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Huang Y, Su H, Wang Y, Zhang Y. Threshold effects between caffeine intake and urine flow rate: a population-based cross-sectional study. Int Urol Nephrol 2024:10.1007/s11255-024-04153-y. [PMID: 39012583 DOI: 10.1007/s11255-024-04153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE The potential benefits of caffeine intake are currently receiving much attention and exploration. Urine flow rate (UFR) is an objective index to comprehensively reflect bladder function. The aim of this study was to investigate the association between caffeine intake and UFR using the National Health and Nutrition Examination Survey (NHANES) database. METHODS 14,142 participants were enrolled in this study. Weighted multivariate adjusted regression models were used to explore the relationship between caffeine intake and UFR. The dose-response relationships were explored using a restricted cubic spline (RCS) and a threshold effect analysis was conducted based on the inflection points identified by the two-segment linear regression model. In addition, subgroup analysis and sensitivity analysis were applied. RESULTS The findings suggested that the intake of caffeine was correlated with improved UFR [Model 3: 0.091 (0.057, 0.126), P value < 0.001]. In addition, the RCS supported a nonlinear relationship between them. The analysis of threshold effect further revealed a specific level of caffeine intake (34.51 mg/day) that exhibited a significant enhancement in UFR. Finally, through re-analyzing the data set obtained after multiple imputation (MI), we obtained similar results. CONCLUSION This study found a nonlinear beneficial relationship between caffeine intake and UFR, and revealed the recommended intake of caffeine. The values varied by gender, race, education, and smoking status.
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Affiliation(s)
- Yong Huang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Huiyi Su
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yingying Wang
- Department of Oncology, Chongqing Jiulongpo District People's Hospital, Chongqing, 400050, China
| | - Yao Zhang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Muacevic A, Adler JR, AlBaraki J, AlMutairi M, AlEnazi N, AlDhalaan S, AlYahya S, Masud N. Quality of Life of Saudi Women With Chronic Lower Urinary Tract Symptoms. Cureus 2022; 14:e32439. [PMID: 36644084 PMCID: PMC9833424 DOI: 10.7759/cureus.32439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
Background Chronic lower urinary symptoms (LUTS) are reported to affect more than half of women of all ages and have a significant impact on their quality of life (QoL). We aimed in this study to assess the QoL of adult Saudi women with chronic LUTS. Methods A cross-sectional study was done on 390 female patients diagnosed with LUTS at three tertiary care hospitals in Riyadh, Saudi Arabia, from October to December 2021. LUTS are classified into three categories: symptoms related to bladder storage (increased daytime frequency, nocturia, and urinary incontinence [UI]), symptoms of bladder voiding (hesitancy, extended micturition time, and insufficient emptying), and symptoms involved in the post-urination phase such as post-micturition dribbling. The data was collected using a self-administered questionnaire which comprised demographic characteristics, International Prostate Symptom Score (IPSS) for assessment of LUTS severity, and King's Health Questionnaire (KHQ) for assessment of QoL. Results After analyzing the study results, we found that symptoms were mild, moderate, and severe in 11%, 51%, and 39% of participants, respectively. Increased age and parity were found to have a significant association with increased symptom severity (p-value <0.05). The current study reported a moderate effect of LUTS on QoL. There was a significant correlation between increased symptom severity and negative impact on QoL, excluding the personal relationships domain. The highest scores in KHQ, which indicate worse QoL, were found in the domains of incontinence impact and emotions, while the lowest scores, which indicate better QoL, were found in the domains of social limitations and severity measures. Employed females were found to have worse QoL in the severity measures domain, which refers to the degree of urinary symptoms affecting day-to-day functioning. In addition, younger age, below 45 years, was found associated significantly with better QoL, especially in the domains of general health, personal relationships, and severity measures. Conclusion In the current study, the majority of patients reported moderate symptoms severity. Chronic LUTS have a significant impact on the QoL of Saudi women in many aspects, including physical, social, and emotional health, especially for those who have moderate to severe symptoms. Healthcare providers should assess high-risk women for the presence of LUTS. Furthermore, we recommend evaluating the QoL of patients with LUTS as a part of routine management.
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Huang J, Chan CK, Yee S, Deng Y, Bai Y, Chan SC, Tin MS, Liu X, Lok V, Zhang L, Xu W, Zheng ZJ, Teoh JYC, Ng CF, Wong MCS. Global burden and temporal trends of lower urinary tract symptoms: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00610-w. [DOI: 10.1038/s41391-022-00610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
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Weng S, Weiss JP. The Relationship Between Overactive Bladder and Nocturia. Eur Urol Focus 2022; 8:4-5. [DOI: 10.1016/j.euf.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/03/2021] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
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Pöyhönen A, Åkerla J, Koskimäki J, Tammela TLJ, Auvinen A. Seasonal changes in occurrence and severity of lower urinary tract symptoms-Tampere Aging Male Urologic Study (TAMUS). Low Urin Tract Symptoms 2020; 13:216-223. [PMID: 33034153 DOI: 10.1111/luts.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine if lower urinary tract symptoms (LUTS) involve seasonal variation and how this affects the severity of LUTS. METHODS A total of 3163 men aged 50 to 70 years were mailed a questionnaire on urinary symptoms. The overall response rate was 65.3% (2064 out of 3163 men). The men were asked whether their urinary symptoms showed variation in degree of difficulty according to time of year and if yes, when LUTS were the worst and the mildest. Ten different LUTS were evaluated with four response options for the severity of symptoms. Mean symptom scores and the proportions of symptomatic men were evaluated according to the presence of seasonal changes in different symptoms. RESULTS Overall, 17.1% of men reported seasonal variation in severity of LUTS, older men more frequently than younger men. Worse LUTS during winter were reported by 81% of the men reporting seasonal variation, and 93% reported that LUTS were relieved in summer. More seasonal variation was reported by men with comorbidities (stroke, neurological disease) and those with medical treatment for LUTS or operative treatment for benign prostatic hyperplasia. Men with more severe LUTS were more likely to report seasonal changes. CONCLUSIONS One out of six men reported seasonal changes in LUTS, with winter worsening and summer relieving the symptoms. Men with seasonal variation in LUTS had more severe LUTS in all 10 symptom groups that were investigated.
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Affiliation(s)
- Antti Pöyhönen
- Centre for Military Medicine, The Finnish Defence Forces, Riihimäki, Finland
| | - Jonne Åkerla
- Department of Urology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Juha Koskimäki
- Department of Urology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Teuvo L J Tammela
- Department of Urology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Santini ACM, Santos ES, Vianna LS, Bernardes JM, Dias A. Prevalence and factors associated with the occurrence of urinary incontinence during pregnancy. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000400013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to determine the prevalence of urinary incontinence (UI) during pregnancy, to identify and quantify the factors associated with gestational UI. Methods: a cross-sectional study carried out with women admitted for deliveries in all maternity wards in the city of Botucatu (São Paulo). Data were collected through a structured questionnaire, based on the literature, containing questions about the occurrence of UI, its types, risk factors and moments when urinary losses occurred. Associations between UI and the predictive variables were analyzed with logistic regression models. Results: 950 women were interviewed, out of which 472 complained of urinary losses during pregnancy, resulting in a prevalence of 49.68% (CI95%= 46.51 - 52.86). The majority (61.8%) were classified as mixed UI. Among the covariates investigated, smoking (OR= 4.56), illicit drugs use (OR= 25.14), stimulant foods (OR= 1.84), constipation (OR=1.99), hypertensive disorders during gestation (OR= 3.23), gestational diabetes mellitus (OR= 2.89), parity (OR= 1.52) and previous caesarean sections (OR= 2.56) increased the chance of urinary losses during pregnancy. Conclusions: there was a high prevalence of UI during pregnancy. This condition was strongly associated with lifestyle habits and gestational morbidities. Finally, it is worth high-lighting the fact that delivery via caesarean section increased the chance of UI in subsequent pregnancies.
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Affiliation(s)
| | | | | | | | - Adriano Dias
- Universidade Estadual Paulista Julio de Mesquita Filho, Brasil
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Lowder JL, Bavendam TG, Berry A, Brady SS, Fitzgerald CM, Fok CS, Goode PS, Lewis CE, Mueller ER, Newman DK, Palmer MH, Rickey L, Stapleton A, Lukacz ES. Terminology for bladder health research in women and girls: Prevention of Lower Urinary Tract Symptoms transdisciplinary consortium definitions. Neurourol Urodyn 2019; 38:1339-1352. [PMID: 30957915 PMCID: PMC6581588 DOI: 10.1002/nau.23985] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/22/2019] [Accepted: 03/14/2019] [Indexed: 12/20/2022]
Abstract
AIM To report research terminology and definitions for describing healthy bladder function among women and girls. METHODS The Prevention of Lower Urinary tract Symptoms (PLUS) Consortium developed research terminology and definitions for elements of healthy bladder function based on existing understanding of storage and emptying functions of the bladder and accepted definitions of lower urinary tract symptoms (LUTS). The novel concept of a bladder "bioregulatory" function was also proposed. Elements of bladder function corresponding to bladder health (BH) and LUTS were developed and refined using an iterative process. A comprehensive reference table structured by bladder function (Storage, Emptying, and Bioregulatory) and elements of each function was created to document proposed research terminology and definitions. RESULTS The BH research definitions for each bladder function are: (1) Storage: the ability to hold urine for a reasonable duration of time and sense bladder fullness without fear of or concern about urgency, discomfort or leakage; (2) Emptying: the ability to empty the bladder completely in a timely, efficient, effortless, comfortable manner; and (3) Bioregulatory: the bladder barrier protects the individual/host from pathogens, chemicals, and malignancy. Research definitions for seven Storage, seven Emptying, and three Bioregulatory elements of function are presented. Novel LUTS research definitions were developed when gaps in existing definitions were identified or nonclinical language was desired. CONCLUSIONS PLUS BH definitions reflect a transdisciplinary approach to standardizing research definitions for elements of bladder function from a perspective of health rather than dysfunction and provide a framework for studying BH in clinical practice, public health promotion, and LUTS prevention.
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Affiliation(s)
- Jerry L Lowder
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Tamara G Bavendam
- Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Colleen M Fitzgerald
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Loyola University Stritch School of Medicine, Chicago, Illinois
- Department of Physical Medicine and Rehabilitation, Loyola University Stritch School of Medicine, Chicago, Illinois
| | - Cynthia S Fok
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Patricia S Goode
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Birmingham, Alabama
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth R Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Loyola University Stritch School of Medicine, Chicago, Illinois
| | - Diane K Newman
- Department of Urology, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary H Palmer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leslie Rickey
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology and Obstetrics & Gynecology, Yale University, New Haven, Connecticut
| | - Ann Stapleton
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington
| | - Emily S Lukacz
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, San Diego, California
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Abstract
The term OAB (overactive bladder) describes a symptom complex. Therefore, initial treatment should be based on clinical symptoms and the results of basic diagnostics. Patient preference is essential for the choice of the initial treatment. Behavioural therapy, electrostimulation and medical treatment are available treatment options. If these are not effective, extended diagnostic examinations should be performed prior to minimally invasive treatments, like onabotulinumtoxin injections in the detrusor or sacral neuromodulation. Surgical interventions like augmentation cystoplasty are rarely required today.
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Bray R, Cacciatore S, Jiménez B, Cartwright R, Digesu A, Fernando R, Holmes E, Nicholson JK, Bennett PR, MacIntyre DA, Khullar V. Urinary Metabolic Phenotyping of Women with Lower Urinary Tract Symptoms. J Proteome Res 2017; 16:4208-4216. [PMID: 28937771 DOI: 10.1021/acs.jproteome.7b00568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lower urinary tract symptoms (LUTS), including urinary incontinence, urgency and nocturia, affect approximately half of women worldwide. Current diagnostic methods for LUTS are invasive and costly, while available treatments are limited by side effects leading to poor patient compliance. In this study, we aimed to identify urine metabolic signatures associated with LUTS using proton nuclear magnetic resonance (1H NMR) spectroscopy. A total of 214 urine samples were collected from women attending tertiary urogynecology clinics (cases; n = 176) and healthy control women attending general gynecology clinics (n = 36). Despite high variation in the urine metabolome across the cohort, associations between urine metabolic profiles and BMI, parity, overactive bladder syndrome, frequency, straining, and bladder storage were identified using KODAMA (knowledge discovery by accuracy maximization). Four distinct urinary metabotypes were identified, one of which was associated with increased urinary frequency and low BMI. Urine from these patients was characterized by increased levels of isoleucine and decreased levels of hippurate. Our study suggests that metabolic profiling of urine samples from LUTS patients offers the potential to identify differences in underlying etiology, which may permit stratification of patient populations and the design of more personalized treatment strategies.
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Affiliation(s)
- Rhiannon Bray
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | | | - Beatriz Jiménez
- Imperial Clinical Phenotyping Centre, QEQM Building, Imperial College London, Saint Mary's Hospital , London W21NY, U.K
| | - Rufus Cartwright
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | - Alex Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | - Ruwan Fernando
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
| | | | | | - Phillip R Bennett
- Queen Charlotte's Hospital, Imperial College Healthcare NHS Trust , London W12 0HS, U.K
| | | | - Vik Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust , London W2 1NY, U.K
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11
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Homma Y. Hypersensitive bladder: a solution to confused terminology and ignorance concerning interstitial cystitis. Int J Urol 2015; 21 Suppl 1:43-7. [PMID: 24807494 DOI: 10.1111/iju.12314] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/04/2013] [Indexed: 12/30/2022]
Abstract
Taxonomy or nomenclature concerning interstitial cystitis and its related symptom syndromes is in a state of confusion. After analyzing the reasons for confusion in regard to three components (disease name, symptoms, Hunner's lesion), I would like to propose a new term, "hypersensitive bladder", taking after overactive bladder, as a solution. Hypersensitive bladder symptoms are defined as "increased bladder sensation, usually associated with urinary frequency and nocturia, with or without bladder pain." The proposal of hypersensitive bladder is based on: (i) it does not appear a symptom syndrome, but a disease by ending with an organ name, "bladder"; (ii) it does not contain confusable symptom terms (pain and urgency), but indicates irritative symptoms including pain and urgency; and (iii) it suggests pathophysiological hyperactivity of sensory nerves. Interstitial cystitis is defined by three requirements: (i) hypersensitive bladder symptoms; (ii) bladder pathology; and (iii) no other diseases, where bladder pathology should be clearly stated either as Hunner's lesion or glomerulations after hydrodistention. Hypersensitive bladder can be used for the condition with hypersensitive bladder symptoms, but no obvious disease explaining hypersensitive bladder symptoms identified. Interstitial cystitis is a representative disease causing hypersensitive bladder symptoms, most typically with pain, but might be painless and indistinguishable from overactive bladder. Introducing hypersensitive bladder as a counter concept of overactive bladder into bladder dysfunction taxonomy will facilitate clinical practice and research progress, and attract considerable attention from the medical world.
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Affiliation(s)
- Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyoku, Tokyo, Japan
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Margreiter M, Heinisch BB, Schwarzer R, Klatte T, Shariat SF, Ferlitsch A. Lower urinary tract symptoms in patients with liver cirrhosis. World J Urol 2014; 33:315-21. [PMID: 24798455 DOI: 10.1007/s00345-014-1313-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 04/26/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the prevalence of lower urinary tract symptoms (LUTS) in men with liver cirrhosis. METHODS In total, 128 men with known liver cirrhosis were prospectively evaluated using the validated German version of the International Prostate Symptom Score (IPSS) questionnaire. In parallel, all men underwent a detailed examination including medical history; physical examination; Child-Pugh liver function score (CPS) assessment; and measurement of blood levels of prostate-specific antigen (PSA), total and free testosterone, sexual hormone-binding globulin (SHBG), prolactin, luteotropic hormone (LH), and follicle-stimulating hormone (FSH). RESULTS Mean patient age and mean IPSS was 56 ± 9 years and 8 ± 6, respectively. Mild (IPSS: 1-7), moderate (IPSS: 8-19), and severe (IPSS: 20-35) LUTS were present in 60.2 % (77/128), 31.3 % (40/128), and 7.0 % (9/128) of the patients, respectively. Storage symptoms increased with the CPS (p = 0.04). Voiding symptoms and overall IPSS did not differ between the CPS groups (p = 0.93 and p = 0.67). No correlation was found between ascites volume and IPSS, storage symptoms, voiding symptoms, or quality of life (QoL) (p = 0.46, p = 0.26, p = 0.81, p = 0.87). From CPS groups A to C, mean PSA levels (p = 0.04), total and free testosterone levels (p < 0.001 and p < 0.001), and SHBG levels decreased (p = 0.03); however, prolactin levels increased (p = 0.03). LH and FSH levels did not differ between the CPS groups (p = 0.15 and p = 0.35). CONCLUSIONS Men with liver cirrhosis commonly have LUTS, with a predominance of storage symptoms. Liver cirrhosis may also affect PSA-based prostate cancer risk assessment. Accurate diagnosis and therapy strategies are warranted to improve the QoL of these patients.
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Affiliation(s)
- Markus Margreiter
- Department of Urology, General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
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Asoglu MR, Selcuk S, Cam C, Cogendez E, Karateke A. Effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state. Eur J Obstet Gynecol Reprod Biol 2014; 176:187-90. [PMID: 24630299 DOI: 10.1016/j.ejogrb.2014.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 01/11/2014] [Accepted: 02/02/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our aim was to investigate the effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state. STUDY DESIGN The patients, who applied to our clinic from March 2011 to August 2011, were identified and stratified into three groups: those with stress incontinence proved urodynamically (USI), those with urge incontinence (UI), and those with mixed incontinence urge incontinence (UI) proved by urodynamic and clinic evaluation. Scores on the Beck anxiety inventory (BAI), pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), urogenital distress inventory (UDI-6), and incontinence impact questionnaire (IIQ-7) were compared between the urinary incontinence subtypes. RESULTS According to urodynamic and clinical examination of 111 women with urinary incontinence, 59 (53%) had USI, 35 (32%) had UI, and 17 (15%) had MI. BAI-scores significantly differed between the USI and UI groups (p=0.030) and between the USI and MI groups (p=0.011) not between the UI and MI groups (p=0.597). UDI-6 scores did not significantly differ between the three groups (p=0.845). IIQ-7 scores significantly differed between the USI and MI groups (p=0.003) and between the UI and MI groups (p=0.006) but not between the USI and UI groups. Patients with USI had significantly lower PISQ-12 scores than those with UI (p=0.015). CONCLUSIONS These differences in the effects of incontinence subtypes should be kept in mind in the evaluation of patients with urinary incontinence. Psychiatric assessment may improve the management of incontinence in women, especially UI and MI.
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Affiliation(s)
- Mehmet Resit Asoglu
- The University of Texas-Houston MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Selcuk Selcuk
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Cetin Cam
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ebru Cogendez
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ates Karateke
- Zeynep Kamil Training and Education Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Ueda T, Yoshida T, Tanoue H, Ito M, Tamaki M, Ito Y, Yoshimura N. Urine alkalization improves the problems of pain and sleep in hypersensitive bladder syndrome. Int J Urol 2013; 21:512-7. [PMID: 24224617 DOI: 10.1111/iju.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 09/23/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the efficacy of urine alkalization therapy using citrates in patients with hypersensitive bladder syndrome. METHODS A total of 76 patients with urinary frequency were assessed for their symptoms using a 2-day voiding diary as well as the urine pH at each voiding during the screening period. Their symptoms were also assessed by pain score, King's health questionnaire, and O'Leary-Sant symptom and problem index scores. Finally, 50 patients were evaluated for changes in symptoms after oral treatment with citrates for 2-4 weeks after the screening period. RESULTS After the treatment, significant increases in the urine pH (from 5.8 ± 0.4 to 6.3 ± 0.4; increment of 0.5 ± 0.4; P < 0.01), and significant decreases in the number of micturitions per day (from 14.5 ± 6.5 to 13.5 ± 5.9; P = 0.02) and the number of episodes of pain/discomfort per day (from 7.8 ± 6.8 to 6.1 ± 7.1; P = 0.02) were observed. In the King's health questionnaire, the sleep/energy domain score was significantly improved (from 60.0 ± 25.0 to 50.3 ± 29.6; P < 0.01). In a subgroup analysis based on urine pH (urine pH <6.2 and ≥6.2), significant improvements in the voiding symptoms, the sleep/energy domain score and the O'Leary-Sant problem index were observed in the group with urine pH of ≥6.2. There were statistically significant differences between the subgroups in the volume per voiding, maximum volume per voiding and the problem index. In addition, the subgroup, in which patients had pain in the screening period, showed statistically significant improvements in the number of micturitions per day, episodes of pain/discomfort per day, the sleep/energy domain score and the problem index. CONCLUSIONS Urine alkalization therapy is likely to be effective in the treatment for hypersensitive bladder syndrome.
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Effect of low-dose triple therapy using gabapentin, amitriptyline, and a nonsteroidal anti-inflammatory drug for overactive bladder symptoms in patients with bladder pain syndrome. Int Neurourol J 2013; 17:78-82. [PMID: 23869272 PMCID: PMC3713246 DOI: 10.5213/inj.2013.17.2.78] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/17/2013] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Patients with bladder pain syndrome/interstitial cystitis (BPS/IC) can have pain as a main symptom and overactive bladder (OAB) symptoms that are directly or indirectly related to a major mechanism that causes pain. The primary purpose of this study is firstly to identify the prevalence rate of OAB symptoms in patients with BPS/IC, secondly to identify changes in OAB symptoms after low-dose triple therapy, and thirdly to build a theoretical foundation to improve quality of life for patients. METHODS Patients who met the inclusion criteria of BPS/IC through basic tests including the O'Leary-Sant symptom index, overactive bladder symptom score (OABSS), and visual analog scale (VAS) were identified. Treatment-based changes in OAB symptoms were identified using the IC Symptom Index and IC Problem Index (ICSI/ICPI), OABSS, and VAS before, and 4 and 12 weeks after low-dose triple therapy. RESULTS The patients consisted of 3 men and 20 women, and their mean age was 61.9 years (41.0-83.2 years). Comparing values before treatment, and 4 and 12 weeks after treatment (baseline vs. 4 weeks to baseline vs. 12 weeks), the rates of improvement were as follows: ICSI, 44.2% to 63.7%; ICPI, 46.9% to 59.4%; OABSS, 34.3% to 58.2%; and VAS, 53.6% to 75.0%, which showed statistically significant differences (P<0.05). However, comparing values at 4 and 12 weeks after treatment (4 weeks vs. 12 weeks), the ICSI and VAS showed a statistically significant decrease (P<0.05). The ICPI and OABSS showed slight improvement, but no statistically significant differences (P>0.05). CONCLUSIONS Low-dose triple therapy in BPS/IC results in a clear decrease in OAB symptoms in the first 4 weeks after treatment, and additional treatment for 8 weeks had a partial effect with varied statistical significances depending on the questionnaires.
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Homma Y. Hypersensitive bladder: towards clear taxonomy surrounding interstitial cystitis. Int J Urol 2013; 20:742-3. [PMID: 23521051 DOI: 10.1111/iju.12143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 02/18/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Hanno P, Andersson KE, Birder L, Elneil S, Kanai A, Pontari M. Chronic pelvic pain syndrome/bladder pain syndrome: Taking stock, looking ahead: ICI-RS 2011. Neurourol Urodyn 2012; 31:375-83. [DOI: 10.1002/nau.22202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 12/23/2011] [Indexed: 12/21/2022]
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Abstract
Nocturia is a common and bothersome symptom that impacts on sleep-quality and quality of life. Nocturia often has a multi-factorial etiology which makes thorough assessment of the complaint indispensable. This review summarizes the definition of nocturia, its epidemiology, clinical presentation, pathophysiology, diagnostics, and treatment options with special reference to older men. Nocturia is defined as a nocturnal voiding frequency of two or more, based on impact on quality of life. It is very prevalent in older men. Apart from the negative effects of sleep-disruption, it may be a risk-factor for hip fractures and increased mortality. Most common causes are: nocturnal polyuria, 24-h polyuria, overactive bladder (sometimes due to BPH) and sleep disturbance. A clear understanding of the etiology in the individual patient is indispensable when addressing the various possible causes and co-morbidities. Most important tool for this is the frequency-volume chart, but also patient history, physical examination and serum analysis. For treatment, lifestyle adjustments are often helpful. Medical therapy with 5-alpha reductase inhibitors, alpha-blockers, a combination of the two, or anti-muscarinics, has a limited effect. Most important medical option is desmopressin (arginine vasopressin analogue); however, treatment with this drug is limited to men under 65 years mainly due to the risk of hyponatraemia.
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Affiliation(s)
- Boris van Doorn
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Nordling J, Fall M, Hanno P. Global concepts of bladder pain syndrome (interstitial cystitis). World J Urol 2011; 30:457-64. [DOI: 10.1007/s00345-011-0785-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 10/12/2011] [Indexed: 11/24/2022] Open
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21
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Bladder Pain Syndrome, Interstitial Cystitis, Painful Bladder Syndrome, and Hypersensitive Bladder Syndrome: New Nomenclature/New Guidelines. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0098-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Abstract
Biomarkers constitute any objectively measurable indicator of a biological process. The classic biomarker used in the diagnosis of overactive bladder (OAB) has been detrusor overactivity, which is assessed urodynamically. In the search for a reliable, noninvasive alternative to urodynamics, interest has focused on genetic, imaging, and urinary factors. Along with other cytokines detectable in urine, prostaglandin E2 and nerve growth factor are indicators of low-grade inflammation. Although they correlate with OAB symptom severity, they have not been shown to have independent prognostic benefit. Imaging biomarkers have been investigated since the earliest days of video urodynamics. Despite extensive research on the ultrasonographic estimation of bladder wall thickness, further standardization of the technique is required before conclusions can be reached regarding diagnostic accuracy. Genetic factors contribute approximately half of the total risk for urgency incontinence. Functional polymorphisms of the cytochrome P450 IID6 gene significantly alter the metabolism of some commonly used anticholinergic drugs, but no genetic loci that influence risk of OAB have been definitively identified. The first genome-wide association studies for OAB are in progress, and should identify new susceptibility genes. Although current putative biomarkers correlate with OAB severity, much future work is required to assess their prognostic value, and establish their role in clinical practice.
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Karateke A, Tug N, Cam C, Selcuk S, Asoglu MR. Concomitant surgical correction of occult stress urinary incontinence by TOT in patients with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2011; 154:105-7. [DOI: 10.1016/j.ejogrb.2010.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/01/2010] [Accepted: 08/02/2010] [Indexed: 12/01/2022]
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24
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Thulin H, Kreicbergs U, Wijkström H, Steineck G, Henningsohn L. Sleep disturbances decrease self-assessed quality of life in individuals who have undergone cystectomy. J Urol 2010; 184:198-202. [PMID: 20478603 DOI: 10.1016/j.juro.2010.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE The best possible urinary diversion after cystectomy, if any, is yet to be defined to our knowledge. Therefore, we investigated nocturnal urinary disturbances and quality of life in individuals who have undergone cystectomy with urinary diversion for bladder cancer. MATERIALS AND METHODS All patients 30 to 80 years old who had undergone cystectomy with urinary diversion at 7 urological centers in Sweden were included in the study. Sleep disturbances, nocturnal urinary leakage and urine evacuation frequency, as well as their effect on self-assessed quality of life variables were measured with a study specific questionnaire. We received the questionnaire from 452 (92%) of 491 identified individuals. Outcome variables were dichotomized and the results are presented as relative risks. RESULTS Those individuals with an orthotopic neobladder had an increased risk of nocturnal urinary leakage and/or urine evacuation frequency compared to those with a noncontinent urostomy or cutaneous continent reservoir. Of the patients with an orthotopic neobladder 37% reported negative effects on nocturnal sleep compared to 22% and 14% of those with a noncontinent or continent urostomy, respectively. Of those patients reporting that the urinary diversion had a negative effect on nocturnal sleep 88% had a decreased quality of life vs 65% of those who stated that the urinary diversion had no or little influence on nocturnal sleep. CONCLUSIONS Nocturnal urinary problems are of great concern for individuals with urinary diversion, especially those with an orthotopic neobladder. Regular disruption of sleep decreases quality of life.
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Affiliation(s)
- Helena Thulin
- Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
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25
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Michel MC. The forefront for novel therapeutic agents based on the pathophysiology of lower urinary tract dysfunction: alpha-blockers in the treatment of male voiding dysfunction - how do they work and why do they differ in tolerability? J Pharmacol Sci 2010; 112:151-7. [PMID: 20134112 DOI: 10.1254/jphs.09r15fm] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
alpha(1)-Adrenoceptor antagonists are the mainstay of medical treatment of male voiding dysfunction which typically is attributed to benign prostatic hyperplasia. While original concepts have assumed that they relieve voiding dysfunction by relaxing prostatic smooth muscle, newer data indicate that their therapeutic effects at least partly occur independent of prostatic relaxation, perhaps involving direct effects on blood vessels, urothelium, afferent nerves, and/or smooth muscle of the urinary bladder. The adverse event profiles differ among alpha(1)-adrenoceptor antagonists, with tamsulosin having a particularly good cardiovascular tolerability. While this was originally attributed to its selectivity for alpha(1A)-adrenoceptors, it appears that alfuzosin which lacks subtype-selectivity, has a very similar tolerability. In contrast, doxazosin and terazosin, which are chemically and pharmacologically more closely related to alfuzosin than to tamsulosin, appear to have more side effects attributable to the cardiovascular system. More recent data indicate that tolerability differences between alpha(1)-adrenoceptor antagonists may at least partly relate to pharmacokinetic rather than to pharmacodynamic differences. Taken together, these data emphasize the idea that concepts about drug efficacy and tolerability despite being highly plausible may not necessarily be true and always require thorough experimental testing.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology & Pharmacotherapy, Academic Medical Center, University of Amsterdam, The Netherlands.
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Cardozo L, Chapple CR, Dmochowski R, Fitzgerald MP, Hanno P, Michel MC, Staskin D, Van Kerrebroeck P, Wyndaele JJ, Yamaguchi O, Yoshida M. Urinary urgency - translating the evidence base into daily clinical practice. Int J Clin Pract 2009; 63:1675-82. [PMID: 19930329 DOI: 10.1111/j.1742-1241.2009.02205.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM To consider the currently available knowledge and understanding of the symptom of urgency. MATERIALS & METHODS Each faculty member reviewed the literature base of a different aspect of urgency and along with their personal clinical experience provided a base of evidence for discussion. RESULTS This overview summarises relevant published literature and the current clinical experience of the authors. DISCUSSION Whilst the mechanisms producing the sensation of urgency are still not fully understood and we are working within a definition that may complicate measurement and treatment, our pressing need is to effectively manage our patients for whom the practical nature of urgency can be all too apparent. CONCLUSION Health care professionals have an important role to play today in helping to alleviate the widespread problem of urgency and its consequences.
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Affiliation(s)
- L Cardozo
- King's College Hospital, London, UK.
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Cardozo LD, Van Kerrebroeck PEVA, Staskin DR. Considerations for the management of urgency symptoms in patients with overactive bladder syndrome. World J Urol 2009; 27:755-63. [DOI: 10.1007/s00345-009-0455-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 07/09/2009] [Indexed: 11/28/2022] Open
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28
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Homma Y, Ueda T, Tomoe H, Lin ATL, Kuo HC, Lee MH, Lee JG, Kim DY, Lee KS. Clinical guidelines for interstitial cystitis and hypersensitive bladder syndrome. Int J Urol 2009; 16:597-615. [DOI: 10.1111/j.1442-2042.2009.02326.x] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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29
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Bladder pain syndrome/interstitial cystitis: a sense of urgency. World J Urol 2009; 27:717-21. [DOI: 10.1007/s00345-009-0439-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 06/12/2009] [Indexed: 11/26/2022] Open
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Barchi JJ, Kaczmarek P. Short and sweet: evolution of a small glycopeptide from a bladder disorder to an anticancer lead. Mol Interv 2009; 9:14-7. [PMID: 19299659 DOI: 10.1124/mi.9.1.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Glycopeptides are a class of molecules that comprise two distinct families of biologically important scaffolds, peptides and oligosaccharides, each playing important roles in cellular communication and signaling. Rarely are small, endogenous secreted glycopeptides found that have significant impact on the progression of a specific disease state, but such is the case for the antiproliferative factor (APF) found in the urine and tissue of patients with the poorly understood bladder diseases collectively referred to as interstitial cystitis (IC). APF is a 9-mer peptide containing a sialylated O-linked trisaccharide glycan attached to the N-terminal threonine. APF dramatically inhibits normal bladder cell proliferation and is thought to cause some of the characteristic pathological changes in the bladder of IC patients. Importantly, APF also potently inhibits the growth of certain tumor cells. The details of the cellular receptors to which APF interacts, and the structural features that are critical for its potency are now beginning to unfold. This interesting molecule is a powerful model for the design of new treatments and diagnostic tests for IC, as well as an unprecedented lead agent for novel anticancer drug design.
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Affiliation(s)
- Joseph J Barchi
- National Cancer Institute at Frederick, 376 Boyles Street, PO Box B, Frederick, MD 21702, USA
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Urinary frequency in community-dwelling women: what is normal? Am J Obstet Gynecol 2009; 200:552.e1-7. [PMID: 19249726 DOI: 10.1016/j.ajog.2008.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 09/25/2008] [Accepted: 11/06/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to assess urinary frequency in community-dwelling women. STUDY DESIGN Voiding habits were assessed in 4061 women 25-84 years of age using survey responses from the Epidemiology of Prolapse and Incontinence Questionnaire. Bother related to daytime and nighttime frequency was assessed with 100-mm visual analog scales and compared using t tests and analysis of variance. RESULTS Median daytime frequency was every 3-4 hours. Urinary frequency every 2 hours or more occurred in 27% and was more bothersome than every 3-4 hours or less (51.7 +/- 30.1 mm vs 23.6 +/- 23.7 mm; P < .001). Nocturia was reported in 72%, whereas 33% had 2 or more voids per night. Bother increased with increasing nighttime frequency (27.3 +/- 26.3 for 1 time vs 57.3 +/- 28.5 for > or = 2 times; P < .001). CONCLUSION Bothersome urinary frequency is common and occurs when frequency is at least every 2 hours by day and more than once per night.
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Hanno P, Dmochowski R. Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurourol Urodyn 2009; 28:274-86. [DOI: 10.1002/nau.20687] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Schneider T, de la Rosette JJMCH, Michel MC. Nocturia: A non-specific but important symptom of urological disease. Int J Urol 2009; 16:249-56. [DOI: 10.1111/j.1442-2042.2008.02246.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
PURPOSE OF REVIEW The concept of overactive bladder has helped us address the problem of urgency and urge incontinence from a symptomatic perspective. In this review, we provide a critical summary of clinically relevant recent publications, focusing in particular on advances in our understanding of assessment methods and therapeutic interventions for overactive bladder in women. RECENT FINDINGS According to current definitions, the prevalence of overactive bladder in western nations is now estimated as 13.0%. Although the prevalence increases with age, the symptoms of overactive bladder may follow a relapsing and remitting course. There has been a proliferation of validated symptom and quality of life measures and increasing sophistication in the analysis of bladder diaries. The role of urodynamics in the evaluation of urgency remains uncertain, with many trials showing limited benefit as a preoperative investigation. Fluid restriction and bladder retraining remain important first-line interventions. Many new anticholinergic medications have been licensed, with limited benefits compared with existing preparations. Intravesical botulinum toxin has become a popular alternative for patients who fail oral therapies. SUMMARY Although there have been few important therapeutic innovations, recent publications have led to greater sophistication in assessment methods and a clearer understanding of the role of existing interventions.
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Abstract
PURPOSE OF REVIEW Bladder pain syndrome/interstitial cystitis is an important and poorly understood disorder. This review highlights current research findings that may be of benefit to the clinician who is responsible for the diagnosis and treatment of patients who suffer from this condition. RECENT FINDINGS The perspective from which we view bladder pain syndrome/interstitial cystitis is evolving, as is apparent in the literature this year. It is best perceived as one of many chronic pain syndromes, some of which may be related. International efforts aimed at consistent definition and nomenclature are ongoing. Some new treatments have been reported that may be of benefit. SUMMARY In the age of the internet, it is incumbent upon the clinician to keep up with current ideas, epidemiology, and treatment findings to be able to discuss these with well informed patients who come to clinics around the world. In this review we hope to bring practicing healthcare providers up to date with the literature on bladder pain syndrome/interstitial cystitis, and the implications for their patients.
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Park JM, Yu JH, Sung LH, Chung JY, Noh CH. Suprapubic Arch Procedure for the Treatment of Urinary Incontinence in Elderly Female Patients. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.7.604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Joon Myoung Park
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ji Hyeong Yu
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Luck Hee Sung
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Yong Chung
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Choong Hee Noh
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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