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Jo JK, Kim H, Bang WJ, Oh CY, Cho JS, Shim M. Effect of Diabetes Mellitus on Symptomatic Improvement After Surgery for Benign Prostatic Hyperplasia in Patients With Lower Urinary Tract Symptom and its Relations With Prostatic Urethral Angulation. Int Neurourol J 2023; 27:116-123. [PMID: 37401022 DOI: 10.5213/inj.2346008.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/08/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE To compare improvement of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia in diabetic versus nondiabetic patients after transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP). METHODS The medical records of 437 patients who underwent TURP or HoLEP at a tertiary referral center from January 2006 to January 2022 were retrospectively analyzed. Among them, 71 patients had type 2 diabetes. Patients in the diabetic mellitus (DM) and non-DM groups were matched 1:1 according to age, baseline International Prostate Symptom Score (IPSS), and ultrasound measured prostate volume. Changes in LUTS were assessed at 3 months after surgery using IPSS and evaluated by categorizing patients according to prostatic urethral angulation (PUA; <50° vs. ≥50°). Medication-free survival after surgery was also investigated. RESULTS No significant differences were noted between the DM and non-DM groups in baseline characteristics except for comorbidities (i.e., hypertension, cerebrovascular disease, and ischemic heart disease, P=0.021, P=0.002, and P=0.017, respectively) and postvoid residual urine volume (115±98 mL vs. 76±105 mL, P=0.028). Non-DM patients showed significant symptomatic improvement regardless of PUA, while DM patients demonstrated improvement in obstructive symptoms only in those with large PUA (≥51°). Among patients with small PUA, DM patients had worse medication-free survival after surgery compared to controls (P=0.044) and DM was an independent predictor of medication reuse (hazard ratio, 1.422; 95% confidence interval, 1.285-2.373; P=0.038). CONCLUSION DM patients experienced symptomatic improvement after surgery only in those with large PUA. Among patients with small PUA, DM patients were more likely to reuse medication after surgery.
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Affiliation(s)
- Jung Ki Jo
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
| | - Hwanik Kim
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Myungsun Shim
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Bo H, Peng J, Zhuang M, Qiu W, Yu Q, Yao Q, Liang H. Therapeutic effect of acupuncture and moxa combustion on prostate hyperplasia. Medicine (Baltimore) 2022; 101:e30925. [PMID: 36221341 PMCID: PMC9542813 DOI: 10.1097/md.0000000000030925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Both acupuncture and moxibustion have been used for thousands of years in China for diverse conditions. But there are few reports on their combined effect in managing benign prostatic hyperplasia (BPH). To answer this question, we designed a prospectively study and the present protocol described details of this randomized controlled trial (RCT). METHODS In this RCT, an estimated number of 200 patients with BPH will be enrolled from Shanghai Fourth People's Hospital, China. They will be assigned to either the combined therapy group or the conventional western medicine group in a ratio of 1:1. The International Prostate Symptom Score (IPSS) will be assessed as the primary outcome, other parameters, including the post-voiding residual urine volume, maximum flow rate (Qmax), and average flow rate (Qave), voiding time, and time to maximum flow, are secondary outcomes. DISCUSSION Results of this study will provide the theoretical basis for clinicians to select combined therapy or conventional western medicine treatments for BPH patients based on the efficacy of these therapies. TRIAL REGISTRATION chictr.org.cn, ID: ChiCTR2000030504/ChiMCTR2000003082. http://www.chictr.org.cn/edit.aspx?pid=47719&htm=4, Registered on 5th March 2020.
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Affiliation(s)
- Huajun Bo
- Department of Traditional Chinese Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China
| | - Jisheng Peng
- Department of Traditional Chinese Medicine, Peking University Shougang Hospital, China
| | - Minzhi Zhuang
- Department of Traditional Chinese Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China
| | - Wenchao Qiu
- Department of Traditional Chinese Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China
| | - Qianqian Yu
- Department of Traditional Chinese Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China
| | - Quanbao Yao
- Department of Traditional Chinese Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China
| | - Huazheng Liang
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China
- Translational Research Institute of Brain and Brain-like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China
- *Correspondence: Huazheng Liang, Clinical Research Center for Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, 1279 Sanmen Road, Hongkou District, Shanghai, 200434, China (e-mail: )
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3
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Erdogan BR, Liu G, Arioglu-Inan E, Michel MC. Established and emerging treatments for diabetes-associated lower urinary tract dysfunction. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2022; 395:887-906. [PMID: 35545721 PMCID: PMC9276575 DOI: 10.1007/s00210-022-02249-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/28/2022] [Indexed: 12/16/2022]
Abstract
Dysfunction of the lower urinary tract (LUT) including urinary bladder and urethra (and prostate in men) is one of the most frequent complications of diabetes and can manifest as overactive bladder, underactive bladder, urinary incontinence, and as aggravated symptoms of benign prostate hyperplasia. We have performed a selective literature search to review existing evidence on efficacy of classic medications for the treatment of LUT dysfunction in diabetic patients and animals, i.e., α1-adrenoceptor and muscarinic receptor antagonists, β3-adrenoceptor agonists, and phosphodiesterase type 5 inhibitors. Generally, these agents appear to have comparable efficacy in patients and/or animals with and without diabetes. We also review effects of antidiabetic medications on LUT function. Such studies have largely been performed in animal models. In the streptozotocin-induced models of type 1 diabetes, insulin can prevent and reverse alterations of morphology, function, and gene expression patterns in bladder and prostate. Typical medications for the treatment of type 2 diabetes have been studied less often, and the reported findings are not yet sufficient to derive robust conclusions. Thereafter, we review animal studies with emerging medications perhaps targeting diabetes-associated LUT dysfunction. Data with myoinositol, daidzein, and with compounds that target oxidative stress, inflammation, Rac1, nerve growth factor, angiotensin II receptor, serotonin receptor, adenosine receptor, and soluble guanylyl cyclase are not conclusive yet, but some hold promise as potential treatments. Finally, we review nonpharmacological interventions in diabetic bladder dysfunction. These approaches are relatively new and give promising results in preclinical studies. In conclusion, the insulin data in rodent models of type 1 diabetes suggest that diabetes-associated LUT function can be mostly or partially reversed. However, we propose that considerable additional experimental and clinical studies are needed to target diabetes itself or pathophysiological changes induced by chronic hyperglycemia for the treatment of diabetic uropathy.
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Affiliation(s)
- Betül R Erdogan
- Department of Pharmacology, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ebru Arioglu-Inan
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Martin C Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
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Saad AAA, Zhang F, Refat M, Mohammed EAH, Zhang M, Chen Y, Al Hamyari B, Alafifi J, Wu X. Tamsulosin alters the pharmacokinetics of metformin via inhibition of renal multidrug and toxin extrusion protein 1 and organic cation transporter 2 in rats. J Pharm Biomed Anal 2022; 212:114666. [DOI: 10.1016/j.jpba.2022.114666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/30/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
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Male Lower Urinary Tract Dysfunction: An Underrepresented Endpoint in Toxicology Research. TOXICS 2022; 10:toxics10020089. [PMID: 35202275 PMCID: PMC8880407 DOI: 10.3390/toxics10020089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
Lower urinary tract dysfunction (LUTD) is nearly ubiquitous in men of advancing age and exerts substantial physical, mental, social, and financial costs to society. While a large body of research is focused on the molecular, genetic, and epigenetic underpinnings of the disease, little research has been dedicated to the influence of environmental chemicals on disease initiation, progression, or severity. Despite a few recent studies indicating a potential developmental origin of male LUTD linked to chemical exposures in the womb, it remains a grossly understudied endpoint in toxicology research. Therefore, we direct this review to toxicologists who are considering male LUTD as a new aspect of chemical toxicity studies. We focus on the LUTD disease process in men, as well as in the male mouse as a leading research model. To introduce the disease process, we describe the physiology of the male lower urinary tract and the cellular composition of lower urinary tract tissues. We discuss known and suspected mechanisms of male LUTD and examples of environmental chemicals acting through these mechanisms to contribute to LUTD. We also describe mouse models of LUTD and endpoints to diagnose, characterize, and quantify LUTD in men and mice.
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Xin C, Fan H, Xie J, Hu J, Sun X, Liu Q. Impact of Diabetes Mellitus on Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia Patients: A Meta-Analysis. Front Endocrinol (Lausanne) 2022; 12:741748. [PMID: 35178024 PMCID: PMC8844560 DOI: 10.3389/fendo.2021.741748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/27/2021] [Indexed: 12/30/2022] Open
Abstract
Background Benign prostatic hyperplasia (BPH) is a disease that causes lower urinary tract symptoms (LUTS), which are the most common urological problem in approximately one-third of the male population aged over 50 years. Some studies have suggested that diabetes may be a risk factor for the development of BPH. However, whether diabetes aggravates the LUTS of BPH patients is still controversial. Aim To investigate the impact of diabetes mellitus on LUTS in BPH patients. Methods A literature search was conducted using Web of Science, Embase, PubMed, and China National Knowledge Infrastructure literature databases. This meta-analysis was registered in PROSPERO (registration number: CRD 42020200794). Fixed- or random-effects models were used for analysis according to heterogeneity. The results of the systematic analysis are presented as weighted mean difference (WMD) with the corresponding 95% confidence intervals (CI). Results In total, 1308 studies were retrieved from databases and 18 articles comprising 1685 cases and 4653 controls were selected for meta-analysis. The results of the meta-analysis showed that the International Prostate Symptom Score (IPSS) value and prostate volume of BPH patients with diabetes was significantly higher than that of BPH patients without diabetes. Conclusions This systematic review is the first to evaluate the impact of diabetes mellitus on LUTS in BPH patients. The results of our meta-analysis support the hypothesis that LUTS in BPH patients is increased in patients with diabetes mellitus compared with controls, which suggests that physicians should pay more attention to BPH patients with diabetes mellitus. Systematic Review Registration PROSPERO [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=200794], identifier CRD 42020200794.
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Affiliation(s)
- Caihong Xin
- Department of Endocrinology and Metabolism, Fourth People’s Hospital of Shenyang, Shenyang, China
| | - Huaying Fan
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Xie
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingcheng Hu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Sun
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiuchen Liu
- Department of Urology, First Affiliated Hospital of Soochow University, Suzhou, China
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7
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Noweir A, Abusamra A, Al Zarooni A, Binbay M, Doble A, Tariq L, Aziz F, El Hasnaoui A. Prevalence of benign prostatic hyperplasia among the adult general population of five Middle Eastern Countries: Results of the SNAPSHOT programme. Arab J Urol 2022; 20:14-23. [PMID: 35223105 PMCID: PMC8881068 DOI: 10.1080/2090598x.2021.2010451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Amr Noweir
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Abusamra
- Division of Urology, Department of Surgery, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | - Abdelqader Al Zarooni
- Emergency and Surgical Departments, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Murat Binbay
- Department of Urology, Haseki Research and Training Hospital, Istanbul, Turkey
| | | | - Luqman Tariq
- Medical Department, GlaxoSmithKline, Dubai, United Arab Emirates
| | - Fayaz Aziz
- Medical Department, GlaxoSmithKline, Dubai, United Arab Emirates
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8
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Abler LL, O’Driscoll CA, Colopy SA, Stietz KPK, Wang P, Wang Z, Hartmann F, Crader-Smith SM, Oellete JN, Mehta V, Oakes SR, Grimes MD, Mitchell GS, Baan M, Gallagher SJ, Davis DB, Kimple ME, Bjorling DE, Watters JJ, Vezina CM. The influence of intermittent hypoxia, obesity, and diabetes on male genitourinary anatomy and voiding physiology. Am J Physiol Renal Physiol 2021; 321:F82-F92. [PMID: 34121451 PMCID: PMC8807064 DOI: 10.1152/ajprenal.00112.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We used male BTBR mice carrying the Lepob mutation, which are subject to severe and progressive obesity and diabetes beginning at 6 wk of age, to examine the influence of one specific manifestation of sleep apnea, intermittent hypoxia (IH), on male urinary voiding physiology and genitourinary anatomy. A custom device was used to deliver continuous normoxia (control) or IH to wild-type and Lepob/ob (mutant) mice for 2 wk. IH was delivered during the 12-h inactive (light) period in the form of 90 s of 6% O2 followed by 90 s of room air. Continuous room air was delivered during the 12-h active (dark) period. We then evaluated genitourinary anatomy and physiology. As expected for the type 2 diabetes phenotype, mutant mice consumed more food and water, weighed more, and voided more frequently and in larger urine volumes. They also had larger bladder volumes but smaller prostates, seminal vesicles, and urethras than wild-type mice. IH decreased food consumption and increased bladder relative weight independent of genotype and increased urine glucose concentration in mutant mice. When evaluated based on genotype (normoxia + IH), the incidence of pathogenic bacteriuria was greater in mutant mice than in wild-type mice, and among mice exposed to IH, bacteriuria incidence was greater in mutant mice than in wild-type mice. We conclude that IH exposure and type 2 diabetes can act independently and together to modify male mouse urinary function. NEW & NOTEWORTHY Metabolic syndrome and obstructive sleep apnea are common in aging men, and both have been linked to urinary voiding dysfunction. Here, we show that metabolic syndrome and intermittent hypoxia (a manifestation of sleep apnea) have individual and combined influences on voiding function and urogenital anatomy in male mice.
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Affiliation(s)
- Lisa L. Abler
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin,2University of Wisconsin-Madison/UMASS Boston/UT-Southwestern George M. O’Brien Center for Benign Urologic Research, Madison, Wisconsin
| | - Chelsea A. O’Driscoll
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin,2University of Wisconsin-Madison/UMASS Boston/UT-Southwestern George M. O’Brien Center for Benign Urologic Research, Madison, Wisconsin
| | - Sara A. Colopy
- 3Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kimberly P. Keil Stietz
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Peiqing Wang
- 3Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Zunyi Wang
- 3Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Faye Hartmann
- 4Microbiology Laboratory, UW Veterinary Care, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stephanie M. Crader-Smith
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jonathan N. Oellete
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Vatsal Mehta
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Steven R. Oakes
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Matthew D. Grimes
- 5Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gordon S. Mitchell
- 6Department of Physical Therapy and McKnight Brain Institute, grid.15276.37University of Florida, Gainesville, Florida
| | - Mieke Baan
- 7Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin,8William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Shannon J. Gallagher
- 7Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin,8William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Dawn B. Davis
- 7Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin,8William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Michelle E. Kimple
- 7Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin,8William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Dale E. Bjorling
- 2University of Wisconsin-Madison/UMASS Boston/UT-Southwestern George M. O’Brien Center for Benign Urologic Research, Madison, Wisconsin,3Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jyoti J. Watters
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Chad M. Vezina
- 1Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin,2University of Wisconsin-Madison/UMASS Boston/UT-Southwestern George M. O’Brien Center for Benign Urologic Research, Madison, Wisconsin
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Zhao MJ, Huang Q, Wang XH, Ren XY, Jin YH, Zeng XT. Comparing clinical parameters of abnormal and normal fasting blood glucose in benign prostatic hyperplasia patients. Aging Male 2020; 23:655-662. [PMID: 30739562 DOI: 10.1080/13685538.2019.1570493] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate the correlation of clinical measurements on normal and abnormal fasting blood glucose (FBG) with benign prostatic hyperplasia (BPH). METHODS From September 2016 to January 2018, 771 BPH patients were enrolled for further selection. The eligible patients were divided into normal FBG, impaired fasting glucose (IFG), and high risk of type 2 diabetes mellitus (HR-T2DM) groups. Then, relevant parameters were compared among these three groups using Pearson's correlation coefficient. RESULTS Finally including 443 patients with normal FBG, 113 with IFG and 56 with HR-T2DM. Height, weight, body mass index, smoking status, hemoglobin, serum Na+, serum Cl-, and serum Ca2+ were significantly different between normal and abnormal FBG groups. In IFG/HR-T2DM group, obviously connections were demonstrated for weight with prostate volume (PV), for serum Na+, PV, and serum Cl- with total prostate-specific antigen (t-PSA), for FBG with international prostate symptom score (IPSS). In normal FBG group, significant correlations of age, weight, body mass index, hemoglobin, and serum Ca2+ with PV, of age, systolic blood pressure, PV, and serum Cl- with t-PSA; and of FBG, hemoglobin, and serum Na+ with IPSS were also observed. CONCLUSIONS Our study suggests that FBG level probably plays an important role in BPH.
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Affiliation(s)
- Ming-Juan Zhao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Cardiology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuan-Yi Ren
- Department of Urology, Kaifeng Central Hospital, Kaifeng, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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10
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Agochukwu-Mmonu N, Pop-Busui R, Wessells H, Sarma AV. Autonomic neuropathy and urologic complications in diabetes. Auton Neurosci 2020; 229:102736. [PMID: 33197694 DOI: 10.1016/j.autneu.2020.102736] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/21/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022]
Abstract
Diabetic autonomic neuropathy affects the entire autonomic nervous system and can lead to dysfunction of the cardiovascular, gastrointestinal, and genitourinary organ systems. Genitourinary dysfunction associated with diabetic autonomic neuropathy includes diabetic bladder dysfunction, sexual dysfunction, and recurrent urinary tract infections. Urological complications in diabetes mellitus are very common; in fact, genitourinary complications are more common than diabetic neuropathy or nephropathy. While several studies have reported on genitourinary dysfunction in individuals with diabetes, UroEDIC, an ancillary study to the Diabetes Control and Complications Trial (DCCT) and its observational follow up, the Epidemiology of Diabetes Interventions and Complications study (EDIC), comprehensively characterized the association between urologic complications and cardiovascular autonomic neuropathy. UroEDIC demonstrated significant associations between autonomic neuropathy and urologic complications in type 1 diabetes, specifically erectile dysfunction, female sexual dysfunction, and lower urinary tract symptoms. In this narrative review, we review the current literature on urological complications in diabetes.
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Affiliation(s)
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI, United States of America
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11
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Zi H, Wang XJ, Zhao MJ, Huang Q, Wang XH, Zeng XT. Fasting blood glucose level and hypertension risk in aging benign prostatic hyperplasia patients. Aging (Albany NY) 2020; 11:4438-4445. [PMID: 31280253 PMCID: PMC6660045 DOI: 10.18632/aging.102061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
Abstract
Evidence suggests there maybe an association among abnormal fasting blood glucose, hypertension and benign prostatic hyperplasia. In this study, we investigated whether abnormal fasting blood glucose correlates with hypertension in aging benign prostatic hyperplasia patients. Ultimately, 612 benign prostatic hyperplasia patients, including 230 hypertensive patients and 382 normotensive patients, were included. Univariate and multivariate logistic regression analyses were used to evaluate the associations. The results indicated that neither impaired fasting glucose/high risk of type 2 diabetes mellitus nor high risk of type 2 diabetes mellitus were associated with an increased risk of hypertension. When patients were stratified based on the severity of their hypertension, similar results were obtained (all P> 0.05). After adjusting for confounding factors, the nonsignificant tendencies for high risk of type 2 diabetes mellitus and impaired fasting glucose/high risk of type 2 diabetes mellitus to associate with hypertension persisted (all P> 0.05). Unlike earlier studies, the present study suggests that the level of fasting blood glucose may not be significantly related to hypertension in aging patients with benign prostatic hyperplasia.
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Affiliation(s)
- Hao Zi
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.,Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, Henan 475000, China
| | - Xue-Jun Wang
- Department of Emergency, Beijing Electric Power Hospital, Beijing 100073, China
| | - Ming-Juan Zhao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.,Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, Henan 475000, China.,Department of Cardiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan 475000, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Xian-Tao Zeng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
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12
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Yoo S, Oh S, Suh J, Park J, Cho MC, Jeong H, Won S, Son H. Optimal high-density lipoprotein cholesterol level for decreasing benign prostatic hyperplasia in men not taking statin medication: A historical cohort study. Prostate 2020; 80:570-576. [PMID: 32196725 DOI: 10.1002/pros.23970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND We evaluated the optimal high-density lipoprotein cholesterol level for benign prostatic hyperplasia (BPH) prevention in men not taking statin medication using a large historical cohort. METHODS We initially selected 130 454 men who underwent health checkups in 2009 from the National Health Information Database of the National Health Insurance Service. After excluding 36 854 men with BPH in 2009, and 45 061 men for statin use, 48 539 men were ultimately included in the analysis. A Kaplan-Meier analysis and multivariable Cox regression analysis was performed to assess the optimal high-density lipoprotein cholesterol level for preventing BPH. RESULTS High-density lipoprotein cholesterol levels were less than 40 mg/dL in 7431 (15.3%) men, 40 to 49 in 15 861 (32.7%), 50 to 59 in 15 328 (27.5%), and greater than or equal to 60 in 11 919 (24.6%). The overall cumulative incidence of BPH was 4.4%, 8.7%, 13.0%, and 17.8% at the 1-, 2-, 3-, and 4-year follow-up periods, respectively. In multivariable analysis, high-density lipoprotein greater than or equal to 60 mg/dL were significantly associated with a decreased incidence of BPH, as were age, residence, income, body mass index, diabetes, hypertension, triglyceride, and increased annual clinic visits, especially in men in their 40s. CONCLUSION Elevated serum high-density lipoprotein cholesterol levels were negatively associated with BPH incidence. In addition, maintaining high-density lipoprotein greater than or equal to 60 mg/dL was associated with a decreased BPH incidence compared with high-density lipoprotein less than 40 mg/dL, especially in men in their 40s.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jungyo Suh
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Min Chul Cho
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sungho Won
- Department of Public Health Science, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Yesilyurt ZE, Erdogan BR, Karaomerlioglu I, Muderrisoglu AE, Michel MC, Arioglu-Inan E. Urinary Bladder Weight and Function in a Rat Model of Mild Hyperglycemia and Its Treatment With Dapagliflozin. Front Pharmacol 2019; 10:911. [PMID: 31474866 PMCID: PMC6706456 DOI: 10.3389/fphar.2019.00911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/18/2019] [Indexed: 11/13/2022] Open
Abstract
Hypertrophy and dysfunction of the urinary bladder are consistently observed in animal models of type 1 and less consistently in those of type 2 diabetes. We have tested the effects of mild hyperglycemia (n = 10 per group) in a randomized, blinded study and, in a blinded pilot study, of type 2 diabetes (n = 6 per group) and its treatment with dapagliflozin (1 mg/kg per day) on weight, contraction, and relaxation of the rat bladder. Based on a combination of high-fat diet and a low dose of streptozotocin, animals in the main study reached a mean peak blood glucose level of about 300 mg/dl, which declined to 205 mg/dl at study end. This was associated with a small, if any, increase in bladder weight. In a pooled analysis of all animals of the main and the pilot study, we detected a correlation of moderate strength between blood glucose and bladder weight (r2 = 0.2013; P = 0.0003 for Pearson correlation coefficient). Neither the main nor the pilot study found evidence for an altered contractility (responses to carbachol or KCl) or relaxation (responses to isoprenaline, fenoterol, CL 316,243, or forskolin). Treatment with dapagliflozin in the absence of hyperglycemia increased diuresis in the main study by 43% relative to control and increased bladder weight by 15% in the pooled groups of both studies (post hoc analysis). We conclude that mild hyperglycemia has no major effects on bladder hypertrophy or function.
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Affiliation(s)
| | - Betül Rabia Erdogan
- Department of Pharmacology, School of Pharmacy, Ankara University, Ankara, Turkey
| | - Irem Karaomerlioglu
- Department of Pharmacology, School of Pharmacy, Ankara University, Ankara, Turkey
| | | | | | - Ebru Arioglu-Inan
- Department of Pharmacology, School of Pharmacy, Ankara University, Ankara, Turkey
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Hong Y, Lee S, Won S. The preventive effect of metformin on progression of benign prostate hyperplasia: A nationwide population-based cohort study in Korea. PLoS One 2019; 14:e0219394. [PMID: 31323022 PMCID: PMC6641083 DOI: 10.1371/journal.pone.0219394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022] Open
Abstract
Metformin, a first-line treatment for type 2 diabetes mellitus (T2DM), has recently been recognized for its pleotropic anti-proliferative, anti-cancer, and anti-aging effects. Contrary to the studies characterizing metformin effects in prostate cancer, little is known about these effects in BPH progression. With the Sample Cohort DB data during 2007 and 2017 from the Health Insurance Review and Assessment Service (HIRA) in South Korea, we investigated the preventative effect of metformin on BPH progression. The study population consisted of 211,648 BPH naïve patients that were diagnosed with BPH in 2009 and a follow-up occurrence of prostatectomy until 2017 that was defined as progression of BPH. These patients were divided into three treatment groups: without T2DM, T2DM without metformin, and T2DM with metformin. The hazard ratio in the T2DM with metformin group was 0.86 for prostatectomy compared to the group without T2DM (CI = 0.77-0.96, P value = 0.007) after adjusting for confounding factors such as age, comorbidity, residential area, level of hospital, and category of BPH medications. The T2DM with high-dose metformin group had a significantly lower risk of prostatectomy with hazard ratio of 0.76 (CI = 0.62-0.92, P value = 0.005) in stratified analysis. Our results suggest that metformin may improve BPH progression based on the reduced risk of prostatectomy, although T2DM effects on BPH were unclear. Future observational studies and prospective trials are needed to confirm the effects of metformin on BPH progression.
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Affiliation(s)
- Yehee Hong
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Sanghun Lee
- Department of Medical Consilience, Graduate School, Dankook University, Yongin, South Korea
- * E-mail: (SW); (SL)
| | - Sungho Won
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Interdisciplinary Program for Bioinformatics, College of Natural Science, Seoul National University, Seoul, South Korea
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
- * E-mail: (SW); (SL)
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15
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Macoska JA, Wang Z, Virta J, Zacharias N, Bjorling DE. Inhibition of the CXCL12/CXCR4 axis prevents periurethral collagen accumulation and lower urinary tract dysfunction in vivo. Prostate 2019; 79:757-767. [PMID: 30811623 PMCID: PMC7269149 DOI: 10.1002/pros.23781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several studies show that prostatic fibrosis is associated with male lower urinary tract dysfunction (LUTD). Development of fibrosis is typically attributed to signaling through the transforming growth factor β (TGF-β) pathway, but our laboratory has demonstrated that in vitro treatment of human prostatic fibroblasts with the C-X-C motif chemokine ligand 12 (CXCL12) chemokine stimulates myofibroblast phenoconversion and that CXCL12 has the capacity to activate profibrotic pathways in these cells in a TGF-β-independent manner. We have previously reported that feeding mice high-fat diet (HFD) results in obesity, type II diabetes, increased prostatic fibrosis, and urinary voiding dysfunction. The purpose of this study was to test the hypothesis that in vivo blockade of the CXCL12/CXCR4 axis would inhibit the development of fibrosis-mediated LUTD in HFD-fed mice. METHODS Two-month-old male senescence-accelerated mouse prone-6 mice were fed either a HFD or low-fat diet (LFD) for 8 months. Half of each dietary group were given constant access to normal water or water that contained the C-X-C chemokine receptor type 4 (CXCR4; CXCL12 receptor) antagonist CXCR4AIII. At the conclusion of the study, mice were weighed, subjected to oral glucose tolerance testing and cystometry, and lower urinary tract tissues collected and assessed for collagen content. RESULTS HFD-fed mice became significantly obese, insulin resistant, and hyperglycemic, consistent with acquisition of metabolic syndrome, compared with LFD-fed mice. Anesthetized cystometry demonstrated that HFD-fed mice experienced significantly longer intercontractile intervals and greater functional bladder capacity than LFD-fed mice. Immunohistochemistry demonstrated high levels of CXCR4 and CXCR7 staining in mouse prostate epithelial and stromal cells. Picrosirius red staining indicated significantly greater periurethral collagen deposition in the prostates of HFD than LFD-fed mice. Treatment with the CXCR4 antagonist CXCR4AIII did not affect acquisition of metabolic syndrome but did reduce both urinary voiding dysfunction and periurethral prostate collagen accumulation. CONCLUSIONS This is the first study to report that obesity-induced lower urinary tract fibrosis and voiding dysfunction can be repressed by antagonizing the activity of the CXCR4 chemokine receptor in vivo. These data suggest that targeting the CXCL12/CXCR4 signaling pathway may be a clinical option for the prevention or treatment of human male LUTD.
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Affiliation(s)
- Jill A. Macoska
- Center for Personalized Cancer Therapy, The University of Massachusetts Boston, Boston, Massachusetts
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
| | - Zunyi Wang
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
- School of Veterinary Medicine, The University of Wisconsin Madison, Madison, Wisconsin
| | - Johanna Virta
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
- School of Veterinary Medicine, The University of Wisconsin Madison, Madison, Wisconsin
| | - Nicholas Zacharias
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
- School of Veterinary Medicine, The University of Wisconsin Madison, Madison, Wisconsin
| | - Dale E. Bjorling
- Department of Urology, George M. O’Brien Center for Urologic Research, Madison, Wisconsin
- School of Veterinary Medicine, The University of Wisconsin Madison, Madison, Wisconsin
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16
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Yoo S, Oh S, Park J, Cho SY, Cho MC, Jeong H, Son H. The impacts of metabolic syndrome and lifestyle on the prevalence of benign prostatic hyperplasia requiring treatment: historical cohort study of 130 454 men. BJU Int 2018; 123:140-148. [DOI: 10.1111/bju.14528] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sangjun Yoo
- Department of Urology; Seoul National University Boramae Medical Center; Seoul South Korea
| | - Sohee Oh
- Department of Biostatistics; Seoul National University Boramae Medical Center; Seoul South Korea
| | - Juhyun Park
- Department of Urology; Seoul National University Boramae Medical Center; Seoul South Korea
| | - Sung Yong Cho
- Department of Urology; Seoul National University Boramae Medical Center; Seoul South Korea
| | - Min Chul Cho
- Department of Urology; Seoul National University Boramae Medical Center; Seoul South Korea
| | - Hyeon Jeong
- Department of Urology; Seoul National University Boramae Medical Center; Seoul South Korea
| | - Hwancheol Son
- Department of Urology; Seoul National University Boramae Medical Center; Seoul South Korea
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17
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Kaplan SA. Re: Is Diabetes Mellitus Associated with Clinical Outcomes in Aging Males Treated with Transurethral Resection of Prostate for Bladder Outlet Obstruction: Implications from Taiwan Nationwide Population-Based Cohort Study. J Urol 2018. [DOI: 10.1016/j.juro.2017.11.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Erbay AR, Ede H, Zengin K, Erkoc MF, Tanık S, Albayrak S, Yetkin E. Association of Prostatic Volume and Carotid Intima-media Thickness in Patients With Benign Prostatic Hyperplasia. Urology 2018; 113:166-170. [DOI: 10.1016/j.urology.2017.11.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
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19
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Arioglu Inan E, Ellenbroek JH, Michel MC. A systematic review of urinary bladder hypertrophy in experimental diabetes: Part I. Streptozotocin‐induced rat models. Neurourol Urodyn 2018; 37:1212-1219. [DOI: 10.1002/nau.23490] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/24/2017] [Indexed: 12/18/2022]
Affiliation(s)
| | - Johanne H. Ellenbroek
- Department of Internal MedicineLeiden University Medical CentreLeidenThe Netherlands
| | - Martin C. Michel
- Department of PharmacologyJohannes Gutenberg UniversityMainzGermany
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20
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Zeng XT, Liu TZ, Gong K, He DL, Wang XH. The BPSC: A prospective study investigating the clinical effect of interventional therapy and the risk factors for bladder cancer and benign prostatic hyperplasia in Chinese population. J Evid Based Med 2018; 11:64-67. [PMID: 29484844 DOI: 10.1111/jebm.12290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 01/11/2023]
Abstract
Bladder cancer and benign prostatic hyperplasia have been two very common diseases among the elderly men, especially with the aging of the population in the world. We have designed a study to investigate the clinical effect of interventional therapy for plasmakinetic resection of the prostate and plasmakinetic resection of the bladder, which is called "BPSC" (The bladder cancer and benign prostatic hyperplasia study in Chinese population). The BPSC is not only a specific study, it is made up of many studies. In this article, we introduced the research background, source, name, study framework, study management and further direction of BPSC project. We hope this process will contribute to the growth of the database through sharing data and enriching the evidence of bladder cancer and benign prostatic hyperplasia in the Chinese population, thereby finally improving the accessibility of these important findings for doctors, researchers, and patients.
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Affiliation(s)
- Xian-Tao Zeng
- Department of Urology, Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College of Wuhan University, Center for Evidence-Based and Translational Medicine, Wuhan University, The Endourological Clinical Research Medical Center of Hubei Province, Wuhan, Hubei, P.R. China
| | - Tong-Zu Liu
- Department of Urology, Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College of Wuhan University, Center for Evidence-Based and Translational Medicine, Wuhan University, The Endourological Clinical Research Medical Center of Hubei Province, Wuhan, Hubei, P.R. China
| | - Kan Gong
- Department of Urology, National Urological Cancer Center, Peking University First Hospital, Institute of Urology, Peking University, Beijing, P.R. China
| | - Da-Lin He
- Department of Urology, Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Oncology Research Laboratory, Key Laboratory of Environment and Genes Related to Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, P.R. China
| | - Xing-Huan Wang
- Department of Urology, Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College of Wuhan University, Center for Evidence-Based and Translational Medicine, Wuhan University, The Endourological Clinical Research Medical Center of Hubei Province, Wuhan, Hubei, P.R. China
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21
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Singh G, Schulthess D, Hughes N, Vannieuwenhuyse B, Kalra D. Real world big data for clinical research and drug development. Drug Discov Today 2017; 23:652-660. [PMID: 29294362 DOI: 10.1016/j.drudis.2017.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 12/27/2022]
Abstract
The objective of this paper is to identify the extent to which real world data (RWD) is being utilized, or could be utilized, at scale in drug development. Through screening peer-reviewed literature, we have cited specific examples where RWD can be used for biomarker discovery or validation, gaining a new understanding of a disease or disease associations, discovering new markers for patient stratification and targeted therapies, new markers for identifying persons with a disease, and pharmacovigilance. None of the papers meeting our criteria was specifically geared toward novel targets or indications in the biopharmaceutical sector; the majority were focused on the area of public health, often sponsored by universities, insurance providers or in combination with public health bodies such as national insurers. The field is still in an early phase of practical application, and is being harnessed broadly where it serves the most direct need in public health applications in early, rare and novel disease incidents. However, these exemplars provide a valuable contribution to insights on the use of RWD to create novel, faster and less invasive approaches to advance disease understanding and biomarker discovery. We believe that pharma needs to invest in making better use of Electronic Health Records and the need for more precompetitive collaboration to grow the scale of this 'big denominator' capability, especially given the needs of precision medicine research.
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Affiliation(s)
| | | | - Nigel Hughes
- Janssen Research and Development, Beerse, Belgium
| | | | - Dipak Kalra
- Dept. Medical Informatics & Statistics, University of Ghent, De Pintelaan 185, Gent 9000, Belgium.
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22
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Kwon T, Park S, Park S, Moon KH. Metabolic syndrome is predictive of lower urinary tract symptom improvement after holmium laser enucleation of the prostate for benign prostatic obstruction. Int Urol Nephrol 2017; 49:1105-1110. [DOI: 10.1007/s11255-017-1580-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
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Prostatic vascular damage induced by cigarette smoking as a risk factor for recovery after holmium laser enucleation of the prostate (HoLEP). Oncotarget 2017; 8:14039-14049. [PMID: 27732940 PMCID: PMC5355160 DOI: 10.18632/oncotarget.12538] [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: 08/15/2016] [Accepted: 10/04/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the relationship between prostatic vessel changes induced by cigarette smoking and the perioperative outcome of holmium laser enucleation of the prostate (HoLEP). Materials and Methods A total of 268 postoperative patients with benign prostatic hyperplasia (BPH) were prospectively analysed in our department. They were divided into two groups (smokers and non-smokers) according to smoking history. Transrectal colour Doppler ultrasound was performed to evaluate the prostate vascular changes. Pathologically, HE staining, CD31 and CD34 were analysed in prostatic section chips. Furthermore, postoperative outcomes were determined during a 6-month follow-up period. Results The preoperative prostate volume was significantly decreased in smoking patients (P = 0.04). CPI was significantly lower in smoking BPH patients (P < 0.01), whereas RI was significantly increased in smokers compared with non-smokers (P < 0.01). Histological assays revealed elevated CD34 in the smoking BPH individuals presenting an increased number of microvessels. The HoLEP duration was increased in smokers. Interestingly, we identified significantly increased overactive bladder syndrome score (OABSS) and decreased Qmax in smoking individuals during the 6-month follow-up with no difference being observed preoperatively. However, no significant difference between the groups was observed for the International Prostate Symptom Score (IPSS). Conclusions The significantly lower CPI and higher RI values in smoking BPH patients indicated the presence of considerable vascular damage in these subjects. Moreover, cigarette smoking extended the surgical duration and prolonged the recovery period of overactive bladder (OAB) syndrome. Thus, integrated treatment should be suggested for various BPH individuals.
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Abstract
This review details the epidemiology, possible mechanisms, and risk factors associated with urogenital autonomic dysfunction in diabetes. Autonomic neuropathy in diabetes is associated with various urological complications including bladder and sexual dysfunction. Several studies have reported the high prevalence of bladder and sexual dysfunction in both men and women. The DCCT/EDIC UroEDIC study examined the association between cardiovascular autonomic neuropathy and bladder and sexual dysfunction in a large cohort of participants with type 1 diabetes and was the first to report significant associations. Future studies are needed to further evaluate the association of urogenital complications and autonomic dysfunction in diabetes.
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Affiliation(s)
- Barbara H Braffett
- The Biostatistics Center, George Washington University, 6110 Executive Blvd, Suite 750, Rockville, MD, 20852, USA.
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356510, Seattle, WA, 98195, USA
| | - Aruna V Sarma
- Department of Urology, University of Michigan, 2800 Plymouth Rd, Bldg 16, 109E, Ann Arbor, MI, 48109, USA
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25
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Capon G, Caremel R, de Sèze M, Even A, Fontaine S, Loche CM, Bart S, Castel-Lacanal E, Duchêne F, Karsenty G, Mouracade P, Perrouin-Verbe MA, Phé V, Rey D, Scheiber-Nogueira MC, Gamé X. [The impact of mellitus diabetes on the lower urinary tract: A review of Neuro-urology Committee of the French Association of Urology]. Prog Urol 2015; 26:245-53. [PMID: 26452712 DOI: 10.1016/j.purol.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Specify urinary functional impairment associated with diabetic pathology. Propose guidance for screening, monitoring of clinical signs of lower urinary tract (LUTS) and describe the specifics of the urological treatment of patients. METHODS A review of literature using PubMed library was performed using the following keywords alone or in combination: "diabetes mellitus", "diabetic cystopathy", "overactive bladder", "bladder dysfunction", "urodynamics", "nocturia". RESULTS LUTS are more common in the diabetic population with an estimated prevalence between 37 and 70 %, and are probably underevaluated in routine practice. They are heterogeneous and are frequently associated with other diabetic complications. Both storage and voiding symptoms can coexist. Despite a major evaluation in the literature, no recommendation supervises the assessment and management of LUTS in this specific population. An annual screening including medical history, bladder and kidney ultrasound and post-void residual measurement is required in the follow-up of diabetic patients. Specific urologial referral and urodynamic investigations will be performed according to the findings of first-line investigations. The type of bladder dysfunction, the risk of urinary tract infections and dysautonomia should be considered in the specific urological management of these patients. CONCLUSION Diabetes mellitus significantly impacts on the lower urinary tract function. A screening of LUTS is required as well as other complications of diabetes. The management of LUTS must take into consideration the specific risks of the diabetic patient regarding the loss of bladder contractility, the possibility of dysautonomia and infectious complications.
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Affiliation(s)
- G Capon
- Service d'urologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France.
| | - R Caremel
- Service d'urologie, hôpital Charles-Nicolle, 76000 Rouen, France
| | - M de Sèze
- Cabinet de neuro-urologie, urodynamique et pelvipérinéologie, clinique Saint-Augustin, 33000 Bordeaux, France
| | - A Even
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, AP-HP, 92340 Garches, France
| | - S Fontaine
- Service de médecine interne, endocrinologie, diabète, nutrition, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - C-M Loche
- Service de rééducation neurolocomotrice, CHU Henri-Mondor, AP-HP, 94010 Créteil, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, 95300 Cergy-Pontoise, France
| | - E Castel-Lacanal
- Service de médecine physique et réadaptation, CHU Rangueil, 31400 Toulouse, France
| | - F Duchêne
- Service d'urologie, clinique de l'Alliance, 37540 Saint-Cyr-sur-Loire, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, hôpital de la Conception, AP-HM, Aix-Marseille université, 13005 Marseille, France
| | - P Mouracade
- Service d'urologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - M-A Perrouin-Verbe
- Service d'urologie, hôpital de la Cavale-Blanche, CHU de Brest, 29609 Brest, France
| | - V Phé
- Service d'urologie, hôpital de la Pitié-Salpêtrière, AP-HP, université Paris VI, 75013 Paris, France
| | - D Rey
- Clinique Saint-Augustin, 33000 Bordeaux, France
| | - M-C Scheiber-Nogueira
- Services d'urologie et d'explorations neurologiques, CHU Lyon Sud, 69495 Pierre-Bénite, France
| | - X Gamé
- Service d'urologie, CHU Rangueil, 31400 Toulouse, France
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Breyer BN, Sarma AV. Hyperglycemia and insulin resistance and the risk of BPH/LUTS: an update of recent literature. Curr Urol Rep 2015; 15:462. [PMID: 25287259 DOI: 10.1007/s11934-014-0462-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) are highly prevalent in older men and represent a substantial challenge to public health. Increasing epidemiologic evidence suggests that diabetes and associated hyperglycemia and insulin resistance significantly increase the risks of BPH and LUTS. Plausible pathophysiologic mechanisms to explain these associations include increased sympathetic tone, stimulation of prostate growth by insulin and related trophic factors, alterations in sex steroid hormone expression, and induction of systemic inflammation and oxidative stress. This article presents a comprehensive update of the current understanding of clinical and epidemiologic research on diabetes and BPH/LUTS, describes hypothesized pathophysiologic mechanisms linking these conditions, and recommends future directions for research.
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Affiliation(s)
- Benjamin N Breyer
- Department of Urology, University of California, San Francisco, 1001 Potrero Ave, Suite 3A20, San Francisco, CA, 94110-1444, USA,
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Michel MC, Chess-Williams R, Hegde SS. Are blood vessels a target to treat lower urinary tract dysfunction? Naunyn Schmiedebergs Arch Pharmacol 2015; 388:687-94. [PMID: 26026700 DOI: 10.1007/s00210-015-1137-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 01/12/2023]
Abstract
Bladder dysfunction is common in the general population (Stewart et al. 2010) and even more so among patients seeing a physician for any reason (Goepel et al. 2002). It often manifests as lower urinary tract symptoms (LUTS), a term originally coined to describe voiding and storage symptoms in men with benign prostatic hyperplasia (BPH) but now more universally used to describe any type of voiding and storage symptoms in both sexes. Studies into possible causes of urinary bladder dysfunction have long focused on detrusor smooth muscle cells (Turner and Brading 1999). More recently, it became clear that several other types of cells and organs contribute to regulating detrusor smooth muscle function. These include the urothelium (Andersson and McCloskey 2014; Michel 2015), afferent nerves (Michel and Igawa 2015; Yoshimura et al. 2014b), and the central and autonomic nervous systems (Fowler and Griffiths 2010; Yoshimura et al. 2014a). Alterations in any of these may at least partly be responsible for detrusor dysfunction and, accordingly, be potential targets for the treatment of bladder dysfunction. As highlighted by an article in this issue of Naunyn-Schmiedeberg's Archives of Pharmacology (Bayrak et al. 2015), there is an additional suspect, the bladder vasculature. This article will discuss the currently available experimental and clinical evidence for a role of the vasculature in causing bladder dysfunction, and how existing and emerging treatments may modulate bladder function by acting on blood vessels. Due to a similarity in concept, data on prostate perfusion will also be discussed to some extent.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology, Johannes Gutenberg Universität, Obere Zahlbacher Str. 67, 55101, Mainz, Germany,
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Otunctemur A, Besiroglu H, Dursun M, Ozcan L, Polat EC, Somay A, Ozbay N, Ozer K, Ozbek E. The comparison of GLUT-4 and nNOS expression in diabetic and non-diabetic patients with BPH/LUTS. Int Urol Nephrol 2015; 47:899-904. [DOI: 10.1007/s11255-015-0964-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
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Sener NC, Zengin K, Ozturk U, Bas O, Ercil H, Ekici M, Evliyaoglu Y, Imamoglu MA. The Impact of Metabolic Syndrome on the Outcomes of Transurethral Resection of the Prostate. J Endourol 2015; 29:340-3. [DOI: 10.1089/end.2014.0562] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nevzat Can Sener
- Ministry of Health, Department of Urology, Adana Numune Teaching and Research Hospital, Adana, Turkey
| | - Kursad Zengin
- Department of Urology, Bozok University, Yozgat, Turkey
| | - Ufuk Ozturk
- Ministry of Health, Department of Urology, Ankara Dişkapi Yıldırım Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Okan Bas
- Ministry of Health, Department of Urology, Ankara Onkoloji Teaching and Research Hospital, Ankara, Turkey
| | - Hakan Ercil
- Ministry of Health, Department of Urology, Adana Numune Teaching and Research Hospital, Adana, Turkey
| | - Musa Ekici
- Ministry of Health, Department of Urology, Corum Teaching and Research Hospital, Corum, Turkey
| | - Yalcin Evliyaoglu
- Ministry of Health, Department of Urology, Adana Numune Teaching and Research Hospital, Adana, Turkey
| | - M. Abdurrahim Imamoglu
- Ministry of Health, Department of Urology, Ankara Dişkapi Yıldırım Beyazit Teaching and Research Hospital, Ankara, Turkey
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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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Leoci R, Aiudi G, Silvestre F, Lissner E, Lacalandra GM. Effect of pulsed electromagnetic field therapy on prostate volume and vascularity in the treatment of benign prostatic hyperplasia: a pilot study in a canine model. Prostate 2014; 74:1132-41. [PMID: 24913937 PMCID: PMC4145661 DOI: 10.1002/pros.22829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/02/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a result of urogenital aging. Recent studies suggest that an age-related impairment of the blood supply to the lower urinary tract plays a role in the development of BPH and thus may be a contributing factor in the pathogenesis of BPH. The canine prostate is a model for understanding abnormal growth of the human prostate gland. We studied the efficacy of pulsed electromagnetic field therapy (PEMF) in dogs to modify prostate blood flow and evaluated its effect on BPH. METHODS PEMF (5 min, twice a day for 3 weeks) was performed on 20 dogs affected by BPH. Prostatic volume, Doppler assessment by ultrasonography, libido, semen quality, testosterone levels, and seminal plasma volume, composition and pH were evaluated before and after treatment. RESULTS The 3 weeks of PEMF produced a significant reduction in prostatic volume (average 57%) without any interference with semen quality, testosterone levels or libido. Doppler parameters showed a reduction of peripheral resistances and a progressive reduction throughout the trial of the systolic peak velocity, end-diastolic velocity, mean velocity, mean, and peak gradient of the blood flow in the dorsal branch of the prostatic artery. The pulsatility index and the resistance index did not vary significantly over time. CONCLUSIONS The efficacy of PEMF on BPH in dogs, with no side effects, suggests the suitability of this treatment in humans and supports the hypothesis that impairment of blood supply to the lower urinary tract may be a causative factor in the development of BPH.
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Affiliation(s)
- Raffaella Leoci
- Department of Emergency and Organ Transplantation (DETO), Section of Veterinary Clinic and Animal Production, University of Bari Aldo MoroValenzano, Bari, Italy
- *Correspondence to: Raffaella Leoci, PhD, Department of Emergency and Organ Transplantation (DETO), Section of Veterinary Clinic and Animal Production, University of Bari Aldo Moro, SP per Casamassima km 3, Valenzano, Bari, Italy. E-mail:
| | - Giulio Aiudi
- Department of Emergency and Organ Transplantation (DETO), Section of Veterinary Clinic and Animal Production, University of Bari Aldo MoroValenzano, Bari, Italy
| | - Fabio Silvestre
- Department of Emergency and Organ Transplantation (DETO), Section of Veterinary Clinic and Animal Production, University of Bari Aldo MoroValenzano, Bari, Italy
| | | | - Giovanni Michele Lacalandra
- Department of Emergency and Organ Transplantation (DETO), Section of Veterinary Clinic and Animal Production, University of Bari Aldo MoroValenzano, Bari, Italy
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Wong L, Gipp J, Carr J, Loftus C, Benck M, Lee S, Mehta V, Vezina C, Bushman W. Prostate angiogenesis in development and inflammation. Prostate 2014; 74:346-58. [PMID: 24293357 PMCID: PMC3901368 DOI: 10.1002/pros.22751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/22/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Prostatic inflammation is an important factor in development and progression of BPH/LUTS. This study was performed to characterize the normal development and vascular anatomy of the mouse prostate and then examine, for the first time, the effects of prostatic inflammation on the prostate vasculature. METHODS Adult mice were perfused with India ink to visualize the prostatic vascular anatomy. Immunostaining was performed on the E16.5 UGS and the P5, P20, and adult prostate to characterize vascular development. Uropathogenic E. coli 1677 was instilled transurethrally into adult male mice to induce prostate inflammation. RT-PCR and BrdU labeling was performed to assay anigogenic factor expression and endothelial proliferation, respectively. RESULTS An artery on the ventral surface of the bladder trifurcates near the bladder neck to supply the prostate lobes and seminal vesicle. Development of the prostatic vascular system is associated with endothelial proliferation and robust expression of pro-angiogenic factors Pecam1, Tie1, Tek, Angpt1, Angpt2, Fgf2, Vegfa, Vegfc, and Figf. Bacterial-induced prostatic inflammation induced endothelial cell proliferation and increased vascular density but surprisingly decreased pro-angiogenic factor expression. CONCLUSIONS The striking decrease in pro-angiogenic factor mRNA expression associated with endothelial proliferation and increased vascular density during inflammation suggests that endothelial response to injury is not a recapitulation of normal development and may be initiated and regulated by different regulatory mechanisms.
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Affiliation(s)
- Letitia Wong
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Molecular and Environmental Toxicology Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jerry Gipp
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jason Carr
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher Loftus
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Molly Benck
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sanghee Lee
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Vatsal Mehta
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Chad Vezina
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Wade Bushman
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Correspondence to: Dr. Wade Bushman, MD, PhD, Department of Urology, University of Wisconsin School of Medicine and Public Health, K6/562 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792.
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Vignozzi L, Filippi S, Comeglio P, Cellai I, Morelli A, Maneschi E, Sarchielli E, Gacci M, Carini M, Vannelli GB, Maggi M. Tadalafil effect on metabolic syndrome-associated bladder alterations: an experimental study in a rabbit model. J Sex Med 2014; 11:1159-72. [PMID: 24612540 DOI: 10.1111/jsm.12478] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) are often associated. Bladder detrusor hyper-contractility-a major LUTS determinant-is characterized by increased Ras homolog gene family, member A/Rho-associated protein kinase (RhoA/ROCK) signaling, which is often upregulated in MetS. AIM This study investigated the effects of tadalafil dosing on RhoA/ROCK signaling in bladder, in a rabbit model of high-fat diet (HFD)-induced MetS. METHODS Adult male rabbits feeding a HFD for 12 weeks. A subset of HFD animals was treated with tadalafil (2 mg/kg/day, 1 week: the last of the 12 weeks) and compared with HFD and control (feeding a regular diet) rabbits. MAIN OUTCOME MEASURES In vitro contractility studies to evaluate the relaxant effect of the selective ROCK inhibitor, Y-27632, in carbachol precontracted bladder strips. Evaluation of RhoA activation by its membrane translocation. Immunohistochemistry for ROCK expression has been performed to evaluate ROCK expression in bladder from the different experimental groups. mRNA expression of inflammation, pro-fibrotic markers by quantitative RT-PCR has been performed to evaluate the effect of tadalafil on MetS-induced inflammation and fibrosis within the bladder. The in vitro effect of tadalafil on RhoA/ROCK signaling in bladder smooth muscle cells was evaluated by using chemotaxis assay. RESULTS Bladder strips from HFD rabbits showed hyper-responsiveness to Y-27632, indicating RhoA/ROCK overactivity in HFD bladder compared with matched controls. Accordingly, the fraction of activated (translocated to the membrane) RhoA as well as ROCK expression are increased in HFD bladder. Tadalafil dosing normalized HFD-induced bladder hypersensitivity to Y-27632, by reducing RhoA membrane translocation and ROCK overexpression. Tadalafil dosing reduced mRNA expression of inflammatory, pro-fibrotic, and hypoxia markers. A direct inhibitory effect of tadalafil on RhoA/ROCK signaling in bladder smooth muscle cell was demonstrated by using chemotaxis assay. Pre-treatment with tadalafil inhibited both basal and PDGF-induced migration of bladder smooth muscle cells. CONCLUSIONS Tadalafil dosing reduced RhoA/ROCK signaling and smooth muscle overactivity in an animal model of MetS-associated bladder alterations. Our findings suggest a novel mechanism of action of tadalafil in alleviating LUTS in MetS patients.
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Affiliation(s)
- Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Corona G, Vignozzi L, Rastrelli G, Lotti F, Cipriani S, Maggi M. Benign prostatic hyperplasia: a new metabolic disease of the aging male and its correlation with sexual dysfunctions. Int J Endocrinol 2014; 2014:329456. [PMID: 24688539 PMCID: PMC3943333 DOI: 10.1155/2014/329456] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/05/2013] [Indexed: 12/21/2022] Open
Abstract
Metabolic syndrome (MetS) is a well-recognized cluster of cardiovascular (CV) risk factors including obesity, hypertension, dyslipidemia, and hyperglycaemia, closely associated with an increased risk of forthcoming cardiovascular disease and type 2 diabetes mellitus. Emerging evidence indicates that benign prostate hyperplasia (BPH) and its related lower urinary tract symptoms (LUTS) represent other clinical conditions frequently observed in subjects with MetS. Several modifiable factors involved in MetS determinism, such as inadequate diet, lack of physical exercise, and smoking and drinking behaviours are emerging as main contributors to the development of BPH. The pathogenetic mechanisms underlying the connection between MetS and BPH have not been completely clarified. MetS and its components, hypogonadism, and prostate inflammation probably play an important role in inducing BPH/LUTS. Although historically considered as a "normal" consequence of the aging process, BPH/LUTS should now be faced proactively, as a preventable disorder of the elderly. Type of diet and level of physical activity are now considered important factors affecting prostate health in the aging male. However, whether physical exercise, weight loss, and modifications of dietary habit can really alter the natural history of BPH/LUTS remains to be determined. Further research is advisable to better clarify these points.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Linda Vignozzi
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Giulia Rastrelli
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Francesco Lotti
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Sarah Cipriani
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Mario Maggi
- Sexual Medicine Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
- *Mario Maggi:
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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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Oger-Roussel S, Behr-Roussel D, Caisey S, Kergoat M, Charon C, Audet A, Bernabé J, Alexandre L, Giuliano F. Bladder and erectile dysfunctions in the Type 2 diabetic Goto-Kakizaki rat. Am J Physiol Regul Integr Comp Physiol 2013; 306:R108-17. [PMID: 24305064 DOI: 10.1152/ajpregu.00033.2013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Despite the fact that urogenito-sexual complications significantly impact the quality of life of diabetic patients, a robust in vivo experimental model is lacking. Bladder and erectile function in the Type 2 diabetic Goto-Kakizaki (GK) rat and responses to standard-of-care treatments for each disorder have been assessed. GK rats (n = 25, 18-wk-old, GK/Par colony) and age-matched Wistar rats (n = 23), characterized for their metabolic parameters, were used. Bladder function was assessed by cystometry in conscious rats treated by intravenous solifenacin (1 mg/kg). Subsequently, erectile function was assessed under anesthesia following electrical stimulation of the cavernous nerve in presence of intravenous sildenafil (0.3 mg/kg). GK rats displayed detrusor overactivity with a significant increase in frequency/amplitude of nonvoiding contractions during the filling phase, together with an increase in bladder capacity, intercontraction interval, voided volume, and maximal pressure of voiding contraction. Solifenacin significantly decreased parameters characterizing voiding contractions without modifying voiding efficiency. Erectile function in GK rats was markedly impaired and remained so after sildenafil treatment despite a significant improvement. GK rats display both bladder and erectile dysfunctions and respond at least partially to standard-of-care treatments for each disorder, thus representing a suitable model to investigate the pathophysiology and assess the efficacy of new therapeutic agents for Type 2 diabetes-associated bladder and erectile complications.
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Schneider T, Marschall-Kehrel D, Hanisch JU, Michel MC. Does concomitant diabetes affect treatment responses in overactive bladder patients? Int J Clin Pract 2013; 67:1138-43. [PMID: 24165427 DOI: 10.1111/ijcp.12196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 04/20/2013] [Indexed: 11/29/2022] Open
Abstract
AIMS To compare the efficacy and tolerability of a muscarinic receptor antagonist, darifenacin, in the treatment of overactive bladder (OAB) patients with concomitant diabetes as compared with those without comorbidities. METHODS Post hoc exploratory analysis of a published, large, non-interventional study in OAB patients treated with darifenacin including 532 diabetics and 1315 controls. Associations of diabetes with treatment responses were evaluated by multiple regression models. RESULTS Diabetics (largely type 2 patients) and controls differed in baseline age, body weight, duration of OAB symptoms and presence of co-medications. However, they exhibited similar OAB symptom episode frequency and problem rating and received similar starting doses of darifenacin. Presence of diabetes was associated with a significantly smaller reduction of OAB symptoms, but the effect attributable to diabetes was small relative to the overall treatment response. The presence of diabetes was not associated with differences in tolerability. DISCUSSION AND CONCLUSIONS We conclude that a muscarinic receptor antagonist has comparable efficacy and tolerability in the treatment of OAB patients with and without concomitant diabetes.
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Affiliation(s)
- T Schneider
- Praxisklinik Urologie Rhein-Ruhr, Mülheim, Germany
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Kusljic S, Manias E, Tran B, Williams A. Enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia. Aging Male 2013; 16:112-7. [PMID: 23750816 DOI: 10.3109/13685538.2013.801951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify the enablers and barriers affecting medication-taking behaviour in aging men with benign prostatic hyperplasia. METHODS A total of 40 patients attending the urology outpatient clinic in Melbourne in 2012 were screened. Patients who successfully met the inclusion criteria were interviewed using a structured interview schedule. Information regarding the patient's medication, demographic data and presence of co-morbidities was collected. Content analysis was compared with patient demographic and medical data, contributing to the analysis. RESULTS Problems with medication-taking were reported in 58% of patients. All patients without co-morbidities reported issues regarding their medications, whereas only 27% of patients with co-morbidities reported concerns regarding their medications. Statistical analysis revealed that patients without co-morbidities were significantly more likely (p = 0.002) to have complaints with their medications compared to those with co-morbidities. Furthermore, patients with co-morbidities who required help of caregivers to assist with their medication-taking were significantly less likely (p = 0.05) to have complaints with their medications compared to patients who self-managed. CONCLUSIONS Older patients with caregivers who assisted managing their medication-taking had better adherence. Those receiving aid from their caregivers were significantly less likely to have complaints regarding their medications as opposed to those not requiring a caregiver. This highlights the importance of having support for medication-taking in patients with co-morbidities to assist with better adherence.
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Affiliation(s)
- Snezana Kusljic
- Department of Nursing, The University of Melbourne, Australia.
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Abstract
Lower urinary tract symptoms (LUTS)--constituting a spectrum disorder that encompasses weak stream, nocturia, and sensations of incomplete emptying and intermittent or hesitant urination--are indicative of lower urinary tract dysfunction (LUTD). LUTD is a progressive disease that can lead to bladder dysfunction if left untreated or treated ineffectively. Sequelae include urinary retention, recurrent UTI, bladder calculi, and, eventually, renal impairment. LUTD involving the prostate is associated with both ageing and inflammation. Tissue inflammation resulting from ageing, infection, or other inflammatory disease processes (for example, type 2 diabetes mellitus) is epidemiologically associated with the subsequent development of tissue fibrosis in multiple organ systems, including the prostate. Recent studies show that tissue fibrosis in the lower urinary tract is associated with LUTD, and suggest that fibrosis might be a previously unrecognized pathobiology that contributes to LUTD. Thus, antifibrotic therapeutic agents should be considered as a new approach to efficaciously treating men with LUTD, especially those who don't experience durable responses to 5α-reductase inhibitors or α-adrenergic receptor antagonists.
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Gharaee-Kermani M, Rodriguez-Nieves JA, Mehra R, Vezina CA, Sarma AV, Macoska JA. Obesity-induced diabetes and lower urinary tract fibrosis promote urinary voiding dysfunction in a mouse model. Prostate 2013; 73:1123-33. [PMID: 23532836 PMCID: PMC5512573 DOI: 10.1002/pros.22662] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/17/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Progressive aging- and inflammation-associated fibrosis effectively remodels the extracellular matrix (ECM) to increase prostate tissue stiffness and reduce urethral flexibility, resulting in urinary flow obstruction and lower urinary tract symptoms (LUTS). In the current study, we sought to test whether senescence-accelerated mouse prone (SAMP)6 mice, which were reported to develop prostatic fibrosis, would also develop LUTS, and whether these symptoms would be exacerbated by diet-induced obesity and concurrent Type 2 Diabetes Mellitus (T2DM). METHODS To accomplish this, SAMP6 and AKR/J background strain mice were fed regular mouse chow, low fat diet chow, or high fat diet chow for 8 months, then subjected to glucose tolerance tests, assessed for plasma insulin levels, evaluated for urinary voiding function, and assessed for lower urinary tract fibrosis. RESULTS The results of these studies show that SAMP6 mice and AKR/J background strain mice develop diet-induced obesity and T2DM concurrent with urinary voiding dysfunction. Moreover, urinary voiding dysfunction was more severe in SAMP6 than AKR/J mice and was associated with pronounced prostatic and urethral tissue fibrosis. CONCLUSIONS Taken together, these studies suggest that obesity, T2DM, lower urinary tract fibrosis, and urinary voiding dysfunction are inextricably and biologically linked.
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Affiliation(s)
| | - Jose A. Rodriguez-Nieves
- The Department of Urology, The University of Michigan, Ann Arbor, Michigan
- The Graduate Program in Cellular and Molecular Biology, The University of Michigan, Ann Arbor, Michigan
| | - Rohit Mehra
- The Department of Pathology, The University of Michigan, Ann Arbor, Michigan
| | - Chad A. Vezina
- The Department of Comparative Biosciences, The University of Wisconsin, Madison, Wisconsin
| | - Aruna V. Sarma
- The Department of Urology, The University of Michigan, Ann Arbor, Michigan
| | - Jill A. Macoska
- The Department of Urology, The University of Michigan, Ann Arbor, Michigan
- The Graduate Program in Cellular and Molecular Biology, The University of Michigan, Ann Arbor, Michigan
- Correspondence to: Jill A. Macoska, PhD, Department of Urology, The University of Michigan, 6217 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0944.
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Uzun H, Çiçek Y, Kocaman SA, Durakoğlugil ME, Zorba OÜ. Increased pulse-wave velocity and carotid intima–media thickness in patients with lower urinary tract symptoms. Scand J Urol 2013; 47:393-8. [DOI: 10.3109/21681805.2013.780185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oh BS, Jang JW, Kwon JH, You CR, Chung KW, Kay CS, Jung HS, Lee S. Prognostic value of C-reactive protein and neutrophil-to-lymphocyte ratio in patients with hepatocellular carcinoma. BMC Cancer 2013; 13:7. [PMID: 23286275 PMCID: PMC3541059 DOI: 10.1186/1471-2407-13-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/02/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Accumulating evidence indicates that components of the systemic inflammatory response, such as C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), have been associated with prognosis of various cancers. We aimed to elucidate whether CRP and NLR could serve as potential surrogate markers for response and survival in patients with hepatocellular carcinoma (HCC). METHODS The study population consisted of 318 consecutive patients with HCC. CRP and NLR were measured at baseline with follow-up measurements. RESULTS With the mean follow-up of 13.9 months, the median survival time was 13.8 months. Child-Pugh class, tumor size > 5 cm, tumor multiplicity, presence of portal vein thrombosis, α-fetoprotein > 200 ng/mL, CRP > 6.3 mg/L and NLR > 2.3 were identified as independent factors for worse survival of HCC (all p < 0.05). Patients with elevated CRP (> 6.3 mg/L) and elevated NLR (> 2.3) had a significantly shorter overall survival than those with low CRP and low NLR (all p < 0.001). The combined use of CRP and NLR provided incremental prognostic information. With significant inter-correlations, levels of CRP and NLR escalated with aggravating Child-Pugh class from A to C or progressing tumor stage from I to IV. CRP and NLR on baseline and serial measurements were well predictive of treatment response (p < 0.001). CONCLUSIONS CRP and NLR are independent indicators for survival in HCC patients, reflecting tumor burden and hepatic reserve. Their role in predicting tumor response and survival is more enhanced when used in combination. This study suggests that CRP and NLR are important prognostic biomarkers for HCC.
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Affiliation(s)
- Byong Sun Oh
- Department of Internal Medicine, The Catholic University of Korea, Incheon St, Mary's Hospital, Incheon, Korea
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Kupelian V, McVary KT, Kaplan SA, Hall SA, Link CL, Aiyer LP, Mollon P, Tamimi N, Rosen RC, McKinlay JB. Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston area community health survey. J Urol 2013; 189:S107-14; discussion S115-6. [PMID: 23234611 DOI: 10.1016/j.juro.2012.11.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE In this study we investigated the relationship between lower urinary tract symptoms as defined by the American Urological Association symptom index and the metabolic syndrome, and determined the relationship between individual symptoms comprising the American Urological Association symptom index and the metabolic syndrome. MATERIALS AND METHODS The Boston Area Community Health Survey used a 2-stage cluster design to recruit a random sample of 2,301 men 30 to 79 years old. Analyses were conducted on 1,899 men who provided blood samples. Urological symptoms comprising the American Urological Association symptom index were included in the analysis. The metabolic syndrome was defined using a modification of the Adult Treatment Panel III guidelines. The association between lower urinary tract symptoms and the metabolic syndrome was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. RESULTS Increased odds of the metabolic syndrome were observed in men with mild to severe symptoms (American Urological Association symptom index 2 to 35) compared to those with an American Urological Association symptom index score of 0 or 1 (multivariate OR 1.68, 95% CI 1.21-2.35). A statistically significant association was observed between the metabolic syndrome and a voiding symptom score of 5 or greater (multivariate adjusted OR 1.73, 95% CI 1.06-2.80) but not for a storage symptom score of 4 or greater (multivariate adjusted OR 0.94, 95% CI 0.66-1.33). Increased odds of the metabolic syndrome were observed even with mild symptoms, primarily for incomplete emptying, intermittency and nocturia. These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older). CONCLUSIONS The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract.
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Affiliation(s)
- Varant Kupelian
- New England Research Institutes, 9 Galen St., Watertown, MA 02472, USA.
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Inci M, Sarli B, Davarci M, Yalcinkaya FR, Rifaioğlu MM, Davran R, Arica S, Motor S, DemirbaŞ O. Relationship between endothelial dysfunction and nocturia with benign prostatic hyperplasia. Scand J Urol 2013; 47:384-9. [DOI: 10.3109/21681805.2012.762038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim JW, Chae JY, Kim JW, Yoon CY, Oh MM, Kim JJ, Moon DG. Survey on the perception of urogenital complications in diabetic patients. World J Mens Health 2012; 30:172-6. [PMID: 23596608 PMCID: PMC3623533 DOI: 10.5534/wjmh.2012.30.3.172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/12/2012] [Accepted: 09/21/2012] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Retinopathy, neuropathy, and nephropathy are well-known complications of diabetes; they are often expected to occur and, therefore, are usually tested for. However, urogenital complications, such as sexual and voiding dysfunctions, are less well known, and consequently, many patients are not treated appropriately despite their symptoms. Thus, we surveyed diabetic patients with regard to their perception of urogenital complications. MATERIALS AND METHODS We designed a survey for patients in our hospital who were being treated for diabetes mellitus (DM). The questionnaire included items on age, sex, treatment duration, treatment options for and the level of perception of urogenital symptoms, the presence of urogenital symptoms, and whether treatment was intended or had been initiated. RESULTS In total, 275 patients participated in the survey. The perception questions on DM-associated urogenital complications showed that 89 patients (32.4%) had no knowledge, 84 patients (30.5%) had some knowledge, and 102 patients (37.1%) had detailed knowledge about these complications. A total of 124 patients (45.1%) reported urogenital symptoms: 93 patients (75.0%) reported voiding dysfunction and 61 patients (49.2%) reported sexual dysfunction. Common symptoms of voiding dysfunction were urinary frequency, nocturia, sense of residual urine, weak stream, and urinary incontinence. Common symptoms of sexual dysfunction were reduced libido, and erectile and ejaculatory dysfunction. CONCLUSIONS The survey showed that the subjective prevalence rate of urogenital symptoms in diabetic patients was 45.1%. However, only a small percentage (37.1%) of the patients cognized that these symptoms were associated with DM. Therefore, it is necessary to properly inform and educate diabetic patients on possible urogenital complications that may occur.
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Affiliation(s)
- Jong Wook Kim
- Department of Urology, Korea University Medical Center, Seoul, Korea
| | - Ji Yun Chae
- Department of Urology, Korea University Medical Center, Seoul, Korea
| | - Jin Wook Kim
- Department of Urology, Korea University Medical Center, Seoul, Korea
| | - Cheol Yong Yoon
- Department of Urology, Korea University Medical Center, Seoul, Korea
| | - Mi Mi Oh
- Department of Urology, Korea University Medical Center, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University Medical Center, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University Medical Center, Seoul, Korea
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Strand DW, Jiang M, Murphy TA, Yi Y, Konvinse KC, Franco OE, Wang Y, Young JD, Hayward SW. PPARγ isoforms differentially regulate metabolic networks to mediate mouse prostatic epithelial differentiation. Cell Death Dis 2012; 3:e361. [PMID: 22874998 PMCID: PMC3434663 DOI: 10.1038/cddis.2012.99] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent observations indicate prostatic diseases are comorbidities of systemic metabolic dysfunction. These discoveries revealed fundamental questions regarding the nature of prostate metabolism. We previously showed that prostate-specific ablation of PPARγ in mice resulted in tumorigenesis and active autophagy. Here, we demonstrate control of overlapping and distinct aspects of prostate epithelial metabolism by ectopic expression of individual PPARγ isoforms in PPARγ knockout prostate epithelial cells. Expression and activation of either PPARγ 1 or 2 reduced de novo lipogenesis and oxidative stress and mediated a switch from glucose to fatty acid oxidation through regulation of genes including Pdk4, Fabp4, Lpl, Acot1 and Cd36. Differential effects of PPARγ isoforms included decreased basal cell differentiation, Scd1 expression and triglyceride fatty acid desaturation and increased tumorigenicity by PPARγ1. In contrast, PPARγ2 expression significantly increased basal cell differentiation, Scd1 expression and AR expression and responsiveness. Finally, in confirmation of in vitro data, a PPARγ agonist versus high-fat diet (HFD) regimen in vivo confirmed that PPARγ agonization increased prostatic differentiation markers, whereas HFD downregulated PPARγ-regulated genes and decreased prostate differentiation. These data provide a rationale for pursuing a fundamental metabolic understanding of changes to glucose and fatty acid metabolism in benign and malignant prostatic diseases associated with systemic metabolic stress.
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Affiliation(s)
- D W Strand
- Department of Urologic Surgery, Vanderbilt-Ingram Comprehensive Cancer Center, Vanderbilt University School of Engineering, and Vanderbilt University Medical Center, Nashville, TN 37232-2765, USA
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Troubles vésicosphinctériens et syndrome métabolique. Prog Urol 2012; 22:207-13. [DOI: 10.1016/j.purol.2012.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 12/16/2011] [Indexed: 11/30/2022]
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Kirschner-Hermanns R, Daneshgari F, Vahabi B, Birder L, Oelke M, Chacko S. Does diabetes mellitus-induced bladder remodeling affect lower urinary tract function? ICI-RS 2011. Neurourol Urodyn 2012; 31:359-64. [PMID: 22415965 DOI: 10.1002/nau.22228] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/16/2012] [Indexed: 11/11/2022]
Abstract
AIMS Due to an increase in aging population and changing eating habits diabetes mellitus (DM) type II is a rapidly increasing condition worldwide. Although not so detrimental as other co-morbidities, uropathy contributes to a significantly reduced quality-of-life in those affected. The purpose of this ICS-RS report is to highlight clinical and basic research data to outline directions for further research and possible treatment approaches. METHODS This report is based on a think tank presentation and discussion at the ICI-RS 2011, original research data and literature research. RESULTS Clinical and experimental data confirm that detrusor overactivity, both neurogenic and myogenic, and changes in transmitter regulation leading to a hyper- excitability of the detrusor are the major findings in diabetic neuropathic bladders. These findings seem to be related to an earlier stage of DM, whereas detrusor underactivity appears to be linked to later stages of DM. Detrusor smooth muscle cells seem to be modulated directly by hyperglycemia. Data support the theory that hyperglycemia-induced oxidative stress in the detrusor smooth muscle and that micro- and macrovascular events are also responsible for urologic complications of DM. CONCLUSIONS DM causes bladder remodelling leading to uropathy in a mulitfactorial way. Future research should focus on the effects of DM as a function of time and develop novel animal models looking at defined aspects as well as interaction of different aspects- such as oxidative stress in neurogenic, myogenic and urothelial components and the role of inflammation and hypoxia caused by vascular complications.
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Gomez CS, Kanagarajah P, Gousse AE. Bladder dysfunction in patients with diabetes. Curr Urol Rep 2012; 12:419-26. [PMID: 21894526 DOI: 10.1007/s11934-011-0214-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With diabetes mellitus (DM) reaching epidemic proportions, the identification of voiding dysfunction as a common and burdensome complication of this disease is critical. Research into diabetic voiding dysfunction significantly lags behind other complications of DM, such as retinopathy and nephropathy. Recent studies have revealed that DM predisposes patients to a wide range of lower urinary tract dysfunction, from the classic diabetic cystopathy of incomplete emptying to urgency incontinence. In this review, we discuss the current concepts of diabetic voiding dysfunction with a critical analysis of the available evidence.
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Affiliation(s)
- Christopher S Gomez
- Bladder Health and Reconstructive Urology Institute, Memorial Hospital Miramar, 1951 Southwest 172nd Avenue, Suite #408, Miramar, FL 33029, USA
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Van Dijk MM, Wijkstra H, Debruyne FM, De La Rosette JJMCH, Michel MC. The role of nocturia in the quality of life of men with lower urinary tract symptoms. BJU Int 2012; 105:1141-6. [PMID: 22299137 DOI: 10.1111/j.1464-410x.2009.08969.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the role of treatment-associated improvement in nocturia in health-related quality of life (HRQL) in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia, and secondarily to confirm the role of nocturia in HRQL at baseline and to compare the effects of watchful waiting, transurethral microwave treatment (TUMT) and transurethral resection of the prostate (TURP) to those of α1-adrenoceptor antagonists (α-blockers) on nocturia. PATIENTS AND METHODS We retrospectively analysed using multiple regression a large single-centre database of patients receiving routine care for treatment-associated alterations of symptoms and HRQL (assessed at baseline, 2611 men) and 6-12 months after initiation of treatment (1258 men). RESULTS Among the symptoms assessed using the International Prostate Symptom Score, nocturia (together with urgency and weak stream) had the strongest correlation with HRQL at baseline and after treatment. Watchful waiting, α-blockers, TUMT and TURP reduced nocturia episodes by a mean (sd) of 7 (53)%, 17 (40)%, 32 (47)% and 75 (23)%, respectively. The treatment-associated improvements in nocturia (together with those of weak stream) had the strongest association with those of HRQL. CONCLUSIONS We conclude that among all LUTS assessed in the IPSS, nocturia has one of the strongest associations with HRQL, and that treatment-associated improvements in nocturia contribute considerably to overall improvements in HRQL.
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Affiliation(s)
- Marleen M Van Dijk
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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