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Jain S, Patel RB, Vala L, Kinthada S, Patel N, Jain S, Khan T, Nanjundappa A, Sirekulam V, Naik N, Siripuram C, Gill H. Missing Renal Stone Diagnosis in Dementia Patients With Recurrent Urinary Tract Infections: A Case Report and Literature Review. Cureus 2024; 16:e58908. [PMID: 38800185 PMCID: PMC11117170 DOI: 10.7759/cureus.58908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
In older adults, diagnosing, treating, and preventing urinary tract infections (UTIs) can be challenging. This case is of an 82-year-old female of white descent, who was admitted to a post-acute care facility following hospitalization for delirium and a UTI. Hypoactive delirium may be the only clinical manifestation of recurrent UTI. Due to challenges in obtaining a history from this patient with dementia, she had to be admitted multiple times for sepsis. During her final hospitalization, a CT scan of the abdomen and pelvis was ordered, which revealed an obstructed kidney stone as the cause of her recurrent UTIs. Recurrent UTIs especially in patients with dementia should prompt further imaging to look for kidney stones. Factors like dehydration and poor oral intake are risk factors for kidney stones, which patients with dementia are susceptible to.
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Affiliation(s)
- Sakshi Jain
- Department of Geriatrics, Hackensack University Medical Center, Hackensack, USA
| | | | - Lovekumar Vala
- Department of Anatomy, Shantabaa Medical College, Amreli, IND
| | - SudhaRani Kinthada
- Department of Obstetrics and Gynecology, Rangaraya Medical College, Kakinada, IND
| | - Neel Patel
- Department of Medical Education, GMERS Medical College Gotri, Vadodara, IND
| | - Shikha Jain
- Department of Medicine, MVJ Medical College and Research Hospital, Bengaluru, IND
| | - Tanzina Khan
- Department of Internal Medicine, Bangladesh Medical College, Dhaka, BGD
| | | | - Vaishnavi Sirekulam
- Department of Medicine, Vijayanagar Institute of Medical Sciences, Ballari, IND
| | - Nishthaben Naik
- Department of Health & Family Welfare, Primary Health Center, Bigri, Navsari, IND
| | - Chandu Siripuram
- Department of Hospital Medicine, Geisinger Medical Center, Scranton, USA
| | - Harmeet Gill
- Department of Medicine, HopeHealth, Florence, USA
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Hughes FM, Odom MR, Cervantes A, Livingston AJ, Purves JT. Why Are Some People with Lower Urinary Tract Symptoms (LUTS) Depressed? New Evidence That Peripheral Inflammation in the Bladder Causes Central Inflammation and Mood Disorders. Int J Mol Sci 2023; 24:2821. [PMID: 36769140 PMCID: PMC9917564 DOI: 10.3390/ijms24032821] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Anecdotal evidence has long suggested that patients with lower urinary tract symptoms (LUTS) develop mood disorders, such as depression and anxiety, at a higher rate than the general population and recent prospective studies have confirmed this link. Breakthroughs in our understanding of the diseases underlying LUTS have shown that many have a substantial inflammatory component and great strides have been made recently in our understanding of how this inflammation is triggered. Meanwhile, studies on mood disorders have found that many are associated with central neuroinflammation, most notably in the hippocampus. Excitingly, work on other diseases characterized by peripheral inflammation has shown that they can trigger central neuroinflammation and mood disorders. In this review, we discuss the current evidence tying LUTS to mood disorders, its possible bidirectionally, and inflammation as a common mechanism. We also review modern theories of inflammation and depression. Finally, we discuss exciting new animal studies that directly tie two bladder conditions characterized by extensive bladder inflammation (cyclophosphamide-induced hemorrhagic cystitis and bladder outlet obstruction) to neuroinflammation and depression. We conclude with a discussion of possible mechanisms by which peripheral inflammation is translated into central neuroinflammation with the resulting psychiatric concerns.
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Affiliation(s)
- Francis M. Hughes
- Department Urology, Duke University Medical Center, P.O. Box 3831, Durham, NC 27710, USA
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Vartolomei L, Cotruș A, Tătaru SO, Vartolomei MD, Man A, Ferro M, Stanciu C, Sin AI, Shariat SF. Lower urinary tract symptoms are associated with clinically relevant depression, anxiety, and stress symptoms. Aging Male 2022; 25:62-66. [PMID: 35179090 DOI: 10.1080/13685538.2022.2040981] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To investigate the correlation between lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and testosterone deficiency (TD) with depressive, stress, and anxiety symptoms. MATERIAL AND METHODS From October 2019 to March 2020, 113 males were included. Inclusion criteria: age 40-75, no clinical suspicion of prostate cancer, no serious cardiovascular comorbidities. All patients completed a set of questionnaires: International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), and Depression Anxiety Stress Scales (DASS-21). RESULTS Median age was 62 years (range 40-74), mean IPSS score was 10.94 (SD 7.75), mean IIEF-5 score 13.12 (SD 7.08), and mean DASS-21 score 11.35 (SD 8.24). According to DASS-21 subscales, 28 (24.8%) patients had depressive symptoms, 25 (22.1%) anxiety symptoms, and 25 (22.1%) stress symptoms. Depression was associated with LUTS (14.5 vs. 8 score, p = .002). Similarly, stress symptoms were associated with LUTS (IPSS 15 vs. 7 score, p = .0001) and with ED (IIEF-5 5 vs. 15 score, p = .01). Positive Spearman's rho correlations between LUTS and all three, depression, anxiety, and stress symptoms were found (p values <.001). CONCLUSIONS LUTS is associated with depression, anxiety, and stress symptoms. Screening for these symptoms could help with individual counseling and management.
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Affiliation(s)
- Liliana Vartolomei
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Andrei Cotruș
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Sabin Octavian Tătaru
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Mihai Dorin Vartolomei
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Adrian Man
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Camelia Stanciu
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Anca Ileana Sin
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
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Huang J, Chan CK, Yee S, Deng Y, Bai Y, Chan SC, Tin MS, Liu X, Lok V, Zhang L, Xu W, Zheng ZJ, Teoh JYC, Ng CF, Wong MCS. Global burden and temporal trends of lower urinary tract symptoms: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00610-w. [DOI: 10.1038/s41391-022-00610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
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Zheng Y, Gao M, Hou G, Hou N, Feng X, Jannini TB, Wei D, Zheng W, Zhang L, Dun X, Zhang G, Wang F, Meng P, Jannini EA, Yuan J. A Prospectively Validated Nomogram for Predicting the Risk of PHQ-9 Score ≥15 in Patients With Erectile Dysfunction: A Multi-Center Study. Front Public Health 2022; 10:836898. [PMID: 35784263 PMCID: PMC9247334 DOI: 10.3389/fpubh.2022.836898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although erectile dysfunction (ED) often occurs simultaneously with depression, not all patients with ED suffer major depression (MD), with a PHQ-9 score ≥15 indicating MD. Because the PHQ-9 questionnaire includes phrases such as “I think I am a loser” and “I want to commit suicide,” the psychological burdens of ED patients are likely to increase inevitably after using the PHQ-9, which, in turn, may affect ED therapeutic effects. Accordingly, we endeavored to develop a nomogram to predict individual risk of PHQ-9 score ≥15 in these patients. Methods The data of 1,142 patients with ED diagnosed in Xijing Hospital and Northwest Women and Children's Hospital from January 2017 to May 2020 were analyzed. While the Least Absolute Shrinkage and Selection Operator regression was employed to screen PHQ-9 score ≥15 related risk factors, multivariate logistic regression analysis was performed to verify these factors and construct the nomogram. The training cohort and an independent cohort that comprised 877 prospectively enrolled patients were used to demonstrate the efficacy of the nomogram. Results The IIEF-5 score, PEDT score, physical pain score, frequent urination, and feeling of endless urination were found to be independent factors of PHQ-9 score ≥15 in patients with ED. The nomogram developed by these five factors showed good calibration and discrimination in internal and external validation, with a predictive accuracy of 0.757 and 0.722, respectively. The sensitivity and specificity of the nomogram in the training cohort were 0.86 and 0.52, respectively. Besides, the sensitivity and specificity of the nomogram in the validation cohort were 0.73 and 0.62, respectively. Moreover, based on the nomogram, the sample was divided into low-risk and high-risk groups. Conclusion This study established a nomogram to predict individual risk of PHQ-9 score ≥15 in patients with ED. It is deemed that the nomogram may be employed initially to avoid those with a low risk of MD completing questionnaires unnecessarily.
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Affiliation(s)
- Yu Zheng
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
- Department of Anatomy, Histology and Embryology, Air Force Medical University, Xi'an, China
- Medical Innovation Center, Air Force Medical University, Xi'an, China
| | - Ming Gao
- Department of Andrology, Xi'an Daxing Hospital, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Niuniu Hou
- Department of General Surgery, Eastern Theater Air Force Hospital of PLA, Nanjing, China
| | - Xiao Feng
- Department of Anatomy, Histology and Embryology, Air Force Medical University, Xi'an, China
| | - Tommaso B. Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Di Wei
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Wanxiang Zheng
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Lei Zhang
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xinlong Dun
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Geng Zhang
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Fuli Wang
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ping Meng
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Emmanuele A. Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Emmanuele A. Jannini
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China
- *Correspondence: Jianlin Yuan
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Comprehensive assessment of holding urine as a behavioral risk factor for UTI in women and reasons for delayed voiding. BMC Infect Dis 2022; 22:521. [PMID: 35668379 PMCID: PMC9172065 DOI: 10.1186/s12879-022-07501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women of reproductive age group have greater predilection to urinary tract infections (UTI). Various risk factors increase the prevalence in women. Emergence of multidrug resistant uropathogens make clinical management of UTI challenging. Here we assess holding of urine as risk factor of UTI in women and reasons for delayed voiding. We also investigate the relationship between frequency of UTIs and overall behavioural features, menstrual hygiene and attitude of women towards their own health issues. METHODS A questionnaire based cross-sectional study was performed with 816 hostel residents with written consent. Self-reported data was statistically analysed using SPSS software. Urinalysis and urine culture were done for 50 women by random sampling to obtain the information on leading causative agents of UTI in the study population and their antimicrobial resistance profile. RESULTS The prevalence of UTI among the participants without risk factors was found to be 27.5 (95% CI: 24.4-30.7). Attitude of women towards their own personal health issues and use of public toilets showed a correlation with prevalence of infection. Delay in urination on habitual basis was found to be associated with UTI. Uropathogens isolated by random sampling were resistant to multiple drugs that are generally used to treat UTI. CONCLUSIONS Holding urine for long time had proven to be an important risk factor and amongst different reasons of holding urine, holding due to poor sanitary condition of public toilets was the most common. Higher frequency of self-reported UTIs is related to holding of urine, behavioural features and attitude of women.
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Qiu Z, Li W, Huang Y, Huang W, Shi X, Wu K. Urinary incontinence and health burden of female patients in China: Subtypes, symptom severity and related factors. Geriatr Gerontol Int 2022; 22:219-226. [PMID: 35068065 DOI: 10.1111/ggi.14350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 02/05/2023]
Abstract
AIM Urinary incontinence (UI) causes long-term physical and psychological suffering to patients. Risk factors for different UI subtypes and symptom severity are still unclear, as well as their associations. We aimed to examine the potential influencing factors of UI episodes, UI severity and UI subtypes, and the associations among them. METHODS A total of 611 women were recruited in Shantou, China. Clinical and demographic data were collected through electronic medical records, measurements and self-reports. UI diagnosis, subtypes and symptom severity were confirmed according to international uniform standards. The health burden of UI was evaluated by the Incontinence Impact Questionnaire. Multivariate logistic and linear regression models were carried out to examine the potential risk factors and associations among UI subtypes, symptom severity, and health burdens. RESULTS Age, body mass index, comorbidity, lower urinary tract symptoms and constipation were associated with UI episodes and UI severity. Mixed UI patients had worse severity than urgency UI and stress UI, especially in leak times/week and daily life obstructing. Mixed UI patients also had higher health burdens, including mental health burdens, than urgency UI and stress UI patients. UI severity was positively associated with higher health burdens (β = 0.46, 95% CI 0.34-0.60), especially in physical activities, travel and social relationship burden (β = 0.61, 95% CI 0.40-0.85; β = 0.55, 95% CI 0.19-0.76; β = 0.65, 95% CI 0.38-0.91; respectively). CONCLUSIONS Age, body mass index, comorbidity, somnipathy and constipation were associated with UI episodes and symptom severity. Mixed UI showed the highest symptoms severity and health burdens. Worse UI severity increased the patient's physical health burden, but was not obvious for mental health burden. Geriatr Gerontol Int 2022; 22: 219-226.
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Affiliation(s)
- Zhaolong Qiu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Wanzhen Li
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Yanhong Huang
- Mental Health Center of Shantou University, Shantou, China
| | - Wenlong Huang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Xiaoling Shi
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Kusheng Wu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
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Martin SA, Tully PJ, Kahokehr AA, Jay A, Wittert GA. The bidirectional association between depression and lower urinary tract symptoms (LUTS) in men: A systematic review and meta-analysis of observational studies. Neurourol Urodyn 2022; 41:552-561. [PMID: 35019156 DOI: 10.1002/nau.24868] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent evidence from observational studies suggests a bidirectional association between lower urinary tract symptoms (LUTS) and depression in men. We sought to systematically quantify the effect of the presence of LUTS on depression symptoms, compared to those without LUTS, in adult males, and vice versa. METHODS Electronic databases (MEDLINE, PsycINFO, SCOPUS, Embase) were examined for articles in English before March 2021. Observational studies of men aged over 18 years; reporting an association between LUTS and depression; including a validated scale for LUTS and depression symptoms were eligible for study inclusion. RESULTS Seventeen studies out of 1787 records identified 163 466 men with reported depression symptoms by LUTS status, while 10 studies reported 72 363 men with LUTS by depression symptoms. Pooled estimates showed a strong effect of LUTS presence on depression risk (OR: 2.89, 95% CI: 2.50-3.33), with a high degree of heterogeneity among the examined studies (I2 = 83%; τ2 = 0,06; p < 0.001). Subgroup analyses demonstrated differences by study region (Q value:13.7, df:4, p = 0.003), setting (7.8(2), p = 0.020), design (7.2(1), p = 0.003), quality (6.2(1), p = 0.013), and LUTS measure (40.9(3), p < 0.001). Pooled estimates also showed a strong effect of depression presence on LUTS risk in men (OR: 3.13, 95% CI: 2.72-3.60), with only moderate heterogeneity between studies (I2 = 58%; τ2 = 0,02; p = 0.001). CONCLUSIONS The strong relationship observed between LUTS and depression implies shared risk factors that cannot be solely attributed to the prostate. This has immediate implications for future studies and the assessment and management of patients with either condition.
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Affiliation(s)
- Sean A Martin
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
| | - Phillip J Tully
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia.,School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Arman A Kahokehr
- Lyell McEwin Health Service, SA Health, Elizabeth Vale, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of Urology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Alex Jay
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
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Mou T, Brown O, Hua Y, Simon M, Dong X, Kenton K, Bretschneider CE. Gender differences of lower urinary tract symptoms in older Chinese Americans. Asian J Urol 2021. [DOI: 10.1016/j.ajur.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shoham DA, Wang Z, Lindberg S, Chu H, Brubaker L, Brady SS, Coyne-Beasley T, Fitzgerald CM, Gahagan S, Harlow BL, Joinson C, Low LK, Markland AD, Newman DK, Smith AL, Stapleton A, Sutcliffe S, Berry A. School Toileting Environment, Bullying, and Lower Urinary Tract Symptoms in a Population of Adolescent and Young Adult Girls: Preventing Lower Urinary Tract Symptoms Consortium Analysis of Avon Longitudinal Study of Parents and Children. Urology 2021; 151:86-93. [PMID: 32679271 PMCID: PMC8074340 DOI: 10.1016/j.urology.2020.06.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To examine whether the school toilet environment at age 13, including bullying at toilets, is associated with female lower urinary tract symptoms (LUTS) at ages 13 and 19, as little is known about the association among school toilet environment, voiding behaviors, and LUTS in adolescent girls. METHODS The sample comprised 3962 female participants from the Avon Longitudinal Study of Parents and Children. At age 13, participants reported on 7 school toilet environment characteristics and a range of LUTS items. At age 19, participants completed the Bristol Female Lower Urinary Tract Symptoms questionnaire. RESULTS All toilet environmental factors were associated with at least 1 LUTS outcome at age 13. Holding behavior was associated with all school toilet environmental factors, with odds ratios ranging from 1.36 (95% confidence interval [CI]: 1.05, 1.76) for dirty toilets to 2.38 (95% CI: 1.60, 3.52) for feeling bullied at toilets. Bullying was associated with all daytime LUTS symptoms and nocturia; odds ratios ranged from 1.60 (95% CI: 1.04, 2.07) for nocturia to 2.90 (95% CI: 1.77, 4.75) for urgency. Associations between age 13 school toilets and age 19 LUTS were in the same direction as age 13 LUTS. CONCLUSION This is the first examination of associations between school toilets and LUTS. Toileting environments were cross-sectionally associated with LUTS in adolescent girls. While further work is needed to determine whether these associations are causal, school toilet environments are modifiable and thus a promising target for LUTS prevention.
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Affiliation(s)
- David A Shoham
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL.
| | - Zhenxun Wang
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Sarah Lindberg
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Haitao Chu
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Linda Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, CA
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, University of Alabama at Birmingham Medical School, Birmingham, AL
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | - Sheila Gahagan
- Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, CA
| | | | | | - Lisa Kane Low
- University of Michigan School of Nursing, Women's Studies, Dept. Obstetrics and Gynecology, Ann Arbor, MI
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL
| | - Diane K Newman
- Department of Surgery, Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ariana L Smith
- Department of Surgery, Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ann Stapleton
- Department of Medicine, University of Washington, Seattle, WA
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, University of Minnesota, Minneapolis, MN
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Association of lower urinary tract symptoms and hip fracture in adults aged ≥ 50 years. PLoS One 2021; 16:e0246653. [PMID: 33657118 PMCID: PMC7928482 DOI: 10.1371/journal.pone.0246653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/24/2021] [Indexed: 11/25/2022] Open
Abstract
Aim Lower urinary tract symptoms (LUTS) result in morbidities; however, their association with the occurrence of hip fracture is relatively unknown in the context of Asian studies. The purpose of the study was to investigate this link with the hip fracture risk in Taiwanese men and women aged 50 years and above. Materials and methods From 2000 through 2012, a population-based retrospective cohort study was conducted; claims data of 18,976 patients diagnosed with LUTS (dysuria, urinary retention, incontinence, and increased urinary frequency and urgency) were retrieved from Taiwan’s National Health Insurance Research Database. The patients were compared with 1:2 age, sex, and index year-matched controls (comparison group, n = 37,952). The incidence and hazard ratios of the hip fracture risk were calculated by the Cox proportional hazard regression models. Results The mean age was 66.2 ± 9.7 years, and the proportion of men was 58.1% in both study groups. Fractures occurred in 772 patients and 1,156 control subjects. The corresponding incidences were 7.0 and 5.0/1000 person-years. Compared to the control subjects, the patients with LUTS had an increased hip fracture risk [adjusted hazard ratio (aHR) = 1.29; 95% confidence interval (CI): 1.17–1.42]. LUTS was independently associated with an increased hip fracture risk in both men (aHR = 1.24; 95% CI: 1.08–1.42) and women (aHR = 1.34; 95% CI: 1.18–1.53) (p for interaction = 0.557). Similarly, the subgroup effect of age on hip fracture risks was not found (p for interaction = 0.665). Conclusion The study found LUTS was associated with an increased risk of hip fracture. Large-scale prospective studies in diverse populations are required to investigate causalities.
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Wasfy IS, Soltan EM, Abdelwahab HA, Salama HM. Predictors of urogenital distress and impaired quality of life in adult Egyptians with lower urinary tract symptoms. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00124-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aims to assess the severity of lower urinary tract symptoms, and to assess predictors of impaired quality of life among Egyptian adults complain of lower urinary tract symptoms.
Methods
An observational cross-sectional research was done using an online anonymous poll survey. The survey was implemented through sharing on different social media applications. The survey was posted from June 1, 2020, to June 10, 2020. The overall communities of the Egyptian adults who satisfied the incorporation rules and consented to take an interest in the research were incorporated using convenience and snowball collecting methods (188 adults). A semi-structured questionnaire on socio-demographic characteristics and Arabic Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) short forms were used.
Results
Approximately 220 Egyptian adults shared in the research but only 188 fulfilled inclusion and exclusion criteria. Approximately 92% of them had at least one symptom of lower urinary tract manifestations. Irritative symptoms presented in 65 (85.5%) of males and 102 (91.1%) of females. Stress symptoms presented in 44 (57.9%) of males and 63 (56.2%) of females with higher statistically significant mean of stress symptoms. Obstruction/discomfort symptoms presented in 51 (67.1%) of males, and 77 (68.8%) of females. Seeking help and duration of the urological problem were statistically significant independent positive predictors of UDI-6-total. The Irritative score, obstruction/discomfort score, and duration of the urological problem were statistically significant independent positive predictors of IIQ-7-total.
Conclusions
Urological problems are common and have an impact on the quality of life in various domains of physical activity, social relationships, travel, and emotional health.
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Kawahara T, Ito H, Uemura H. The impact of smoking on male lower urinary tract symptoms (LUTS). Sci Rep 2020; 10:20212. [PMID: 33214664 PMCID: PMC7678847 DOI: 10.1038/s41598-020-77223-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/09/2020] [Indexed: 11/20/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are substantially prevalent and increase with age. Research on smoking as a risk factor for LUTS has been inconclusive. The present study examined the association between smoking habits and male LUTS in a population-based study using a web-based questionnaire. We firstly screened a total of 10,000 male participants who were selected according to the age distribution in the Japanese population in government data, in order to check smoking habits. We then performed a web-based survey to further investigate factors associated with LUTS, using the Overactive Bladder Symptom Score (OABSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and International Prostate Symptom Score (IPSS) questionnaire. Finally, 9042 participants (non-smokers, n = 3545; ex-smokers, n = 3060; and current-smokers, n = 2437) completed the full continence survey. Current-smokers (2.54 ± 2.73, 1.98 ± 3.57, 5.75 ± 7.02) and ex-smokers (2.80 ± 2.52, 1.81 ± 3.10, 6.58 ± 6.96) showed significantly higher OABSS total, ICIQ-SF total, and IPSS total scores than non-smokers (1.98 ± 2.40, 1.35 ± 2.90, 4.23 + -/6.33) (p: < 0.0001, < 0.0001, < 0.0001, respectively). In comparison to non-smokers, the prevalence of risk ratio for day-time frequency, nocturia, urgency urinary incontinence (UUI), OAB, and IPSS ≥ 8 were 1.2 1.2 1.4 1.5 1.5, respectively, in current-smokers and 1.3, 1.5, 1.5, 4.5, 1.8 in ex-smokers. The relative risk of OAB, nocturia, UUI, and IPSS ≥ 8 in ex- and current-smokers in comparison to non-smokers was high in the young age groups in comparison to the elderly groups. Current-smokers and ex-smokers showed a higher prevalence of male LUTS. This phenomenon was highly observed in relatively young age groups.
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Affiliation(s)
- Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 2320024, Japan. .,Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
| | - Hiroki Ito
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 2320024, Japan.,Department of Urology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 2320024, Japan
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Mou T, Brown O, Simon M, Dong X, Kenton K, Bretschneider CE. Lower urinary tract symptoms in older Chinese American women: prevalence and risk factors. Int Urogynecol J 2020; 32:703-708. [PMID: 33128163 DOI: 10.1007/s00192-020-04582-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim was to examine the prevalence of and risk factors for lower urinary tract symptoms (LUTS) in a community-dwelling cohort of older Chinese American women. METHODS We performed a secondary analysis of a prospective cross-sectional population-based survey of community-dwelling Chinese Americans aged 60 and older in English, Mandarin, Cantonese, Taishanese, or Teochew between 2011 and 2013. A clinical Review of Systems (ROS) was used to assess LUTS, which included urinary frequency, urgency, burning or pain, blood in urine, and urinary incontinence. RESULTS Of the 1,829 women queried, 28.6% reported LUTS. The cohort of women who reported LUTS had a mean ± SD age of 74.7 ± 8.7 years, with a BMI of 23.4 ± 3.7 kg/m2 and had lived in the USA for 21.5 ± 13.1 years. Nearly 90% earned less than $10,000 a year, 50% were married, and 50% used traditional Chinese medicine (TCM) once monthly or more. In comparison with women without LUTS, women with LUTS had significantly higher rates of medical comorbidities and a poorer perception of their general health and quality of life. In multivariate regression analysis, any LUTS were significantly associated with older age (aOR 1.03, 95% CI 1.01-1.04), TCM use (aOR 1.67, 95% CI 1.34-2.07), anxiety (aOR 1.45, 95% CI 1.02-2.06), depression (aOR 2.00, 95% CI 1.53-2.61), and a history of stroke (aOR 1.90, 95% CI 1.19-3.02). CONCLUSIONS Lower urinary tract symptoms are common among older Chinese American women, particularly in those who are older, use TCM regularly, or report a history of anxiety, depression, or stroke.
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Affiliation(s)
- Tsung Mou
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, Suite 05-2370, Chicago, IL, 60611, USA.
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, Suite 05-2370, Chicago, IL, 60611, USA
| | - Melissa Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, Suite 05-2370, Chicago, IL, 60611, USA
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, Suite 05-2370, Chicago, IL, 60611, USA
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A Prospective Study of Physical Activity, Sedentary Behavior, and Incidence and Progression of Lower Urinary Tract Symptoms. J Gen Intern Med 2020; 35:2281-2288. [PMID: 32347424 PMCID: PMC7403234 DOI: 10.1007/s11606-020-05814-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/19/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS), often secondary to benign prostatic hyperplasia, are a common problem for older men. Lifestyle factors, including physical activity and sedentariness, may be important LUTS risk factors and suitable targets for intervention. OBJECTIVE To determine whether physical activity and sedentariness are associated with LUTS incidence and progression. DESIGN The Health Professionals Follow-up Study is a prospective cohort of men that began in 1986. Follow-up for LUTS is complete through 2008. PARTICIPANTS Men aged 40-75 years at enrollment and members of health professions. MAIN MEASURES Total weekly metabolic equivalent of task (MET)-hour scores were calculated and were categorized (< 9, 9 to < 21, 21 to < 42, 42 to < 63, ≥ 63 MET-hours/week). Participants reported their average time/week spent sitting watching television as a measure of sedentariness, which was categorized (< 1, 1-3, 4-10, 11-29, ≥ 30 h/week). Participants completed the International Prostate Symptom Score survey and reported treatments for LUTS periodically. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HR) of physical activity and television watching with LUTS incidence and progression. KEY RESULTS After multivariable adjustment, including for body mass index (BMI), men with the highest physical activity were 19% (HR = 0.81, 95% CI = 0.74-0.89; p trend < 0.0001) less likely to develop incident moderate or worse LUTS than men in the lowest category. Men who watched television ≥ 30 h/week were 24% (HR = 1.24, 95% CI = 1.05-1.45; p trend = 0.004) more likely to develop incident moderate or worse LUTS than men who watched < 1 h/week. These associations persisted after mutual adjustment. We observed no associations with LUTS progression. CONCLUSIONS In this large prospective study, more activity and less sedentariness were associated with lower risk of incident LUTS independent of one another and BMI. Physical inactivity and sedentariness were not associated with LUTS worsening. Increasing physical activity and reducing sedentariness may be strategies for preventing LUTS in addition to their well-established benefits for other diseases.
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Epperson CN, Duffy KA, Johnson RL, Sammel MD, Newman DK. Enduring impact of childhood adversity on lower urinary tract symptoms in adult women. Neurourol Urodyn 2020; 39:1472-1481. [PMID: 32368829 DOI: 10.1002/nau.24375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/22/2022]
Abstract
AIMS To determine whether childhood adversity is associated with self-reported lower urinary tract symptoms (LUTS) among older adult women. METHODS A convenience sample of women (≥55 years old) who presented to an academic urology practice or who had participated in a previous bladder health prevention study completed questionnaires including the LUTS Tool (on frequency and bother of LUTS), the Adverse Childhood Experiences (ACEs) Questionnaire, the Spielberger State-Trait Anxiety Inventory, and the Center for Epidemiologic Studies Depression Scale. RESULTS The average age (SD) of participants (N = 151) was 64.7 (6.9) years. The total number of ACEs predicted the total number of LUTS, β = .39 (95% confidence interval [CI] = 0.14, 0.64), P = .003, as well as LUTS frequency, β = .09 (95% CI = 0.04, 0.13), P < .001. ACEs predicted bother for nocturia, β = 0.12 (95% CI = 0.03, 0.22), P = .008. Negative affect symptoms did not mediate the relationship between the total number of ACEs and the total number of LUTS. Rather, ACEs predicted LUTS and negative affect symptoms through (at least partially) independent pathways. Analyses controlled for tobacco use, number of vaginal deliveries, hypertension, overactive bladder medication use, body mass index, income, and race because these variables were significantly associated with the total number of ACEs or total number of LUTS. CONCLUSIONS Childhood adversity has an enduring impact on risk for LUTS in adulthood even when controlling for potential confounds and this relationship cannot be explained by negative affect symptoms.
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Affiliation(s)
- C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Department of Family Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Mary D Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Brady SS, Berry A, Camenga DR, Fitzgerald CM, Gahagan S, Hardacker CT, Harlow BL, Hebert-Beirne J, LaCoursiere DY, Lewis JB, Low LK, Lowder JL, Markland AD, McGwin G, Newman DK, Palmer MH, Shoham DA, Smith AL, Stapleton A, Williams BR, Sutcliffe S. Applying concepts of life course theory and life course epidemiology to the study of bladder health and lower urinary tract symptoms among girls and women. Neurourol Urodyn 2020; 39:1185-1202. [PMID: 32119156 PMCID: PMC7659467 DOI: 10.1002/nau.24325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/23/2020] [Indexed: 01/18/2023]
Abstract
AIMS Although lower urinary tract symptoms (LUTS) may occur at different periods during the life course of women, a little research on LUTS has adopted a life course perspective. The purpose of this conceptual paper is to demonstrate how life course theory and life course epidemiology can be applied to study bladder health and LUTS trajectories. We highlight conceptual work from the Prevention of Lower Urinary Tract Symptoms Research Consortium to enhance the understanding of life course concepts. METHODS Consortium members worked in transdisciplinary teams to generate examples of how life course concepts may be applied to research on bladder health and LUTS in eight prioritized areas: (a) biopsychosocial ecology of stress and brain health; (b) toileting environment, access, habits, and techniques; (c) pregnancy and childbirth; (d) physical health and medical conditions; (e) musculoskeletal health; (f) lifestyle behaviors; (g) infections and microbiome; and (h) hormonal status across the life span. RESULTS Life course concepts guided consortium members' conceptualization of how potential risk and protective factors may influence women's health. For example, intrapartum interventions across multiple pregnancies may influence trajectories of bladder health and LUTS, illustrating the principle of life span development. Consortium members also identified and summarized methodologic and practical considerations in designing life course research. CONCLUSIONS This paper may assist researchers from a variety of disciplines to design and implement research identifying key risk and protective factors for LUTS and bladder health across the life course of women. Results from life course research may inform health promotion programs, policies, and practices.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Amanda Berry
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deepa R Camenga
- Department of Emergency Medicine and Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheila Gahagan
- Department of Pediatrics, Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | | | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - D Yvette LaCoursiere
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, San Diego, California
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Lisa K Low
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
- Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Diane K Newman
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary H Palmer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - David A Shoham
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois
| | - Ariana L Smith
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann Stapleton
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington
| | - Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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Komiya H, Umegaki H, Asai A, Kanda S, Maeda K, Nomura H, Kuzuya M. Prevalence and risk factors of constipation and pollakisuria among older home-care patients. Geriatr Gerontol Int 2019; 19:277-281. [PMID: 30628140 DOI: 10.1111/ggi.13610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 01/28/2023]
Abstract
AIM The prevalence of constipation and prevalence of pollakisuria among older patients receiving home medical care have not been reported, and risk factors for these symptoms are not clear in this setting. The present study sought to determine the prevalence and risk factors of constipation and pollakisuria among older patients receiving home medical care in Japan. METHODS This study utilized data from patients in the Observational Study of Nagoya Elderly with Home Medical Care (n = 153). We carried out univariate and multivariate logistic regression analyses with the presence of constipation or pollakisuria as the dependent variable to evaluate the relationships between constipation or pollakisuria and several covariates. RESULTS The prevalence of constipation and pollakisuria were 56.9% and 15.7%, respectively. Multivariate logistic analysis showed that constipation was associated with Charlson Comorbidity Index score, polypharmacy and pollakisuria, and pollakisuria was associated with constipation and insomnia. Cardiovascular disease was inversely associated with constipation. CONCLUSIONS The prevalence of constipation among home-care patients was as high as that reported for nursing home residents and higher than that among community-dwelling individuals. Clinicians should be aware of increased constipation risk among home-care patients, particularly for those with a high Carlson Comorbidity Index score, polypharmacy and/or pollakisuria. Geriatr Gerontol Int 2019; 19: 277-281.
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Affiliation(s)
- Hitoshi Komiya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital, Nagoya, Japan
| | - Keiko Maeda
- Mokuren Clinic, Department of Home Medical Care, Nagoya, Japan
| | | | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Zhang AY, Xu X. Prevalence, Burden, and Treatment of Lower Urinary Tract Symptoms in Men Aged 50 and Older: A Systematic Review of the Literature. SAGE Open Nurs 2018; 4:2377960818811773. [PMID: 33415211 PMCID: PMC7774430 DOI: 10.1177/2377960818811773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022] Open
Abstract
We conducted a systematic review of literature from the years 2000 through 2017 on the prevalence and burden of lower urinary tract symptoms (LUTS) in men aged 50 and older, and medical treatments of and alternative nonmedical approaches to LUTS. EBSCOhost (Medline with Full Text) was searched for observational, experimental, and review studies in peer-reviewed journals in the English language. Our review found that LUTS were highly prevalent in the world and estimated to affect 2.3 billion people in 2018, with 44.7% being men. Men with LUTS suffer from not only burdensome symptoms such as nocturia and urgency but also adverse psychological consequences (e.g., anxiety and depression) and financial burden. Current medical treatments are clinically effective, but their efficacy is compromised by side effects and low compliance rates. Alternative nonmedical treatments for LUTS were also sought worldwide. There is evidence that lifestyle modifications such as pelvic muscle exercises and bladder training, physical activity, dietary modification, and nutritional supplements can alleviate LUTS and improve patient quality of life; however, evidence based on rigorous methodology remains minimal and cannot be generalized across populations. Evidence of effectiveness of weight loss programs to reduce LUTS is inconclusive. We conclude that although behavioral treatment is a promising approach to alleviating LUTS, especially when combined with medical treatments, well-designed randomized controlled and longitudinal clinical trials on behavioral treatments of LUTS are still needed. Minimally invasive procedures and neuromodulation therapy also show positive results of alleviating LUTS but require further research as well.
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Affiliation(s)
- Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Xinyi Xu
- University Hospitals Cleveland Medical Center Seidman Cancer Center, Cleveland, OH, USA
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Factors Influencing Lower Urinary Tract Symptoms in Advanced Cancer Patients With Chemotherapy-Induced Peripheral Neuropathy. Int Neurourol J 2018; 22:192-199. [PMID: 30286582 PMCID: PMC6177728 DOI: 10.5213/inj.1836084.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/12/2018] [Indexed: 01/16/2023] Open
Abstract
Purpose This study aimed to investigate the severity of lower urinary tract symptoms (LUTS) and to identify factors that influenced LUTS in advanced cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). Methods This cross-sectional study included a total of 158 advanced cancer patients with CIPN. A structured questionnaire including the International Prostate Symptom Score and the Functional Assessment of Cancer Therapy/Gynecology Oncology Group/Neurotoxicity scale was used. Data were analyzed using the Pearson correlation coefficient and multiple regression analysis. Results Nocturia was the most prevalent LUTS. A positive relationship was found between CIPN symptoms and LUTS. The duration of cancer diagnosis and the severity of CIPN were key factors that influenced LUTS. Conclusions The severity of CIPN symptoms was the most important predictor of LUTS. Nurses’ care for advanced cancer patients should incorporate a comprehensive health assessment, which includes a history of treatment and physical neuropathic symptoms, for any patient complaining of CIPN symptoms.
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Lee KS, Yoo TK, Liao L, Wang J, Chuang YC, Liu SP, Chu R, Sumarsono B. Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study. BMC Urol 2017; 17:108. [PMID: 29162085 PMCID: PMC5698954 DOI: 10.1186/s12894-017-0294-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022] Open
Abstract
Background Lower urinary tract symptoms (LUTS) and overactive bladder (OAB) symptoms have a substantial effect on quality of life (QoL). We report QoL and mental health results from a LUTS prevalence study in three Asian countries. Methods A cross-sectional, population-representative, internet-based study among individuals aged ≥40 years in China, Taiwan and South Korea. Instruments included: Overactive Bladder Symptom Score (OABSS); International Prostate Symptom Score (IPSS); other International Continence Society (ICS) symptom questions; health-related QoL 12-item short-form (HRQoL-SF12v2); Work Limitations Questionnaire (WLQ); Hospital Anxiety and Depression Scale (HADS). Presence of LUTS was determined according to ICS criteria, with three symptom groups (storage, voiding and post-micturition). Post-stratification weighting matched the age and sex population distribution per country. Initial data analyses were based on descriptive statistics. Significance testing undertaken post hoc included: independent-samples t-test (differences in HRQoL between sexes and between individuals with/without LUTS; relationship between HRQoL score and OABSS; differences in HADS anxiety and depression scores between individuals with/without LUTS; association between HADS anxiety/depression scores and OABSS), chi-square test (association between LUTS prevalence and workplace productivity) and analysis of variance (differences in HRQoL score and in HADS anxiety/depression scores between individuals with different symptom groups, association between HADS anxiety/depression scores and IPSS). Results In total, 8284 participants were included. HRQoL scores were significantly worse (p < 0.001) among individuals with versus without LUTS (ICS criteria): mean physical health domain scores were 61.1 (standard deviation [SD], 20.1) and 76.7 (17.0), respectively; corresponding mental health domain scores were 34.8 (12.7) and 43.7 (10.7). Workplace productivity was best among individuals without LUTS (difficulties reported by 2–3% of individuals), and worst in those with all three ICS symptom groups (difficulties reported by 29–38% of individuals; p = 0.001). Mean HADS scores showed significantly worse (p < 0.001) levels of anxiety and depression among individuals with versus without LUTS: anxiety, 6.5 (SD, 3.7) and 4.0 (3.3); corresponding mean depression scores were 6.8 (4.3) and 4.2 (3.6). Increasing OAB severity was also associated with decreasing HRQoL physical and mental health scores. Conclusion LUTS and increasing OAB severity are both associated with impaired QoL, reduced workplace productivity, and increased tendency towards anxiety and depression. These results highlight the need to ensure that individuals with LUTS receive appropriate, effective treatment. Trial registration ClinicalTrials.gov identifier: NCT02618421, registered 26 November 2015 (retrospectively registered).
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Affiliation(s)
- Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, Korea.
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, Beijing, China
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Romeo Chu
- Astellas Pharma Singapore Pte. Ltd., Singapore, Singapore.,, Present address: 5 Pemimpin Drive, #19-03 Seasons View, Singapore, Singapore
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Ohtake PJ, Borello-France D. Rehabilitation for Women and Men With Pelvic-Floor Dysfunction. Phys Ther 2017; 97:390-392. [PMID: 28499005 DOI: 10.1093/ptj/pzx035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Ho Lee S, Kon Lee S. Does Race/Ethnicity Have a Role in a Link Between Lower Urinary Tract Symptoms and Metabolic Syndrome? EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Metabolic syndrome (MS) is a highly prevalent disease related to the risk of cardiovascular disease and diabetes. A large body of evidence has suggested a link between MS and the components of MS with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) complex. The pathogenesis of MS is complex and not fully understood. Furthermore, recent results from epidemiological studies, including multiple Asian reports, have not been consistent. The risk of BPH is lower in Asian men compared with white men and the prevalence of MS varies by race and ethnicity. An elevated risk of Type 2 diabetes mellitus, hypertension, and dyslipidaemia is closely related to MS and is observed in Asian men even if their body mass index is low. However, the role of race and ethnic disparity in the link between MS and LUTS secondary to BPH is not elucidated. It has been suggested that the pathogenesis of LUTS is multifactorial rather than developing from BPH, which is the traditional concept. Lifestyle and genetic factors may substantially modify the risk of MS and LUTS/BPH. This comprehensive literature review summarises the scientific evidence of the racial/ethnic disparity regarding the association between MS and LUTS/BPH in order to improve current understanding of this controversial issue.
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Affiliation(s)
- Seong Ho Lee
- Department of Urology, School of Medicine, Hallym University, Chuncheon, South Korea
| | - Sang Kon Lee
- Department of Urology, School of Medicine, Hallym University, Chuncheon, South Korea
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Eshkoor SA, Hamid TA, Shahar S, Mun CY. Factors Related to Urinary Incontinence among the Malaysian Elderly. J Nutr Health Aging 2017; 21:220-226. [PMID: 28112780 DOI: 10.1007/s12603-016-0779-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Urinary incontinence is a prevalent condition in the elderly that is the spontaneous leakage of urine. It is an age-related problem and increases especially in people aged above 65 years. It can cause many psychological, behavioral, biological, economic and social effects. The treatment of urinary incontinence can reduce morbidity and mortality. Thus, this study aimed to determine the effects of variables including age, ethnicity, gender, education, marital status, body weight, blood elements and nutritional parameters on urinary incontinence among the Malaysian elderly. METHODS The study was on 2322 non-institutionalized Malaysian elderly. The hierarchy logistic regression analysis was applied to estimate the risk of independent variables for urinary incontinence among respondents. RESULTS The findings indicated that approximately 3.80% of subjects had urinary incontinence. In addition, constipation was found a significant factor that increased the risk of urinary incontinence in samples (p=0.006; OR=3.77). The increase in dietary monounsaturated fat (p=0.038; OR=0.59) and plasma triglyceride levels (p=0.029; OR=0.56) significantly reduced the risk of incontinence in subjects. Many of suspected variables including socio-demographic factors, diseases, nutritional minerals, blood components and body weight were non-relevant factors to urinary incontinence in respondents. CONCLUSIONS Constipation increased the risk of urinary incontinence in subjects, and increase in dietary monounsaturated fat and plasma triglyceride levels decreased the risk.
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Affiliation(s)
- S A Eshkoor
- Tengku Aizan Hamid, Malaysian Research on Aging (MyAging), University Putra Malaysia, Serdang, Malaysia, E-mail:
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An association between diet, metabolic syndrome and lower urinary tract symptoms. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Huang WJ. Hypogonadism and voiding dysfunction in men. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vlachopoulos C, Oelke M, Maggi M, Mulhall JP, Rosenberg MT, Brock GB, Esler A, Büttner H. Impact of cardiovascular risk factors and related comorbid conditions and medical therapy reported at baseline on the treatment response to tadalafil 5 mg once-daily in men with lower urinary tract symptoms associated with benign prostatic hyperplasia: an integrated analysis of four randomised, double-blind, placebo-controlled, clinical trials. Int J Clin Pract 2015; 69:1496-507. [PMID: 26299520 DOI: 10.1111/ijcp.12722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The influence of cardiovascular risk factors/comorbidities on response to oral once-daily tadalafil 5 mg was explored in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). METHODS This post hoc analysis pooled data from four double-blind studies in which 1498 men with > 6-mo history of LUTS/BPH were randomised and received either once-daily placebo (n = 746) or tadalafil 5 mg (n = 752) for 12 weeks. Descriptive statistics were reported for changes in total International Prostate Symptom Score (IPSS), IPSS voiding and storage subscores, and IPSS quality-of-life (QoL) index. Treatment group differences by baseline clinical and cardiovascular factors and medical therapies were examined using analysis of covariance. RESULTS Tadalafil was effective in men with LUTS/BPH and cardiovascular risk factors/comorbidities except for patients receiving > 1 antihypertensive medication. Placebo-adjusted least squares (LS) mean improvements in total IPSS were -1.2 (95% CI: -2.5 to -0.0) in men taking > 1 antihypertensive medication vs. -3.3 (95% CI: -4.4 to -2.1) in men taking one medication (interaction p = 0.020). In addition, placebo-adjusted LS mean improvements in total IPSS were -0.2 (95% CI, -2.1 to 1.7) in men who reported use of diuretics vs. -2.8 (95% CI, -3.7 to -1.9) in men who reported taking other antihypertensive medications vs. -2.3 (95% CI, -3.2 to -1.5) in men who reported not using any antihypertensive drug (p-value for interaction = 0.053). CONCLUSIONS Once-daily tadalafil 5 mg improved LUTS/BPH, regardless of severity, in men with coexisting cardiovascular risk factors/comorbidities, except for patients with history of > 1 drug for arterial hypertension. Use of diuretics may contribute to patients' perception of a negated efficacy of tadalafil on LUTS/BPH. Comorbidities should be considered when choosing the optimal medicine to treat men with LUTS/BPH.
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Affiliation(s)
- C Vlachopoulos
- 1st Department of Cardiology, Athens Medical School, Athens, Greece
| | - M Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - M Maggi
- University of Florence, Florence, Italy
| | - J P Mulhall
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - G B Brock
- University of Western Ontario, London, ON, Canada
| | - A Esler
- Inventiv Health Clinical, Indianapolis, IN, USA
| | - H Büttner
- Eli Lilly Biomedicines BU - Men's Health Therapeutic Area Europe, c/o Lilly Deutschland, GmbH, Bad Homburg, Germany
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Takahashi S, Takei M, Nishizawa O, Yamaguchi O, Kato K, Gotoh M, Yoshimura Y, Takeyama M, Ozawa H, Shimada M, Yamanishi T, Yoshida M, Tomoe H, Yokoyama O, Koyama M. Clinical Guideline for Female Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2015; 8:5-29. [PMID: 26789539 DOI: 10.1111/luts.12111] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/28/2015] [Indexed: 12/16/2022]
Abstract
The "Japanese Clinical Guideline for Female Lower Urinary Tract Symptoms," published in Japan in November 2013, contains two algorithms (a primary and a specialized treatment algorithm) that are novel worldwide as they cover female lower urinary tract symptoms other than urinary incontinence. For primary treatment, necessary types of evaluation include querying the patient regarding symptoms and medical history, examining physical findings, and performing urinalysis. The types of evaluations that should be performed for select cases include evaluation with symptom/quality of life (QOL) questionnaires, urination records, residual urine measurement, urine cytology, urine culture, serum creatinine measurement, and ultrasonography. If the main symptoms are voiding/post-voiding, specialized treatment should be considered because multiple conditions may be involved. When storage difficulties are the main symptoms, the patient should be assessed using the primary algorithm. When conditions such as overactive bladder or stress incontinence are diagnosed and treatment is administered, but sufficient improvement is not achieved, the specialized algorithm should be considered. In case of specialized treatment, physiological re-evaluation, urinary tract/pelvic imaging evaluation, and urodynamic testing are conducted for conditions such as refractory overactive bladder and stress incontinence. There are two causes of voiding/post-voiding symptoms: lower urinary tract obstruction and detrusor underactivity. Lower urinary tract obstruction caused by pelvic organ prolapse may be improved by surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Osamu Nishizawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Osamu Yamaguchi
- Division of Bioengineering and LUTD Research, School of Engineering, Nihon University, Koriyama, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Hideo Ozawa
- Department of Urology, Kawasaki Hospital, Kawasaki Medical School, Kurashiki, Japan
| | - Makoto Shimada
- Department of Urology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masayasu Koyama
- Women's Lifecare Medicine, Department of Obstetrics & Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Maharajh S, Abdel Goad EH, Ramklass SS, Conradie MC. Lower urinary tract symptoms (LUTS) in males: a review of pathophysiology. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2014.983307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Choi EPH, Lam CLK, Chin WY. Mental Health Mediating the Relationship Between Symptom Severity and Health-Related Quality of Life in Patients with Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2015; 8:141-9. [PMID: 27619778 DOI: 10.1111/luts.12086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/24/2014] [Accepted: 11/04/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Lower urinary tract symptoms (LUTS) can impact both mental health and health-related quality of life (HRQOL). To date, however, their associations with outcomes have only been examined in isolation and the interactive relationship between LUTS, mental health and HRQOL remains poorly understood. The aim of this study was to determine whether mental health mediates the relationship between LUTS severity and HRQOL. METHODS Five hundred and nineteen primary care subjects with LUTS completed a structured questionnaire including the International Prostate Symptom Score (IPSS), the adapted Incontinence Impact Questionnaire-7 (IIQ-7), the Chinese (HK) SF-12 Health Survey Version 2 (SF-12 v2) and the Depression, Anxiety and Stress Scale-21 (DASS-21). Mediation modeling was tested using Baron and Kenney's multistage regression approach and bootstrapping method. RESULTS Overall, mental health partially mediated the association between LUTS severity and HRQOL as measured by the SF-12 v2 physical component summary (PCS) and the IIQ-7. The depression, anxiety and stress scores all have similar mediation effects in the relationship between LUTS severity and HRQOL. Subgroup analysis by gender showed that anxiety fully mediated the relationship between LUTS severity and HRQOL as measured by the SF-12 v2 PCS in males whilst the mediation effects of mental health in the relationship between LUTS severity and HRQOL as measured by the SF-12 v2 PCS could not be found in females. CONCLUSIONS In order to enhance HRQOL, LUTS interventions should address the mental health of patients in addition to providing physical relief of symptoms.
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Affiliation(s)
- Edmond P H Choi
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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Kupelian V, Araujo AB, Wittert GA, McKinlay JB. Association of Moderate to Severe Lower Urinary Tract Symptoms with Incident Type 2 Diabetes and Heart Disease. J Urol 2015; 193:581-6. [DOI: 10.1016/j.juro.2014.08.097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Varant Kupelian
- New England Research Institutes, Inc., Watertown, Massachusetts, and Department of Medicine, University of Adelaide, Royal Adelaide Hospital (GAW), Adelaide, South Australia, Australia
| | - Andre B. Araujo
- New England Research Institutes, Inc., Watertown, Massachusetts, and Department of Medicine, University of Adelaide, Royal Adelaide Hospital (GAW), Adelaide, South Australia, Australia
| | - Gary A. Wittert
- New England Research Institutes, Inc., Watertown, Massachusetts, and Department of Medicine, University of Adelaide, Royal Adelaide Hospital (GAW), Adelaide, South Australia, Australia
| | - John B. McKinlay
- New England Research Institutes, Inc., Watertown, Massachusetts, and Department of Medicine, University of Adelaide, Royal Adelaide Hospital (GAW), Adelaide, South Australia, Australia
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Lee UJ, Ackerman AL, Wu A, Zhang R, Leung J, Bradesi S, Mayer EA, Rodríguez LV. Chronic psychological stress in high-anxiety rats induces sustained bladder hyperalgesia. Physiol Behav 2014; 139:541-8. [PMID: 25449389 DOI: 10.1016/j.physbeh.2014.11.045] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate whether anxiety-prone rats exposed to chronic water avoidance stress (WAS) develop visceral bladder hyperalgesia in addition to increased voiding frequency and anxiety-related behaviors. MATERIALS AND METHODS Female Wistar-Kyoto (WKY) rats were exposed to chronic (10-day) WAS or sham paradigms. Referred hyperalgesia and tactile allodynia were tested using von Frey filaments applied to the suprapubic region and plantar region of the hindpaw, respectively. To confirm that suprapubic nociception represented referred visceral bladder hyperalgesia, we recorded abdominal visceromotor responses (VMR) to slow (100 μl/min) and fast (1 cc/sec) bladder filling with room temperature or ice-cold saline. We assessed the development of hyperalgesia over the 10-day WAS protocol and the durability of increased pain sensations over time. RESULTS Animals exposed to chronic WAS had significantly lower hindpaw withdrawal thresholds post-stress and significant differences in referred hyperalgesia. Rats exposed to chronic WAS demonstrated an increased pain response to suprapubic stimulation and decreased response threshold to mechanical hindpaw stimulation by day 8 of the stress protocol, which persisted for more than one month. Animals exposed to chronic WAS showed increased VMR to fast filling and ice water testing in comparison to sham animals. Cystometry under anesthesia did not show increases in the frequency of non-voiding contractions. CONCLUSION Chronic WAS induces sustained bladder hyperalgesia, lasting over a month after exposure to stress. The urinary frequency demonstrated previously in anxiety-prone rats exposed to chronic WAS seems to be associated with bladder hyperalgesia, suggesting that this is a potential model for future studies of bladder hypersensitivity syndromes such as interstitial cystitis/painful bladder syndrome (IC/PBS).
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Affiliation(s)
- Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason, Seattle, WA.
| | - A Lenore Ackerman
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Ais Wu
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Rong Zhang
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Joanne Leung
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Sylvie Bradesi
- Center for the Neurobiology of Stress, The David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Emeran A Mayer
- Center for the Neurobiology of Stress, The David Geffen School of Medicine at UCLA, Los Angeles, CA
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Yang YJ, Koh JS, Ko HJ, Cho KJ, Kim JC, Lee SJ, Pae CU. The influence of depression, anxiety and somatization on the clinical symptoms and treatment response in patients with symptoms of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. J Korean Med Sci 2014; 29:1145-51. [PMID: 25120327 PMCID: PMC4129209 DOI: 10.3346/jkms.2014.29.8.1145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/08/2014] [Indexed: 11/20/2022] Open
Abstract
This is the first study to investigate the influence of depression, anxiety and somatization on the treatment response for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the Korean versions of the International Prostate Symptom Score (IPSS), the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the PHQ-15. The primary endpoint was a responder rate defined by the total score of IPSS (≤ 7) at the end of treatment. The LUTS/BPH severity was significantly higher in patients with depression (whole symptoms P = 0.024; storage sub-symptom P = 0.021) or somatization (P = 0.024) than in those without, while the quality of life (QOL) was significantly higher in patients with anxiety (P = 0.038) than in those without. Anxious patients showed significantly higher proportion of non-response (odds ratio [OR], 3.294, P = 0.022) than those without, while somatic patients had a trend toward having more non-responders (OR, 2.552, P = 0.067). Our exploratory results suggest that depression, anxiety and somatization may have some influences on the clinical manifestation of LUTS/BPH. Further, anxious patients had a lower response to treatment in patients with LUTS/BPH. Despite of limitations, the present study demonstrates that clinicians may need careful evaluation of psychiatric symptoms for proper management of patients with LUTS/BPH.
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Affiliation(s)
- Yong June Yang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jun Sung Koh
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyo Jung Ko
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
| | - Kang Joon Cho
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo-Jung Lee
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Hanna-Mitchell AT, Kashyap M, Chan WV, Andersson KE, Tannenbaum C. Pathophysiology of idiopathic overactive bladder and the success of treatment: a systematic review from ICI-RS 2013. Neurourol Urodyn 2014; 33:611-7. [PMID: 24844598 DOI: 10.1002/nau.22582] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/10/2014] [Indexed: 12/11/2022]
Abstract
AIMS To investigate the frequency of phenotype profiling of patients with idiopathic overactive bladder (OAB) syndrome, and to determine the effectiveness of treatment among individuals with different pathophysiologic profiles. METHODS The electronic databases MEDLINE, EMBASE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and CINAHL were searched from January 1, 1980 to August 12, 2013 for interventional randomized controlled treatment trials (RCTs) of idiopathic OAB. Phenotying for pathophysiologies originating in the urothelial/mucosal layer of the bladder, the detrusor muscle cell layer, and the central nervous system were sought. Articles that analyzed urgency outcomes based on pathophysiologic profiling were selected. Due to the heterogeneity of the included interventions and outcome assessment measures, meta-analysis was not appropriate and a qualitative synthesis was undertaken. RESULTS Of 239 original RCTs of idiopathic OAB, 48 (20%) profiled participants on underlying pathophysiology. Less than half of these (n = 20) reported treatment efficacy for urgency symptoms by pathophysiological sub-type. One examined the effect of botulinum A toxin on interstitial cell protein expression. Four compared treatment efficacy in OAB patients with and without involuntary detrusor contractions. Fifteen compared the effect of treatment on urgency reduction in patients with detrusor overactivity. There were no consistent trends in treatment efficacy according to pathophysiologic sub-type. No studies examined urothelial dysfunction or abnormal central processing of bladder afferent signaling in response to treatment. CONCLUSIONS In order to advance the field of idiopathic OAB, more trials are needed that profile and test urgency outcomes in participants according to suspected underlying pathophysiology. Neurourol. Urodynam. 33:611-617, 2014. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Ann T Hanna-Mitchell
- University Hospitals Case Medical Center and Department of Urology, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Abstract
IMPORTANCE Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice. OBJECTIVE To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women. EVIDENCE REVIEW A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. RESULTS The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs. CONCLUSIONS AND RELEVANCE Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.
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Affiliation(s)
- Lona Mody
- Divisions of Geriatric and Palliative Care Medicine, University of Michigan, Ann Arbor2Geriatric Research Education and Clinical Center, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Manisha Juthani-Mehta
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Bouwman II, Kollen BJ, van der Meer K, Nijman RJM, van der Heide WK. Are lower urinary tract symptoms in men associated with cardiovascular diseases in a primary care population: a registry study. BMC FAMILY PRACTICE 2014; 15:9. [PMID: 24422708 PMCID: PMC3898227 DOI: 10.1186/1471-2296-15-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 01/03/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although lower urinary tract symptoms (LUTS) seem to be related to cardiovascular disease (CVD) in men, it is unclear whether this relationship is unbiased. In order to investigate this relationship, we used longitudinal data for establishing the possible predictive value of LUTS for the development of CVD in a primary care population. METHODS We performed a registry study using data from the Registration Network Groningen (RNG). All data from men aged 50 years and older during the study period from 1 January 1998 up to 31 December 2008 were collected. Cox proportional hazard regression analysis was used to determine the association between the proportions of CVD (outcome) and LUTS in our population. RESULTS Data from 6614 men were analysed. The prevalence of LUTS increased from 92/1000 personyears (py) in 1998 up to 183/1000 py in 2008. For cardiovascular diseases the prevalence increased from 176/1000 py in 1998 up to 340/1000 py in 2008. The incidence numbers were resp. 10.2/1000 py (1998) and 5.1/1000 py (2008) for LUTS, and 12.9/1000 py (1998) and 10.4/1000 py (2008) for CVD. Of all men, 23.2% reported CVD (41.1% in men with LUTS vs 19.5% in men without LUTS, p < 0.01). The hazard ratio of LUTS for cardiovascular events, compared to no LUTS, in the adjusted multivariate model, was 0.921(95% CI: 0.824 - 1.030; p = 0.150). CONCLUSION Based on the results, LUTS is not a factor that must be taken into account for the early detection of CVD in primary care.
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Affiliation(s)
- Inge I Bouwman
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Boudewijn J Kollen
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Klaas van der Meer
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
| | - Rien JM Nijman
- Department of urology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, GZ 9713, Netherlands
| | - Wouter K van der Heide
- Department of general practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, Netherlands
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Comeglio P, Morelli A, Cellai I, Vignozzi L, Sarchielli E, Filippi S, Maneschi E, Corcetto F, Corno C, Gacci M, Vannelli GB, Maggi M. Opposite effects of tamoxifen on metabolic syndrome-induced bladder and prostate alterations: a role for GPR30/GPER? Prostate 2014; 74:10-28. [PMID: 24037776 DOI: 10.1002/pros.22723] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/23/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND BPH and LUTS have been associated to obesity, hypogonadism, and metabolic syndrome (MetS). MetS-induced prostate and bladder alterations, including inflammation and tissue remodeling, have been related to a low-testosterone and high-estrogen milieu. In addition to ERs, GPR30/GPER is able to mediate several estrogenic non-genomic actions. METHODS Supplementing a subgroup of MetS rabbits with tamoxifen, we analyzed the in vivo effects on MetS-induced prostate and bladder alterations. The effects of selective ER/GPER ligands and GPER silencing on prostate inflammation were also studied in vitro using hBPH cells. RESULTS ERα, ERβ, and PR expression was upregulated in MetS bladder, where tamoxifen decreased ERα and PR expression, further stimulating ERβ. In addition, tamoxifen-dosing decreased MetS-induced overexpression of inflammatory and tissue remodeling genes. In prostate, sex steroid receptors, pro-inflammatory and pro-fibrotic genes were upregulated in MetS. However, tamoxifen did not affect them and even increased COX-2. In hBPH cells, 17β-estradiol increased IL-8 secretion, an effect blunted by co-treatment with GPER antagonist G15 but not by ER antagonist ICI 182,780, which further increased it. GPER agonist G1 dose-dependently (IC50 = 1.6 nM) induced IL-8 secretion. In vitro analysis demonstrated that GPER silencing reverted these stimulatory effects. CONCLUSIONS GPER can be considered the main mediator of estrogen action in prostate, whereas in bladder the mechanism appears to rely on ERα, as indicated by in vivo experiments with tamoxifen dosing. Limiting the effects of the MetS-induced estrogen action via GPER could offer new perspectives in the management of BPH/LUTS, whereas tamoxifen dosing showed potential benefits in bladder.
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Affiliation(s)
- P Comeglio
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Hsieh CI, Lung AL, Chang LI, Sampselle CM, Lin CC, Liao YM. Prevalence, associated factors, and relationship to quality of life of lower urinary tract symptoms: a cross-sectional, questionnaire survey of cancer patients. Int J Clin Pract 2013; 67:566-75. [PMID: 23679908 DOI: 10.1111/ijcp.12141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/25/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Few studies conducted outside of Asia have shown that lower urinary tract symptoms (LUTS) could be a concern for cancer patients. This gap necessitates more research on LUTS among cancer patients in Asia, particularly regarding associated factors and the relationship between quality of life and LUTS. OBJECTIVES This study investigates the prevalence, associated factors, and relationship to quality of life of LUTS based on a sample of cancer patients. DESIGN A cross-sectional, questionnaire survey. SETTINGS/PARTICIPANTS This study was conducted at two oncology outpatient departments in two hospitals in Taiwan, and included 134 Asian cancer patients. METHODS We collected information about each participant's individual characteristics, personal habits, LUTS, and quality of life by using a questionnaire. We calculated descriptive statistics to demonstrate the distribution of collected information, and used multivariate logistic regression to identify the factors associated with LUTS. We used Student's t-test to compare the mean quality of life scores for participants with and without LUTS. RESULTS Ninety-nine (73.9%) participants experienced at least one type of LUTS, and the prevalence rates for various types of LUTS ranged from 3.7% to 52.2%. Radiotherapy and the time since the diagnosis of cancer were associated with LUTS. Participants with LUTS reported lower quality of life scores than participants without LUTS. CONCLUSIONS The high prevalence of LUTS suggests that cancer treatment might be linked to LUTS, which in turn has a negative effect on a patient's quality of life. These results suggest that future research should involve studies in larger, more homogeneous samples. Health care providers should monitor the presence of LUTS and deliver the management and treatments of LUTS to optimise cancer patients' quality of life.
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Affiliation(s)
- C-I Hsieh
- Department of Internal Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Piccolo RS, Araujo AB, Pearce N, McKinlay JB. Cohort profile: the Boston Area Community Health (BACH) survey. Int J Epidemiol 2012; 43:42-51. [PMID: 23220718 DOI: 10.1093/ije/dys198] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
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).
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Affiliation(s)
- Rebecca S Piccolo
- Institute for Health Services and Disparities Research, New England Research Institutes, Watertown, MA, USA and Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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Impact of lower urinary tract symptoms and depression on health-related quality of life in older adults. Int Neurourol J 2012; 16:132-8. [PMID: 23094219 PMCID: PMC3469832 DOI: 10.5213/inj.2012.16.3.132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/16/2012] [Indexed: 12/05/2022] Open
Abstract
Purpose We aimed primarily to investigate the level of health-related quality of life (HRQoL), lower urinary tract symptoms (LUTS), and depression in older adults and secondly to identify the impact of LUTS and depression on HRQoL. Methods A community-based cross-sectional study was conducted from April to November 2010. Participants were recruited from five community senior centers serving community dwelling older adults in Jeju city. Data analysis was based on 171 respondents. A structured questionnaire was used to guide interviews; the data were collected including demographic characteristics, body mass index, adherence to regular exercise, comorbidities (hypertension, diabetes mellitus, and osteoarthritis), depression, urinary incontinence, LUTS (measured via the International Prostate Symptom Score [IPSS]), and HRQoL as assessed by use of the EQ-5D Index. Stepwise multiple regression analysis was used to test predictors of HRQoL. Results Eighteen percent (18.6%) of the respondents reported depressive symptoms. The mean LUTS score was 8.9 (IPSS range, 0 to 35). The severity of LUTS, was reported to be mild (score, 0 to 7) by 53% of the respondents, moderate (score, 8 to 19) by 34.5%, and severe (score, 20 to 35) by 12.5%. HRQoL was significantly predicted by depression (Partial R2=0.193, P<0.01) and LUTS (Partial R2=0.048, P=0.0047), and 24% of the variance in HRQoL was explained. Conclusions LUTS and depression were the principal predictors of HRQoL in older adults.
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Balkanci ZD, Pehlivanoğlu B, Bayrak S, Karabulut I, Karaismailoğlu S, Erdem A. The effect of hypercholesterolemia on carbachol-induced contractions of the detrusor smooth muscle in rats: increased role of L-type Ca2+ channels. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2012; 385:1141-8. [PMID: 22868398 DOI: 10.1007/s00210-012-0784-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 07/15/2012] [Indexed: 10/27/2022]
Abstract
To investigate a possible relation between hypercholesterolemia and detrusor smooth muscle function, we studied the contractile response to potassium challenge, carbachol (CCh), and the components of CCh-induced contractile mechanism in high-cholesterol diet-fed rats. Adult male Sprague-Dawley rats were fed with standard (control group, N = 17) or 4 % cholesterol diet (hypercholesterolemia group (HC), N = 16) for 4 weeks. Spontaneous contractions of detrusor muscle strips and their responses to potassium chloride (KCl) or cumulative dose-contraction curves to CCh were recorded. The effects of muscarinic receptor antagonists (methoctramin and/or 4-diphenylacetoxy-N-methylpiperidine), L-type Ca(+2) channel blocker (nifedipine), and/or rho-kinase inhibitor Y-27632 were investigated. Blood cholesterol level was increased in the HC group with no sign of atherosclerosis. The KCl-induced detrusor smooth muscle contractions were higher in HC, whereas spontaneous and CCh-induced responses were similar in both groups. Preincubation with receptor antagonist for M(3) but not for M(2) attenuated contraction significantly, shifting the dose-response curve to the right. This response was similar in both groups. Among two effector mechanisms of M(3)-mediated detrusor smooth muscle contraction, rho-kinase pathway was not affected by hypercholesterolemia, whereas blockade of L-type Ca(+2) channels potently reduced contractions. The results of this study point out a relation between hypercholesterolemia and contractile mechanism of detrusor smooth muscle likely to change urinary bladder function, via altering L-type Ca(+2) channels. Taken together with escalating incidence of hypercholesterolemia and lower urinary tract symptoms, it is a field which deserves to be investigated further.
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Affiliation(s)
- Zeynep Dicle Balkanci
- Department of Physiology, Faculty of Medicine, Hacettepe University, 39, Sihhiye, 06100, Ankara, Turkey
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Coyne KS, Sexton CC, Bell JA, Thompson CL, Dmochowski R, Bavendam T, Chen CI, Quentin Clemens J. The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-POLL. Neurourol Urodyn 2012; 32:230-7. [PMID: 22847394 DOI: 10.1002/nau.22295] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/25/2012] [Indexed: 11/08/2022]
Abstract
AIMS To estimate the prevalence of LUTS and OAB in a large, ethnically diverse US study. METHODS This cross-sectional, population-representative survey was conducted via the Internet in the US among 10,000 men and women aged 18-70 (2,000 African-Americans [AA], 2,000 Hispanics, 6,000 whites). The LUTS tool assessed how often participants experienced LUTS during the past 4 weeks on a five-point Likert scale. OAB was defined by the presence of urinary urgency ≥ "sometimes" or ≥ "often," and/or the presence of urgency urinary incontinence (UUI). Descriptive statistics were used to evaluate group differences. Logistic regression analyses were conducted to examine the impact of racial/ethnic group on OAB. RESULTS Response rate, 56.7%. Prevalent LUTS included terminal dribble and nocturia across gender, post-micturition leaking (men), and stress incontinence (women). Prevalence of OAB ≥ "sometimes" and ≥ "often" were 17% and 8% in men and 30% and 20% in women--with significantly higher rates among AA men and women. A similar trend was found for UUI among men (AA, 10%; Hispanic and whites, 6%), while AA and white women had higher prevalence of UUI (19%) as compared to Hispanic women (16%). In logistic regression analyses, AA and Hispanic men and women were significantly more likely than whites to have OAB despite having lower prevalence of self-reported comorbid conditions and risk factors. CONCLUSIONS LUTS and OAB are highly prevalent in both men and women and increase with advancing age. Further, racial/ethnic group is a robust predictor of OAB in men and women.
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Affiliation(s)
- Karin S Coyne
- United BioSource Corporation, 7101 Wisconsin Ave, Suite 600, Bethesda, MD, USA.
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Zhang S, Lv JW, Yang P, Yu Q, Pang J, Wang Z, Guo H, Liu S, Hu J, Li J, Leng J, Huang Y, Ye Z, Wang CY. Loss of dicer exacerbates cyclophosphamide-induced bladder overactivity by enhancing purinergic signaling. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:937-46. [PMID: 22796409 DOI: 10.1016/j.ajpath.2012.05.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 05/30/2012] [Indexed: 12/23/2022]
Abstract
microRNAs (miRNAs) have regulated the expression and function of genes implicated in many pathological settings, but their impact on the pathoetiological characteristics of overactive bladder (OAB) largely remains unknown. We have generated a mouse model in which adult mice can be induced for detrusor deletion of Dicer, an enzyme essential for miRNA processing. Targeted deletion of Dicer did not lead to a significant change for detrusor functionality under physiological conditions; however, loss of Dicer exacerbated cyclophosphamide-induced OAB, manifested by the higher severity of altered detrusor contractile force and sensitivity, abnormal urodynamics, and enhanced macrophage infiltration. Mechanistic studies revealed that loss of Dicer may impair the expression of miRNAs that are capable of targeting P2x mRNAs. As a result, mice deficient in Dicer manifest enhanced P2X expression in the detrusor on cyclophosphamide treatment, predisposing to the increased risk for OAB development. More important, studies using bladder biopsy samples of patients with OAB also demonstrated similar results as those found in animals. Taken together, our results suggest that miRNAs modulate OAB susceptibility by regulating purinergic signaling, in which the pathogenic insult induces the expression of miRNAs capable of targeting P2X mRNAs to suppress OAB symptoms.
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Affiliation(s)
- Shu Zhang
- The Center for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Risk Factors for New-onset Overactive Bladder in Older Subjects: Results of the Fujiwara-Kyo Study. Urology 2012; 80:71-6. [DOI: 10.1016/j.urology.2012.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 01/08/2023]
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Maserejian NN, Kupelian V, Miyasato G, McVary KT, McKinlay JB. Are physical activity, smoking and alcohol consumption associated with lower urinary tract symptoms in men or women? Results from a population based observational study. J Urol 2012; 188:490-5. [PMID: 22704109 DOI: 10.1016/j.juro.2012.03.128] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Lower urinary tract symptoms are highly prevalent and reduce quality of life. Lifestyle behaviors and the development of lower urinary tract symptoms have been largely unexamined. We investigated physical activity, smoking and alcohol drinking in relation to the development of lower urinary tract symptoms in men and women. MATERIALS AND METHODS Data were obtained from the BACH (Boston Area Community Health) Survey, a longitudinal observational study. Baseline (2002 to 2005) in-person interviews assessed activity, smoking and alcohol consumption. Five-year followup interviews (2006 to 2010 in 4,145) assessed new reports of moderate to severe lower urinary tract symptoms defined by the AUASI (AUA symptom index). Analysis was conducted using multivariable logistic regression. RESULTS Lower urinary tract symptoms developed in 7.7% and 12.7% of at-risk men and women, respectively. Women were 68% less likely to experience lower urinary tract symptoms (OR 0.32; 95% CI 0.17, 0.60; p <0.001) if they had high vs low levels of physical activity. Although the association was similar among men, it was not statistically significant upon adjustment for medical or sociodemographic characteristics in the multivariable model. Women smokers were twice as likely to experience lower urinary tract symptoms, particularly storage symptoms (OR 2.15; 95% CI 1.30, 3.56; p = 0.003), compared to never smokers. Among men, smoking was not associated with lower urinary tract symptoms. Results for alcohol intake were inconsistent by intake level and symptom subtype. CONCLUSIONS A low level of physical activity was associated with a 2 to 3 times greater likelihood of lower urinary tract symptoms. Smoking may contribute to the development of lower urinary tract symptoms in women but not in men. Clinicians should continue to promote physical activity and smoking cessation, noting the additional potential benefits of the prevention of lower urinary tract symptoms, particularly for women.
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Chiu AF, Huang MH, Wang CC, Kuo HC. Prevalence and factors associated with overactive bladder and urinary incontinence in community-dwelling Taiwanese. Tzu Chi Med J 2012. [DOI: 10.1016/j.tcmj.2012.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Güngör İ, Beji NK, Bayram GO, Erkan HA, Gökyıldız Ş, Yalçın Ö. Lower urinary tract symptoms in women with and without urinary incontinence. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2012. [DOI: 10.1111/j.1749-771x.2012.01140.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vignozzi L, Morelli A, Sarchielli E, Comeglio P, Filippi S, Cellai I, Maneschi E, Serni S, Gacci M, Carini M, Piccinni MP, Saad F, Adorini L, Vannelli GB, Maggi M. Testosterone protects from metabolic syndrome-associated prostate inflammation: an experimental study in rabbit. J Endocrinol 2012; 212:71-84. [PMID: 22010203 DOI: 10.1530/joe-11-0289] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Metabolic syndrome (MetS) and benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) are often associated. One of their common denominators is hypogonadism. However, testosterone supplementation is limited by concerns for potential prostatic side effects. The objective was to determine whether MetS-associated prostate alterations are prevented by testosterone supplementation. We used a previously described animal model of MetS, obtained by feeding male rabbits a high-fat diet (HFD) for 12 weeks. Subsets of HFD rabbits were treated with testosterone or with the farnesoid X receptor agonist INT-747. Rabbits fed a standard diet were used as controls. HFD-animals develop hypogonadism and all the MetS features: hyperglycemia, glucose intolerance, dyslipidemia, hypertension, and visceral obesity. In addition, HFD-animals show a prostate inflammation. Immunohistochemical analysis demonstrated that HFD-induced prostate fibrosis, hypoxia, and inflammation. The mRNA expression of several proinflammatory (IL8, IL6, IL1β, and TNFα), T lymphocyte (CD4, CD8, Tbet, Gata3, and ROR γt), macrophage (TLR2, TLR4, and STAMP2), neutrophil (lactoferrin), inflammation (COX2 and RAGE), and fibrosis/myofibroblast activation (TGFβ, SM22α, αSMA, RhoA, and ROCK1/ROCK2) markers was significantly increased in HFD prostate. Testosterone, as well as INT-747, treatment prevented some MetS features, although only testosterone normalized all the HFD-induced prostate alterations. Interestingly, the ratio between testosterone and estradiol plasma level retains a significant, negative, association with all the fibrosis and the majority of inflammatory markers analyzed. These data highlight that testosterone protects rabbit prostate from MetS-induced prostatic hypoxia, fibrosis, and inflammation, which can play a role toward the development/progression of BPH/LUTS.
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Affiliation(s)
- Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, Florence 50139, Italy
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Hall SA, Maserejian NN, Link CL, Steers WD, McKinlay JB. Are commonly used psychoactive medications associated with lower urinary tract symptoms? Eur J Clin Pharmacol 2011; 68:783-91. [PMID: 22138718 DOI: 10.1007/s00228-011-1170-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/09/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) such as urinary frequency and urgency are bothersome and associated with reduced quality of life. Atypical antipsychotics (AAPs) have been implicated in increasing the risk of urinary incontinence. In a large community-based sample of men and women, we examined the associations of AAP and selective serotonin reuptake inhibitor (SSRIs) use with LUTS. METHODS Data were collected (2002-2005) from a generalizable sample of Boston, MA, USA, residents aged 30-79 (N = 5503). LUTS were assessed using the American Urologic Association Symptom Index (AUA-SI). The prevalence of clinically-significant LUTS was estimated using a cutoff AUA-SI score of 8+ to indicate moderate-to-severe symptoms. Confounder-adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated from multivariate logistic regression to estimate the associations for psychoactive drugs used in the previous month (SSRIs, AAPs, both) and LUTS. RESULTS Among women, AAP users had a higher prevalence of LUTS (46.2%) compared with SSRI users (23.5%) and those with depressive symptoms not using SSRIs or AAPs (26.3%). Corresponding prevalence estimates among men were 32.7%, 29.8%, and 33.3%. In multivariate models, AAP use was significantly associated with LUTS among women when used either with (OR = 2.72, 95% CI:1.45-5.10) or without (OR = 3.05, 95% CI:1.30-7.16) SSRIs, but SSRI use without AAP use was not associated with LUTS compared with nonusers without depressive symptoms. No associations were observed among men. CONCLUSIONS In our study, AAPs but not SSRIs were associated with increased prevalence of LUTS among women only. Further prospective research is needed to determine time sequence and cause and effect.
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Affiliation(s)
- Susan A Hall
- New England Research Institutes, 9 Galen St., Watertown, MA 02472, USA.
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Huang CY, Chiu KM, Chung SD, Keller JJ, Huang CC, Lin HC. Increased risk of depressive disorder following the diagnosis of benign prostatic enlargement: one-year follow-up study. J Affect Disord 2011; 135:395-9. [PMID: 21824662 DOI: 10.1016/j.jad.2011.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE In previous studies, benign prostatic enlargement (BPE) and urinary tract symptoms were demonstrated to be associated with depressive symptoms. However, no longitudinal follow-up study to date has evaluated the relationship between BPE and the subsequent risk of developing depressive disorder. This nationwide, population-based study aimed to prospectively examine the relationship between a history of BPE and the risk of developing depressive disorder. MATERIALS AND METHODS A total of 16,130 adult patients diagnosed with BPE for the first time between 2005 and 2007 were recruited along with a comparison cohort of 48,390 matched enrollees without a history of BPE. All the subjects were tracked for a one-year period following their index date to identify those who subsequently developed a depressive disorder. The Cox proportional hazards model was utilized to compute the risk difference for depressive disorder between cohorts. RESULTS Of 64,520 sampled patients, 325 (2.01%) from the BPE cohort, and 531 (1.10%) from the comparison cohort were subsequently diagnosed with depressive disorder during the follow-up period. The risk of developing depressive disorder within one-year following diagnosis with BPE was found to be 1.87 (95% CI=1.63-2.16, p<0.001) times the risk in absence of BPE after adjusting for the patients' monthly income, and the geographical location and urbanization level of their place of residence. CONCLUSIONS Our results suggest that patients with BPE are at an increased risk for contracting depressive disorder.
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Affiliation(s)
- Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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