Association between life-style, metabolic syndrome and lower urinary tract symptoms and its impact on quality of life in men ≥ 40 years

Lower urinary tract symptoms among normal-weight, overweight, and obese palestinians: a study of prevalence and impact on the quality of life

BACKGROUND

This study was conducted to assess the prevalence of lower urinary tract symptoms (LUTS) among non-obese and obese Palestinians. The study also aimed to assess the effects of LUTS on the quality of life of obese and non-obese Palestinians.

METHODS

This was a cross-sectional study that was conducted among normal-weight, overweight, and obese Palestinians using the King Health Questionnaire. The data collected from participants were entered and analyzed using SPSS (version 22).

RESULTS

In this study, data were collected from 378 participants. The median age of the participants was 42.0 [30.0, 55.0] years, and the median body mass index was 27.1 [24.0, 30.8] kg/m2. Of the participants, 149 (39.4%) were overweight and 112 (29.6%) were obese. The prevalence of urinary hesitancy, incomplete emptying, urgency, nocturia, urgency, urge incontinence, stress incontinence, nocturnal enuresis, intercourse incontinence, bladder pain, number of urinations/24 h, and number of urinations/night was significantly higher among obese participants. Similarly, role limitations, physical/social limitation, personal relationships, emotions, and sleep/energy were affected significantly higher in obese compared to nonobese participants.

CONCLUSION

Higher prevalence of LUTS among obese patients compared to nonobese patients was observed among the Palestinians. Obese patients reported significantly higher deterioration of the quality of life as a result of LUTS compared to nonobese patients. Urologists, nutritionists, public health specialists, and other healthcare providers should consider measures to reduce LUTS among obese patients and improve their quality of life.

A high salt diet impairs the bladder epithelial barrier and activates the NLRP3 and NF‑κB signaling pathways to induce an overactive bladder in vivo

Overactive bladder (OAB) is a condition characterized by an urgency to urinate, which is associated with the urodynamic observation of detrusor overexcitation. Although the etiology of OAB is currently unclear, it has been suggested that in patients with OAB, disruption of bladder epithelial barrier integrity can disturb the normal contractile function of the detrusor. Additionally, dietary preferences have been suggested to influence the severity of OAB. Therefore, the aim of the present study was to investigate the effect of a high salt diet (HSD) on the development of OAB in a murine model. Mice were fed either a HSD or standard diet for 8 weeks, following which voiding characteristics and bladder barrier function were assessed. The present study demonstrated that a HSD in mice was associated with OAB-like symptoms such as increased urinary frequency and non-voiding bladder contractions. The HSD group demonstrated a thinner bladder mucus layer and decreased expression of bladder barrier markers, tight junction protein-1 and claudin-1, which may be potentially indicative of induced bladder damage. A HSD for 8 weeks in mice and a high salt treatment at the uroepithelium cellular (SV-HUC-1s) level resulted in increased uroepithelial oxidative stress and inflammatory cell infiltration, as indicated by increased expression levels of TNF-α and IL-1β, as well as activation of the nucleotide-binding domain leucine-rich-containing family pyrin domain-containing 3 (NLRP3) and NF-κB signaling pathways in vivo and in vitro. Therefore, the present study indicated that a HSD could be a potentially important risk factor for the development of OAB, as it may be associated with overactivation of contractile function of the bladder by impairing the integrity of the bladder epithelial barrier and activation of the NLRP3 and NF-κB signaling pathways. Remodeling of the bladder barrier and reduction of the inflammatory response may be potential targets for the treatment of OAB in the future.

An evaluation of lower urinary tract symptoms among patients with hypertension: A cross-sectional study

Background

Hypertension (HTN) is a prevalent and impactful health concern associated with cardiovascular morbidity and mortality. This research delves into the intricate relationship between HTN and lower urinary tract symptoms (LUTS), acknowledging the multifaceted nature of these conditions and their potential impact on individuals' quality of life.

Materials and Methods

This cross-sectional study, conducted in Nablus, Palestine, employed convenient sampling to recruit hypertensive patients from the Ministry of Health clinics between September and December 2023. The inclusion criterion involved confirmed hypertensive patients, while the exclusion criterion included individuals with specific health conditions. The collected data included demographic, comorbidity, and lifestyle factor data. The study utilized the urogenital distress inventory 6 (UDI-6) and Incontinence Impact Questionnaire (IIQ)-7 short forms to assess urinary distress symptoms and the impact of urinary incontinence on quality of life. All the statistical analyses, including Pearson, Chi-square, Fisher's exact, Kruskal-Wallis, and Mann-Whitney tests, were performed with various tests for significance, and the significance level was set at P < 0.05.

Results

Among the 351 participants meeting the inclusion criteria, females (62.1%) and married individuals (83.5%) were the predominant participants. The majority were aged 58-67 (42.5%), had a high school education (39.0%), and had a body mass index (BMI) of 30-34.9 (30.2%). Significant correlations were found between UDI-6 scores and sex, age, marital status, education level, employment status, and comorbidities. The IIQ-7 score was significantly correlated with female sex, marital status, age, comorbidities, duration of HTN, employment status, and education level. Both the UDI-6 and IIQ-7 scores revealed considerable impacts on urinary symptoms and quality of life. A significant negative correlation (r = -0.579) between the IIQ-7 score and UDI-6 score emphasized the interconnectedness of urinary distress symptoms and their impact on quality of life (P < 0.001). These findings underscore the multifaceted nature of LUTS and their profound effects on hypertensive patients' well-being.

Conclusion

Our study revealed a significant association between HTN and LUTS, especially among females and specific demographic groups. This emphasizes the need for comprehensive management. The observed negative impact on quality of life emphasizes the significance of adopting holistic approaches to address both conditions.

Mitigating Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Ameliorating Sexual Function and Psychological Well-Being in Older Men

This study aimed to investigate the prevalence of lower urinary tract symptoms (LUTS) in older men (N= 3056) with benign prostatic hyperplasia (BPH) and its effects on their sexual function and mental health. Descriptive, correlation, and regression analyses were used to explore the relationships between prostate and lower urinary tract health and psychological well-being. Better prostate and lower urinary tract health positively affected psychological well-being, and sexual function also had a positive influence. LUTS have an adverse impact on sexual function and mental health. Early intervention is crucial for mitigating the negative impact of LUTS on the quality of life in older men. Addressing prostate and lower urinary tract health issues through appropriate interventions may improve psychological well-being. Health care professionals must consider the adverse effects of BPH and LUTS on sexual function and mental health, and implement interventions to enhance the overall quality of life in older men.

Tissue immunoexpression of IL-6 and IL-18 in aging men with BPH and MetS and their relationship with lipid parameters and gut microbiota-derived short chain fatty acids

Recent studies indicate that inflammation is one of the causes of the development of benign prostatic hyperplasia (BPH). Inflammation may result from past infections, metabolic disorders, but also from the state of functioning of the intestinal microbiota. The aim of the study was to assess whether the diagnostic lipid parameters for metabolic syndrome and short-chain fatty acids (SCFAs) are related to the immunoexpression of interleukins in prostate tissue with benign hyperplasia. The study involved 103 men with BPH, who were divided into two groups depending on the presence of MetS. We analysed tissue immunoexpression of two proinflammatory interleukins: IL-6, which is known to be involved in the development of BPH, and IL-18, which has not been analysed so far. The results of our study indicate that men with BPH + MetS in the stroma of the prostate have a significantly higher overall percentage of IL-6+ cells compared to men without MetS (p = 0.034). The analysis of IL-18 immunoexpression in prostate tissue indicated that in men with BPH + MetS, the glandular part of the prostate had a significantly higher percentage of cells with strong IL-18 expression (p = 0.040). We also noticed a relationship between tissue expression of IL-6 and IL-18 and lipid parameters (TG and HDL). We conclude that lipid disorders occurring in men with BPH increase inflammation in the prostate gland. Moreover, it has also been demonstrated for the first time that, indirectly, through SCFAs, the gut microbiota can act to prevent or create an inflammatory microenvironment in the prostate gland.

Lower Urinary Tract Symptoms in Depression: A Review

Lower Urinary Tract Symptoms (LUTS) are frequently present in the general population as patients age with approximately a third of individuals experiencing LUTS during their lifetime. LUTS can be further defined as having any of the following symptoms: urinary hesitancy, straining, nocturia, increased urination frequency, and dysuria. LUTS has the potential for patients to contribute their symptoms to what can normally occur as we age. This can lead to a decrease in patients seeking care and could negatively impact patients' health-related quality of life (HRQL). In conjunction with LUTS, we obtained from our analysis that LUTS and depression are closely related and worsening depressive symptoms may increase the severity of LUTS. We also discerned three categories of factors that can yield major depression namely adversity, internalizing, and externalizing factors. Within these categories, trauma, social support, genetic factors, and minimal education appeared to increase the risk of depression in patients. With the recent increase in mental health awareness and more access to mental health care amid the COVID-19 Pandemic, further screening, and collaboration between providers to treat both urological and psychiatric symptoms could improve patient outcomes. It is important for providers to have an increased understanding of the mental and physical impact both LUTS and depression can have on patients' wellbeing. This has the potential to help patients be more open about their symptoms with the aim of better addressing LUTS and depression to positively impact their HRQL.

Relationship between lower urinary tract symptoms and frailty

OBJECTIVE

To elucidate the relationship between frailty and lower urinary tract symptoms (LUTS).

METHODS

We longitudinally evaluated the temporal changes and the relationships between frailty and LUTS in 247 community-dwelling adults (45 years or older) at baseline and at a 5-year follow-up. We used the Fried phenotype (phenotype-based frailty), 5-item modified frailty index (5i-mFI; comorbidity-based frailty), and frailty discriminant score (comprehensive frailty assessment) to evaluate frailty. LUTS were evaluated using the international prostate symptom score (IPSS) and overactive bladder symptom score (OABSS).

RESULTS

We analyzed 247 participants with a median age of 60 years. The median IPSS and OABSS were significantly increased over the 5 years. The proportion of frail individuals did not increase significantly over the 5 years. Of the three frailty assessment tools, the 5i-mFI score significantly increased between 2014 and 2019. Multiple linear regression analyses showed that the 5i-mFI score was significantly associated with the severity of LUTS in 2014 to 5i-mFI in 2019 but not with 5i-mFI in 2014 to the severity of LUTS in 2019.

CONCLUSION

The effect of LUTS on frailty might be greater than the effect of frailty on LUTS. Further large-scale studies are needed to elucidate the relationship between LUTS and frailty.

Effects of different diets used to induce obesity/metabolic syndrome on bladder function in rats

Preclinical and human studies on the relationship between obesity/metabolic syndrome (MetS) and lower urinary tract dysfunction (LUTD) are inconsistent. We compared the temporal effects of feeding four different diets used to induce obesity/MetS, including 60% fructose, 2% cholesterol +10% lard, 30% fructose + 20% lard, or 32.5% lard diet, up to 42 wk, on metabolic parameters and bladder function in male Sprague-Dawley rats. Rats fed a 30% fructose + 20% lard or 32.5% lard diet consumed less food (grams), but only the 32.5% lard diet group took in more calories. Feeding rats a 60% fructose or 30% fructose + 20% lard diet led to glucose intolerance and increased blood pressure. Higher body weight and increased cholesterol levels were observed in the rats maintained on a 2% cholesterol +10% lard diet, whereas exposure to a 32.5% lard diet affected most of the above parameters. Voiding behavior measurement showed that voiding frequency and the total voided volume were lower in the experimental diet groups except for the 30% fructose + 20% lard group. The mean voided volume was lower in the 30% fructose + 20% lard and 32.5% lard groups compared with the control group. Cystometric analysis revealed a decreased bladder capacity, mean voided volume, intermicturition interval, and compliance in the 32.5% lard diet group. In conclusion, experimental diets including 60% fructose, 30% fructose + 20% lard, or 2% cholesterol + 10% lard diet differently affected physiological and metabolic parameters and bladder function to a limited extent, while exposure to a 32.5% lard diet had a greater impact.