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Voiding and storage symptoms in depression/anxiety. Auton Neurosci 2021; 237:102927. [PMID: 34923228 DOI: 10.1016/j.autneu.2021.102927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/27/2021] [Accepted: 12/05/2021] [Indexed: 12/11/2022]
Abstract
We here described the frequency and nature of voiding and storage bladder symptoms in depression/anxiety, for which we propose the name "bladder somatic symptom disorder (SSD)" because such symptoms most probably have brain mechanisms. SSD was formerly called as various terms including "somatoform disorder", "medically unexplained physical symptoms", "functional somatic syndrome" and "hysterical neurosis/hysteria". Bladder SSD has the following specific features that are distinguishable from "true" neurologic/organic bladder dysfunction: 1) situation-dependence (close association with life event in some), 2) urodynamically increased bladder sensation/hypersensitivity and 3) absence of neurologic/organic diseases, in addition to 4) other stress symptoms (insomnia, etc.), are key clues to the possibility of bladder SSD. Urodynamics in these patients showed, to a lesser extent, underactive bladder without post-void residual. These findings might reflect the biological changes of the depressive brain; e.g., decreases in serotonin and GABA, and possible increases in CRH. Treatment of bladder SSD can follow that of general depression/anxiety, with the potential addition of anticholinergic or selective beta3 bladder drugs.
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Tateno F, Sakakibara R, Aiba Y. Lower Urinary Tract Symptoms in Myasthenia Gravis. Case Rep Neurol 2021; 13:490-498. [PMID: 34413752 PMCID: PMC8339478 DOI: 10.1159/000514825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 01/29/2023] Open
Abstract
It remains uncertain to what extent lower urinary tract (LUT) symptom (LUTS) is a comorbidity of myasthenia gravis (MG). We prospectively administered a LUTS questionnaire devised for detecting neurogenic pelvic organ dysfunction (not validated) in an MG group and a healthy control group and compared the results. The MG group comprised 21 patients: 15 women and 6 men, with age range 22–73 (mean 47) years, illness duration range 0.2–8 (mean 3.5) years, median Myasthenia Gravis Foundation of America (MGFA) grade 2, all walking independently. Therapies included thymectomy in 17, predonisolone 5–20 mg/day in 10, and pyridostigmine bromide 60–180 mg/day in 9 patients. The control group, who were undergoing an annual health survey, comprised 235 consecutive subjects: 120 women and 115 men, with age range 30–69 (mean 48) years. The questionnaire had 9 questions. Each question was scored from 0 (none) to 3 (severe) with an additional quality of life (QOL) index scored from 0 (satisfied) to 3 (extremely dissatisfied). Statistical analysis was made using Student's t test. Compared with the control subjects, the frequency of LUTSs in the MG patients was significantly higher for daytime frequency (43%; p < 0.01), nocturia (24%; p < 0.01), and urinary incontinence (43%; p < 0.05). The LUTS-related QOL index for the MG patients was significantly higher for MG patients as a whole than that for all control patients (29%) (p < 0.05). In conclusion, our study results showed that MG patients had significantly more LUTSs (overactive bladder) than healthy control subjects and had worse LUTS-related QOL; therefore, amelioration of LUTS in MG is important.
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Affiliation(s)
- Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.,Neurology, Chiba University, Chiba, Japan
| | - Yosuke Aiba
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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Triple-disease etiology is common for LUTS in octogenarians: a neuro-urological approach. Int Urol Nephrol 2021; 53:1507-1513. [PMID: 33860900 DOI: 10.1007/s11255-021-02850-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Older individuals often have multiple etiologies for their lower urinary tract symptoms (LUTS); i.e., both urologic (U) and neurologic (N) etiologies. Few studies have investigated 'triple disease' (typically one U and two N components) in the LUTS of older adults. Herein, we had specialists from both urology and neurology address triple- and quadruple-etiology disease. PATIENTS AND METHODS This was a retrospective study with a 12-month recruiting period. We ascertained LUTS by standard questionnaires and bladder diaries. Urodynamics, sphincter EMG, prostate echography, and a neurologic examination were conducted for each patient as well as neuroimaging and neurophysiology examinations when appropriate. The diagnoses of the etiologies were based on published criteria. RESULTS We analyzed the cases of 141 older (age > 65 years) adults with LUTS referred from both urology (27%) and neurology departments (73%). The final etiologies were U (n = 69, 49%), N (n = 136, 96%), and a combination (U and N) (n = 77, 55%, overlap counted). The majority of U diagnoses were benign prostatic hyperplasia. The majority of N diagnoses were dementia with Lewy bodies, white matter disease (brain); lumbar spondylosis, and diabetes (peripheral disease). We noted triple-disease etiology in 25% (n = 35), increasing with each decade of age (18.2% of sexagenarians, 23.5% of septuagenarians, 39.1% of octogenarians). However, the differences were not significant. CONCLUSION Our results demonstrate that triple disease for LUTS is the most common in octogenarians, and clinicians thus need to untangle LUTS etiologies to provide appropriate care and management of older adults.
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The Evidence For and Against Prostate-Reducing Procedures for Men with Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00615-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sakakibara R, Lee FC, Suzuki H, Tateno F, Kishi M, Aiba Y. Parkinson's disease and prostate enlargement: Both contribute to overactive bladder in the elderly. Int J Urol 2018; 25:982-983. [PMID: 30155980 DOI: 10.1111/iju.13792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ryuji Sakakibara
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Chiba, Japan
| | - Fang-Ching Lee
- Department of Urology, Sakura Medical Center, Toho University, Sakura, Chiba, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Sakura Medical Center, Toho University, Sakura, Chiba, Japan
| | - Fuyuki Tateno
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Chiba, Japan
| | - Masahiko Kishi
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Chiba, Japan
| | - Yosuke Aiba
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Chiba, Japan
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SAKAKIBARA R, ITO T, YAMAMOTO T, UCHIYAMA T, YAMANISHI T, KISHI M, TSUYUSAKI Y, TATENO F, KATSURAGAWA S, KUROKI N. Depression, Anxiety and the Bladder. Low Urin Tract Symptoms 2013; 5:109-20. [DOI: 10.1111/luts.12018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Ryuji SAKAKIBARA
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Takashi ITO
- Division of Neurology; Chiba University; Chiba Japan
| | | | | | | | - Masahiko KISHI
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Yohei TSUYUSAKI
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | - Fuyuki TATENO
- Division of Neurology, Department of Internal Medicine, Sakura Medical Center; Toho University; Sakura Japan
| | | | - Nobuo KUROKI
- Mental Health Clinic, Sakura Medical Center; Toho University; Sakura Japan
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Sakakibara R, Panicker J, Fowler CJ, Tateno F, Kishi M, Tsuyuzaki Y, Ogawa E, Uchiyama T, Yamamoto T. Vascular incontinence: incontinence in the elderly due to ischemic white matter changes. Neurol Int 2012; 4:e13. [PMID: 23139851 PMCID: PMC3490472 DOI: 10.4081/ni.2012.e13] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/17/2011] [Accepted: 01/16/2012] [Indexed: 01/21/2023] Open
Abstract
This review article introduces the new concept of vascular incontinence, a disorder of bladder control resulting from cerebral white matter disease (WMD). The concept is based on the original observation in 1999 of a correlation between the severity of leukoareosis or WMD, urinary symptoms, gait disorder and cognitive impairment. Over the last 20 years, the realization that WMD is not a benign incidental finding in the elderly has become generally accepted and several studies have pointed to an association between geriatric syndromes and this type of pathology. The main brunt of WMD is in the frontal regions, a region recognized to be crucial for bladder control. Other disorders should be excluded, both neurological and urological, such as normal-pressure hydrocephalus, progressive supranuclear palsy, etc., and prostatic hyperplasia, physical stress incontinence, nocturnal polyuria, etc. Treatment involves management of small vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood brain barrier to improve bladder control.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Jalesh Panicker
- Uro-Neurology, the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Clare J Fowler
- Uro-Neurology, the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Fuyuki Tateno
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Masahiko Kishi
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Yohei Tsuyuzaki
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Emina Ogawa
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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ITO T, SAKAKIBARA R, SHIMIZU E, KISHI M, TSUYUZAKI Y, TATENO F, UCHIYAMA T, YAMAMOTO T. Is Major Depression a Risk for Bladder, Bowel, and Sexual Dysfunction? Low Urin Tract Symptoms 2012; 4:87-95. [DOI: 10.1111/j.1757-5672.2011.00140.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Pinggera GM, Mitterberger M, Steiner E, Pallwein L, Frauscher F, Aigner F, Bartsch G, Strasser H. Association of lower urinary tract symptoms and chronic ischaemia of the lower urinary tract in elderly women and men: assessment using colour Doppler ultrasonography. BJU Int 2008; 102:470-4. [PMID: 18476974 DOI: 10.1111/j.1464-410x.2008.07587.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate, using transrectal colour Doppler ultrasonography, (TRCDUS) whether perfusion of the bladder and prostate is reduced in elderly patients with lower urinary tract symptoms (LUTS), common in later life, as experimental data suggest that chronic ischaemia has a key role in the development of LUTS. PATIENTS, SUBJECTS AND METHODS In 32 elderly patients with LUTS (12 women, mean age 82.3 years, group 1; and 20 men, 79.4 years, group 2) perfusion of the bladder neck (in women) and of the bladder neck and prostate (in men) was measured using TRCDUS and the resistive index (RI) and colour pixel density (CPD) determined, assessed by a TRUS unit and special software. To assess the age-related effect two control groups of 10 young healthy women (mean age 42.3 years, group 3) and 10 age-matched healthy men (mean age 41.5 years, group 4) were also enrolled. RESULTS Irrespective of gender, there was markedly lower bladder perfusion in elderly patients with LUTS than in the younger subjects. The mean (SD) RI of the bladder neck in group 1, of 0.88 (0.06), and group 2, of 0.80 (0.08), was higher than in control groups 3, of 0.62 (0.05), and group 4, of 0.64 (0.09). The results were similar for the CPD measurements. The frequency of daily and nightly micturition showed a strong negative correlation with perfusion in the urinary bladder. CONCLUSION In elderly patients with LUTS there was decreased perfusion of the bladder neck and prostate when assessed using TRCDUS. Therefore, decreased perfusion in the urinary bladder might be responsible for the development of LUTS with advancing age.
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Yamaguchi C, Sakakibara R, Uchiyama T, Yamamoto T, Ito T, Liu Z, Awa Y, Yamamoto K, Nomura F, Yamanishi T, Hattori T. Overactive bladder in diabetes: a peripheral or central mechanism? Neurourol Urodyn 2008; 26:807-13. [PMID: 17357115 DOI: 10.1002/nau.20404] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS To study diabetic cystopathy with reference to overactive bladder (OAB). METHODS We retrospectively analyzed diabetic cystopathy in our digitized database that comprised 2300 case records, including data from a lower urinary tract symptoms questionnaire, data from a urodynamic study, and data from neurological examinations. RESULTS Diabetic cystopathy was seen in 4% of cases (84 cases): 58 males, 26 females; mean age, 60.8 years; duration of diabetes, 143.5 months; HbA1C, 7.7 %. In addition to large post-void residual and decreased sensation, OAB, detrusor overactivity (DO), and increased bladder sensation were seen in 55%, 42%, and 14%, respectively. The frequency of DO in patients with increased bladder sensation was 58%. DO increased with age, but not with the duration of diabetes. A brain MRI was performed in 32 cases. The frequency of multiple cerebral infarction (MCI) in patients with DO was 76.5%. The remaining 23.5% of patients with DO had no MCI, and the remaining 42% with increased bladder sensation had no DO. CONCLUSIONS OAB commonly occurs in diabetic cystopathy. Both central and peripheral mechanisms are involved, e.g., MCI due to diabetic cerebral vasculopathy for the DO, and, to a lesser extent, peripheral nerve irritation for the DO and increased bladder sensation.
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Affiliation(s)
- Chiharu Yamaguchi
- Central Laboratory Unit, Department of Molecular Diagnosis, Chiba University, Chiba, Japan
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Wagg AS, Cardozo L, Chapple C, De Ridder D, Kelleher C, Kirby M, Milsom I, Vierhout M. Overactive bladder syndrome in older people. BJU Int 2007; 99:502-9. [PMID: 17407511 DOI: 10.1111/j.1464-410x.2006.06677.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The overactive bladder symptom complex (OAB) is the commonest cause of urinary incontinence in older people, and is usually due to underlying detrusor overactivity, and as such is a treatable condition. Older people are a heterogeneous group, which includes fit community-dwelling individuals and those with significant medical comorbidity; thus the requirements of care for this group are many and varied. The International Continence Society definition of the frail elderly, those aged >65 years with continence problems, who by virtue of comorbidity are house-bound or living in an institution, is clearly not applicable to all. However, many conditions begin to appear in later life and practitioners need to be aware of the need to manage these, and their treatment, when dealing with older people. Studies of medication for OAB have included the elderly and there is evidence of an equivalent benefit in younger people. The impact of treatment on the cognitively impaired and those receiving acetylcholinesterase inhibitors is discussed.
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Affiliation(s)
- Adrian S Wagg
- Department of Geriatric Medicine, University College London Hospitals, London, UK.
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