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.

Development and validation of a clinical diagnostic model for pregnant women with renal colic in the emergency department in China: a protocol for a retrospective cohort study

INTRODUCTION

Urolithiasis affects many people throughout their lives. Among the maternal population, although the morbidity of acute urolithiasis in pregnant women is unremarkable, it is the leading cause of hospitalisation during pregnancy. There is no effective clinical diagnostic tool to help doctors diagnose diseases. Our primary aim was to develop and validate a clinical prediction model based on statistical methods to predict the probability of having disease in pregnant women who visited the emergency department because of urolithiasis-induced colic.

METHODS AND ANALYSIS

We will use multivariate logistic regression analysis to build a multivariate regression linear model. A receiver operating characteristic curve plot and calibration plot will be used to measure the discrimination value and calibration value of the model, respectively. We will also use least absolute shrinkage and selection operator regression analysis combined with logistic regression analysis to select predictors and construct the multivariate regression model. The model will be simplified to an application that has been reported before, and users will only need to enter their clinical parameters so that risk probability is automatically derived.

ETHICS AND DISSEMINATION

The review and approval documents of the clinical research ethics committee have been received from the ethics committee of our hospital (The Third Affiliated Hospital of Wenzhou Medical University). We will disseminate research findings through presentations at scientific conferences and publication in peer-reviewed journals.

Atlas of scoring systems, grading tools and nomograms in Endourology: A comprehensive overview from The TOWER Endourological Society research group

INTRODUCTION

With an increase in the prevalence of kidney stone disease (KSD), there has been a universal drive to develop reliable and user-friendly tools such as grading systems and predictive nomograms. An atlas of scoring systems, grading tools and nomograms in Endourology is provided in this paper.

METHODS

A comprehensive search of world literature was performed to identify nomograms, grading systems and classification tools in endourology related to KSD. Each of these were reviewed by the authors and have been evaluated in a narrative format with details on those which are externally validated and their respective citation count on google scholar.

RESULTS

A total of 54 endourological tools have been described in our atlas of endourological scoring systems, grading tools and nomograms. Of the tools, 23 (43%) are published in the last 3 years showing an increasing interest in this area. This includes 5 for percutaneous nephrolithotomy (PCNL), 6 for flexible ureteroscopy (fURS), 3 for semi-rigid URS (sURS), 9 for shockwave lithotripsy (SWL), 2 for stent encrustations, 3 for intra-operative appearance at the time of URS and 3 to classify intra-operative ureteric injury. There were 3 tools for renal colic assessment, one each for prediction of future stone event, stone classification and stone impaction and 2 for need of emergency intervention in ureteric stone. While 2 tools are related to stone recurrence, 6 are related to post-procedural complications. There are now 2 tools for simulation in endourology and 5 for patient reported outcome measures (PROMS).

CONCLUSIONS

A number of reliable and established tools exist currently in endourology. Each of these offers their own respective advantages and disadvantages. While nomograms and scoring systems can help in the decision making, these must be tailored to individual patients based on their specific clinical scenarios, expectations and informed consent.

A Longitudinal Study of Bidirectional Relationships between Sleep Disorder and Frequency of Nocturia: Results from the Iwaki Health Promotion Project

INTRODUCTION

The causal relationship between sleep disorder and frequency of nocturia remains unclear.

METHODS

We longitudinally evaluated sleep disorder and frequency of nocturia in 547 community-dwelling adults between baseline and 5-year follow-up. We included participants ≥50 years old who have no sleep disorder (the Pittsburgh Sleep Quality Index [PSQI] ≥ 5) nor nocturia (≥1). For 5 years, we evaluated the temporal changes in sleep disorder and nocturia and the bidirectional relationships between sleep disorder and nocturia.

RESULTS

Of the 547 participants, we included 268 adults with a median age of 61 years in this study. Median PSQI and nocturia were significantly increased for 5 years from 2 to 3 and from 1 to 2, respectively. New onset of sleep disorder (PSQI > 5) and nocturia >1 was observed in 42 (16%) and 137 (51%) participants, respectively. The cross-lagged panel analysis showed that the path coefficient from PSQI to nocturia (β = 0.22, p = 0.031) was significantly higher than that from nocturia to PSQI (β = 0.02, p = 0.941).

CONCLUSIONS

Our longitudinal study showed the effect of sleep disorder on nocturia was significant, although nocturia may not significantly worsen sleep disorder in community-dwelling adults.

Overactive bladder and sleep disturbance have a significant effect on indoor falls: Results from the community health survey in Japan

OBJECTIVES

To evaluate the effect of overactive bladder (OAB) and frailty on indoor fall events in community-dwelling adults aged 50 or older.

METHODS

We conducted a cross-sectional study involving 723 adults between 2016 and 2017 in Hirosaki, Japan. OAB symptoms and sleep disturbance were assessed using the Overactive Bladder Symptom Score (OABSS) and the Pittsburgh Sleep Quality Index (PSQI). Indoor fall events (falls or near-falls) within 1 year were evaluated. Frailty was evaluated by the frailty discriminant score. We investigated the association of OAB symptoms with sleep disturbance, frailty, and indoor fall events. Multivariate logistic regression analysis was performed to investigate the effect of OAB symptoms on fall events controlling for confounding factors such as age, gender, comorbidity, frailty, and sleep disturbance.

RESULTS

The median age was 64. We observed OABSS ≥6 in 98 participants (14%), nocturia ≥2 in 445 (62%), urgency score ≥3 in 80 (11%), urge incontinence score ≥3 in 36 (5.0%), PSQI ≥6 in 153 (21%), frailty in 169 (23%), and indoor fall events in 251 (35%). Older age, diabetes, OABSS, nocturia, urgency, urge incontinence, and the PSQI were significantly associated with indoor fall events. Multivariate logistic regression analyses showed that OAB symptoms and sleep disturbance were significantly associated with fall events.

CONCLUSIONS

The effect of OAB symptoms and sleep disturbance on indoor fall events was significant. The causal relationship between OAB and falls needs further study.