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Zhang W, Ding Z, Peng Y, Wang H, Sun Y, Ke H, Su D, Wang Q, Xu K. LUTS/BPH increases the risk of depressive symptoms among elderly adults: A 5-year longitudinal evidence from CHARLS. J Affect Disord 2024; 367:210-218. [PMID: 39233239 DOI: 10.1016/j.jad.2024.08.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE The prevalence of Lower Urinary Tract Symptoms suggestive of Benign Prostatic Hyperplasia (LUTS/BPH) is notably high and potentially elevates the likelihood of depressive symptoms. This study was designed to employ both cross-sectional and longitudinal methodologies to explore the correlation between LUTS/BPH and depressive symptoms among middle-aged and elderly men in China. METHODS This investigation utilized data from the China Health and Retirement Longitudinal Study (CHARLS), with the initial dataset from 2015 serving as the baseline and subsequent data from 2018 and 2020 facilitating longitudinal analysis. The study encompassed a baseline cohort of 5156 men aged 45 years and above, and an expansive longitudinal analytical sample of 23,530 participants spanning from 2015 to 2020. The assessment of depressive symptoms was conducted using the 10-item Center for Epidemiological Studies Depressive Symptoms Scale (CESD-10). To investigate the factors associated with LUTS/BPH, the relationship between LUTS/BPH and depressive symptoms, and to evaluate the incidence rate of depressive symptoms onset based on LUTS/BPH status, multivariate logistic analyses and logistic regression models were employed. RESULTS Our results reveal a markedly higher incidence of depressive symptoms among individuals with LUTS/BPH, at 30.16 %, compared to 22.94 % in those without LUTS/BPH. This pattern was consistent in both mild and moderate depressive symptoms categories. However, the prevalence of severe depressive symptoms did not exhibit a significant disparity between the two groups. Longitudinal analysis spanning from 2015 through 2018 and 2020 further corroborated these observations. Individuals with LUTS/BPH showed a substantially higher incidence of depressive symptoms across all severity levels compared to those without LUTS/BPH. Specifically, the presence of LUTS/BPH was linked to a 53 % heightened risk of mild depressive symptoms, a 45 % increase in moderate depressive symptoms, and an alarming 229 % surge in severe depressive symptoms risk between 2015 and 2018. Additionally, from 2015 to 2020, there was a 30 % increased risk for mild depressive symptoms, a 41 % rise for moderate depressive symptoms, and a 106 % escalation in the risk of severe depressive symptoms among those with LUTS/BPH. CONCLUSION In middle-aged and older Chinese adults, LUTS/BPH were correlated with an elevated risk of depressive symptoms.
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Affiliation(s)
- Weiyu Zhang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
| | - Zehua Ding
- Department of Urology, Peking University People's Hospital, Beijing 100044, China; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
| | - Yu Peng
- Naval Aviation University, No.188, Erma Road, Zhifu District, Yantai, Shandong Province 264008, China
| | - Huanrui Wang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
| | - Yiran Sun
- Department of Urology, Peking University People's Hospital, Beijing 100044, China; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
| | - Hanwei Ke
- Department of Urology, Peking University People's Hospital, Beijing 100044, China; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
| | - Dongyu Su
- Department of Urology, Peking University People's Hospital, Beijing 100044, China; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China
| | - Qi Wang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China.
| | - Kexin Xu
- Department of Urology, Peking University People's Hospital, Beijing 100044, China; The Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China.
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Liu J, Zhou W, Yang L, Li Y, Qiu J, Fu X, Ren P, Guo F, Zhou Y, Liu J, Chen P, DiSanto ME, Zhang X. STEAP4 modulates cell proliferation and oxidative stress in benign prostatic hyperplasia. Cell Signal 2024; 113:110933. [PMID: 37866665 DOI: 10.1016/j.cellsig.2023.110933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/08/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
Benign prostatic hyperplasia (BPH) is a quite common chronic disease plagued elderly men and its etiology remains unclear. It was reported that the six-transmembrane epithelial antigen of prostate 4 (STEAP4) could modulate cell proliferation/apoptosis ratio and oxidative stress in cancers. Our current study aimed to explore the expression, biological function, and underlying mechanism of STEAP4 in BPH progress. Human prostate tissues and cell lines were utilized. qRT-PCR and immunofluorescence staining were employed. STEAP4 knockdown (STEAP4-KD) or STEAP4 overexpression (STEAP4-OE) cell models were established. Cell proliferation, cell cycle, apoptosis, and reactive oxygen species (ROS) were determined by cell counting kit-8 (CCK-8) assay and flow cytometry. Apoptosis-related proteins and antioxidant enzymes were identified by Western Blot. In addition, the epithelial-mesenchymal transition (EMT) process and fibrosis biomarker (collagen I and α-SMA) were analyzed. It was indicated that STEAP4 was mainly located in the prostate epithelium and upregulated in BPH tissues. STEAP4 deficiency induced apoptosis and inhibited cell survival, but had no effect on the cell cycle, fibrosis, and EMT process. In addition, ROS changes were observed in the STEAP4-KD model. Consistently, overproduction of STEAP4 suppressed apoptosis and promoted cell proliferation, as well as facilitated ROS production. We further examined AKT / mTOR, p38MAPK / p-p38MAPK, and WNT/ β-Catenin signaling pathway and demonstrated that STEAP4 regulated the proliferation and apoptosis of prostate cells through AKT / mTOR signaling, rather than p38MAPK / p-p38MAPK and WNT/ β-Catenin pathways. Furthermore, activating AKT / mTOR signaling with SC79 significantly reversed apoptosis triggered by STEAP4 deficiency, whereas suppressing AKT / mTOR signaling with MK2206 reduced the increase of cell viability triggered by STEAP4 overproduction. Our original data demonstrated that STEAP4 is crucial in the onset and progression of prostate hyperplasia and may become a new target for the treatment of BPH.
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Affiliation(s)
- Jiang Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Zhou
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, China
| | - Liang Yang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan Li
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jizhang Qiu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xun Fu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Pengfei Ren
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feng Guo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongying Zhou
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianmin Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ping Chen
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Michael E DiSanto
- Department of Surgery and Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Xinhua Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Cunningham SD, Carandang RR, Boyd LM, Lewis JB, Ickovics JR, Rickey LM. Psychosocial Factors Associated with Lower Urinary Tract Symptoms One Year Postpartum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:40. [PMID: 38248505 PMCID: PMC10815698 DOI: 10.3390/ijerph21010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Pregnancy carries substantial risk for developing lower urinary tract symptoms (LUTSs), with potential lifelong impacts on bladder health. Little is known about modifiable psychosocial factors that may influence the risk of postpartum LUTSs. We examined associations between depressive symptoms, perceived stress, and postpartum LUTSs, and the moderating effects of perceived social support, using data from a cohort study of Expect With Me group prenatal care (n = 462). One year postpartum, 40.3% participants reported one or more LUTS. The most frequent LUTS was daytime frequency (22.3%), followed by urinary incontinence (19.5%), urgency (18.0%), nocturia (15.6%), and bladder pain (6.9%). Higher odds of any LUTS were associated with greater depressive symptoms (adjusted odds ratio (AOR) 1.08, 95% confidence interval (CI) 1.04-1.11) and perceived stress (AOR 1.12, 95% CI 1.04-1.19). Higher perceived social support was associated with lower odds of any LUTS (AOR 0.94, 95% CI 0.88-0.99). Perceived social support mitigated the adverse effects of depressive symptoms (interaction AOR 0.99, 95% CI 0.98-0.99) and perceived stress (interaction AOR 0.97, 95% CI 0.95-0.99) on experiencing any LUTS. Greater depressive symptoms and perceived stress may increase the likelihood of experiencing LUTSs after childbirth. Efforts to promote bladder health among postpartum patients should consider psychological factors and social support.
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Affiliation(s)
- Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA;
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA;
| | - Lisa M. Boyd
- Virginia Polytechnic Institute, State University, Blacksburg, VA 24061, USA;
| | - Jessica B. Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Jeannette R. Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Leslie M. Rickey
- Departments of Urology and Obstetrics, Gynecology & Reproductive Services, Yale School of Medicine, New Haven, CT 06510, USA;
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Anderson DJ, Aucoin A, Toups CR, Cormier D, McDonald M, Hasoon J, Viswanath O, Kaye AD, Urits I. Lower Urinary Tract Symptoms in Depression: A Review. Health Psychol Res 2023; 11:81040. [PMID: 37465591 PMCID: PMC10351871 DOI: 10.52965/001c.81040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
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.
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Affiliation(s)
| | - Alise Aucoin
- Department of Anesthesiology Louisiana State University Health
| | - Colton R Toups
- Department of Anesthesiology Louisiana State University Health
| | - Devin Cormier
- Department of Anesthesiology Louisiana State University Health
| | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Alan D Kaye
- Department of Anesthesiology Louisiana State University Health
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Selai C, Elmalem MS, Chartier-Kastler E, Sassoon N, Hewitt S, Rocha MF, Klitsinari L, Panicker JN. Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms. Int Urogynecol J 2023; 34:635-653. [PMID: 35751671 PMCID: PMC9947020 DOI: 10.1007/s00192-022-05277-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA. METHODS A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed. RESULTS Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation. CONCLUSIONS The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment.
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Affiliation(s)
- Caroline Selai
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Michael S Elmalem
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- UCL Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, Queen Square, London, UK
| | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpêtrière, Medical School, Sorbonne University, AP-HP, 47-83, Bd de l'Hôpital, 75651, Paris cedex 13, France
| | - Natalia Sassoon
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sam Hewitt
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Maria Francisca Rocha
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Larisa Klitsinari
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, Queen Square, London, UK
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6
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Perez DM. α 1-Adrenergic Receptors: Insights into Potential Therapeutic Opportunities for COVID-19, Heart Failure, and Alzheimer's Disease. Int J Mol Sci 2023; 24:4188. [PMID: 36835598 PMCID: PMC9963459 DOI: 10.3390/ijms24044188] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
α1-Adrenergic receptors (ARs) are members of the G-Protein Coupled Receptor superfamily and with other related receptors (β and α2), they are involved in regulating the sympathetic nervous system through binding and activation by norepinephrine and epinephrine. Traditionally, α1-AR antagonists were first used as anti-hypertensives, as α1-AR activation increases vasoconstriction, but they are not a first-line use at present. The current usage of α1-AR antagonists increases urinary flow in benign prostatic hyperplasia. α1-AR agonists are used in septic shock, but the increased blood pressure response limits use for other conditions. However, with the advent of genetic-based animal models of the subtypes, drug design of highly selective ligands, scientists have discovered potentially newer uses for both agonists and antagonists of the α1-AR. In this review, we highlight newer treatment potential for α1A-AR agonists (heart failure, ischemia, and Alzheimer's disease) and non-selective α1-AR antagonists (COVID-19/SARS, Parkinson's disease, and posttraumatic stress disorder). While the studies reviewed here are still preclinical in cell lines and rodent disease models or have undergone initial clinical trials, potential therapeutics discussed here should not be used for non-approved conditions.
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Affiliation(s)
- Dianne M Perez
- The Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
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Tarcan T, Selai C, Herve F, Vrijens D, Smith PP, Apostolidis A, Panicker JN, Kirschner-Hermanns R, Arlandis S, Mosiello G, Dmochowski R, Cardozo L, von Gontard A. Should we routinely assess psychological morbidities in idiopathic lower urinary tract dysfunction: ICI-RS 2019? Neurourol Urodyn 2020; 39 Suppl 3:S70-S79. [PMID: 32662559 DOI: 10.1002/nau.24361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
AIMS Psychological morbidities play a major role in idiopathic lower urinary tract dysfunction (iLUTD). The aim of the Think Tank (TT) was to discuss the relevance of psychological morbidities in idiopathic LUTD over the life span, including overactive bladder (OAB) or dysfunctional voiding (DV) and methods of assessment. METHODS The paper is based on a selective review of the literature and in-depth discussions, leading to research recommendations regarding the assessment of psychological morbidities in iLUTD on children and adults held during the TT of the International Consultation on Incontinence Research Society in 2019. RESULTS Psychological comorbidities affect the health behaviors and treatment outcomes in patients with iLUTD. Both clinically relevant comorbid mental disorders, as well as subclinical psychological symptoms have a major impact and negatively influence incontinence treatment. Research is needed to elucidate mechanisms underlying iLUTD and psychological comorbidities. Clinical studies are needed to determine how perception generation and cognition impacts on the relationship of urinary perceptions, symptoms, and objective urodynamic function. Due to high psychological comorbidity rates, screening with validated, generic questionnaires for emotional and behavioral disorders in children with nocturnal enuresis, daytime urinary incontinence, and fecal incontinence is recommended. Brief screening is recommended for all adults with iLUTD, especially with OAB and DV, who are refractory to treatment. CONCLUSIONS Due to the high rate and relevance in clinical practice, screening for psychological comorbidities is recommended for all age groups. The research recommendations of this TT may be followed to improve the assessment of psychological morbidities in iLUTD.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.,Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - François Herve
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Phillip P Smith
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Ruth Kirschner-Hermanns
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
| | - Salvador Arlandis
- Department of Urology, La Fe University and Polytechnic Hospital, Valencia University, Spain
| | - Giovanni Mosiello
- Department of Surgery, Neuro-Urology Unit, Bambino Gesu Pediatric Hospital, Rome, Italy
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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Nottingham CU, Agarwal DK, Valadon C, Large T, Rivera ME, Krambeck AE. Correlating Patient Anxiety with Urinary Symptoms Before and After Holmium Laser Enucleation of the Prostate. J Endourol 2020; 34:782-787. [PMID: 32394722 DOI: 10.1089/end.2020.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objective: Preoperative anxiety has been shown to correlate with certain urinary symptoms in patients with certain types of voiding dysfunction, particularly overactive bladder. The purpose of this study was to evaluate if patient-reported anxiety correlates with pathologic characteristics, voiding symptoms, and objective metrics of bladder emptying in male patients undergoing holmium laser enucleation of the prostate (HoLEP). Patients and Methods: We began collecting patient-reported anxiety scores (generalized anxiety disorder 7-item or GAD-7) in addition to patient-reported scores of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) starting in November 2018 for men with LUTS due to benign prostate hyperplasia (BPH). We retrospectively evaluated the relationship between preoperative GAD-7 score with preoperative age, body mass index (BMI), preoperative urine flow metrics, preoperative postvoid residual (PVR), and preoperative symptom scores for LUTS (American Urological Association, BPH impact index [BII], and Michigan incontinence symptom index [MISI]) and ED (sexual health inventory for men and male sexual health questionnaire for ejaculatory dysfunction [MSHQ-EjD]). We then compared preoperative GAD-7 score with enucleated prostate weight, postoperative GAD-7 scores, postoperative urine flow metrics, postoperative PVR, and postoperative symptom scores for LUTS and ED. Results: We included 139 patients for analysis. The preoperative GAD-7 score positively correlated with preoperative BII scores (rs = 0.202, p = 0.019), MISI total (rs = 0.260, p = 0.002), and MISI bother (rs = 0.345, p < 0.001) scores. Preoperative GAD-7 negatively correlated with preoperative MSHQ-EjD (rs = -0.191, p = 0.031). Following HoLEP, all four of these correlations disappear. The GAD-7 score did not correlate with age, BMI, preoperative urine flow metrics, preoperative PVR, or other preoperative LUTS and ED symptom scores. In addition, preoperative GAD-7 score showed no correlation with enucleated prostate weight, postoperative urine flow metrics, postoperative PVR, and postoperative LUTS and ED symptom scores. Conclusions: Higher preoperative anxiety correlated with more severe preoperative urinary LUTS, particularly incontinence symptoms, in patients undergoing HoLEP. Following HoLEP, these symptoms improve regardless of patient anxiety level.
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Affiliation(s)
- Charles U Nottingham
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Deepak K Agarwal
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Crystal Valadon
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcelino E Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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9
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Subrata SA. Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2020. [DOI: 10.1111/ijun.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sumarno A. Subrata
- Doctoral Candidate in Doctor of Philosophy Program in NursingInternational and Collaborative Program with Foreign University Program, Mahidol University Nakhon Pathom Thailand
- Department of Nursing and Wound Research Center, Faculty of Health SciencesUniversitas Muhammadiyah Magelang Magelang Indonesia
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10
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Convergence of psychiatric symptoms and restless legs syndrome: A cross-sectional study in an elderly French population. J Psychosom Res 2020; 128:109884. [PMID: 31794908 DOI: 10.1016/j.jpsychores.2019.109884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/14/2019] [Accepted: 11/24/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective was to evaluate the association between restless legs syndrome (RLS) with generalized anxiety disorder (GAD), major depression disorder (MDD), dysthymia, and GAD-depression comorbidity. Secondary aims were to examine the association between RLS with the cognitive-affective and somatic-vegetative disturbances experienced as part of depression and GAD. METHODS This was a cross-sectional study of 1493 elderly participants (median age 80.6 years, 64% women) from Dijon, France. Probable RLS was assessed using the minimal diagnostic criteria of the International Restless Legs Study Group and RLS symptom frequency and treatment. Participants underwent structured interviews for MDD, dysthymia, and GAD. Participants also completed the Center for Epidemiological Studies-Depression scale (CES-D). The association between RLS and psychiatric disorders, their criterion symptoms, or symptom factors was examined using logistic regression. RESULTS The point prevalence of probable RLS in this sample was 8.2%. Probable RLS was associated with isolated GAD (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.01-4.68) and comorbid GAD-any depression disorder (OR 3.26, 95% CI 1.14-9.29), but not MDD or dysthymia. Probable RLS was also associated with the GAD criterion worry most days and feeling tense, and the CES-D factors representing depressed affect, somatic symptoms, and positive affect. CONCLUSIONS Probable RLS was associated with GAD-depression comorbidity as well as isolated GAD. The findings challenge previous reports linking RLS solely with MDD, suggesting the association is partly driven by GAD-depression comorbidity.
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11
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Tong Y, Xie K, Li S. Self-Care and Quality of Life in Elderly Chinese Patients with Benign Prostatic Hyperplasia. Nurs Sci Q 2019; 33:79-84. [PMID: 31795887 DOI: 10.1177/0894318419883417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors in this study explored the relationship between self-care agency and quality of life in patients with benign prostatic hyperplasia. A convenience sample of 157 patients was interviewed. The levels of both self-care agency and quality of life were close to the mean. Pearson correlation analysis demonstrated that quality of life was positively correlated with self-care agency and the self-care subgroups of abilities, responsibility, esteem, and evaluation. Improved self-care agency and the four subscale items could enhance quality of life. Intervention programs for benign prostatic hyperplasia patients must emphasize self-care agency so as to improve their health behavior and quality of life.
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Affiliation(s)
- Yongcheng Tong
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Keji Xie
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shuxia Li
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
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12
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Cocci A, Campi R, Di Maida F. Comment on "Lower urinary tract symptoms and depressive symptoms among patients presenting for distressing early ejaculation". Int J Impot Res 2019; 32:253-254. [PMID: 31748713 DOI: 10.1038/s41443-019-0217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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13
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Rhee SJ, Kim EY, Kim SW, Kim SH, Lee HJ, Yoon DH, Ahn YM. Longitudinal study of the relationship between lower urinary tract symptoms and depressive symptoms. J Psychosom Res 2019; 116:100-105. [PMID: 30654985 DOI: 10.1016/j.jpsychores.2018.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/12/2018] [Accepted: 11/20/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyze the longitudinal association between lower urinary tract symptoms (LUTS) and the development of incident depressive symptoms in Korean men. METHODS This study initially recruited 16,155 Korean men who underwent routine health examinations between 2005 and 2012, and completed the International Prostate Symptom Score (IPSS) screening tool and Beck Depression Inventory-1 (BDI). The final study population included 9080 men, aged 15-89, who had a baseline BDI score < 10 and follow-up BDI data, with no history of depression, bladder or prostate operations. Cox proportional hazard models were used to assess the relationship between LUTS and the development of incident depressive symptoms. Multiple imputation was used to handle missing values. RESULTS After adjusting for significant covariates, LUTS were associated longitudinally with the development of incident depressive symptoms (hazard ratio [HR] = 1.81 [95% confidence interval [CI] = 1.26-2.61]). An analysis of the specific domains of LUTS revealed that voiding LUTS (HR = 1.58 [95% CI = 1.07-2.33]), but not storage LUTS (HR = 1.43 [95% CI = 0.96-2.13]), were associated longitudinally with depressive symptoms. CONCLUSION LUTS and voiding LUTS, but not storage LUTS, were associated longitudinally with incident depressive symptoms.
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Affiliation(s)
- Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Eun Young Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Mental Health Center, Seoul National University Health Care Center, Seoul, Republic of Korea.
| | - Soo Woong Kim
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Se Hyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Hyun Jeong Lee
- Cancer Survivorship Branch, National Cancer Control Institute, Goyang, Republic of Korea..
| | - Dae Hyun Yoon
- Department of Psychiatry, Gangnam Health Promotion Center, Seoul National University Hospital, 737 Yeoksam-Dong, Gangnam-Gu, Seoul 135-984, Republic of Korea.
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
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14
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Detering M, Steels E, Koyyalamudi SR, Allifranchini E, Bocchietto E, Vitetta L. Ageratum conyzoides L. inhibits 5-alpha-reductase gene expression in human prostate cells and reduces symptoms of benign prostatic hypertrophy in otherwise healthy men in a double blind randomized placebo controlled clinical study. Biofactors 2017; 43:789-800. [PMID: 29048765 DOI: 10.1002/biof.1389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/03/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023]
Abstract
A double-blind, randomized, placebo-controlled clinical trial assessed the efficacy and safety of Ageratum conyzoides in treating benign prostatic hypertrophy (BPH). In this study, 109 men with medically diagnosed BPH, aged 41-76 years, were administered the investigational product, A. conyzoides extract at a dose of 250 mg/d or placebo, q.d. for 12 weeks. The primary outcome measures were the International Prostate Symptom Score (IPSS), daily urinary frequency and safety evaluations. The secondary outcome measures were testosterone, dihydrotestosterone, oestradiol, sex hormone binding globulin (SHBG), Dehydroepiandrosterone sulfate (DHEA-S) and cortisol levels, and prostate specific antigen (PSA), lipids, blood glucose, the Aging Male's Symptom (AMS) Score and sexual function assessed by Derogatis Interview for Sexual Functioning-Self Report (DISF-SR). The effect of A. conyzoides L extract on gene expression of 5-alpha-reductase in human prostate cells was also investigated to elucidate a potential mechanism of action. The clinical study, showed a significant reduction in total IPSS score (p < 0.01) and day- and night-time urinary frequency (P < 0.01) over time after treatment with A. conyzoides. Steroid hormones, SHBG, PSA levels, lipids, and blood glucose remained within healthy reference range in both groups. There were no changes in AMS or DISF-SR in either group. Gene arrays demonstrated that A. conyzoides extract was effective in reducing the expression of mRNA coding for 5-alpha-reductase types 2 and 1 in human prostate epithelial cells. The overall results indicate that A. conyzoides may be an effective treatment for reducing symptoms of BPH in healthy men, in part, through inhibition of 5-alpha-reductase enzyme activity. © 2017 BioFactors, 43(6):789-800, 2017.
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Affiliation(s)
- Matthew Detering
- School of Chemistry, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elizabeth Steels
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sundar Rao Koyyalamudi
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, The University of Sydney, Sydney, NSW, Australia
| | - Elena Allifranchini
- ABICH S.r.l, Biological and chemical analysis, via 42 Martiri 213/B 28924 Verbania, Italy
| | - Elena Bocchietto
- ABICH S.r.l, Biological and chemical analysis, via 42 Martiri 213/B 28924 Verbania, Italy
| | - Luis Vitetta
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Medlab Clinical, Sydney, NSW, Australia
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Liao SC, Huang WL, Ma HM, Lee MT, Chen TT, Chen IM, Gau SSF. The relation between the patient health questionnaire-15 and DSM somatic diagnoses. BMC Psychiatry 2016; 16:351. [PMID: 27756342 PMCID: PMC5070166 DOI: 10.1186/s12888-016-1068-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 10/11/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Our purpose was to examine the reliability and validity of the Chinese version of the Patient Health Questionnaire-15 (PHQ-15) in Taiwan, and to explore its relation to somatoform disorders (DSM-IV) and to somatic symptom and related disorders (DSM-5). METHODS We recruited 471 individuals, 151 with somatoform disorders and 200 with somatic symptom and related disorders. Subjects completed the Chinese version of the PHQ-15, Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and received a DSM-IV- and DSM-5-based diagnostic interview. We performed exploratory factor analysis and assessed test-retest reliability, internal consistency, and correlation with BDI-II/BAI to confirm reliability and validity, and carried out ROC curve analysis to determine suitability for evaluation or screening purposes. PHQ-15 scores were compared between patients with various DSM-IV psychiatric diagnoses (such as DSM-IV somatoform disorders, panic disorder, other anxiety/depressive disorders) or no DSM-IV diagnosis and patients with DSM-5 somatic symptom and related disorders or no DSM-5 diagnosis. RESULTS The Chinese version identified cardiopulmonary, pain-fatigue, and gastrointestinal as major factors and had good reliability (0.803-0.930), internal consistency (0.637-0.861), and correlation coefficients with BDI-II/BAI (0.407-0.619, 0.536-0.721, respectively). The PHQ-15 scores were similar in patients with somatoform disorders and patients with panic disorder; higher in patients with somatoform disorders and panic disorder than in patients with other anxiety/depressive disorders; and significantly higher in patients with somatic symptom and related disorders than in patients without this diagnosis. The AUC of the PHQ-15 was 0.678 (cutoff 6/7) for screening somatoform disorders (DSM-IV) and 0.725 (cutoff 4/5) for screening somatic symptom and related disorders (DSM-5). CONCLUSIONS The Chinese version of the PHQ-15 is suitable for evaluating somatic symptom and related disorders. The preponderance of somatic symptom disorder in our sample, lack of evaluation of functional disorders, and recruitment solely from psychiatric clinics are possible limitations.
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Affiliation(s)
- Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Zhongzheng Dist Taipei City, 100 Taiwan (Republic of China) ,Department of Psychiatry, College of Medicine, National Taiwan University, No.1, Sec. 1, Ren’ai Rd, Zhongzheng Dist Taipei City, 100 Taiwan (Republic of China)
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Zhongzheng Dist, Taipei City, 100, Taiwan (Republic of China). .,Department of Psychiatry, College of Medicine, National Taiwan University, No.1, Sec. 1, Ren'ai Rd, Zhongzheng Dist, Taipei City, 100, Taiwan (Republic of China). .,Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County, 64041, Taiwan (Republic of China). .,Graduate Institute of Clinical Medicine, National Taiwan University, No.7, Zhongshan S. Rd, Zhongzheng Dist, Taipei City, 100, Taiwan (Republic of China).
| | - Huei-Mei Ma
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 64041 Taiwan (Republic of China)
| | - Min-Tzu Lee
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 64041 Taiwan (Republic of China)
| | - Tzu-Ting Chen
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 64041 Taiwan (Republic of China)
| | - I-Ming Chen
- Department of Psychiatry, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Zhongzheng Dist Taipei City, 100 Taiwan (Republic of China) ,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Rm. 651, 6 F., No.17, Xuzhou Rd, Zhongzheng Dist Taipei City, 100 Taiwan (Republic of China)
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Zhongzheng Dist Taipei City, 100 Taiwan (Republic of China) ,Department of Psychiatry, College of Medicine, National Taiwan University, No.1, Sec. 1, Ren’ai Rd, Zhongzheng Dist Taipei City, 100 Taiwan (Republic of China) ,Graduate Institute of Clinical Medicine, National Taiwan University, No.7, Zhongshan S. Rd, Zhongzheng Dist Taipei City, 100 Taiwan (Republic of China)
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Dunphy C, Laor L, Te A, Kaplan S, Chughtai B. Relationship Between Depression and Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Rev Urol 2016; 17:51-7. [PMID: 27222640 DOI: 10.3909/riu0658] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article provides an overview of current data on the relationship between depression and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), with a focus on pathophysiology and patient management implications. Review of the literature indicated a clear relationship between LUTS secondary to BPH and depression. It is unknown whether this relationship is bidirectional or unidirectional. Depression is associated with the impact of LUTS on quality of life in men with BPH. Research suggests that depression alters the experience of LUTS in this population. Medical and surgical treatments for BPH may impact quality of life and, therefore, depression. Results conflict on the exact nature of the relationship examined, and on the extent to which the relationship may be attributed to physiological factors such as inflammation. Practicing clinicians should consider using a brief self-administered scale to assess for depression in patients with BPH. There is a clear need for additional research to decisively determine the nature of the relationship between LUTS secondary to BPH and depression, as well as the extent to which change in either condition may be affected by the other.
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Affiliation(s)
- Claire Dunphy
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Leanna Laor
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Steven Kaplan
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY
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Fusco F, D’Anzeo G, Henneges C, Rossi A, Büttner H, Nickel JC. Predictors of Individual Response to Placebo or Tadalafil 5mg among Men with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: An Integrated Clinical Data Mining Analysis. PLoS One 2015; 10:e0135484. [PMID: 26284523 PMCID: PMC4540425 DOI: 10.1371/journal.pone.0135484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A significant percentage of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) achieve clinically meaningful improvement when receiving placebo or tadalafil 5mg once daily. However, individual patient characteristics associated with treatment response are unknown. METHODS This integrated clinical data mining analysis was designed to identify factors associated with a clinically meaningful response to placebo or tadalafil 5mg once daily in an individual patient with LUTS-BPH. Analyses were performed on pooled data from four randomized, placebo-controlled, double-blind, clinical studies, including about 1,500 patients, from which 107 baseline characteristics were selected and 8 response criteria. The split set evaluation method (1,000 repeats) was used to estimate prediction accuracy, with the database randomly split into training and test subsets. Logistic Regression (LR), Decision Tree (DT), Support Vector Machine (SVM) and Random Forest (RF) models were then generated on the training subset and used to predict response in the test subset. Prediction models were generated for placebo and tadalafil 5mg once daily Receiver Operating Curve (ROC) analysis was used to select optimal prediction models lying on the ROC surface. FINDINGS International Prostate Symptom Score (IPSS) baseline group (mild/moderate vs. severe) for active treatment and placebo achieved the highest combined sensitivity and specificity of 70% and ~50% for all analyses, respectively. This was below the sensitivity and specificity threshold of 80% that would enable reliable allocation of an individual patient to either the responder or non-responder group. CONCLUSIONS This extensive clinical data mining study in LUTS-BPH did not identify baseline clinical or demographic characteristics that were sufficiently predictive of an individual patient response to placebo or once daily tadalafil 5mg. However, the study reaffirms the efficacy of tadalalfil 5mg once daily in the treatment of LUTS-BPH in the majority of patients and the importance of evaluating individual patient need in selecting the most appropriate treatment.
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Affiliation(s)
- Ferdinando Fusco
- Urologic Clinic, University Federico II of Naples, Naples, Italy
| | | | | | - Andrea Rossi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, FI, Italy
| | | | - J. Curtis Nickel
- Department of Urology, Queen’s University, Kingston, Ontario, Canada
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