Beyond the lower urinary tract: the association of urologic and sexual symptoms with common illnesses

Effective Interventions for Idiopathic Chronic Pelvic Pain: A Systematic Review

BACKGROUND

Chronic pelvic pain (CPP) in women is a debilitating condition with symptoms that affect both medical and psychological systems, yet for those with idiopathic CPP (i.e., those without a known physiologic cause), no consensus for intervention exists.

AIM

A systematic review was conducted to identify the effectiveness of current biomedical, psychosocial, and integrative interventions for idiopathic CPP (ICPP).

METHOD

Five databases (PubMed, CINAHL, Cochrane, PsycInfo, Web of Science) were systematically searched with multiple keywords for publications from 2008-2022. Articles were coded for sample characteristics, research design, type of intervention, and intervention outcomes.

RESULTS

Nineteen studies met criteria. The majority of the interventions (14 studies) were biomedical, either invasive (e.g., injections), or non-invasive (e.g., medications). Five studies evaluated integrative interventions that combined biomedical and psychosocial components (e.g., a multimodal pain treatment center). Invasive biomedical interventions were better at relieving short-term pain and non-invasive biomedical interventions were superior for long-term pain; integrated interventions reduced both short-term and long-term pain. Integrative interventions also improved mental health, sexual health, and QOL.

CONCLUSION

Although most interventions for ICPP have been biomedical, integrative interventions showed greater outcome effectiveness, suggesting a focus on integrative interventions in the future.

Do men adapt to lower urinary tract symptoms? An 11-year longitudinal study of male urinary urgency and associated bother

OBJECTIVE

The study objective is to evaluate prognosis and predictors of bother caused by urinary urgency among middle-aged and older men.

MATERIAL AND METHODS

A population-based sample of men born in 1974, 1964, 1954, 1944, 1934 and 1924 was followed-up from 2004 to 2015. The course of urgency and associated bother was evaluated with the Danish Prostatic Symptom Score at baseline and follow-up. Logistic regression was utilized to explore risk factors of increased bother at follow-up.

RESULTS

A total of 2,480 men (39%) who had responded at baseline and follow-up were included in the study. Of them, 1,056 men (43%) had persistent mild urgency and 132 men (5%) persistent moderate or severe urgency at follow-up. The proportions of men experiencing at least moderate bother due to persistent urgency at follow-up were 6% (95% confidence interval 4.5-7.3) of those with mild and 79% (71.7-85.9) of the men with moderate or severe urgency. In multivariable-adjusted logistic regression, moderate to severe urgency was strongly associated with bother (odds ratio, OR 55.2, 95% CI 32.1-95.2). Other predictors of bother included cardiac disease (OR 1.8, 95% CI 1.0-31.1), pulmonary disease (OR 1.9, 95% CI 1.1-3.5) and medical treatment (OR 2.7, 95% CI 1.6-4.6).

CONCLUSIONS

Most men with urinary urgency have mild symptoms and bother. Only one out of five men with persistent moderate or severe urgency adapt to the symptoms. Men with a history of medical treatment for lower urinary tract symptoms (LUTS) or impaired cardiopulmonary health are more likely to experience bother from urinary urgency.

Urologic complications in diabetes

Urologic complications such as bladder and sexual dysfunction among men and women with diabetes have received relatively little attention. This is despite emerging evidence that demonstrates that urologic complications increase with age in the general population and are more common in individuals with diabetes compared to those without diabetes. Here we summarize the latest information about the epidemiology of urologic complications in the setting of diabetes and the most recent findings regarding pathophysiology. In addition, we identify knowledge gaps and need for future funding to address these gaps that will reduce the burden of urologic complications in diabetes and optimize quality of life for all individuals affected by it.

Depression increases the risk of kidney stone: Results from the National Health and Nutrition Examination Survey 2007-2018 and Mendelian randomization analysis

BACKGROUND

To investigate whether depression increases the kidney stone risk.

METHODS

First, we performed an observational study in the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Depression severity was evaluated using the Patient Health Questionnaire-9 (PHQ-9) and classified into no, mild, moderate, and severe depression groups. Multivariable-adjusted logistic regression was used to assess the correlation between depression severity and kidney stone risk. Second, Mendelian randomization (MR) was applied to decrease the bias and avoid the reverse causality in the observational study. Genetic instruments were obtained from a large genome-wide association study (GWAS) meta-analysis of depression involved 246,363 cases and 561,190 controls. We obtained summary data for kidney stone from another large GWAS, which integrates data from 6536 stone formers and 388,508 controls. Inverse variance weighted (IVW) was the primary analytical method.

RESULTS

In the observational study, a total of 24,892 individuals were enrolled. Individuals with moderate (OR 1.38, 95 % CI 1.05-1.83, P = 0.022) and severe (OR 1.56, 95 % CI 1.02-2.40, P = 0.040) depression had a higher risk of kidney stone (P for trend = 0.006) compared with the control. For the MR, results also showed that genetically predicted depression was causally associated with a higher risk of kidney stone disease (OR 1.26, 95 % CI 1.04-1.53, P = 0.017) in IVW.

CONCLUSIONS

Depression might be associated with kidney stone risk. This finding is needed to be verified in further prospective cohort studies with a large sample size and enough follow-up time.

Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases

Aging and major chronic diseases are risk factors for lower urinary tract symptoms (LUTS). On the other hand, oxidative stress (OS) is one of the fundamental mechanisms of aging and the development of chronic diseases. Therefore, OS might be a candidate mechanism linking these two clinical entities. This article aims to summarize the studies on the prevalence of LUTS, the role of OS in aging and chronic diseases, and the potential mechanisms supporting the putative link. A comprehensive literature search was performed to identify recent reports investigating LUTS and OS in major chronic diseases. In addition, studies on the impact of OS on the lower urinary tract, including bladder, urethra, and prostate, were collected and summarized. Many studies showed LUTS are prevalent in aging and major chronic diseases, including obesity, metabolic syndrome, diabetes, cardiovascular disease, hypertension, obstructive sleep apnea, autoimmune diseases, Alzheimer’s disease, and Parkinson’s disease. At the same time, OS is a key component in the pathogenesis of those chronic diseases and conditions. Recent studies also provided evidence that exacerbated OS can cause functional and/or structural changes in the bladder, urethra, and prostate, leading to LUTS. The reviewed data support the concept that OS is involved in multiple risk factors-associated LUTS, although further studies are needed to confirm the causative relationship. The specific ROS/RNS and corresponding reactions/pathways involved in chronic diseases and associated LUTS should be identified in the future and could serve as therapeutic targets.

Management of chronic primary pelvic pain syndromes

Management of chronic pelvic pain (CPP) remains a huge challenge for care providers and a major burden for healthcare systems. Treating chronic pain that has no obvious cause warrants an understanding of the difficulties in managing these conditions. Chronic pain has recently been accepted as a disease in its own right by the World Health Organization, with chronic pain without obvious cause being classified as chronic primary pain. Despite innumerable treatments that have been proposed and tried to date for CPP, unimodal therapeutic options are mostly unsuccessful, especially in unselected individuals. In contrast, individualised multimodal management of CPP seems the most promising approach and may lead to an acceptable situation for a large proportion of patients. In the present review, the interdisciplinary and interprofessional European Association of Urology Chronic Pelvic Pain Guideline Group gives a contemporary overview of the most important concepts to successfully diagnose and treat this challenging disease.

Physical activity effects on bladder dysfunction in an obese and insulin-resistant murine model

Objective

To investigate the role of physical activity in functional and molecular bladder alterations in an obese and insulin‐resistant murine model.

Methods

Wistar rats were randomized into 1. physical activity and standard diet; 2. physical activity and high‐fat diet; 3. no physical activity and standard diet; and 4. no physical activity and high‐fat diet. Groups 1 and 2 were subjected to a 10‐week swimming protocol. Urodynamic study (UDS) was performed, and the expression of genes in the bladder tissue related to the insulin pathway (IRS1/IRS2/PI3K/AKT/eNOS) was assessed using quantitative real‐time polymerase chain reaction.

Results

Groups 1 and 2 presented lower body weight gains than groups 3 (213.89 ± 13.77 vs 261.63 ± 34.20 grams (g), p = 0.04) and 4 (209.84 ± 27.40 vs 257.57 ± 32.95 g, p = 0.04), respectively. Group 4 had higher insulin level (6.05 ± 1.79 vs 4.14 ± 1.14 ng/ml, p = 0.038) and higher homeostasis model assessment of insulin resistance (HOMA‐IR) index (1.95 ± 0.73 vs 1.09 ± 0.37, p = 0.006) than group 1. On UDS, group 4 had greater number of micturition (13.6 ± 4.21 vs 6.0 ± 1.82, p = 0.04), higher postvoid pressure (8.06 ± 2.24 vs 5.08 ± 1.23, p = 0.04), lower capacity (0.29 ± 0.18 vs 0.91 ± 0.41 ml, p = 0.008), and lower bladder compliance (0.027 ± 0.014 vs 0.091 ± 0.034 ml/mmHg, p = 0.016) versus group 1. High‐fat diet was related to an underexpression throughout insulin signaling pathway, and physical activity was related to an overexpression of the pathway.

Conclusions

The insulin signaling pathway may be involved in the pathogenesis of bladder dysfunction related to a high‐fat diet. Physical activity may help to prevent bladder disfunction induced by a high‐fat diet through the insulin pathway.

Is There a Link Between Carotid Atherosclerosis and Idiopathic Overactive Bladder Among Women with Metabolic Syndrome?

Purpose

To evaluate the association between increased intima-media thickness (IMT) and atherosclerotic carotid plaque (CP) with idiopathic overactive bladder syndrome (OAB) in women with metabolic syndrome (MetS).

Methods

This is a cross-sectional study, which included consecutive women aged 40–75 years with MetS, seeking medical assistance at a reference center between April and December 2016. OAB-V8 questionnaire was used to estimate the prevalence of OAB symptoms, which were defined by a score ≥8 points. All patients underwent bilateral carotid artery ultrasound to assess IMT and CP. Atherosclerosis was defined by the identification of CP during ultrasound, which was diagnosed according to the Mannheim carotid intima-media thickness and plaque consensus.

Results

Forty-five women were prospectively included. Mean age was 60±9.3 years (range 40–75 ys). Eighteen (40%) patients were diagnosed with OAB. IMT in the general population was 0.72 mm (SD = 0.20). Overall prevalence of atherosclerosis, defined by the presence of the carotid artery plaque, was 51%. OAB prevalence among women with atherosclerosis was higher than in those without atherosclerosis (56.52% versus 22.73%), with a prevalence ratio of 2.49 (p=0.04). Additionally, OAB was associated with degree of carotid stenosis (p = 0.029).

Conclusion

In this cohort of female patients with MetS, there was an association between carotid atherosclerosis and OAB. Identification of carotid ultrasound abnormalities may lead to refined treatment decision-making among OAB patients.

The association of depression with lower urinary tract symptoms: data from the National Health and Nutrition Examination Survey, 2005-2008

BACKGROUND

To identify the factors associated with lower urinary tract symptoms (LUTS), we investigated associations between psychological factors, including depression and sleep disorders, and LUTS using the National Health and Nutrition Examination Survey (NHANES) database.

MATERIALS AND METHODS

The NHANES database was examined for the period of 2005 to 2008. Men older than 40 years, who had completed questionnaires surveying their kidney/urologic, prostate, mental health, and sleep conditions were included in this study. LUTS was defined as the presence of two or more of the following symptoms: incomplete emptying, urinary hesitancy, urinary frequency, and nocturia. Multivariable models using logistic regression were used to compare groups of men with or without LUTS.

RESULTS

Of 1,820 participants, 110 (6.1%) men reported depression, and 235 (12.9%) presented with LUTS. Men with LUTS were older and had a significantly higher prevalence of depression and unemployment. Sleep disorder was not associated with LUTS. Multivariable logistic regression models demonstrated that men reporting moderate depression had the highest age-adjusted odds (odds ratio = 5.89, 95% CI [3.44-10.11]; p < 0.001) of reporting clinical LUTS.

CONCLUSIONS

A significant association was observed between LUTS and depression, and between LUTS and employment status. Although the pathophysiology of these relationships is unclear, physicians should consider multi-disciplinary evaluation and treatment approaches for LUTS.

Longitudinal study of the relationship between lower urinary tract symptoms and depressive symptoms

OBJECTIVE

To analyze the longitudinal association between lower urinary tract symptoms (LUTS) and the development of incident depressive symptoms in Korean men.

METHODS

This study initially recruited 16,155 Korean men who underwent routine health examinations between 2005 and 2012, and completed the International Prostate Symptom Score (IPSS) screening tool and Beck Depression Inventory-1 (BDI). The final study population included 9080 men, aged 15-89, who had a baseline BDI score < 10 and follow-up BDI data, with no history of depression, bladder or prostate operations. Cox proportional hazard models were used to assess the relationship between LUTS and the development of incident depressive symptoms. Multiple imputation was used to handle missing values.

RESULTS

After adjusting for significant covariates, LUTS were associated longitudinally with the development of incident depressive symptoms (hazard ratio [HR] = 1.81 [95% confidence interval [CI] = 1.26-2.61]). An analysis of the specific domains of LUTS revealed that voiding LUTS (HR = 1.58 [95% CI = 1.07-2.33]), but not storage LUTS (HR = 1.43 [95% CI = 0.96-2.13]), were associated longitudinally with depressive symptoms.

CONCLUSION

LUTS and voiding LUTS, but not storage LUTS, were associated longitudinally with incident depressive symptoms.

Overactive Bladder is a Distress Symptom in Heart Failure

The prevalence of Heart failure (HF) is expected to increase worldwide with the aging population trend. The numerous symptoms of and repeated hospitalizations for HF negatively affect the patient’s quality of life and increase the patient’s economic burden. Up to 50% of patients with HF suffer from urinary incontinence (UI) and an overactive bladder (OAB). However, there are limited data about the relationship between UI, OAB, and HF. The association between HF and urinary symptoms may be directly attributable to worsening HF pathophysiology. A comprehensive literature review was conducted for all publications between January 2000 and November 2017 using the PubMed, Embase, and Cochrane databases. HF represents a major and growing public health problem, with an increased risk of UI and an OAB as comorbidities. Possible effects of HF on urinary problems may be mediated by the prescription of medications for symptomatic relief. Although diuretics are typically used to relieve congestion, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improve survival, these classes of drugs have been suggested to worsen urinary symptoms in the presence of HF. Further research is required to understand the impact of UI and an OAB on the HF illness trajectory.

Impacto de la Prostatectomía en Síntomas Depresivos en pacientes con Hipertrofia Prostática Benigna

Introducción: La hiperplasia prostática benigna (HPB) es una enfermedad caracterizada por síntomas del tracto urinario inferior (1). Estos síntomas suelen causar un impacto negativo en la calidad de vida del paciente llevándolo a padecer trastornos depresivos (7). Se han encontrado síntomas depresivos hasta en el 22.5% de los pacientes con HPB sin embargo, hay poca evidencia de que estos síntomas disminuyan luego de tratar la HPB (5). Una herramienta útil para medir los síntomas depresivos es la Escala de Medición de Depresión de Hamilton (3). Objetivos: Este estudio pretende evaluar la presencia de síntomas depresivos en pacientes con HPB y comprobar si estos síntomas disminuyen posteriormente al tratamiento quirúrgico para HPB. Métodos. Se utilizó un muestra de 30 pacientes, edad (promedio 67 ± 8 años), sometidos a tratamiento quirúrgico para HPB y quienes presentaran por lo menos un síntoma depresivo según la escala de medición de depresión de Hamilton. Resultados. Todos tuvieron resección transuretral de próstata (RTUP). Previo a la cirugía se encontraron síntomas depresivos en el 76%. Un mes posterior a la cirugía se encontraron síntomas depresivos en 28, sin embargo, se encontró depresión leve en el 23.3% (vs pre op 30%), depresión moderada en el 16.6% (vs pre op 30%) y depresión severa en el 13.3% (vs pre-op 16.6%). La Escala de Medición de Depresión de Hamilton tuvo una puntuación media preoperatoria de 13.93 puntos. Un mes posterior a la cirugía la puntuación media fue de 9.36 puntos. La diferencia fue de 4.56 puntos, lo cual es estadísticamente significativo (P=0.05). Hubo complicaciones quirúrgicas en 3 pacientes quienes tuvieron un aumento en el puntaje postoperatorio y hubo aumento del nivel de depresión. En el estudio 15 refirieron disfunción eréctil previo a la cirugía y únicamente 8 persistieron con disfunción luego de la cirugía. Conclusiones. Los pacientes con HBP constituyen una población en riesgo de padecer  síntomas depresivos. Los síntomas depresivos están relacionados con padecer STUI y disfunción eréctil; ambas condiciones afectan la calidad de vida. El tratamiento quirúrgico para tratar la HPB es efectivo en disminuir los síntomas depresivos mejorando la calidad de vida causando mínimos efectos negativos.

Perceived Sexual Difficulties and Sexual Counseling in Men and Women Across Heart Diagnoses: A Nationwide Cross-Sectional Study

BACKGROUND

Ischemic heart disease and heart failure often lead to sexual difficulties in men, but little is known about the sexual difficulties in women and patients with other heart diagnoses or the level of information patients receive about the risk of sexual difficulties.

AIM

To investigate perceived sexual difficulties and associated factors in a mixed population of men and women newly diagnosed with heart disease and provide insight into sexual counseling and information given by health care professionals.

METHODS

This article reports on a cross-sectional, questionnaire study sent to a randomly selected sample of men and women newly diagnosed with heart failure, ischemic heart disease, atrial fibrillation, or heart valve surgery. Eligible patients were identified by diagnosis using the Danish National Patient Register, which contains all diagnoses.

OUTCOMES

Sexual difficulties were self-reported using single-item questions, and factors associated with sexual difficulties were collected from the survey and national registers.

RESULTS

The study population consisted of 1,549 men and 807 women (35-98 years old) with heart failure (n = 243), ischemic heart disease (n = 1,036), heart valve surgery (n = 375), and atrial fibrillation (n = 702). Sexual difficulties were reported by 55% of men and 29% of women. In a multiple regression analysis, difficulties in men were associated with being older (≥75 years old; odds ratio [OR] = 1.97, 95% CI = 1.13-3.43), having heart failure (OR = 2.07, 95% CI = 1.16-3.71), diabetes (OR = 1.80, 95% CI = 1.15-2.82), hypertension (OR = 1.43, 95% CI = 1.06-1.93), receiving β-blockers (OR = 1.37, 95% CI = 1.02-1.86), or having anxiety (OR = 2.25, 95% CI = 1.34-3.80) or depression (OR = 2.74, 95% CI = 1.38-5.43). In women, difficulties were significantly associated with anxiety (OR = 3.00, 95% CI = 1.51-5.95). A total of 48.6% of men and 58.8% of women did not feel informed about sexuality, and 18.1% of men and 10.3% of women were offered sexual counseling.

CLINICAL IMPLICATIONS

Heart disease increases the risk of sexual difficulties and there is a need for improved information and counseling about sex and relationships for patients.

STRENGTHS AND LIMITATIONS

This large nationwide survey of men and women combined a survey with administrative data from national registries. However, this study used non-validated single-item questions to assess sexual difficulties without addressing sexual distress.

CONCLUSION

More than half the men and one fourth the women across common heart diagnoses had sexual difficulties. No difference was found among diagnoses, except heart failure in men. Despite guidelines recommending sexual counseling, sexual difficulties were not met by sufficient information and counseling. Rundblad L, Zwisler AD, Johansen PP, et al. Perceived Sexual Difficulties and Sexual Counseling in Men and Women Across Heart Diagnoses: A Nationwide Cross-Sectional Study. J Sex Med 2017;14:785-796.

Lower urinary tract symptoms/benign prostatic hypertrophy and vascular function: Role of the nitric oxide-phosphodiesterase type 5-cyclic guanosine 3',5'-monophosphate pathway

It is well known that there is an association of lower urinary tract symptoms/benign prostatic hypertrophy with cardiovascular disease, suggesting that lower urinary tract symptoms/benign prostatic hypertrophy is a risk factor for cardiovascular events. Vascular function, including endothelial function and vascular smooth muscle function, is involved in the pathogenesis, maintenance and development of atherosclerosis, leading to cardiovascular events. Vascular dysfunction per se should also contribute to lower urinary tract symptoms/benign prostatic hypertrophy. Both lower urinary tract symptoms/benign prostatic hypertrophy and vascular dysfunction have cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes mellitus, aging, obesity and smoking. Inactivation of the phosphodiesterase type 5-cyclic guanosine 3',5'-monophosphate-nitric oxide pathway causes lower urinary tract symptoms/benign prostatic hypertrophy through an enhancement of sympathetic nervous activity, endothelial dysfunction, increase in Rho-associated kinase activity and vasoconstriction, and decrease in blood flow of pelvic viscera. Both endogenous nitric oxide and exogenous nitric oxide act as vasodilators on vascular smooth muscle cells through an increase in the content of cyclic guanosine 3',5'-monophosphate, which is inactivated by phosphodiesterase type 5. In a clinical setting, phosphodiesterase type 5 inhibitors are widely used in patients with lower urinary tract symptoms/benign prostatic hypertrophy. Phosphodiesterase type 5 inhibitors might have beneficial effects on vascular function through not only inhibition of cyclic guanosine 3',5'-monophosphate degradation, but also increases in testosterone levels and nitric oxide bioavailability, increase in the number and improvement of the function of endothelial progenitor cells, and decrease in insulin resistance. In the present review, the relationships between lower urinary tract symptoms/benign prostatic hypertrophy, the phosphodiesterase type 5-nitric oxide-cyclic guanosine 3',5'-monophosphate pathway, vascular function and cardiovascular outcomes are examined.

Association between benign prostatic hyperplasia, body mass index, and metabolic syndrome in Chinese men

Previous studies have showed that men suffering from diabetes mellitus, metabolic syndrome (MetS) and obesity have a higher risk of benign prostatic hyperplasia (BPH). The present study aimed to examine the association between BPH, obesity, and features of MetS among men of the Hunan area of China. For this cross-sectional study, 904 males (aged 50–59 years) were included. MetS parameters, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA) levels, total prostate volume (TPV), postvoid residual volume (PVR) and maximum urine flow rate (Qmax) were measured. Results showed that MetS was associated with TPV (P = 0.048), PVR (P = 0.004) and IPSS (P = 0.011), but not with other indicators of BPH progression such as PSA levels or Qmax. MetS was associated with the voiding symptoms score (P < 0.05), but not with the storage symptom score. In addition, body mass index and fasting blood glucose positively correlated with TPV (r = 0.416, P < 0.001; and r = 0.310, P= 0.011, respectively). In conclusion, results suggest that MetS is associated with higher prostatic volume, prostate symptom score and voiding symptoms, but not with other features of prostatic hyperplasia such as PSA levels or Qmax. Changes in lifestyle factors, including physical activity and prevention of MetS, might be useful to prevent BPH and its progression, but further studies are needed.

Associations between lower urinary tract dysfunction and glycemic control in women with type 2 diabetes: A cross-sectional study

AIMS

Patients with diabetes are predisposed to develop a variety of complications, including lower urinary tract (LUT) dysfunction. We aimed to examine the associations between glycemic control and LUT dysfunction in women with type 2 diabetes (T2D).

METHODS

We included 400 women with T2D (age range, 48-75 years) in this cross-sectional analysis. The participants were divided into tertiles according to glycosylated hemoglobin (HbA1c) measurements. The mean HbA1c levels for tertiles 1, 2, and 3 were 6.2% (N=132), 7.1% (N=132), and 8.4% (N=136), respectively. We evaluated LUT dysfunction with the American Urological Association Symptom Index (AUA-SI) questionnaire, uroflowmetry (UFM), and post-void residual (PVR).

RESULTS

No significant differences were found among HbA1c tertiles regarding storage, voiding and total AUA-SI scores, and prevalence of LUT symptoms. However, women in tertile 3 had higher prevalences of severe LUT symptoms (AUA-SI≥20) and clinically significant PVR (≥100mL) compared to women in the other tertiles. Multivariate analysis revealed that diabetic neuropathy, but not HbA1c, significantly predicted LUT symptoms in women with T2D after adjustment for age, body mass index (BMI) and hypertension. However, HbA1c was associated with an increased risk of developing clinically significant PVR.

CONCLUSIONS

Our findings do not support significant associations between glycemic control and LUT symptoms in women with T2D. However, women with poor glycemic control are more likely to develop urinary retention than women with proper glycemic control. Clinicians should, therefore, be aware of and educate patients about the association between urinary retention and glycemic control.

Nocturia and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: The Dogo Study

Aims/Introduction

Several epidemiological studies have reported a positive association between nocturia and erectile dysfunction (ED). Yet only limited evidence exists regarding the association between nocturia and ED among patients with type 2 diabetes mellitus, although nocturia and ED are common among type 2 diabetes mellitus patients.

Material and Methods

Study participants were 332 male Japanese patients with type 2 diabetes mellitus, aged 19–70 years, who had undergone blood tests at our institutions. A self‐administered questionnaire was used to collect information on the variables under study. Adjustment was made for age, body mass index, hypertension, stroke, ischemic heart disease, glycated hemoglobin and diabetic neuropathy. ED, moderate to severe ED and severe ED were defined as present when a participant had a Sexual Health Inventory for Men score <22, <12 and <8, respectively. Study participants were considered to have nocturia if they answered ‘once or more’ to the question: ‘Within 1 week, how many times do you typically wake up to urinate from sleeping at night until waking in the morning?’

Results

The prevalence of nocturia was 79.8%. Nocturia was independently positively associated with ED and moderate to severe ED: the adjusted odds ratios were 7.86 (95% confidence interval 2.11–33.56) and 2.17 (95% confidence interval 1.16–4.12), respectively. The positive association between nocturia and severe ED fell just short of significance.

Conclusions

In Japanese men with type 2 diabetes mellitus, nocturia might be associated with ED and moderate to severe ED.

Several epidemiological studies have reported a positive association between nocturia and erectile dysfunction (ED).

Yet only limited evidence exists regarding the association between nocturia and ED among patients with type 2 diabetes mellitus, although nocturia and ED are common among type 2 diabetes mellitus patients.

Microvascular Complications and Prevalence of Nocturia in Japanese Patients With Type 2 Diabetes Mellitus: The Dogo Study

OBJECTIVE

To evaluate the association between microvascular complications and nocturia among Japanese patients with type 2 diabetes mellitus.

METHODS

Study subjects were 731 Japanese patients with type 2 diabetes mellitus. A self-administered questionnaire was used to collect information on the variables under study. Study subjects were considered to have nocturia if they answered "once or more" to the question: "How many times do you typically wake up to urinate from sleeping at night until waking in the morning?" Diabetic neuropathy was diagnosed if the patients showed two or more of the following three characteristics: neuropathic symptoms, the absence of the Achilles reflex, or abnormal vibration perception. Diabetic nephropathy was defined as positive when the estimated glomerular filtration rate was <30 mL/min/1.73 m(2) and/or the urine albumin-to-creatinine ratio was ≥34 mg/mmol creatinine. Several ophthalmology specialists were responsible for evaluating diabetic retinopathy. Adjustment was made for sex, age, body mass index, duration of diabetes mellitus, current smoking, current drinking, hypertension, stroke, ischemic heart disease, and glycated hemoglobin.

RESULTS

The prevalence of nocturia was 80.4%. Diabetic retinopathy was independently positively associated with nocturia (adjusted odds ratio 2.39 [95% confidence interval: 1.08-6.11]). In contrast, diabetic nephropathy or diabetic neuropathy was not associated with nocturia.

CONCLUSION

In Japanese patients with type 2 diabetes mellitus, only diabetic retinopathy was independently positively associated with nocturia.

Urologic symptoms and functional neurologic disorders

The term functional urologic disorders covers a wide range of conditions related broadly to altered function rather than structure of the lower urinary tract, mainly of impaired urine voiding or storage. Confusingly, for a neurologic readership, these disorders of function may often be due to a urologic, gynecologic, or neurologic cause. However, there is a subset of functional urologic disorders where the cause remains uncertain and, in this chapter, we describe the clinical features of these disorders in turn: psychogenic urinary retention; Fowler's syndrome; paruresis (shy-bladder syndrome); dysfunctional voiding; idiopathic overactive bladder, and interstitial cystitis/bladder pain syndrome. Some of these overlap in terms of symptoms, but have become historically separated. Psychogenic urinary retention in particular has now largely been abandoned as a concept, in part because of the finding of specific urethral electromyogram findings in patients with this symptom now described as having Fowler's syndrome, and their successful treatment with sacral neurostimulation. In this chapter we review the poorly researched interface between these "idiopathic" functional urologic disorders and other functional disorders (e.g., irritable-bowel syndrome, fibromyalgia) as well as specifically functional neurologic disorders. We conclude that there may be a relationship and overlap between them and that this requires further research, especially in those idiopathic functional urologic disorders which involve disorders of the urethral sphincter (i.e., voluntary muscle).

Characteristics of urinary retention in female inpatients managed with medical treatments

Purpose

We aimed to analyze the characteristics of urinary retention (UR) in female inpatients managed with medical treatments.

Materials and Methods

We retrospectively analyzed the medical records of female inpatients referred to the department of urology for UR at our institution from January 2009, to December 2014. UR was defined as a difficulty in self-voiding despite a sufficient urine volume or >300-mL postvoid residual. The data included patients' age, body mass index (BMI), ambulatory status, medical and surgical history, classes of taking drugs, and urinary tract infection.

Results

A total of 182 women were included as retention group, mean age of 72.64±12.94 years and BMI of 22.94±3.10 kg/m². In the chi-square analysis, cardiovascular disorders (p=0.000), diabetes mellitus (p=0.008), metastatic malignancy (p=0.008), chronic renal disorders (p=0.028) were found significantly. In the multiple logistic regression analysis, cardiovascular disorders (p=0.002; odds ratio [OR], 0.491), metastatic malignancy (p=0.013; OR, 2.616) were found to increase the risk of UR. The most common surgical history was anti-incontinence surgery (7.2%). In term of medication use, the most prescribed agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (53.8%). The patients taking multiple drugs with antimuscarinic effects except of NSAIDs, narcotics and diuretics were 48 (26.4%). Urinary tract infection was identified in 43 patients (23.6%).

Conclusions

UR in females managed with medical treatments could be occurred occasionally. We think that thorough attentions are needed for UR to patients with cardiovascular disorders including diabetes mellitus, metastatic malignancy, chronic renal disorders urinary tract infection, and more careful interests when managing with drugs with antimuscarinic effects.

Metabolic syndrome does not impair the response to alfuzosin treatment in men with lower urinary tract symptoms: a double-blind, randomized, placebo-controlled study

OBJECTIVE

This study is a placebo-controlled comparison of the response to alfuzosin treatment for lower urinary tract symptoms (LUTS) in patients with and without metabolic syndrome (MetS).

MATERIAL AND METHODS

A total of 80 men with LUTS were included in the study. Patients had a maximum flow rate of <15 mL/sec, prostate volume of >20 mL, and International Prostate Symptom Score (IPSS) of >8. All eligible men (n=68) for evaluation were initially divided into two groups as MetS (n=34) and non-MetS (n=34) groups. Patients were further randomized to receive alfuzosin (10 mg/day) or placebo (n=17/group; a total of four groups). The outcome was measured at 12(th) week according to the changes from baseline in IPSS, quality of life (QoL) scores, maximum flow rate (Qmax), and postmictional residue.

RESULTS

Alfuzosin significantly improved LUTS in men with and without MetS compared with patients receiving placebo (p<0.05). Mean IPSS scores in treatment groups decreased significantly, whereas patients receiving placebo had no statistically significant difference (p>0.05). Similarly, alfuzosin treatment resulted in a significant increase in Qmax in patients with LUTS/benign prostatic enlargement when compared with patients in placebo group (p<0.05). Mean QoL scores measured by IPSS-QoL and QoL questionnaires also improved significantly in patients receiving alfuzosin for 3 months regardless of the presence of MetS (p<0.05).

CONCLUSION

Our results revealed that the presence of MetS in patients with LUTS did not impair the response to alfuzosin treatment.

Association between Menopausal Symptoms and Overactive Bladder: A Cross-Sectional Questionnaire Survey in China

Purpose

The association between menopause and overactive bladder is controversial. The purpose of this study was to determine the association between menopausal symptoms and overactive bladder, and identify the risk factors for overactive bladder.

Methods

A cross-sectional study was performed. The study included 403 women aged 36–76 years who visited the menopause clinic at Peking University First Hospital between September 2012 and December 2013. The overactive bladder symptom score and modified Kupperman index questionnaires were used. Differences were assessed using descriptive statistics to determine any association between the overactive bladder symptom score and modified Kupperman index score, and to evaluate the risk factors for overactive bladder.

Results

A total of 304 women were finally enrolled. The prevalence of overactive bladder was 9.43%, and the modified Kupperman index score; number of sexual problems; and frequency of urinary tract infections, vertigo, melancholia, and mood swings were significantly higher in patients with overactive bladder than in the patients without overactive bladder (p < 0.05). Menopausal symptoms (modified Kupperman index score ≥ 15) (odds ratio: 1.049, 95% confidence interval: 1.006–1.095, p = 0.025) and a low frequency of sexual intercourse in the last 6 months (odds ratio: 2.580, 95% confidence interval: 1.228–5.422, p = 0.012) were identified as independent risk factors for overactive bladder. The frequency of sexual intercourse was found to decrease with an increase in the severity of overactive bladder (p = 0.004, linear-by-linear association = 0.001).

Conclusion

Menopausal symptoms may be closely associated with overactive bladder, and sexual activity may be associated with the severity of overactive bladder. Moreover, sexual problems, urinary tract infections, vertigo, melancholia, and mood swings may be associated with overactive bladder.

The Impact of Lower Urinary Tract Symptoms on Quality of Life, Work Productivity, Depressive Symptoms, and Sexuality in Korean Men Aged 40 Years and Older: A Population-Based Survey

Purpose:

To examine the impact of lower urinary tract symptoms (LUTS) on health-related quality of life (HRQoL) in Korean men aged ≥40 years.

Methods:

A population-based, cross-sectional door-to-door survey was conducted among men aged ≥40 years. Individuals with LUTS were defined as men reporting at least one LUTS using 2002 International Continence Society definitions. Structuredquestionnaires were used to assess several dimensions of HRQoL, including generic health status (EuroQoL-five-dimensions questionnaire), work productivity (work productivity and activity impairment questionnaire), depressive symptoms (center for epidemiologic studies depression scale), and sexual health (sexual satisfaction and erectile dysfunction). The impact of LUTS was assessed by comparing several dimensions of HRQoL among men with and without LUTS.

Results:

Of the 1,842 participants, 1,536 (83.4%) reported having at least one LUTS. The prevalence of LUTS increased with age (78.3% among those aged 40–49 years to 89.6% among those aged 60 years or older). Those with LUTS reported a significantlylower level of generic health status and worse work productivity compared with those without LUTS. Significantly more individuals with LUTS reported having a higher level of major depressive symptoms compared with those without LUTS.Those with LUTS reported worse sexual activity and enjoyment, and were significantly more likely to have erectile dysfunction than those without LUTS.

Conclusions:

LUTS seem to have a substantial impact on several dimensions of HRQoL in Korean men aged ≥40 years.

Cardiovascular Risk Factors and Ethnicity Are Independent Factors Associated with Lower Urinary Tract Symptoms

Objectives

To determine the lower urinary tract symptoms (LUTS) profile and factors affecting its degree of severity including cardiovascular risk profile, age, ethnicity, education level and prostate volume in a multiethnic Asian setting.

Materials and Methods

We conducted a cross-sectional study of 1021 men aged 40–79 years with no clinical evidence of prostate cancer, prostate surgery or 5α-reductase inhibitor treatment of known prostate conditions. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Potential factors associated with LUTS including age, ethnicity, education, history of hypertension, diabetes and hypercholesterolemia, height, weight, and prostate volume were evaluated using univariable and multivariable analyses.

Results

There were 506 (50%) men found to have moderate-to-severe LUTS attaining an IPSS above 7. Overall, nocturia (45.5%) was the most frequently reported symptom. Multivariable analysis showed that age, ethnicity, prostate volume and history of hypertension and hypercholesterolemia were independent factors associated with severity of LUTS (p < 0.05). Considering individual lower urinary tract symptoms, we found a strong association of storage symptom with history of hypertension and hypercholesterolemia. Malay men were significantly bothered by post micturition symptom compared to their Chinese and Indian counterparts. Stratified analyses of LUTS demonstrated a mutually exclusive cardiovascular risk factors profile defined by ethnicity.

Conclusion

Severity of LUTS varies between different ethnicities across all age groups. In addition to age and prostate volume, ethnicity and cardiovascular risk factors including hypertension and hypercholesterolemia may also need to be taken into account in managing men with LUTS.

Sleep related problems and urological symptoms: testing the hypothesis of bidirectionality in a longitudinal, population based study

PURPOSE

We evaluate the bidirectional association between urological symptoms (urinary incontinence, lower urinary tract symptoms and nocturia) and sleep related variables.

MATERIALS AND METHODS

Data were obtained from a prospective cohort study of 1,610 men and 2,535 women who completed baseline (2002 to 2005) and followup (2006 to 2010) phases of the BACH (Boston Area Community Health) Survey, a population based random sample survey. Sleep restriction (5 hours or less per night), restless sleep, sleep medication use and urological symptoms were assessed by self-report. Urinary incontinence was defined as weekly leakage or moderate/severe leakage, lower urinary tract symptoms (overall, obstructive, irritative) were defined by the AUA-SI (American Urological Association symptom index) and nocturia was defined as urinary frequency 2 or more times per night.

RESULTS

At the 5-year followup 10.0%, 8.5% and 16.0% of subjects newly reported lower urinary tract symptoms, urinary incontinence and nocturia, respectively, and 24.2%, 13.3% and 11.6% newly reported poor sleep quality, sleep restriction and use of sleep medication, respectively. Controlling for confounders, the odds of urological symptoms developing were consistently increased for subjects who reported poor sleep quality and sleep restriction at baseline, but only baseline nocturia was positively associated with incident sleep related problems at followup. Body mass index, a potential mediator, reduced selected associations between sleep and incident urinary incontinence and irritative symptoms, but C-reactive protein did not.

CONCLUSIONS

These data suggest that self-reported sleep related problems and urological symptoms are linked bidirectionally, and that body mass index may be a factor in the relationship between sleep and the development of urological symptoms.

Lower urinary tract symptoms and erectile dysfunction in men with type 2 diabetes mellitus

Purpose

To assess the prevalence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) and the relationships between LUTS, ED, depression, and other factors in Korean men with type 2 diabetes mellitus (T2DM).

Methods

This cross-sectional study included 124 male patients with T2DM who attended a university hospital diabetes clinic between October 2010 and April 2012. Data were collected using structured interviews and chart reviews. LUTS were measured using the International Prostate Symptom Score (IPSS), ED using the five-item Korean version of the International Index of Erectile Function (IIEF), depression using the Center for Epidemiologic Studies Depression Scale, and glycosylated hemoglobin level from clinical data.

Results

The IPSS score was 9.2±6.6. The total IPSS scores indicated that 53.3% of the subjects had either moderate or severe symptoms. The mean IIEF score was 7.3±8.6, indicating the severity of ED to be mild, mild to moderate, moderate, and severe in 10.5%, 9.7%, 1.6%, and 66.9% of the participants, respectively. LUTS showed a significant negative correlation with ED (r=-0.26, P=0.003) and a significant positive correlation with depression (r=0.33, P<0.001). ED was negatively correlated with age (r=-0.44, P<0.001), duration of diabetes (r=-0.26, P=0.004), and depression (r=-0.24, P=0.008).

Conclusions

LUTS and ED were found to have a high prevalence among Korean men with T2DM. More severe ED was associated with worse LUTS, whereas more severe depressive symptoms were found to be associated with more severe ED and LUTS.

The association of lower urinary tract symptoms, depression and suicidal ideation: data from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey

PURPOSE

We examine the association among depression, suicidal ideation and self-reported lower urinary tract symptoms using a large, cross-sectional, population based study.

MATERIALS AND METHODS

The study included 2,890 men from the 2005-2006 or 2007-2008 cycles of the NHANES (National Health and Nutrition Examination Survey) who were 40 years old or older. Men were asked if they experienced nocturia, urinary hesitancy and/or incomplete bladder emptying. The PHQ-9 (Patient Health Questionnaire-9) was used to determine the likelihood of clinical depression and suicidal ideation.

RESULTS

The prevalence of lower urinary tract symptoms was 33.7% and 10.3% for men reporting 1 and 2 or more symptoms, respectively. Moderate to severe depression (PHQ-9 score 10 or greater) and suicidal ideation were reported by 181 (6.3%) and 105 (3.6%) men, respectively. Men reporting moderate to severe depression (compared to those reporting minimal depression) had a higher odds of reporting lower urinary tract symptoms (adjusted odds ratio [AOR] 5.09, 95% CI 3.17-8.17 for PHQ-9 score 5 to 9 and AOR 7.62, 95% CI 3.90-14.87 for PHQ-9 score 10 or greater; p trend <0.0001). More lower urinary tract symptoms were associated with a significantly higher odds of moderate to severe depression (AOR 3.09, 95% CI 1.86-5.15 for 1 symptom and AOR 8.06, 95% CI 4.18-15.53 for 2 or more symptoms, p trend <0.0001) and a higher odds of suicidal ideation (AOR 1.70, 95% CI 0.85-3.42 and AOR 2.71, 95% CI 1.40-5.25, respectively, p trend = 0.004).

CONCLUSIONS

A significant relationship was observed between lower urinary tract symptoms and depression/suicidal ideation. While the pathophysiology of the relationship and its significance in clinical practice remain unclear, clinicians may consider screening men with severe lower urinary tract symptoms for depression.

Lower urinary tract dysfunction in male Iraq and Afghanistan war veterans: association with mental health disorders: a population-based cohort study

OBJECTIVE

To determine the prevalence and correlates of lower urinary tract symptoms (LUTS) among returned Iraq and Afghanistan veterans; in particular its association with mental health diagnoses and medication use.

METHODS

We performed a retrospective cohort study of Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs health care. Mental health diagnoses were defined by International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes from medical records. LUTS was defined by ICD-9-CM code, use of prescription medication for LUTS, or procedure for LUTS. We determined the independent association of mental health diagnoses and LUTS after adjusting for sociodemographic and military service characteristics, comorbidities, and medications.

RESULTS

Of 519,189 veterans, 88% were men and the mean age was 31.8 years (standard deviation ± 9.3). The overall prevalence of LUTS was 2.2% (11,237/519,189). Veterans with post-traumatic stress disorder (PTSD) were significantly more likely to have a LUTS diagnosis, prescription, or related procedure (3.5%) compared with veterans with no mental health diagnoses (1.3%) or a mental health diagnosis other than PTSD (3.1%, P <.001). In adjusted models, LUTS was significantly more common in veterans with PTSD with and without other mental health disorders vs those without mental health disorders (adjusted relative risk [ARR] = 2.04, 95% confidence interval [CI] = 1.94-2.15) and in veterans prescribed opioids (ARR = 2.46, 95% CI = 2.36-2.56).

CONCLUSION

In this study of young returned veterans, mental health diagnoses and prescription for opioids were independently associated with increased risk of receiving a diagnosis, treatment, or procedure for LUTS. Provider awareness may improve the detection and treatment of LUTS, and improve patient care and quality of life.

Lower urinary tract symptoms (LUTS) as a risk factor for depressive symptoms in elderly men: results from a large prospective study in Southern Chinese men

A cross-sectional relationship between lower urinary tract symptoms (LUTS) and depressive symptoms was previously reported among Southern Chinese men; however, the temporal relationship was unclear. Our objective is to evaluate the temporal relationship between moderate to severe lower urinary tract symptoms and clinically significant depressive symptoms in elderly Chinese men aged 65 in a prospective manner. In a prospective cohort of 2,000 Chinese men aged 65 to 92 years in Hong Kong, we studied the association of having moderate to severe LUTS at baseline and having clinically relevant depressive symptoms at year 2 follow-up. After excluding men with prostate or bladder cancer or surgery (n = 20) and lost to follow-up (n = 254), data on 1,726 subjects were analyzed. LUTS were measured by the International Prostate Symptom score; and clinically relevant depressive symptoms were measured by the Geriatric Depression Scale. The multiple logistic regressions showed that the presence of moderate-to-severe LUTS at baseline were significantly associated with increased risk for being depressed at two-year follow-up, with adjustments for demographic, lifestyle, medical factors, weight status and stressful life events (OR = 2.97; CI: 1.70-5.20). Association remained significant with additional adjustments for baseline GDS score (OR = 1.88; CI: 1.03-3.41). LUTS are important risk factors in predicting the presence of clinically relevant depressive symptoms. In elderly men, increased awareness and possible screening are needed to detect the increased risk of clinically relevant depressive symptoms.

Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston area community health survey

PURPOSE

In this study we investigated the relationship between lower urinary tract symptoms as defined by the American Urological Association symptom index and the metabolic syndrome, and determined the relationship between individual symptoms comprising the American Urological Association symptom index and the metabolic syndrome.

MATERIALS AND METHODS

The Boston Area Community Health Survey used a 2-stage cluster design to recruit a random sample of 2,301 men 30 to 79 years old. Analyses were conducted on 1,899 men who provided blood samples. Urological symptoms comprising the American Urological Association symptom index were included in the analysis. The metabolic syndrome was defined using a modification of the Adult Treatment Panel III guidelines. The association between lower urinary tract symptoms and the metabolic syndrome was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models.

RESULTS

Increased odds of the metabolic syndrome were observed in men with mild to severe symptoms (American Urological Association symptom index 2 to 35) compared to those with an American Urological Association symptom index score of 0 or 1 (multivariate OR 1.68, 95% CI 1.21-2.35). A statistically significant association was observed between the metabolic syndrome and a voiding symptom score of 5 or greater (multivariate adjusted OR 1.73, 95% CI 1.06-2.80) but not for a storage symptom score of 4 or greater (multivariate adjusted OR 0.94, 95% CI 0.66-1.33). Increased odds of the metabolic syndrome were observed even with mild symptoms, primarily for incomplete emptying, intermittency and nocturia. These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older).

CONCLUSIONS

The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract.

Cohort profile: the Boston Area Community Health (BACH) survey

The Boston Area Community Health (BACH) Survey is a community-based, random sample, epidemiologic cohort of n = 5502 Boston (MA) residents. The baseline BACH Survey (2002-05) was designed to explore the mechanisms conferring increased health risks on minority populations with a particular focus on urologic signs/symptoms and type 2 diabetes. To this end, the cohort was designed to include adequate numbers of US racial/ethnic minorities (Black, Hispanic, White), both men and women, across a broad age of distribution. Follow-up surveys were conducted ∼5 (BACH II, 2008) and 7 (BACH III, 2010) years later, which allows for both within- and between-person comparisons over time. The BACH Survey's measures were designed to cover the following seven broad categories: socio-demographics, health care access/utilization, lifestyles, psychosocial factors, health status, physical measures and biochemical parameters. The breadth of measures has allowed BACH researchers to identify disparities and quantify contributions to social disparities in a number of health conditions including urologic conditions (e.g. nocturia, lower urinary tract symptoms, prostatitis), type 2 diabetes, obesity, bone mineral content and density, and physical function. BACH I data are available through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repositories (www.niddkrepository.org). Further inquiries can be made through the New England Research Institutes Inc. website (www.neriscience.com/epidemiology).

Lower urinary tract symptoms in relation to region of birth in 95,393 men living in Australia: the 45 and Up Study

PURPOSE

Lower urinary tract symptoms (LUTS) are very common among older men globally, but evidence regarding the relationship between LUTS and country of origin is limited. This study aimed to investigate the relationship between the prevalence of LUTS and region of birth in a large, ethnically diverse population of older men resident in New South Wales, Australia.

METHODS

Data on LUTS, demographic and behavioural factors were collected by postal questionnaire from 2006 to 2009 and analysed for 95,393 men aged 45 and over from the 45 and Up Study, who had not had previous prostate surgery. Logistic regression was used to investigate the association between region of birth and moderate/severe LUTS, ascertained using a modified International Prostate Symptom Score, adjusting for age, income, education, alcohol consumption and smoking.

RESULTS

Overall, 18,530 (19.4 %) men had moderate or severe LUTS. Compared to Australian-born men, prevalence of moderate/severe LUTS was significantly higher in men born in the Middle East & North Africa, Southeast Asia and North America regions (adjusted odds ratios (OR) = 1.43; 95 % CI = 1.23-1.66, OR = 1.25; 1.10-1.42, OR = 1.26; 1.05-1.52, respectively), whereas men from the UK & Ireland had significantly lower prevalence (OR = 0.85; 0.80-0.90). Patterns of association were generally similar for storage- and voiding-related types of LUTS. However, participants born in Sub-Saharan Africa showed a significantly elevated prevalence of moderate/severe voiding symptoms (1.22; 1.03-1.45) but not storage symptoms, compared to Australian-born respondents.

CONCLUSION

The prevalence of LUTS and of specific subtypes of LUTS varies according to region of birth.

Complementary and alternative therapies for urinary symptoms: use in a diverse population sample qualitative study

Study participants reported a range of remedies used to treat urinary symptoms, from popular products, such as saw palmetto, to less commonly known remedies, such as moabi. Participants learned about remedies through social network rather than from their primary care provider.

Metabolic Syndrome and Lower Urinary Tract Symptoms: Epidemiological Study

Increasing evidence from clinical and epidemiological studies has shown associations between lower urinary tract symptoms (LUTS) and major chronic medical diseases. Recent epidemiological studies have revealed that, to a large extent, lifestyle factors associated with metabolism, such as obesity, physical activity, blood glucose, and diet, contribute substantially to the development of these conditions. Multiple studies have demonstrated strong independent associations between LUTS and components of metabolic syndrome. Therefore, modification of lifestyle factors may lower the risk of LUTS. Prevalence of MS is age-dependent with gender differences, and LUTS have different manifestations in men and women. LUTS-associated benign prostatic hyperplasia (BPH) have multiple evidence of correlation with MS factors; however, results were inconsistent in their correlation among prostate volume and prostate-specific antigen. There is limited data on female LUTS or other diseases such as urinary incontinence or overactive bladder and MS. Further research is required to understand their connection in the pathogenesis of LUTS and to establish a more effective prevention and a therapeutic model.

High classification of chronic heart failure increases risk of overactive bladder syndrome and lower urinary tract symptoms

OBJECTIVE

To assess the urologic symptoms among patients with chronic heart failure (CHF) and to explore whether a higher classification of CHF increases the risk associated with overactive bladder syndrome (OAB) and lower urinary tract symptoms.

METHODS

A total of 214 ambulatory patients with CHF (129 men and 85 women) and 378 age-matched subjects (222 men and 156 women) were enrolled in the present study. The urologic symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS) from January to June 2010.

RESULTS

Compared with the controls, the patients with CHF had a significantly greater mean OABSS (4.6±3.6 vs 3.4±3.1, P<.001), total IPSS (8.3±6.9 vs 6.9±7.6, P=.021), and storage IPSS (4.8±3.5 vs 3.7±3.3, P<.001). Of the patients with CHF, 34.1% had moderate/severe OAB symptoms (OABSS≥6), and 43.5% had moderate/severe lower urinary tract symptoms (IPSS≥8). Compared with patients who had New York Heart Association (NYHA) class I CHF, the patients with NYHA class III CHF had a significantly greater OABSS and total, storage, and voiding IPSSs. Patients with NYHA class II CHF did not. A greater body mass index and stroke were significantly associated with the OABSS and storage IPSS, and pulmonary disease was significantly associated with the voiding IPSS.

CONCLUSION

The patients with CHF had more storage urinary symptoms suggestive of OAB than did the age-matched controls. Among the patients with CHF, greater NYHA class heart function was significantly associated with OAB and lower urinary tract symptoms.

Nocturia and quality of life: results from the Boston area community health survey

BACKGROUND

Nocturia, a common complaint in aging men and women, is frequently cited as the cause of nocturnal awakenings leading to sleep loss, daytime fatigue, and reduced quality of life (QOL).

OBJECTIVE

Investigate the association of nocturia with QOL and depressive symptoms among men and women.

DESIGN, SETTING, AND PARTICIPANTS

A population-based epidemiologic survey of urologic symptoms among persons aged 30-79 yr. A multistage stratified cluster sample design was used to randomly sample 5503 residents of Boston, MA, USA.

MEASUREMENTS

Nocturia was defined as a self-report of two or more voiding episodes nightly or having to get up to urinate more than once nightly "fairly often," "usually," or "almost always." QOL was assessed using the physical and mental health component scores of the 12-Item Short-Form Survey (SF-12). Depression was assessed using the Center for Epidemiological Studies Depression Scale. Multiple linear and logistic regression methods were used to model the nocturia and QOL association and to control for confounders.

RESULTS AND LIMITATIONS

Nocturia was associated with decreased SF-12 scores for both the physical and mental health components after multivariate adjustment. Nocturia was also associated with increased odds of depressive symptoms (men: adjusted odds ratio [OR]: 2.79; 95% confidence interval [CI], 1.81-4.31; women: adjusted OR: 1.80; 95% CI, 1.29-2.51). Among women who reported sleep interference due to urologic symptoms, nocturia was associated with a threefold increase in odds of depression. In this cross-sectional analysis, the temporal sequence of causality of the nocturia and depression association could not be assessed.

CONCLUSIONS

Nocturia is associated with decreased QOL and with an increased prevalence of depressive symptoms in both men and women.

Patients' experiences of seeking health care for lower urinary tract symptoms

A gap between experiencing symptoms and receiving effective treatment persists for people with lower urinary tract symptoms (LUTS), even for those who seek health care. In order to better understand how patients experience treatment seeking for LUTS, we interviewed a racially diverse sample of 90 men and women with a range of LUTS about their experiences seeking care. Thematic analysis revealed that patients often disclosed urinary symptoms first to primary care providers during a general examination or a visit for another health problem. Patients seek provider assistance typically when symptoms have intensified or are causing worry, and a desire for treatment trumps potential embarrassment; among women patients, feeling comfortable with a provider also is important for disclosing LUTS.

Moderating perceptions of bother reports by individuals experiencing lower urinary tract symptoms

We compared reports of symptom bother for the same urinary symptoms to understand why symptom severity and bother do not correspond in a straightforward manner. We used a grounded theory approach to analyze qualitative data from 123 individual interviews and developed a conceptual framework, identifying three symptom perceptions that might moderate symptom bother: causal, relative, and uncertainty. Symptom bother was lower for respondents who viewed symptoms causally (symptoms seemed explainable or "normal") or relatively (urinary symptoms were compared to other symptoms or conditions). Bother tended to be higher for respondents who viewed symptoms with uncertainty (when symptom etiology and course were unknown). A greater portion of respondents in the causal perception group had not sought health care for their symptoms. This conceptual framework is useful for understanding the relationship between reactions to and health care seeking for other symptoms.

An evidence-based health workforce model for primary and community care

Background

The delivery of best practice care can markedly improve clinical outcomes in patients with chronic disease. While the provision of a skilled, multidisciplinary team is pivotal to the delivery of best practice care, the occupational or skill mix required to deliver this care is unclear; it is also uncertain whether such a team would have the capacity to adequately address the complex needs of the clinic population. This is the role of needs-based health workforce planning. The objective of this article is to describe the development of an evidence-informed, needs-based health workforce model to support the delivery of best-practice interdisciplinary chronic disease management in the primary and community care setting using diabetes as a case exemplar.

Discussion

Development of the workforce model was informed by a strategic review of the literature, critical appraisal of clinical practice guidelines, and a consensus elicitation technique using expert multidisciplinary clinical panels. Twenty-four distinct patient attributes that require unique clinical competencies for the management of diabetes in the primary care setting were identified. Patient attributes were grouped into four major themes and developed into a conceptual model: the Workforce Evidence-Based (WEB) planning model. The four levels of the WEB model are (1) promotion, prevention, and screening of the general or high-risk population; (2) type or stage of disease; (3) complications; and (4) threats to self-care capacity. Given the number of potential combinations of attributes, the model can account for literally millions of individual patient types, each with a distinct clinical team need, which can be used to estimate the total health workforce requirement.

Summary

The WEB model was developed in a way that is not only reflective of the diversity in the community and clinic populations but also parsimonious and clear to present and operationalize. A key feature of the model is the classification of subpopulations, which gives attention to the particular care needs of disadvantaged groups by incorporating threats to self-care capacity. The model can be used for clinical, health services, and health workforce planning.

Dietary macronutrient intake and lower urinary tract symptoms in women

PURPOSE

To examine associations between macronutrient and total energy intakes with lower urinary tract symptoms (LUTS) in women.

METHODS

Cross-sectional analysis of 2060 women aged 30-79 years in the population-based Boston Area Community Health Survey (2002-2005). Data were collected by validated food frequency questionnaire and in-person interviews. Outcomes for multivariate logistic regression were moderate-to-severe total LUTS, storage, voiding, and postmicturition symptoms.

RESULTS

Greater total energy intake was positively associated with LUTS, specifically among women with lower waist circumferences (<76 cm, p = .005, p(interaction) = .01). Increased saturated fat intake was associated with postmicturition symptoms (Quintile 5 vs. 1, odds ratio 3.94, 95% confidence interval 1.57-9.89, p(trend) = .04). High protein intake was positively associated with storage symptoms (p(trend) = .03), particularly nocturia. No consistent associations were observed for carbohydrate, monounsaturated, or polyunsaturated fat intakes.

CONCLUSIONS

Among women with low waist circumferences, high total daily calorie intake was associated with moderate-to-severe LUTS. Although greater saturated fat intake was linked to postmicturition symptoms, the possibility that postmicturition symptoms in women represent more extensive or severe conditions should be explored in future research. These novel results indicate that dietary contributors to LUTS in women are distinct from those in men and may depend on symptom subtype and body size.

Intakes of vitamins and minerals in relation to urinary incontinence, voiding, and storage symptoms in women: a cross-sectional analysis from the Boston Area Community Health survey

BACKGROUND

Whether lower urinary tract symptoms (LUTS), including voiding, storage, and urinary incontinence, are affected by dietary micronutrients is uncertain.

OBJECTIVE

To test the hypothesis that carotenoid, vitamin C, zinc, and calcium intakes are associated with LUTS and urinary incontinence in women.

DESIGN, SETTING, AND PARTICIPANTS

During an observational, cross-sectional, population-based epidemiologic study of 2060 women (30-79 yr of age) in the Boston Area Community Health (BACH) survey (2002-2005), data were collected by validated food frequency questionnaire and in-person interviews and analyzed using multivariate regression.

MEASUREMENTS

LUTS, storage, and voiding symptoms were assessed using the American Urological Association Symptom Index (AUASI) and a validated severity index for urinary incontinence.

RESULTS AND LIMITATIONS

Women who consumed high-dose vitamin C from diet and supplements were more likely to report storage symptoms, especially combined frequency and urgency (≥ 500 vs < 50mg/d; odds ratio [OR]: 3.42; 95% confidence interval [CI], 1.44-8.12). However, greater consumption of dietary vitamin C or β-cryptoxanthin was inversely associated with voiding symptoms (p(trend) ≤ 0.01). Both dietary and supplemental calcium were positively associated with storage symptoms (eg, supplement ≥ 1000 mg/d vs none; OR: 2.04; 95% CI, 1.35-3.09; p(trend)=0.0002). No consistent associations were observed for β-carotene, lycopene, or other carotenoids, although smokers using β-carotene supplements were more likely to report storage problems. Whether the observed associations represent direct causes of diet on LUTS is uncertain.

CONCLUSIONS

High-dose intakes of vitamin C and calcium were positively associated with urinary storage or incontinence, whereas vitamin C and β-cryptoxanthin from foods and beverages were inversely associated with voiding symptoms. Results indicate that micronutrient intakes may contribute to LUTS in dose-dependent and symptom-specific ways. Further study is needed to confirm these findings and their relevance to clinical treatment decisions.

Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey

PURPOSE

Nocturia, a common problem in men and women, has been associated with chronic illnesses such as heart disease and hypertension. Using data from the Third National Health and Nutrition Examination Survey we investigated the association of nocturia with subsequent mortality risk.

MATERIALS AND METHODS

NHANES III is a national probability survey of the United States between 1988 and 1994. Mortality data were obtained by linkage of NHANES III to the National Death Index. Cox proportional hazards regression models were used to assess the association between nocturia and all cause mortality, controlling for potential confounders in a sample of 15,988 men and women 20 years old or older.

RESULTS

The prevalence of nocturia, defined as 2 or more voiding episodes nightly, was 15.5% in men and 20.9% in women. Multivariate analyses showed a statistically significant trend of increased mortality risk with increased number of voiding episodes in men and women. The magnitude of the nocturia and mortality association was greater in those younger than 65 years with attenuated associations in the 65 years old or older age group.

CONCLUSIONS

Nocturia is a strong predictor of mortality, more so in younger men and women than in the elderly, with a dose-response pattern in increased mortality risk with increasing number of voiding episodes nightly. Potential underlying mechanisms of the observed association of nocturia and increased mortality risk include sleep disruption and subsequent development of related comorbid conditions.

Fluid manipulation among individuals with lower urinary tract symptoms: a mixed methods study

AIMS AND OBJECTIVE

To determine, qualitatively and quantitatively, how individuals use fluid manipulation to self-manage the urinary symptoms of daytime frequency, urgency and urine leakage and the underlying rationale for this behaviour.

BACKGROUND

Lower urinary tract symptoms are prevalent and burdensome, and little is known about how individuals with lower urinary tract symptoms manipulate their fluid intake.

DESIGN

A mixed methods design included statistical analysis of data from a population-based survey of urologic symptoms and qualitative analysis of in-depth interviews.

METHOD

Quantitative data came from 5503 participants of the baseline Boston Area Community Health Survey, a population-based, random sample epidemiologic survey of urologic symptoms. Qualitative data came from in-depth interviews with a random subsample from Boston Area Community Health of 152 black, white and Hispanic men and women with LUTS.

RESULTS

Qualitative data showed that some respondents restricted fluid intake while others increased it, in both cases with the expectation of improved symptoms. Quantitative data showed that fluid intake was greater in men and women reporting frequency (p < 0·001). Women with frequency drank significantly more water (p < 0·001), while women with urgency drank significantly less water (p = 0·047).

CONCLUSIONS

This study found divergent expectations of the role of fluids in alleviating symptoms, leading some individuals to restrict and others to increase fluid intake. Individuals with lower urinary tract symptoms may need guidance in fluid management.

RELEVANCE TO CLINICAL PRACTICE

Nurses should be aware that patients may self-manage lower urinary tract symptoms by restricting fluid intake, putting them at risk for dehydration, constipation and urinary tract infection, but also that they may be increasing their fluid intake, which could worsen symptoms. This study pinpoints a specific area of need among patients with lower urinary tract symptoms and provides a practical opportunity for nurses to assist their patients with behavioural and fluid management by emphasising the clinical guidelines.

Correlation between Metabolic Syndrome and Lower Urinary Tract Symptoms of Males and Females in the Aspect of Gender-Specific Medicine: A Single Institutional Study

Purpose

We attempted to examine the correlation between metabolic syndrome and lower urinary tract symptoms (LUTS) in the aspect of gender-specific medicine.

Materials and Methods

A total of 922 patients participating in a health examination completed the International Prostate Symptom Score (IPSS) questionnaire and the Overactive Bladder Questionnaire Short Form (OABq-SF) symptom bother scale from March 2008 to July 2009. Metabolic syndrome was defined by using the National Cholesterol Education Program Adult Treatment Panel III criteria announced in 2001. We analyzed differences in lower urinary tract symptoms according to the presence of metabolic syndrome and the component elements of metabolic syndrome.

Results

The subjects were 538 males and 384 females with a mean age of 48.8±6.8 years. Among all patients, the number of patients with metabolic syndrome was 143 (15.5%); there were 110 males (20.4%) and 33 females (8.6%), showing a significant difference. There were no differences in scores on the IPSS or OABq-SF with respect to the presence or absence of metabolic syndrome in males. In females, however, there were significant differences in the IPSS and OABq-SF depending on the presence or absence of metabolic syndrome. In males and females, the IPSS total score was significantly correlated with age. Also, high-density lipoprotein (HDL) cholesterol in males and triglyceride in females was significantly correlated with the IPSS total score.

Conclusions

There are sex differences in the morbidity rate of metabolic syndrome and its effect on lower urinary tract symptoms. Therefore, it is necessary to consider gender-specific medicine in the diagnosis and treatment of LUTS.