompanied with overactive bladder (OAB) symptoms. METHODS During 12 weeks of the randomized study, 452 patients with BPO and OAB symptoms (mean age of 61.3 (12.7)) were studied for adherence to the treatment with Tamsulosin, Solifenacin and Trospium using the MASRI. External monitoring instruments included the Brief Medication Questionnaire (BMQ) and the visual remaining pill count. The state of the prostate gland and the lower urinary tract was monitored using questionnaires I-PSS, OAB Awareness Tool, uroflowmetry and voiding diaries. RESULT Correlation between the percentage of men non-adherent to treatment (MASRI) and the percentage of patients having a belief barrier on the screen of the BMQ was r = 0.89, p ≤0.05, r = 0.92, p ≤0.01, r = 0.85, p ≤0.05, a number of missed doses on the Regimen Screen of the BMQ was r = 0.79; p ≤0.05; r = 0.81; p ≤0.05; r = 0.75, p ≤0.05, a number of non-adherent patients according to the BMQ was r = 0.83 (p ≤0.05), r = 0.88 (p ≤0.05), r = 0.79, p ≤0.05, the results of the pill count were r = 0.65-0.76; p ≤0.05-0.01. These data confirm high validity of the MASRI. CONCLUSION The MASRI is a valid tool for rapid assessment of adherence to treatment of patients with BPO and OAB receiving Tamsulosin and antimuscarinic drugs and may be recommended for use in clinical practice.
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Affiliation(s)
- Kirill Kosilov
- a Department of Social Sciences , Far Eastern Federal University , Vladivostok , Russia
| | - Sergey Loparev
- b Department of Urology , Sity Policlinic 3 , Vladivostok , Russia , and
| | - Irina Kuzina
- a Department of Social Sciences , Far Eastern Federal University , Vladivostok , Russia
| | - Olga Shakirova
- c Department of theory and methodology of adaptive physical training , Far Eastern Federal University , Vladivostok , Russia
| | - Natalya Zhuravskaya
- c Department of theory and methodology of adaptive physical training , Far Eastern Federal University , Vladivostok , Russia
| | - Alexandra Lobodenko
- a Department of Social Sciences , Far Eastern Federal University , Vladivostok , Russia
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13
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Wu Y, Pan H, Wang WM, Xu D, Zhang L, Gu ZQ, Bai Q, Qi J, Huang HF. A possible relationship between serum sex hormones and benign prostatic hyperplasia/lower urinary tract symptoms in men who underwent transurethral prostate resection. Asian J Androl 2017; 19:230-233. [PMID: 26763548 PMCID: PMC5312224 DOI: 10.4103/1008-682x.171575] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) who underwent transurethral surgery. The study was conducted in 158 patients who came to our hospital for surgery. Clinical conditions were assessed by body mass index (BMI), digital rectal examination, International Prostate Symptom Score (IPSS) and transrectal ultrasound (TRUS). The levels of sex hormones (including total testosterone (TT), estradiol (E2), progesterone (P), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin (PRL)) and prostate-specific antigen (PSA) were reviewed. Correlations were determined through statistical analysis. The mean age was 72.06 ± 8.68 years. The total IPSS was significantly associated with the TT level (r = −0.21, P= 0.01). Other sex hormone levels were not correlated with total IPSS. However, some ratios such as E2/TT (r = 0.23, P= 0.00) and FSH/LH (r = −0.17, P = 0.04) were associated with total IPSS. Further analysis showed that the nocturia was associated with age (r = 0.16, P= 0.04), BMI (r = 0.21, P = 0.01), and TT (r = −0.19, P= 0.02). Moreover, we divided the patients into two subgroups based on IPSS severity (<20 or ≥20). The mean TT level was in the normal range, but it was significantly related to the presence of severe LUTS. In summary, our study has shown that the severity of LUTS is associated with TT, E2/TT and FSH/LH in men who underwent prostate surgery. Increasing nocturia was observed in lower testosterone patients. Additional larger studies are needed to elucidate the potential mechanisms.
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Affiliation(s)
- Yu Wu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Hong Pan
- Department of Gynecology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Wei-Ming Wang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Ding Xu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Liang Zhang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Zheng-Qin Gu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Qiang Bai
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - He-Feng Huang
- Department of Assisted Reproduction Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
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14
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Androgen Receptor Signaling in Bladder Cancer. Cancers (Basel) 2017; 9:cancers9020020. [PMID: 28241422 PMCID: PMC5332943 DOI: 10.3390/cancers9020020] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/24/2017] [Accepted: 02/16/2017] [Indexed: 01/21/2023] Open
Abstract
Emerging preclinical findings have indicated that steroid hormone receptor signaling plays an important role in bladder cancer outgrowth. In particular, androgen-mediated androgen receptor signals have been shown to correlate with the promotion of tumor development and progression, which may clearly explain some sex-specific differences in bladder cancer. This review summarizes and discusses the available data, suggesting the involvement of androgens and/or the androgen receptor pathways in urothelial carcinogenesis as well as tumor growth. While the precise mechanisms of the functions of the androgen receptor in urothelial cells remain far from being fully understood, current evidence may offer chemopreventive or therapeutic options, using androgen deprivation therapy, in patients with bladder cancer.
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15
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Hristov KL, Parajuli SP, Provence A, Petkov GV. Testosterone decreases urinary bladder smooth muscle excitability via novel signaling mechanism involving direct activation of the BK channels. Am J Physiol Renal Physiol 2016; 311:F1253-F1259. [PMID: 27605581 PMCID: PMC5210203 DOI: 10.1152/ajprenal.00238.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/30/2016] [Indexed: 11/22/2022] Open
Abstract
In addition to improving sexual function, testosterone has been reported to have beneficial effects in ameliorating lower urinary tract symptoms by increasing bladder capacity and compliance, while decreasing bladder pressure. However, the cellular mechanisms by which testosterone regulates detrusor smooth muscle (DSM) excitability have not been elucidated. Here, we used amphotericin-B perforated whole cell patch-clamp and single channel recordings on inside-out excised membrane patches to investigate the regulatory role of testosterone in guinea pig DSM excitability. Testosterone (100 nM) significantly increased the depolarization-induced whole cell outward currents in DSM cells. The selective pharmacological inhibition of the large-conductance voltage- and Ca2+-activated K+ (BK) channels with paxilline (1 μM) completely abolished this stimulatory effect of testosterone, suggesting a mechanism involving BK channels. At a holding potential of -20 mV, DSM cells exhibited transient BK currents (TBKCs). Testosterone (100 nM) significantly increased TBKC activity in DSM cells. In current-clamp mode, testosterone (100 nM) significantly hyperpolarized the DSM cell resting membrane potential and increased spontaneous transient hyperpolarizations. Testosterone (100 nM) rapidly increased the single BK channel open probability in inside-out excised membrane patches from DSM cells, clearly suggesting a direct BK channel activation via a nongenomic mechanism. Live-cell Ca2+ imaging showed that testosterone (100 nM) caused a decrease in global intracellular Ca2+ concentration, consistent with testosterone-induced membrane hyperpolarization. In conclusion, the data provide compelling mechanistic evidence that under physiological conditions, testosterone at nanomolar concentrations directly activates BK channels in DSM cells, independent from genomic testosterone receptors, and thus regulates DSM excitability.
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Affiliation(s)
- Kiril L Hristov
- Department of Drug Discovery and Biomedical Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Shankar P Parajuli
- Department of Drug Discovery and Biomedical Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Aaron Provence
- Department of Drug Discovery and Biomedical Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Georgi V Petkov
- Department of Drug Discovery and Biomedical Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina
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16
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Enatsu N, Chiba K, Sumii K, Fukuda T, Okada K, Matsushita K, Fujisawa M. Dutasteride-mediated morphological changes in the genitourinary tract associated with altered expression patterns of the androgen and estrogen receptors in male rats. Andrology 2016; 5:347-353. [PMID: 27813338 DOI: 10.1111/andr.12297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/20/2016] [Accepted: 09/24/2016] [Indexed: 12/22/2022]
Abstract
We evaluated the effects of dutasteride on the genitourinary tract using fifteen 8-week-old male Sprague-Dawley rats. Animals were divided into three groups comprising five animals each and treated as follows. Group A was a control group, members of Group B received oral administration of dutasteride 0.1 mg/kg/day from the age of 8 to 16 weeks, and members of Group C were castrated at the age of 8 weeks. All rats were killed at the age of 16 weeks for the sample collection of blood, bladder, prostate, seminal vesicles, and penis. Then, we evaluated the pathological examination for evaluating the tissue fibrosis and hormonal receptor expression. The results showed that the mean size of the prostate and seminal vesicles was smaller in Group B and Group C than in Group A. Serum and tissue concentrations of both testosterone and dihydrotestosterone were remarkably reduced in serum and all tissues in Group C compared with Group A. On the other hand, in Group B, only dihydrotestosterone was reduced in serum and penis. Histopathological examination revealed that Group C showed statistically significant histological changes, such as an increase in fibrotic tissue in the bladder, prostate, and penis. Similarly, Group B showed fibrotic changes in the prostate and penis compared with the Group A. Immunofluorescent staining revealed that the androgen receptor was more strongly expressed than the estrogen receptor beta in Group A. On the other hand, in Group C, weak expression of the androgen receptor and strong expression of the estrogen receptor beta was noted. In Group B, these changes were noted in the prostate and penis. These findings suggest that dutasteride cause morphological changes not only in prostate but also in penis. These changes are associated with altered expression patterns of androgen receptor and estrogen receptor.
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Affiliation(s)
- N Enatsu
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Chiba
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Sumii
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Fukuda
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Okada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Matsushita
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - M Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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17
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Yassin AA, Nettleship JE, Salman M, Almehmadi Y. Waist circumference is superior to weight and BMI in predicting sexual symptoms, voiding symptoms and psychosomatic symptoms in men with hypogonadism and erectile dysfunction. Andrologia 2016; 49. [DOI: 10.1111/and.12634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 12/30/2022] Open
Affiliation(s)
- A. A. Yassin
- Institute of Urology and Andrology; Segeberger Kliniken; Norderstedt Germany
- Dresden International University; Dresden Germany
- Gulf Medical University School of Medicine; Ajman United Arab Emirates
| | | | - M. Salman
- Institute of Urology and Andrology; Segeberger Kliniken; Norderstedt Germany
| | - Y. Almehmadi
- Institute of Urology and Andrology; Segeberger Kliniken; Norderstedt Germany
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18
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Crawford ED, Poage W, Nyhuis A, Price DA, Dowsett SA, Muram D. Effects of Testosterone Level on Lower Urinary Tract Symptoms. Am J Mens Health 2016; 10:440-2. [DOI: 10.1177/1557988315590655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are common in older men and are frequently associated with benign prostatic hyperplasia (BPH). The relationship between BPH and endogenous total testosterone (TT) levels has been widely studied. The aim of this post hoc analysis was to determine the association between LUTS and endogenous TT levels in a subset of men participating in the 2013 Prostate Cancer Awareness Week, a U.S. community-based prostate cancer screening program. Men completed the International Prostate Symptom Score (I-PSS) questionnaire, prostate size was estimated by a digital rectal examination, and serum TT and prostate-specific antigen levels were measured. Mean TT levels (ng/dl) did not significantly correlate with prostate size category ( r = +.03, p = .69): normal, 419.2 ( n = 106); enlarged, 394.7 ( n = 71); abnormal, 416.4 ( n = 7); and abnormal/suspicious, 515.2 ( n = 19). Mean TT levels (ng/dl) did not significantly correlate with I-PSS category ( r = −.06, p = .40): none, 468.5 ( n = 15); mild, 414.0 ( n = 138); moderate, 397.4 ( n = 66); and severe, 437.9 ( n = 7). Mean TT levels (ng/dl) did not significantly correlate with I-PSS quality of life rating ( r = −.13, p = .055): delighted, 474.5 ( n = 43); pleased, 424.6 ( n = 65); mostly satisfied, 361.2 ( n = 63); mixed, 448.2 ( n = 29); mostly dissatisfied, 337.2 ( n = 17); and unhappy, 435.8 ( n = 6). Adjustment for prostate size or prostate-specific antigen levels yielded similar findings. In conclusion, endogenous TT levels did not correlate with LUTS or prostate size, and these findings support the saturation theory in which TT is not able to induce further androgen-stimulated prostate tissue growth due to receptor saturation. Any worsening of LUTS following testosterone replacement therapy in hypogonadal men may be related to stimulation of prostatic cells previously deprived of testosterone.
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Affiliation(s)
| | - Wendy Poage
- Prostate Conditions Education Council, Centennial, CO, USA
| | | | | | | | - David Muram
- Eli Lilly and Company, Indianapolis, IN, USA
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19
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Lee JH, Lee SW. Testosterone and Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Propensity Score-Matched Analysis. J Sex Med 2016; 13:1047-55. [DOI: 10.1016/j.jsxm.2016.04.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 12/15/2022]
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20
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Shen YC, Chuang YC. The prevalence and predictors of androgen deficiency in Taiwanese men with lower urinary tract symptoms. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Yassin A, Nettleship JE, Talib RA, Almehmadi Y, Doros G. Effects of testosterone replacement therapy withdrawal and re-treatment in hypogonadal elderly men upon obesity, voiding function and prostate safety parameters. Aging Male 2016; 19:64-9. [PMID: 26742589 DOI: 10.3109/13685538.2015.1126573] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Whether testosterone replacement therapy (TRT) is a lifelong treatment for men with hypogonadism remains unknown. We investigated long-term TRT and TRT withdrawal on obesity and prostate-related parameters. Two hundred and sixty-two hypogonadal patients (mean age 59.5) received testosterone undecanoate in 12-week intervals for a maximum of 11 years. One hundred and forty-seven men had TRT interrupted for a mean of 16.9 months and resumed thereafter (Group A). The remaining 115 patients were treated continuously (Group B). Prostate volume, prostate-specific antigen (PSA), residual voiding volume, bladder wall thickness, C-reactive protein (CRP), aging male symptoms (AMS), International Index of erectile function - erectile function (IIEF-EF) and International Prostate Symptoms Scores (IPSS) were measured over the study period with anthropometric parameters of obesity, including weight, body mass index (BMI) and waist circumference. Prior to interruption, TRT resulted in improvements in residual voiding volume, bladder wall thickness, CRP, AMS, IIEF-EF, IPSS and obesity parameters while PSA and prostate volume increased. TRT interruption reduced total testosterone to hypogonadal levels in Group A and resulted in worsening of obesity parameters, AMS, IPSS, residual voiding volume and bladder wall thickness, IIEF-EF and PSA while CRP and prostate volume were unchanged until treatment resumed whereby these effects were reversed. TRT interruption results in worsening of symptoms. Hypogonadism may require lifelong TRT.
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Affiliation(s)
- Aksam Yassin
- a Institute of Urology & Andrology , Norderstedt , Germany
- b Department of Preventive Medicine, Men's Health Programme , Dresden International University , Dresden , Germany
- c Department of Urology , School of Medicine, Gulf Medical University , Ajman , UAE
| | | | - Raidh A Talib
- e Department of Urology & Andrology , Hamad Medical Corporation , Doha , Qatar , and
| | | | - Gheorge Doros
- f Boston University School of Public Health , Boston , MA , USA
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22
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Zhao C, Kwan Park J. Phosphodiesterase Type 5 Inhibitor and Erectile Dysfunction in Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2015; 4 Suppl 1:75-80. [PMID: 26676704 DOI: 10.1111/j.1757-5672.2011.00121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men and mostly induces lower urinary tract symptoms (LUTS). Multiple studies have shown that BPH inducing LUTS are intensely correlated with erectile dysfunction (ED) and that severity of LUTS was proportional to ED severity. Although a direct causal relationship has not been clarified, a tentative pathophysiology has been suggested to interpret the relationship between two disorders. Androgen plays an important role in the maintenance of the functional and structural integrity of the lower urinary tract and penis. Low testosterone, especially free testosterone, worsened detrusor overactivity and replacement of testosterone improved LUTS in the hypogonadal BPH patients. Nitric oxide synthase and nitric oxide are decreased in the transition zone of the hyperplastic prostate but phosphodiesterase types 4, 5, 11 are prominent in transition zone of hyperplastic prostate. Phosphodiesterase type 5 (PDE5) inhibitor with a long half-life could obtain the desired effect; therefore, tadalafil and undenafil frequently have been used to evaluate the effects in the two disorders. In clinical trials, tadalafil showed improvement of BPH-induced LUTS, but few of the studies showed a significant improvement on uroflowmetry. PDE5 inhibitors increase the concentration of cyclic guanosine monophosphate (cGMP) in plasma and smooth muscle, promoting erection of the penis, as well as relaxation of the bladder neck and prostate, leading to natural voiding. Sexual function and LUTS should be assessed and discussed with the patient when choosing the appropriate strategy and the patient's response to treatment should also be evaluated at the same time.
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Affiliation(s)
- Chen Zhao
- Department of Urology, Medical School, and Institute for Medical Sciences, and Research Institute of Chonbuk National University, Chonbuk National University Hospital, Jeonbuk, Korea
| | - Jong Kwan Park
- Department of Urology, Medical School, and Institute for Medical Sciences, and Research Institute of Chonbuk National University, Chonbuk National University Hospital, Jeonbuk, Korea
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Bae WJ, Ha US, Choi JB, Kim KS, Kim SJ, Cho HJ, Hong SH, Lee JY, Wang Z, Hwang SY, Kim SW. Protective Effects of KH-204 in the Bladder of Androgen-Deprived Rats. World J Mens Health 2015; 33:73-80. [PMID: 26331123 PMCID: PMC4550599 DOI: 10.5534/wjmh.2015.33.2.73] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/23/2015] [Accepted: 07/20/2015] [Indexed: 12/04/2022] Open
Abstract
Purpose We investigated the protective effects of the herbal formulation KH-204 in the bladder of androgen-deprived rats. Materials and Methods Male rats aged eight weeks were randomly divided into four groups, containing eight rats each: sham operation only (normal control group), androgen-deprived only (androgen-deprived control group), and androgen-deprived followed by treatment with 200 mg/kg or 400 mg/kg of KH-204. After 0.5 mg/kg of leuprorelin was subcutaneously injected in the androgen-deprived groups, the oral administration of either distilled water in the two control groups or KH-204 in the treatment group was continued for four weeks. Serum testosterone levels, RhoGEF levels, nitric oxide (NO)-cyclic guanosine monophosphate (cGMP)-related parameters, oxidative stress, and histologic changes were evaluated after treatment. Results Treatment with the herbal formulation KH-204 (1) increased serum testosterone levels; (2) restored the expression of RhoGEFs, endothelial NO synthase, and neuronal NO synthase; (3) increased the expression of superoxide dismutase; and (4) decreased bladder fibrosis. Conclusions Our results suggest that the positive effects of KH-204 on the urinary bladder may be attributed to its antioxidant effects or to an elevation in NO-cGMP activity.
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Affiliation(s)
- Woong Jin Bae
- Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Bong Choi
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Sup Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Jin Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Zhiping Wang
- Department of Urology, Second Hospital of Lanzhou University, Lanzhou, China
| | | | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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24
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Wagg A. Pharmacological Treatment of Voiding Dysfunction in Older Men. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Russo GI, Castelli T, Urzì D, Privitera S, Fragalà E, La Vignera S, Condorelli RA, Calogero AE, Favilla V, Cimino S, Morgia G. Connections between lower urinary tract symptoms related to benign prostatic enlargement and metabolic syndrome with its components: a systematic review and meta-analysis. Aging Male 2015; 18:207-16. [PMID: 26171768 DOI: 10.3109/13685538.2015.1062980] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A significant amount of epidemiological evidences have underlined an emerging link between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement a (BPE). We aimed to assess the connections between LUTS and MetS with its components. Meta-analysis were conducted to determine the mean differences (MD) and confidence intervals of IPSS total score, IPSS-voiding, IPSS-storage and prostate volume (PV) in patients with or without MetS. Ln(odds-ratio) were calculated to estimate the risk of having moderate-to-severe LUTS (IPSS ≥ 8). Nineteen studies were identified as eligible for this systematic review, with a total of 18,476 participants, including 5554 (30.06%) with and 12,922 (69.94%) without MetS. Pooled analysis did not demonstrate significant MD of IPSS, IPSS-voiding and IPSS-storage in men with or without MetS but PV was significantly different (MD = 2.18; p = 0.03). Presence of MetS was not significantly associated with moderate-to-severe LUTS (odds ratio = 1.13; p = 0.53) and only altered serum triglycerides and diabetes were associated with this risk. The association between MetS and LUTS/BPE remain unclear and further observational studies in a population with metabolic disorders should be conducted in order to address it's potential role in determining LUTS/BPE.
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Affiliation(s)
| | | | | | | | | | - Sandro La Vignera
- b Department of Medical and Pediatric Sciences, Section of Endocrinology, Andrology, and Internal Medicine , University of Catania , Catania , Italy
| | - Rosita A Condorelli
- b Department of Medical and Pediatric Sciences, Section of Endocrinology, Andrology, and Internal Medicine , University of Catania , Catania , Italy
| | - Aldo E Calogero
- b Department of Medical and Pediatric Sciences, Section of Endocrinology, Andrology, and Internal Medicine , University of Catania , Catania , Italy
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26
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Suh B, Shin DW, Hwang SS, Choi HC, Kwon H, Cho B, Park JH. Alcohol is longitudinally associated with lower urinary tract symptoms partially via high-density lipoprotein. Alcohol Clin Exp Res 2014; 38:2878-83. [PMID: 25399519 DOI: 10.1111/acer.12564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies on the association of alcohol consumption with lower urinary tract symptoms (LUTS) have been inconsistent, and none took into account the dynamic nature of LUTS, fluctuating over time. The purpose of the study was to determine the longitudinal association of alcohol consumption with LUTS. METHODS We used generalized estimating equations to analyze the longitudinal association of alcohol consumption with LUTS in a longitudinal study of 9,712 healthy men 30 years or older who visited our institution multiple times for routine comprehensive health evaluations, with an average follow-up period of 27.9 months. RESULTS Light-moderate alcohol consumption (0.1 to 29 g/d) was associated with decreased likelihood of moderate-severe LUTS, whereas heavy alcohol consumption (≥30 g/d) was associated with increased likelihood of moderate-severe LUTS in a dose-dependent manner. Compared to those with 0 g/d alcohol intake, subjects who drank 0.1 to 9.9, 10 to 19.9, 20 to 29.9, 30 to 39.9, or ≥40 g/d of alcohol were in general significantly associated with moderate-severe LUTS with adjusted odds ratio (95% confidence interval) as follows respectively: 0.94 (0.87 to 1.02), 1.00 (0.91 to 1.09), 0.85 (0.77 to 0.93), 1.08 (0.98 to 1.19), and 1.31 (1.19 to 1.44). However, the protective association of light-moderate alcohol consumption with LUTS was greatly attenuated when serum high-density lipoprotein (HDL) was added to the analysis, specifically for voiding symptoms. CONCLUSIONS We show strong evidence there is longitudinal association of alcohol consumption with LUTS. The protective effect of light-moderate alcohol consumption on LUTS is in part modulated by HDL as a confounder, similar to its effect on coronary heart disease.
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Affiliation(s)
- Beomseok Suh
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
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Maeda T. Editorial Comment to Early effect of dutasteride added to alpha-1 blocker therapy for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia. Int J Urol 2014; 21:819-20. [DOI: 10.1111/iju.12521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takahiro Maeda
- Department of Urology; Saiseikai Central Hospital; Tokyo Japan
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Voiding characteristics and related hormonal changes in peri-menopausal and post-menopausal women: a preliminary study. Maturitas 2014; 79:311-5. [PMID: 25150899 DOI: 10.1016/j.maturitas.2014.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To characterize voiding symptoms during the peri- and post-menopausal periods and to investigate related hormonal changes. METHODS We enrolled a total of 55 patients between February 10, 2013, and August 15, 2013, to participate in this cross-sectional study. To characterize patients' voiding symptoms, we administered voiding questionnaires, including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Sandvik Severity Index. Measured hormones included E2, FSH, TSH, prolactin, progesterone, and testosterone. RESULTS In the univariate analysis, there were significant intergroup differences for all of the hormones except progesterone. Among the voiding symptoms, straining (IPSS question 1), frequency (IPSS question 2), and SUI were significantly different between the two groups (p=0.039. 0.010, and 0.017, respectively). In the multivariate analysis, frequency (IPSS question 2) and SUI were significantly different between the two groups (p=0.020 and 0.011, respectively). Among the hormones, only testosterone was marginally different between the two groups (p=0.059). CONCLUSIONS During the transition to menopause, voiding symptoms, such as frequency, can potentially worsen in the peri-menopausal period, and SUI is more prevalent in the post-menopausal period. Additionally, testosterone may have a role in voiding changes that occur during the menopausal transition.
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Can treatment of nocturia increase testosterone level in men with late onset hypogonadism? Urology 2014; 83:837-42. [PMID: 24680454 DOI: 10.1016/j.urology.2013.12.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/21/2013] [Accepted: 12/31/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effect of desmopressin on serum testosterone level in men with nocturia and late onset hypogonadism. METHODS We prospectively enrolled men with nocturia and symptoms of late onset hypogonadism. Desmopressin (0.1 mg) was administered once daily to patients for 12 weeks, and we then compared serum testosterone levels, electrolytes, frequency volume chart indices, and changes in the International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Aging Male's Symptom scales before and after treatment. Patients with a history of cardiovascular disease or hyponatremia, those using hypnotics, and those who had primary hypogonadism or hypogonadotrophic hypogonadism were excluded from the study. RESULTS Sixty-two men (mean age, 68.4 years) completed pre- and post-treatment questionnaires and underwent laboratory testing. At the end of the study, the testosterone levels in men with low testosterone levels (<3.5 ng/mL) increased after the 12-week desmopressin treatment (2.85 ± 0.58 to 3.97 ± 1.44 ng/mL; P = .001). Mean scores had decreased from 17.7 to 13.9 (IPSS), 3.8 to 3.2 (IPSS-Quality of Life), and 33.7 to 31.1 (Aging Male's Symptom). On the frequency volume chart, nocturnal urine volume, nocturnal polyuria index, actual number of nocturia events, nocturia index, and nocturnal bladder capacity index were significantly decreased. CONCLUSION Desmopressin improved nocturia and other urinary symptoms. Moreover, serum testosterone levels increased significantly in men with low testosterone levels after 12-week desmopressin treatment.
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Is metabolic syndrome truly a risk factor for male lower urinary tract symptoms or just an epiphenomenon? Adv Urol 2014; 2014:203854. [PMID: 24587797 PMCID: PMC3920975 DOI: 10.1155/2014/203854] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/06/2013] [Accepted: 12/07/2013] [Indexed: 11/18/2022] Open
Abstract
To define whether the association of male lower urinary tract symptoms (LUTS) and metabolic syndrome (MS) is real or simply an epiphenomenon, 490 male adults (mean age 58 ± 9 years) underwent International Prostate Symptom Score (IPSS), physical and prostate digital examinations, blood analysis, and urinary tract transabdominal ultrasound with prostate volume measurement. Mild, moderate, and severe LUTS were found in 350 (71.4%), 116 (23.7%), and 24 (4.9%) patients, respectively. MS was present in 198 (40.4%) patients, representing 37.4% (131 of 350) of those with mild LUTS, 46.5% (54 of 116) of those with moderate, and 54.1% (13 of 24) of those with severe. The odds ratio of MS having moderate or severe LUTS was 2.1. MS was more common in older age, higher body mass index, and larger prostate size. Moderate and severe LUTS were more frequent in older age, lower levels of high density cholesterol, and higher blood pressure. Older age and body mass index had significant relative risk for lower urinary tract symptoms and only age remained independent factor for LUTS on multivariate analysis. Our results suggest that the association of male LUTS, prostate volume, and MS might be coincidental and related to older age.
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Francomano D, Ilacqua A, Bruzziches R, Lenzi A, Aversa A. Effects of 5-Year Treatment With Testosterone Undecanoate on Lower Urinary Tract Symptoms in Obese Men With Hypogonadism and Metabolic Syndrome. Urology 2014; 83:167-73. [DOI: 10.1016/j.urology.2013.08.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/08/2013] [Accepted: 08/10/2013] [Indexed: 10/26/2022]
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Association of Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia Measures With International Index of Erectile Function 5 in Middle-aged Policemen of Korea and the Role of Metabolic Syndrome and Testosterone in Their Relationship. Urology 2013; 82:1008-12. [DOI: 10.1016/j.urology.2013.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 11/20/2022]
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Lower urinary tract symptoms improve with testosterone replacement therapy in men with late-onset hypogonadism: 5-year prospective, observational and longitudinal registry study. World J Urol 2013; 32:1049-54. [DOI: 10.1007/s00345-013-1187-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/08/2013] [Indexed: 12/17/2022] Open
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Naidan N, Rivaad OE, Muukhai N, Janlav M. Testosterone deficiency with erectile dysfunction in mongolian men. World J Mens Health 2013; 31:170-5. [PMID: 24044113 PMCID: PMC3770853 DOI: 10.5534/wjmh.2013.31.2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/31/2013] [Accepted: 08/01/2013] [Indexed: 11/15/2022] Open
Abstract
Purpose To detect the testosterone deficiency syndrome in Mongolian men over 40 years old with erectile dysfunction (ED). Materials and Methods Total of 309 males over 40 years of age who received medical care at the ADAM Urology and Andrology Clinic from 2010 to 2011 were included in this study. An approval from the Ethics Committee of the Ministry of Health of Mongolia was obtained, and each study participant signed a consent form at the beginning of the study. The participants were assigned to either an ED group or a control group, depending on the results of the international index of erectile function (IIEF)-5 questionnaire. The ED group was further divided into three groups (moderate, severe, and very severe) based on the level of ED. The total testosterone (TT) levels were determined in the blood serum using a competitive enzyme-linked immunesorbent assay (ELISA) analytical system UBI Magiwel™ Testosterone Quantitative test, and free testosterone (FT) calculated as described by the Vermeulen calculation. Test samples were collected between 8:00 and 11:00 am in the mornings and testosterone deficiency syndrome was diagnosed based on the International Society for the Study of the Aging Male guidelines, particularly, if TT was ≤3.46 ng/ml or free testosterone FT was ≤0.072 ng/ml. Results ED of moderate, severe, and very severe levels was diagnosed in 199 (64.41%) out of 309 participants. There was an inverse relationship between the main IIEF-5 score and age (r=-0.380, p<0.01). The average TT was 5.75±2.316 ng/ml and FT was 0.091±0.0084 ng/ml. Compared to the ED group, the control group had a higher TT level: 5.6440±1.177 ng/ml and 5.812±2.316 ng/ml, respectively. In the control group, the FT level was 0.061±0.0084 ng/ml, whereas it was 0.041±0.0076 ng/ml in the ED group. Conclusions Our study showed that most of the aging males who came to the clinic had moderate to very severe ED (64.55%). The levels of TT (5.644±1.177 ng/ml) and FT (0.041±0.0036 ng/ml) were significantly lower in ED patients (p<0.05). The testosterone deficiency syndrome was detected in 24.27% of the ED group.
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Affiliation(s)
- Nansalmaa Naidan
- Department of Surgery, School of Medicine, Health Sciences University of Mongolia and ADAM Urology and Andrology Clinic, Ulaanbaatar, Mongolia
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SHIGEHARA K, SUGIMOTO K, KONAKA H, MAEDA Y, KITAGAWA Y, MIZOKAMI A, KOH E, NAMIKI M. Lower Urinary Tract Symptoms are Associated with Erectile Function and Psychological Symptoms in Men with Late-Onset Hypogonadism Syndrome. Low Urin Tract Symptoms 2013; 6:151-6. [DOI: 10.1111/luts.12033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/12/2013] [Accepted: 08/01/2013] [Indexed: 01/17/2023]
Affiliation(s)
- Kazuyoshi SHIGEHARA
- Department of Urology; Ishikawa Prefectural Central Hospital; Kanazawa Japan
| | - Kazuhiro SUGIMOTO
- Department of Integrative Cancer Therapy and Urology; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Hiroyuki KONAKA
- Department of Integrative Cancer Therapy and Urology; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Yuji MAEDA
- Department of Integrative Cancer Therapy and Urology; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Yasuhide KITAGAWA
- Department of Integrative Cancer Therapy and Urology; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Atsushi MIZOKAMI
- Department of Integrative Cancer Therapy and Urology; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Eitetsu KOH
- Department of Integrative Cancer Therapy and Urology; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
| | - Mikio NAMIKI
- Department of Integrative Cancer Therapy and Urology; Kanazawa University Graduate School of Medical Science; Kanazawa Japan
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de Barros CAV, Lorenzetti F, Ortiz V, Dambros M. Testosterone supplementation's effects on age-related bladder remodeling - experimental study in rats. Aging Male 2013; 16:102-7. [PMID: 23803164 DOI: 10.3109/13685538.2013.807426] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was designed to evaluate the effect of testosterone replacement on the fibrotic process of the detrusor bladder muscle during the normal aging process. METHODS 15 Wistar senile rats, aged between 18 and 20 months were divided into two groups: testosterone group - 11 animals submitted to the administration of testosterone undecanoate (50 mg/kg intramuscular), once per month; and, Control group - four animals underwent a sham procedure. At the end of eight weeks, animals from both groups were sacrificed; bladders were removed and subsequently stereologically evaluated to determine the volumetric density of collagen fibers. The success of testosterone administration was confirmed by the measurement of serum testosterone at the beginning and end of the experiment. RESULTS In the replacement group, testosterone average was 3.2 ng/ml, whereas in the control group, the mean testosterone at the end of the experiment was 0.64 ng/ml (p < 0.05). Analysis of stereological collagenous fiber showed higher density in the control group compared to the testosterone group I (56% versus 37.02%, respectively). The difference of volume concentration of collagen between both groups was statistically significant (p < 0.000). CONCLUSION Bladder wall fibrosis was reduced in senile rats subjected to testosterone replacement.
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Wada N, Kita M, Hashizume K, Matsumoto S, Kakizaki H. Urodynamic effects of dutasteride add-on therapy to alpha-adrenergic antagonist for patients with benign prostatic enlargement: Prospective pressure-flow study. Neurourol Urodyn 2013; 32:1123-7. [DOI: 10.1002/nau.22349] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/08/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
| | - Masafumi Kita
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
| | - Kazumi Hashizume
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
| | - Seiji Matsumoto
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery; Asahikawa Medical University; Asahikawa Japan
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Chuang SM, Liu KM, Lee YC, Lin RJ, Chang CY, Wu WJ, Chang WC, Levin RM, Juan YS. Effects of supraphysiological testosterone treatment and orchiectomy on ischemia/reperfusion-induced bladder dysfunction in male rabbits. J Sex Med 2013; 10:1278-90. [PMID: 23445432 DOI: 10.1111/jsm.12104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The roles of testosterone and orchiectomy on male bladder subjected to ischemic/reperfusion (I/R) injuries received little attention. To fill this gap, the present study intended to examine testosterone and orchiectomy effects on male rabbits subjected to I/R damages. AIM To elucidate the effects of testosterone and orchiectomy on contractile response, bladder morphology, interstitial fibrosis, and oxidative stress in male rabbit bladder subjected to I/R surgery. METHODS Male New Zealand rabbits were distributed into five groups as follows: Group 1 received sham surgical procedure. In group 2, I/R surgery was performed. In group 3, testosterone (100 μg/kg/day) was intramuscularly injected prior to I/R surgery. In group 4, orchiectomy was performed prior to I/R surgery. In group 5, orchiectomy was performed with subsequent testosterone administration, followed by I/R surgery. All the rabbits were euthanized 7 days after I/R. Comparative studies were analyzed to elucidate the effects of testosterone and orchiectomy on bladder dysfunction subjected to I/R injuries. MAIN OUTCOME MEASURES Bladder contractile function was evaluated. Masson's trichrome staining and immunohistochemical studies were performed to evaluate bladder morphology and intramural nerve terminals. Western blotting was examined to investigate the expressions of fibrosis and oxidative stress markers. RESULTS I/R surgery significantly decreased bladder contractility in response to various stimulations with and without testosterone treatment. I/R damages decreased bladder nerve density with and without testosterone. The expressions of fibrosis and oxidative stress-related proteins were increased by I/R injuries with or without testosterone treatment. Testosterone depletion significantly decreased the expressions of transforming growth factor-β and fibronectin expressions after I/R injury. Supraphysiological testosterone treatment after orchiectomy greatly increased the expressions of these fibrosis proteins; however, orchiectomy alone ameliorated I/R injuries. CONCLUSIONS Testosterone treatment or orchiectomy affected I/R-induced bladder damages in male rabbits. Orchiectomy decreased the level of fibrosis and oxidative stress markers and increased neurofilament densities. Supraphysiological exogenous testosterone administration after orchiectomy further exacerbated such detrimental effects of I/R.
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Affiliation(s)
- Shu-Mien Chuang
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
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Lorenzetti F, Pintarelli VL, Seraphim DCC, Dambros M. Low testosterone levels induce apoptosis via active 3-caspase dependent signaling in the bladder wall of male rats. Aging Male 2012; 15:216-9. [PMID: 22967305 DOI: 10.3109/13685538.2012.716876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The bladder can be considered a target organ for testosterone action, and low testosterone levels possibly cause damage to bladder cells. We set out to study whether hypoandrogenism influences bladder wall cell damage in castrated and senile male rats. METHODS Thirty male Wistar rats were divided into three groups of 10 animals each: group I (3 months old), sham animals; group II (27 months old), senile animals; group III (3 months old), subjected to bilateral orchiectomy, and sacrificed 8 weeks after the procedure. Bladders were excised, weighed and sent for analysis. Stereological assays on collagen fibers and immunohistochemical analysis with active 3-caspase were performed on bladder cells. RESULTS Bladder weights were greater in the senile group than in the others. Stereological collagen fiber analysis demonstrated higher density in group III than in groups I and II (p < 0.05). The absolute density was 4.15 mm(3) in group I, 22.3 mm(3) in group II and 19.3 mm(3) in group III. Semiquantitative active 3-caspase analysis showed greater percentages in the senile group II than in groups I and III. CONCLUSIONS We can state that low plasma testosterone levels are related to higher collagen fiber density and active 3-caspase percentages in the bladder walls of orchiectomized and senile rats, respectively.
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Affiliation(s)
- Fábio Lorenzetti
- Department of Geriatric Urology, Federal University of São Paulo, São Paulo, SP, Brazil
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Lunenfeld B, Arver S, Moncada I, Rees DA, Schulte HM. How to help the aging male? Current approaches to hypogonadism in primary care. Aging Male 2012; 15:187-97. [PMID: 23067307 DOI: 10.3109/13685538.2012.729110] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Hypogonadism is a common condition which occurs more frequently in older men. It is characterized by low testosterone (T) and is associated with symptoms which are often nonspecific. A key symptom is low libido, but it can also be associated with erectile dysfunction, reduced muscle mass and strength, increased body fat, reduced bone mineral density and osteoporosis, reduced vitality, and depressed mood. Hypogonadism is linked with a variety of comorbid conditions including erectile dysfunction, metabolic syndrome, diabetes, obesity, and osteoporosis. However, the condition is often underdiagnosed. T supplementation in hypogonadism is associated with a range of benefits including improved sexual function, increased lean body mass and/or reduced fat mass, and improved bone mineral density. A variety of T supplementation formulations are available. Although there is no evidence of increased risk of initiating prostate cancer with T supplementation, it is contraindicated in men with prostate cancer. It is important that primary care physicians are aware of both the signs and symptoms of hypogonadism, the monitoring and testing that is required and the merits and advantages of the various T preparations to ensure optimal management of the condition with a treatment approach that best suits patients' needs.
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Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar Ilan University, Ramat Gan, Israel.
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Horstmann M, Foerster B, Brader N, John H, Maake C. Establishment of a protocol for large-scale gene expression analyses of laser capture microdissected bladder tissue. World J Urol 2012; 30:853-9. [PMID: 22638977 DOI: 10.1007/s00345-012-0881-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/26/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) can be caused by structural and functional changes in different compartments of the bladder. To enable extensive investigations of individual regions even in small bladder biopsies, we established a combination protocol consisting of three molecular techniques: laser capture microdissection microscopy (LCM), RNA preamplification and quantitative polymerase chain reaction (qPCR). METHODS Urinary bladders of ten mice were resected and frozen immediately or after a delay of 15 min. Cryosections were obtained and smooth muscle was isolated using the LCM technique. Then, RNA was extracted, including protocols with and without DNase digestion as well as with and without the addition of carrier RNA. Extracted RNA was either used for reverse transcriptase (RT)-PCR plus qPCR or for a combination of RNA preamplification and qPCR. RESULTS Our data showed that with RNA preamplification, 10 μg cDNA can be regularly generated from 2.5 ng RNA. Depending on expression levels, this is sufficient for hundreds of pPCR reactions. The efficiency of preamplification, however, was gene-dependent. DNase digestion before preamplification lead to lower threshold cycles in qPCR. The use of partly degraded RNA for RNA preamplification did not change the results of the following qPCR. CONCLUSIONS RNA preamplification strongly enlarges the spectrum of genes to be analyzed in distinct bladder compartments by qPCR. It is an easy and reliable method that can be realized with standard laboratory equipment. Our protocol may lead in near future to a better understanding of the pathomechanisms in LUTS.
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Affiliation(s)
- M Horstmann
- Department of Urology, Kantonsspital Winterthur, Brauerstr. 15, 8401 Winterthur, Switzerland.
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Li Y, Izumi K, Miyamoto H. The role of the androgen receptor in the development and progression of bladder cancer. Jpn J Clin Oncol 2012; 42:569-77. [PMID: 22593639 DOI: 10.1093/jjco/hys072] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Men are at a higher risk of developing bladder cancer than women. Since bladder cancer cell lines and tissues were found to express the androgen receptor, efforts have been made to inspect whether androgen-mediated androgen receptor signals are implicated in bladder carcinogenesis as well as cancer progression. Mounting evidence supports the view that bladder cancer is a member of the endocrine-related tumors and may clearly explain the gender-specific difference in the incidence. However, the underlying mechanisms of how androgen receptor signals regulate bladder cancer growth are still far from fully characterized. Moreover, it remains controversial whether the androgen receptor pathway always plays a dominant role in bladder cancer progression. In this review, we summarize the available data on the involvement of androgen receptor signaling in bladder cancer. In particular, current evidence demonstrating the stimulatory effects of androgens on tumor progression or, more convincingly, tumorigenesis via the androgen receptor pathway may offer great potential for androgen deprivation as a therapeutic or chemopreventive option in patients with bladder cancer.
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Affiliation(s)
- Yi Li
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 626, Rochester, NY 14642, USA
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Alcohol Consumption Shows a J-Shaped Association With Lower Urinary Tract Symptoms in the General Screening Population. J Urol 2012; 187:1312-7. [DOI: 10.1016/j.juro.2011.11.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Indexed: 11/17/2022]
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Liao CH, Chiang HS, Yu HJ. Serum testosterone levels significantly correlate with nocturia in men aged 40-79 years. Urology 2011; 78:631-5. [PMID: 21782223 DOI: 10.1016/j.urology.2011.05.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 05/22/2011] [Accepted: 05/24/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the association between serum sex hormone levels and lower urinary tract symptoms in men aged 40-79 years. METHODS A cross-sectional study was conducted in 509 men (mean age 58 years). The serum total testosterone (TT), dihydrotestosterone, and estradiol levels were measured. The total prostate volume measured by transrectal ultrasonography and International Prostate Symptom Score (IPSS) questionnaire were obtained. Correlations were determined using univariate and multivariate regression analysis. RESULTS The subjects with moderate to severe lower urinary tract symptoms (total IPSS≥8) were older, with a greater incidence of hypertension and diabetes, a larger prostate, and had lower serum TT levels. On the univariate analysis, the serum TT levels were negatively associated with the total IPSS, IPSS storage subscore, weak stream, and nocturia. After adjusting for age, hypertension, diabetes, and total prostate volume, only the serum TT level was significantly associated with nocturia (>2 times/night; P=.042), and men with serum TT levels in the greatest quartile had a 44% reduced risk of nocturia than in the lowest quartile (P=.037). CONCLUSION In our relative healthy male cohort, most IPSS items showed no significant association with serum sex hormone levels, except for nocturia, which showed a negative correlation with the serum testosterone level.
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Affiliation(s)
- Chun-Hou Liao
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, and Graduate Institute of Basic Medicine, Fu Jen Catholic University College of Medicine, Taipei, Taiwan
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Orabi H, Albersen M, Lue TF. Association of lower urinary tract symptoms and erectile dysfunction: pathophysiological aspects and implications for clinical management. Int J Impot Res 2011; 23:99-108. [PMID: 21593760 DOI: 10.1038/ijir.2011.14] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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St Sauver JL, Jacobson DJ, McGree ME, Girman CJ, Klee GG, Lieber MM, Jacobsen SJ. Associations between longitudinal changes in serum estrogen, testosterone, and bioavailable testosterone and changes in benign urologic outcomes. Am J Epidemiol 2011; 173:787-96. [PMID: 21367876 DOI: 10.1093/aje/kwq438] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Some men have rapid increases in benign prostatic enlargement and lower urinary tract symptoms (LUTS), and it is not clear how sex steroid hormones contribute to the rates of change in these urologic outcomes. Therefore, the authors conducted a population-based cohort study of 648 men residing in Olmsted County, Minnesota, from 1990 to 2007, to examine associations between baseline sex steroid hormones, the rate of change in these hormones, and the rates of change in LUTS, maximum urinary flow rate, and prostate volume. Annual changes in hormone levels and urologic outcomes were calculated using mixed-effects regression models. Associations between hormone variables and rates of change in urologic outcomes were assessed with linear regression models. Higher baseline estradiol levels and rapid declines in estradiol over time were associated with rapid increases in LUTS and rapid decreases in maximum flow rate. Lower baseline bioavailable testosterone levels and more rapid declines in bioavailable testosterone were associated with more rapid increases in prostate volume. These results suggest that both absolute sex steroid hormone levels and the rates at which the levels change may be important in the development of urologic conditions in aging men.
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Affiliation(s)
- Jennifer L St Sauver
- Division of Epidemiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Amano T, Imao T, Takemae K, Iwamoto T, Nakanome M. Testosterone replacement therapy by testosterone ointment relieves lower urinary tract symptoms in late onset hypogonadism patients. Aging Male 2010; 13:242-6. [PMID: 20795793 DOI: 10.3109/13685538.2010.487552] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Patients with late onset hypogonadism (LOH) also suffered from lower urinary tract symptoms (LUTS) and LOH symptoms. The objects of this study are to evaluate the efficacy of testosterone replace therapy (TRT) by testosterone ointment (Glowmin: GL) for LUTS in LOH patients. METHODS The Aging Male Symptom (AMS) scale, Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36), International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) were obtained from patients with LOH. A total of 41 patients with LOH have been treated with TRT using 6 mg/day of GL for 3 months. Serum free testosterone levels (FT) and these four scores were compared before and after TRT. RESULTS Serum FT levels and the scores for the four parameters of AMS, six of eight domains in SF-36, IIEF-5 and total IPSS improved significantly after 3 months TRT. In addition, all IPSS domains also improved significantly, and voiding disturbance seems to have improved more than storage disturbance (P = 0.0280 vs. 0.0483). CONCLUSION TRT by administration of GL is considered to be effective in the improvement of not only ED and LOH symptoms, but also LUTS (especially voiding disturbance) of patients with LOH.
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Affiliation(s)
- Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan.
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Chavalmane AK, Comeglio P, Morelli A, Filippi S, Fibbi B, Vignozzi L, Sarchielli E, Marchetta M, Failli P, Sandner P, Saad F, Gacci M, Vannelli GB, Maggi M. Sex Steroid Receptors in Male Human Bladder: Expression and Biological Function. J Sex Med 2010; 7:2698-713. [DOI: 10.1111/j.1743-6109.2010.01811.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Ludwig L, Seraphim D, Lorenzetti F, Bertolla RP, Ortiz V, Dambros M. Inhibitory activity of α-tocopherol on apoptosis in the rat bladder wall subjected to androgen deprivation. Neurourol Urodyn 2010; 30:194-8. [PMID: 20665547 DOI: 10.1002/nau.20857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 10/26/2009] [Indexed: 11/06/2022]
Abstract
Alpha-tocopherol (2,5,7,8-tetramethyl-2-(4,8,12-trimethyltridecyl)-chromon-8-ol) is used in many previous urological studies. Thus to add to this knowledge in this study we studied the potential inhibitory activity on oxidative stress and process apoptosis on bladder wall in male rats subjected to androgen deprivation. A causal relationship between lower testosterone levels and apoptosis, as a component of castration-induced muscle atrophy, has been shown. Male Wistar rats (250-300 g) were used in this experiment, divided into four groups: control (sham operation; n=10); castration (n=10); castration, with alpha-tocopherol supplementation over preceding four weeks (n=10); and castration, with alpha-tocopherol supplementation over preceding four weeks and subsequent eight weeks (n=10). Activated caspase-3 was detected using a previously described technique, with analysis using stereological methodology. Nonparametric methods were used to test statistical significance, taking a significance level of P<0.005. This study was approved by the ethics committee of the university where the project was developed. The serum testosterone concentrations before castration were less than 20 pg/ml. Analysis of 8-isoprostane showed statistical significance (P<0.0003). The volumetric density of caspase-3 showed significant differences between the groups. There was no statistical significance regarding caspase-3 between sham and alpha-tocopherol plus castration or between the groups that received alpha-tocopherol supplementation. The observations showed that there was greater apoptosis in the group with castration alone than in the groups with alpha-tocopherol supplementation. This finding, together with the induced androgen deprivation and higher 8-isoprostane levels, corroborates the hypothesis that alpha-tocopherol supplementation has an important protective effect under conditions of oxidative stress, thereby avoiding the apoptotic process, especially regarding aging.
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Affiliation(s)
- Luana Ludwig
- Division of Geriatric Urology, Federal University of São Paulo, São Paulo, Brazil
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