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Chen J, Liu Z, Yang L, Zhou J, Ma K, Peng Z, Dong Q. Sleep-related disorders and lower urinary tract symptoms in middle-aged and elderly males: a cross-sectional study based on NHANES 2005-2008. Sleep Breath 2024; 28:359-370. [PMID: 37775620 DOI: 10.1007/s11325-023-02927-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) and sleep disorders both commonly affect people's quality of life. This study aimed to explore the associations between sleep-related disorders and LUTS through epidemiological investigations. METHODS Data were generated from the cross-sectional study called the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Multivariable logistic regression models were conducted to investigate the relationships between sleep-related disorders and LUTS. RESULTS A total of 2516 men were included in the study. Participants sleeping ≤ 6 h/night had higher odds ratios of LUTS (OR: 1.38; 95% CI 1.08, 1.77), daytime LUTS (OR: 1.26; 95% CI 1.03, 1.54), and nocturia (OR: 1.23; 95% CI 1.02, 1.49) than those sleeping 7-8 h/night. Participants who required > 30 min to fall asleep had an approximately 39% higher odds ratios of nocturia than those who fell asleep within 6 to 30 min (OR: 1.39; 95% CI 1.12, 1.73). Sleep problems were positively related to LUTS (OR: 1.42; 95% CI 1.11, 1.82), daytime LUTS (OR: 1.32; 95% CI 1.08, 1.61), urinary hesitancy (OR: 1.75; 95% CI 1.31, 2.34), and nocturia (OR: 1.52; 95% CI 1.26, 1.84). Obstructive sleep apnea (OSA) symptoms were positively associated with urinary incontinence (OR: 1.52; 95% CI 1.12, 2.08). In addition, participants with daytime sleepiness were at higher prevalence of LUTS (OR: 1.66; 95% CI 1.29, 2.15), daytime LUTS (OR: 1.44; 95% CI 1.16, 1.78), urinary hesitancy (OR: 1.95; 95% CI 1.45, 2.63), and nocturia (OR: 1.66; 95% CI 1.35, 2.05). CONCLUSION The findings suggested that sleep-related disorders were associated with LUTS, daytime LUTS, urinary hesitancy, incomplete emptying, urinary incontinence, and nocturia in middle-aged and elderly males.
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Affiliation(s)
- Junhao Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
- West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhenghuan Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
- West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Luchen Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
- West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Zhou
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
- West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Kai Ma
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
- West China School of Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhufeng Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, People's Republic of China.
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Valladales-Restrepo LF, Machado-Alba JE. Potentially inappropriate prescriptions of anticholinergic drugs in patients with benign prostatic hyperplasia. Aging Male 2020; 23:785-792. [PMID: 30955405 DOI: 10.1080/13685538.2019.1595572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prostatic hyperplasia is frequent in the elderly, and it can be associated with urinary retention in patients who use cholinergic antagonists. The objective was to estimate the anticholinergic burden of drugs prescribed to patients diagnosed with benign prostatic hyperplasia. METHODS A cross-sectional study using a population database to identify prescriptions of cholinergic antagonists drugs used in the management of benign prostatic hyperplasia. The anticholinergic burden was evaluated using the Anticholinergic Drug Scale. RESULTS Three thousand seven hundred and sixty patients with benign prostatic hyperplasia were identified, with a mean age of 68.26 ± 10.46 years. Of these patients, 2961 (78.8%) received pharmacological treatment mainly with tamsulosin monotherapy (34.7%, n = 1026). Overall, 34.7% (n = 1303) of all patients were taking cholinergic antagonists. Patients aged 75-84 years (OR: 1.985, 95%CI: 1.063-3.709) and those 85 or older (OR: 2.52, 95%CI: 1.287-4.948) had a greater probability of having an anticholinergic burden score ≥3 points. Of the patients not receiving pharmacological treatment for benign prostatic hyperplasia, 35% (n = 280) were taking medications with anticholinergic properties. CONCLUSIONS A high proportion of patients with benign prostatic hyperplasia were receiving medical management for the relief of symptoms, mostly via monotherapy. However, one-third of patients received some type of medication with anticholinergic properties, being much more frequent after 75 years.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnologica de Pereira-Audifarma S.A, Pereira, Colombia
- Fundación Universitaria Autónoma de las Américas, Avenida de las Américas Calle, Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnologica de Pereira-Audifarma S.A, Pereira, Colombia
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Establishment of animal model manifested as bladder neurogenic changes generated by bilateral pelvic nerve injury in male rats. Int Urol Nephrol 2020; 53:421-429. [PMID: 33025408 DOI: 10.1007/s11255-020-02668-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/25/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To establish a male rat model of neurogenic bladder after bilateral pelvic nerve injury (BPNI) and investigate the factors associated with onset of neurogenic bladder. METHODS Twenty-four 8-week-old male Sprague-Dawley rats were randomly divided into three groups (n = 8 rats per group). Rats in 4-week and 8-week nerve injury group underwent BPNI, while rats in the sham group underwent a sham operation. Bladder functional analysis were performed and then bladders tissues were harvested for morphological examination and investigating the mRNA expression levels of target genes in all rats. RESULTS The bladder weight significantly increased in rats following BPNI. Functional analysis revealed non-voiding contractions and decreased detrusor contractility following BPNI, manifested as elevated post-void residual and bladder capacity while reduced maximum voiding pressure and voiding efficiency. The collagen area in bladder tissue and mRNA expression levels of target genes significantly increased at 4 or 8 weeks post-BPNI except Smad3. At 4 weeks post-BPNI, expression levels of vesicular acetylcholine transporter were reduced, then returned to baseline at 8 weeks. Expression levels of tyrosine hydroxylase were reduced at both 4 and 8 weeks post-BPNI. CONCLUSIONS A neurogenic bladder animal model was successfully established by performing BPNI in male rats, characterized by impaired voiding function, bladder detrusor fibrosis, and reduced neurotransmitter release.
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The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature. Asian J Urol 2019; 6:353-358. [PMID: 31768321 PMCID: PMC6872824 DOI: 10.1016/j.ajur.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/23/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Our objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). Methods A retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. Results Mean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3–22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p < 0.01) and 6.3 ± 4.4 (p < 0.01) at 1 and 6 months, respectively. The Qmax improved from 7.70 ± 4.46 mL/s at baseline to 17.25 ± 9.30 mL/s (p < 0.01) and 19.14 ± 7.19 mL/s (p < 0.001) at 1 and 6 months, respectively, while the PVR improved from 216.0 ± 271.0 mL preoperatively to 32.8 ± 45.3 mL (p < 0.01) and 26.2 ± 46.0 mL (p < 0.01) at 1 and 6 months, respectively. The PSA dropped from 1.97 ± 1.76 ng/mL preoperatively to 0.71 ± 0.61 ng/mL (p < 0.01) and 0.74 ± 0.63 ng/mL at 1 and 6 months, respectively. No patient had a bladder neck contracture postoperatively and no capsular perforations were noted intraoperatively. Conclusion The 180 W GreenLight XPS system is safe and effective for men with small volume BPH. PVP produced improvements in symptomatic and clinical parameters without any safety concern. It represents a safe surgical option in this under studied population.
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Kim SJ, Al Hussein Alawamlh O, Chughtai B, Lee RK. Lower Urinary Tract Symptoms Following Transurethral Resection of Prostate. Curr Urol Rep 2018; 19:85. [DOI: 10.1007/s11934-018-0838-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Piovan S, Pavanello A, Peixoto GML, Matiusso CCI, de Moraes AMP, Martins IP, Malta A, Palma-Rigo K, da Silva Franco CC, Milani PG, Dacome AS, da Costa SC, de Freitas Mathias PC, Mareze-Costa CE. Stevia Nonsweetener Fraction Displays an Insulinotropic Effect Involving Neurotransmission in Pancreatic Islets. Int J Endocrinol 2018; 2018:3189879. [PMID: 29853880 PMCID: PMC5949184 DOI: 10.1155/2018/3189879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
Stevia rebaudiana (Bert.) Bertoni besides being a source of noncaloric sweeteners is also an important source of bioactive molecules. Many plant extracts, mostly obtained with ethyl acetate solvent, are rich in polyphenol compounds that present insulinotropic effects. To investigate whether the nonsweetener fraction, which is rich in phenolic compounds isolated from Stevia rebaudiana with the solvent ethyl acetate (EAF), has an insulinotropic effect, including interference at the terminals of the autonomic nervous system of the pancreatic islets of rats. Pancreatic islets were isolated from Wistar rats and incubated with EAF and inhibitory or stimulatory substances of insulin secretion, including cholinergic and adrenergic agonists and antagonists. EAF potentiates glucose-stimulated insulin secretion (GSIS) only in the presence of high glucose and calcium-dependent concentrations. EAF increased muscarinic insulinotropic effects in pancreatic islets, interfering with the muscarinic receptor subfamily M3. Adrenergic inhibitory effects on GSIS were attenuated in the presence of EAF, which interfered with the adrenergic α2 receptor. Results suggest that EAF isolated from stevia leaves is a potential therapy for treating type 2 diabetes mellitus by stimulating insulin secretion only in high glucose concentrations, enhancing parasympathetic signal transduction and inhibiting sympathetic signal transduction in beta cells.
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Affiliation(s)
- Silvano Piovan
- Department of Physiology Sciences, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | - Audrei Pavanello
- Department of Cell Biology and Genetics, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | | | | | | | - Isabela Peixoto Martins
- Department of Cell Biology and Genetics, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | - Ananda Malta
- Department of Cell Biology and Genetics, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | - Kesia Palma-Rigo
- Department of Cell Biology and Genetics, Universidade Estadual de Maringá, Maringá, PR, Brazil
| | | | - Paula Gimenez Milani
- Department of Biochemistry, Universidade Estadual de Maringá, Maringá, PR, Brazil
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Peyronnet B, Brucker BM, Michel MC. Lower Urinary Tract Symptoms: What's New in Medical Treatment? Eur Urol Focus 2018; 4:17-24. [PMID: 29665997 DOI: 10.1016/j.euf.2018.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/06/2018] [Accepted: 04/01/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT Pharmacological treatment is a cornerstone in the management of patients with lower urinary tract symptoms (LUTS). OBJECTIVE To review emerging evidence in the medical treatment of LUTS. EVIDENCE ACQUISITION An Embase/Pubmed-based literature search was conducted in December 2017, screening for randomized controlled trials (RCTs), prospective and retrospective series, animal model studies, and reviews on medical treatment of LUTS. EVIDENCE SYNTHESIS The main medical innovation in recent years in overactive bladder (OAB) has been the approval of the first β3-adrenoceptor agonists (mirabegron) and intradetrusor onabotulinum toxin A, while several other drugs such as antiepileptics, phosphodiesterase inhibitors, or other β3-agonists have brought promising results in phase 3 trials. Intraprostatic injections of various drugs for LUTS/benign prostatic hyperplasia have been investigated, but results of phase 3 trials are still pending, while combination therapies of phosphodiesterase type 5 inhibitors+α-blockers or finasteride have been proved as superior to single therapies in RCTs conducted in these patients. Two new formulations of desmopressin have been approved for nocturia in the USA (desmopressin nasal spray) and Europe/Canada/Australia (desmopressin orally disintegrated tablet). Fedovapagon, a vasopressin V2 receptor agonist, has recently completed a large phase 3 trial in male patients with nocturia. Other phase 3 trials are ongoing in bladder pain syndrome (AQX 11-25, a SHIP-1 activator) and in neurogenic detrusor overactivity (mirabegron and abobotulinum toxin A). CONCLUSIONS Medical treatment of LUTS is a very active research field with recently approved drugs for nocturia (desmopressin acetate nasal spray/orally disintegrated tablet) and numerous emerging drugs currently investigated in OAB, LUTS/benign prostatic hyperplasia, nocturia, bladder pain syndrome, and neurogenic detrusor overactivity. PATIENT SUMMARY Medical treatment of lower urinary tract symptoms is a very active research field with recently approved drugs for nocturia (desmopressin acetate nasal spray/orally disintegrated tablet) and numerous emerging drugs in overactive bladder, nocturia, neurogenic detrusor overactivity, bladder pain syndrome, or benign prostatic hyperplasia.
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Affiliation(s)
| | | | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
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