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Finazzi Agrò E, Rosato E, Wagg A, Sinha S, Fede Spicchiale C, Serati M, Mancini V, de Rijk M, Tarcan T, Wein A, Abrams P, Bou Kheir G. How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1. Neurourol Urodyn 2024; 43:1261-1271. [PMID: 38178627 DOI: 10.1002/nau.25377] [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: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. OBJECTIVES The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. METHODS A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment. RESULTS AND CONCLUSIONS The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Rosato
- School of specialization in Urology, Policlinico Tor Vergata University Hospital, University of Rome Tor Vergata and Urology Unit, Rome, Italy
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | - Maurizio Serati
- Department Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Varese, Italy
| | - Vito Mancini
- Urology and renal transplantation Unit, Urinary incontinence center, Policlinico di Foggia Hospital and University of Foggia, Foggia, Italy
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Tufan Tarcan
- Marmara University School of Medicine, Istanbul, Turkey and Koç University School of Medicine, Istanbul, Turkey
| | - Alan Wein
- University of Miami Miller School of Medicine, Desai Sethi Institute of Urology, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Sahai A, Robinson D, Abrams P, Wein A, Malde S. What is the best first choice oral drug therapy for OAB? Neurourol Urodyn 2024; 43:1328-1336. [PMID: 38270332 DOI: 10.1002/nau.25397] [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: 12/17/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
AIMS The management of overactive bladder (OAB) involves lifestyle changes and conservative measures in the first instance with the use of liquid/dietary advice, weight loss, and bladder training. Thereafter oral pharmacotherapy is instigated in symptomatic patients. Antimuscarinics and beta 3 agonists form the main classes of drug therapy in this field. Views on what is the best first line OAB treatment is changing based on recent evidence and adverse event profiles of these medications. METHODS At the ICI-RS meeting 2023, Bristol, UK this topic was discussed and debated as a proposal. The following article summarizes the concepts presented that day as well as the interactive discussion that took place thereafter. RESULTS OAB guidelines are moving in many circumstances to an either antimuscarinic or beta 3 agonist approach based on patient factors. Several studies have raised concerns on the long-term impact of antimuscarinics, in relation to cognition, dementia, cardiovascular events, and mortality all related to antimuscarinic load. Neither antimuscarinics nor beta 3 agonists have good persistence and adherence rates in the medium to long term. Several barriers also exist to prescribing including guidelines recommending utilizing drugs with the lowest acquisition cost and "step therapy." A newer approach to managing OAB is personalized therapy in view of the many possible etiological factors and phenotypes. These concepts are highlighted in this article. CONCLUSIONS Current oral pharmacotherapy in managing OAB is limited by adverse events, adherence and persistence problems. Both antimuscarinics and beta 3 agonists are efficacious but most clinical trials demonstrate significant placebo effects in this field. Personalizing treatment to the individual seems a logical approach to OAB. There is a need for better treatments and further studies are required of existing treatments with high quality longer term outcomes.
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Affiliation(s)
- Arun Sahai
- Department of Urology, Guy's Hospital & King's College, London, UK
| | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital & King's College, London, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
- University of Bristol, Bristol, UK
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami Miller School of medicine, Miami, Florida, USA
- University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sachin Malde
- Department of Urology, Guy's Hospital & King's College, London, UK
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Zhang Y, Song J, Li B, Wu Y, Jia S, Shu H, Liu F, Yang X. Association between body roundness index and overactive bladder: results from the NHANES 2005-2018. Lipids Health Dis 2024; 23:184. [PMID: 38867211 PMCID: PMC11167800 DOI: 10.1186/s12944-024-02174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND AND AIM An increasing amount of research has indicated obesity greatly affects individuals with overactive bladder (OAB). However, traditional anthropometric methods present challenges in accurately assessing the likelihood of OAB. Hence, this study's objective was to identify the correlation between the body roundness index (BRI) and OAB. METHODS The research included 12,401 individuals who participated in the National Health and Nutrition Examination Survey spanning 2005-2018. The correlation between BRI and OAB was explored by using weighted multiple logistic regression and weighted restricted cubic spline (RCS). Subgroup analyses showed the associations based on different population types. The study also analyzed the predictive capability of various anthropometric indices, including BRI, body mass index, waist circumference, and weight, in assessing the likelihood of OAB through Receiver-operating characteristic (ROC) curves. RESULTS An independent positive correlation between OAB and BRI was identified after adjusting for potential confounders in weighted multivariate logistic models[odds ratio (OR) = 1.15, 95% confidence interval (CI), 1.12-1.17]. Weighted RCS analysis found a positive dose-response correlation between OAB and BRI. The effect size of BRI on OAB remained stable across all prespecified subgroups (all P for interactions > 0.05). In ROC analysis, BRI showed better discriminatory ability for OAB compared with other anthropometric measures for both genders (all P < 0.01). The best BRI cutoff for predicting OAB was lower for men (5.151) than for women (5.383), suggesting that men were more susceptible to changes in BRI than women. CONCLUSIONS This study demonstrated that a raised BRI is correlated with a higher likelihood of OAB. Due to the effectiveness and non-invasiveness of BRI in predicting OAB, it is expected to become the preferred method for early detection and management strategies.
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Affiliation(s)
- Yujun Zhang
- Department of Urology Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Nanchang, Jiangxi, 330006, China
- Huankui Academy, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Jingjing Song
- Department of Urology Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Nanchang, Jiangxi, 330006, China
- School of Ophthalmology, Optometry of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Benjie Li
- Department of Urology Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Nanchang, Jiangxi, 330006, China
- Queen Mary School, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Yunhao Wu
- The Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Shengjun Jia
- The Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Hongxin Shu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Fang Liu
- Department of Health Management Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Nanchang, Jiangxi, 330006, China.
| | - Xiaorong Yang
- Department of Urology Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Nanchang, Jiangxi, 330006, China.
- Department of Urology Surgery, The First Hospital of Nanchang, Nanchang, Jiangxi, 330008, China.
- Department of Urology Surgery, The People's Hospital of Jing An County, Yichun, Jiangxi, 330600, China.
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Hart TM, Sonnert ND, Tang X, Chaurasia R, Allen PE, Hunt JR, Read CB, Johnson EE, Arora G, Dai Y, Cui Y, Chuang YM, Yu Q, Rahman MS, Mendes MT, Rolandelli A, Singh P, Tripathi AK, Ben Mamoun C, Caimano MJ, Radolf JD, Lin YP, Fingerle V, Margos G, Pal U, Johnson RM, Pedra JHF, Azad AF, Salje J, Dimopoulos G, Vinetz JM, Carlyon JA, Palm NW, Fikrig E, Ring AM. An atlas of human vector-borne microbe interactions reveals pathogenicity mechanisms. Cell 2024:S0092-8674(24)00532-4. [PMID: 38876107 DOI: 10.1016/j.cell.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 01/15/2024] [Accepted: 05/13/2024] [Indexed: 06/16/2024]
Abstract
Vector-borne diseases are a leading cause of death worldwide and pose a substantial unmet medical need. Pathogens binding to host extracellular proteins (the "exoproteome") represents a crucial interface in the etiology of vector-borne disease. Here, we used bacterial selection to elucidate host-microbe interactions in high throughput (BASEHIT)-a technique enabling interrogation of microbial interactions with 3,324 human exoproteins-to profile the interactomes of 82 human-pathogen samples, including 30 strains of arthropod-borne pathogens and 8 strains of related non-vector-borne pathogens. The resulting atlas revealed 1,303 putative interactions, including hundreds of pairings with potential roles in pathogenesis, including cell invasion, tissue colonization, immune evasion, and host sensing. Subsequent functional investigations uncovered that Lyme disease spirochetes recognize epidermal growth factor as an environmental cue of transcriptional regulation and that conserved interactions between intracellular pathogens and thioredoxins facilitate cell invasion. In summary, this interactome atlas provides molecular-level insights into microbial pathogenesis and reveals potential host-directed targets for next-generation therapeutics.
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Affiliation(s)
- Thomas M Hart
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Nicole D Sonnert
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA; Department of Microbial Pathogenesis, Yale School of Medicine, New Haven, CT 06510, USA
| | - Xiaotian Tang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Reetika Chaurasia
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Paige E Allen
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Jason R Hunt
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Curtis B Read
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Emily E Johnson
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA; Department of Epidemiology and Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Gunjan Arora
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Yile Dai
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Yingjun Cui
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Yu-Min Chuang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Qian Yu
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - M Sayeedur Rahman
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Tays Mendes
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Agustin Rolandelli
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pallavi Singh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Abhai K Tripathi
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Choukri Ben Mamoun
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA; Department of Microbial Pathogenesis, Yale School of Medicine, New Haven, CT 06510, USA
| | - Melissa J Caimano
- Department of Medicine, UConn Health, Farmington, CT 06030, USA; Department of Pediatrics, UConn Health, Farmington, CT 06030, USA; Department of Molecular Biology and Biophysics, UConn Health, Farmington, CT 06030, USA
| | - Justin D Radolf
- Department of Medicine, UConn Health, Farmington, CT 06030, USA; Department of Pediatrics, UConn Health, Farmington, CT 06030, USA; Department of Molecular Biology and Biophysics, UConn Health, Farmington, CT 06030, USA; Department of Genetics and Genome Sciences, UConn Health, Farmington, CT 06030, USA; Department of Immunology, UConn Health, Farmington, CT 06030, USA
| | - Yi-Pin Lin
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Volker Fingerle
- Bavarian Health and Food Safety Authority, Oberschleißheim, Munich 85764, Bavaria, Germany
| | - Gabriele Margos
- Bavarian Health and Food Safety Authority, Oberschleißheim, Munich 85764, Bavaria, Germany
| | - Utpal Pal
- Department of Veterinary Medicine, University of Maryland, College Park, MD 20742, USA
| | - Raymond M Johnson
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA; Department of Microbial Pathogenesis, Yale School of Medicine, New Haven, CT 06510, USA
| | - Joao H F Pedra
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Abdu F Azad
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeanne Salje
- Department of Pathology, University of Cambridge, Cambridge CB2 1TN, UK; Department of Biochemistry, University of Cambridge, Cambridge CB2 1TN, UK
| | - George Dimopoulos
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Joseph M Vinetz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA; Laboratorio ICEMR-Amazonia, Laboratorios de Investigación Y Desarrollo, Facultad de Ciencias Y Filosofia, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Jason A Carlyon
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
| | - Noah W Palm
- Department of Immunobiology, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Erol Fikrig
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Aaron M Ring
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA 98102, USA.
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Gibson S, Ellsworth P. Emerging therapies for overactive bladder: preclinical, phase I and phase II studies. Expert Opin Investig Drugs 2024; 33:601-612. [PMID: 38695250 DOI: 10.1080/13543784.2024.2349285] [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: 02/07/2024] [Accepted: 04/25/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Overactive bladder syndrome is a common chronic condition with a significant impact on quality of life and economic burden. Persistence with pharmacologic therapy has been limited by efficacy and side effects. A greater understanding of the pathophysiology of overactive bladder has led to the initial evaluation of several drugs affecting ion channels, the autonomic nervous system, and enzymes which may provide useful alternatives for the management of overactive bladder. AREAS COVERED A comprehensive review was performed using PubMed and Cochrane databases as well as reviewing clinical trials in the United States. The current standard of care for overactive bladder will be discussed, but this paper focuses on investigational drugs currently in preclinical studies and phase I and II clinical trials. EXPERT OPINION Current therapies for overactive bladder have limitations in efficacy and side effects. A greater understanding of the pathophysiology of overactive bladder has identified the role(s) of other pathways in the overactive bladder syndrome. Targeting alternative pathways including ion channels and enzymes may provide alternative therapies of overactive bladder and a more tailored approach to the management of overactive bladder.
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Affiliation(s)
- Samantha Gibson
- Division of urology, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Pamela Ellsworth
- Division of urology, University of Central Florida College of Medicine, Orlando, FL, USA
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Bou Kheir G, Verbakel I, Vande Walle J, Wyndaele M, Sinha S, Arlandis S, Raes A, Abrams P, Wein A, Hervé F, Everaert K. Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process. Neurourol Urodyn 2024; 43:1040-1057. [PMID: 38289322 DOI: 10.1002/nau.25307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) is a prevalent urological condition characterized by urinary urgency, with or without urgency urinary incontinence, accompanied by increased daytime frequency and nocturia. However, the current definition of OAB lacks a specified time frame, hindering our understanding of the temporal aspects and transitions that occur within the OAB spectrum. METHODS A modified Delphi study was conducted in three rounds, involving a panel of international experts in functional urology, urogynaecology, geriatrics, transitional medicine, and pediatric urology. The study took place between February 2023 and June 2023 and employed two sequential rounds of online surveys, followed by a final hybrid group discussion session in June 2023. RESULTS The Delphi process resulted in a consensus definition of lifelong OAB as a persistent and continuous condition that may manifest differently from birth and evolve over time, with varying levels of clinical perception. The course of its progression is influenced by transition periods and modifying factors, mainly anatomical, hormonal, and psychosocial/stressors. Three main transition periods were identified: achievement of daytime continence, adulthood to elderly, and transition to frail elderly. The panel also considered the therapeutic and diagnostic implications of lifelong OAB, as well as future research prospects in terms of importance and feasibility. CONCLUSIONS Future longitudinal research is needed to develop this concept and further identify transitions and temporal dynamics.
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Affiliation(s)
- George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Paediatric Nephrology and Rheumatology, ERknet Center, Ghent University Hospital, Ghent, Belgium
| | - Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ann Raes
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alan Wein
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
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Wei B, Zhao Y, Lin P, Qiu W, Wang S, Gu C, Deng L, Deng T, Li S. The association between overactive bladder and systemic immunity-inflammation index: a cross-sectional study of NHANES 2005 to 2018. Sci Rep 2024; 14:12579. [PMID: 38822015 PMCID: PMC11143340 DOI: 10.1038/s41598-024-63448-3] [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: 02/16/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
Current research indicate that inflammation is linked to the development of overactive bladder (OAB). The aim of this study was to examine the correlation between OAB and the systemic immunity-inflammation index (SII) in the USA. We analyzed data from 31,881 participants in the National Health and Nutrition Examination Survey 2005-2018. SII, calculated as platelet count × neutrophil count/lymphocyte count, was categorized into quartiles. OAB was defined by the presence of urge urinary incontinence and nocturia. Weighted logistic regression models were used to examine the independent relationship between SII and OAB, adjusting for demographic factors, kidney function, and diabetes status. The results showed that each tenfold increase in log-transformed SII was associated with an 18% higher odds of OAB (OR 1.18, 95% CI 1.08-1.28) in the fully adjusted model. Compared to the lowest SII quartile, the highest quartile had a 28% increased OAB risk (OR 1.28, 95% CI 1.12-1.47). The positive association between SII and OAB risk was consistently observed across subgroups stratified by age, sex, race, marital status, education, and poverty level. Our study reveals a positive correlation between SII levels and OAB, indicating that higher SII levels are associated with an increased likelihood of developing OAB.
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Affiliation(s)
- Baian Wei
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Ying Zhao
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Pinli Lin
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Wenqiang Qiu
- The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Shusheng Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Chiming Gu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Lili Deng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Tewei Deng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China.
| | - Siyi Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, China.
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Feng G, Huang S, Zhao W, Gong H. Association between life's essential 8 and overactive bladder. Sci Rep 2024; 14:11842. [PMID: 38783031 PMCID: PMC11116455 DOI: 10.1038/s41598-024-62842-1] [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: 04/21/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024] Open
Abstract
Limited research has explored the relationship between overactive bladder (OAB) and cardiovascular health (CVH). We aim to examine the correlation between OAB and CVH in American adults, utilizing the Life's Essential 8 (LE8). We included 70,190 individuals from the National Health and Nutrition Examination Survey spanning from 2005 to 2018. In our study, the independent variable is LE8 score, where higher scores denote better CVH. The dependent variable is the presence of OAB. We employed multivariable logistic regression along with restricted cubic splines to evaluate the association between LE8 and OAB. Additionally, we performed interaction analyzes on subgroups to validate the findings. There is a significant negative correlation between LE8 scores and OAB. Upon adjusting for all covariates, a 10-point increase in LE8 total score correlated with a 17% decrease in the odds of OAB [0.83 (95% CI 0.78, 0.89)]. Compared to participants with lower LE8 scores, those with higher LE8 scores had a 46% lower probability of developing OAB. Consistent results were also observed in the association between scores of four health behaviors and four health factors and OAB. Furthermore, a notable interaction was observed between LE8 scores and smoking status. This study showed a significant negative correlation between LE8 scores and OAB prevalence.
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Affiliation(s)
- Guoliang Feng
- Department of Oncology, Nanchang Third Hospital, Nanchang, Jiangxi, China
| | - Shaoqun Huang
- Department of Oncology Surgery, Fuzhou Traditional Chinese Medicine Hospital, Fuzhou City, Fujian Province, China
| | - Weimin Zhao
- Department of Clinical Medicine, School of Medicine, Shihezi University, Shihezi City, China
| | - Hongyang Gong
- Department of Physiology, College of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452, Republic of Korea.
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Long T, Cheng B, Zhang K. Abdominal obesity as assessed by anthropometric measures associates with urinary incontinence in females: findings from the National Health and Nutrition Examination Survey 2005-2018. BMC Womens Health 2024; 24:212. [PMID: 38566030 PMCID: PMC10986057 DOI: 10.1186/s12905-024-03059-2] [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: 09/07/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) is significantly link to abdominal obesity. This study aimed to assess the association between anthropometric indices of abdominal obesity, including body roundness index (BRI), conicity index (CI), and waist-to-height ratio (WHtR), and UI risk in adult females. METHODS We analyzed data from 10, 317 adult females in the National Health and Nutrition Examination Survey (NHANES) database (2005-2018). Weighted multivariable-adjusted regression analysis was conducted to determine the odds ratio (OR) and 95% confidence intervals (CI) for the association between BRI, CI, WHtR, and UI. Stratified analyses revealed the association based on the population type. Receiver operating characteristic curve (ROC) analyses were used to assess the predictive value of UI. RESULTS All indices of abdominal obesity investigated were positively and independently associated with the prevalence and severity of three types of UI. After adjusting for all relevant confounding variables, a significantly positive association between BRI and the prevalence of UI were observed (OR quartile 4 vs. quartile 1: urge UI (UUI): 1.93, 95% CI 1.61-2.30; stress UI (SUI): 2.29, 95% CI 1.94-2.70; mixed UI (MUI): 2.26, 95% CI 1.82-2.82; all P < 0.0001, P for trend < 0.0001, respectively), as well as WHtR and CI, which particularly prominent for female in premenopausal. Moreover, a one-unit increment of BRI was significantly associated with an increased severity index of UUI (β: 0.06, 95% CI 0.04-0.09, P < 0.0001), SUI (β: 0.10, 95% CI 0.07-0.13, P < 0.0001) and MUI (β: 0.07, 95% CI 0.04-0.10, P < 0.0001), which this trend was also observed in each subtype of UI for WHtR and CI. Furthermore, the ROC analysis demonstrated a higher diagnostic efficacy of BRI and WHtR compared with BMI in discriminating UI with an AUC of 0.600 for SUI, 0.617 for UUI, and 0.622 for MUI (all P < 0.05). CONCLUSIONS An increased BRI, CI, and WHtR are significantly associated with higher prevalence and severity of UI in females.
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Affiliation(s)
- Ting Long
- Department of Pelvic Floor, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410007, China
| | - Bohuai Cheng
- Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Ke Zhang
- Department of Pelvic Floor, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410007, China.
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Jirillo E, Palmirotta R, Colella M, Santacroce L. A Bird's-Eye View of the Pathophysiologic Role of the Human Urobiota in Health and Disease: Can We Modulate It? PATHOPHYSIOLOGY 2024; 31:52-67. [PMID: 38390942 PMCID: PMC10885084 DOI: 10.3390/pathophysiology31010005] [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: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
For a long time, urine has been considered sterile in physiological conditions, thanks to the particular structure of the urinary tract and the production of uromodulin or Tamm-Horsfall protein (THP) by it. More recently, thanks to the development and use of new technologies, i.e., next-generation sequencing and expanded urine culture, the identification of a microbial community in the urine, the so-called urobiota, became possible. Major phyla detected in the urine are represented by Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. Particularly, the female urobiota is largely represented by Lactobacillus spp., which are very active against urinary pathogenic Escherichia (E.) coli (UPEC) strains via the generation of lactic acid and hydrogen peroxide. Gut dysbiosis accounts for recurrent urinary tract infections (UTIs), so-called gut-bladder axis syndrome with the formation of intracellular bacterial communities in the course of acute cystitis. However, other chronic urinary tract infections are caused by bacterial strains of intestinal derivation. Monomicrobial and polymicrobial infections account for the outcome of acute and chronic UTIs, even including prostatitis and chronic pelvic pain. E. coli isolates have been shown to be more invasive and resistant to antibiotics. Probiotics, fecal microbial transplantation, phage therapy, antimicrobial peptides, and immune-mediated therapies, even including vaccines for the treatment of UTIs, will be described.
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Affiliation(s)
- Emilio Jirillo
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Raffaele Palmirotta
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marica Colella
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
- Doctoral School, eCampus University, 22060 Novedrate, Italy
| | - Luigi Santacroce
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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Lee WC, Chow PM, Hsu CN, Chuang YC. The impact of diabetes on overactive bladder presentations and associations with health-seeking behavior in China, South Korea, and Taiwan: Results from a cross-sectional, population-based study. J Chin Med Assoc 2024; 87:196-201. [PMID: 38132568 DOI: 10.1097/jcma.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This study aimed to explore the impact of diabetes on overactive bladder (OAB) presentations and related predictors of healthcare-seeking behavior among adults aged ≥ 40 years in China, Taiwan, and South Korea. METHODS An internet-based survey was conducted to assess the prevalence of diabetes, OAB presentations, and self-perceived urinary symptoms by a multi-national sample of 8284 individuals who completed the survey between June 2, 2015 and July 31, 2015. Independent associations with health-seeking behavior for urinary symptoms were estimated with odds ratio (OR) with 95% confidence interval (95% CI) using multivariate logistic regression. RESULTS Diabetes was reported in 13.6% of participants and OAB was 20.8%. Diabetic participants were older than non-diabetic participants in both sexes. Participants with diabetes reported a higher rate of OAB (43.1%) and increased bothersome symptoms associated with OAB than those without diabetes. Participants with diabetes (OR, 3.07 [2.39-3.96]], urgent incontinence (OR, 2.38 [1.86-3.03]), frequency (OR, 1.86 [1.45-2.38]), and nocturia (OR, 1.14 [1.05-1.24]) were associated with healthcare-seeking behavior. CONCLUSION The proportion of diabetic participants with OAB was 2.5-fold higher than those without diabetes. Diabetes, urinary frequency, nocturia, and urgent incontinence are predictors of medical treatment-seeking behavior, but the key symptom of OAB-urgency is not a predictor of treatment-seeking behavior. It is important for clinicians to recognize the interplay between diabetes and OAB and to early identify various bothersome urinary symptoms for better health outcomes in daily practice.
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Affiliation(s)
- Wei-Chia Lee
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Yao-Chi Chuang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
- Center for Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
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12
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Xiao Y, Yin S, Bai Y, Wang J, Cui J, Yang Y, Wang J. A positive association between food insecurity and the prevalence of overactive bladder in U.S. adults. Front Nutr 2024; 10:1329687. [PMID: 38370980 PMCID: PMC10870421 DOI: 10.3389/fnut.2023.1329687] [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] [Received: 11/01/2023] [Accepted: 12/29/2023] [Indexed: 02/20/2024] Open
Abstract
Objective This study aims to examine the correlation between overactive bladder (OAB) and food insecurity. Methods We conducted a cross-sectional analysis utilizing extensive population data derived from the National Health and Nutrition Examination Survey 2007-2018. The status of Household food insecurity is evaluated by the US Food Security Survey Module. To explore the relationship between food insecurity and OAB, three multivariable logistic regression models were carried out. Additionally, interaction and stratified analyses were also performed to find whether some factors have the potential to alter the correlation. Results There were 29,129 participants enrolled in the study. Compared to the other three groups, individuals with full food security exhibited a lower proportion of nocturia, urinary urgency incontinence, and OAB. In the fully-adjusted model, it was found that people experiencing food insecurity have a significantly higher prevalence of OAB compared to those with food security in the fully-adjusted model (OR = 1.540, 95%CI 1.359-1.745). Additionally, there was a significant association between the levels of food insecurity and an increased risk of OAB prevalence was also observed (marginal food security: OR = 1.312, low food security: OR = 1.559, and very low food security: OR = 1.759). No significant interaction was seen in the fully-adjusted model. Conclusion There is a strong positive correlation between food insecurity and the prevalence of OAB. Similarly, the correlation between levels of food insecurity and OAB also indicates the same trend. Namely, the more insecure food, the higher risk of OAB prevalence in the population.
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Affiliation(s)
- Yunfei Xiao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiahao Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianwei Cui
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaqing Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Barba M, Cola A, Rezzan G, Costa C, Re I, Volontè S, Terzoni S, Frigerio M, Maruccia S. Flat Magnetic Stimulation for Urge Urinary Incontinence. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1999. [PMID: 38004048 PMCID: PMC10673601 DOI: 10.3390/medicina59111999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods: This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results: Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 (p < 0.001) and ICIQ-UI SF scores (p < 0.001) and an improvement in sexual function (p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusions: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Giorgia Rezzan
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Ilaria Re
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Silvia Volontè
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Stefano Terzoni
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy; (S.T.); (S.M.)
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Serena Maruccia
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy; (S.T.); (S.M.)
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Lin W, Wang H, Wu Z, Zhang W, Lin ME. Associations between exposure to organophosphate esters and overactive bladder in U.S. adults: a cross-sectional study. Front Public Health 2023; 11:1186848. [PMID: 38026372 PMCID: PMC10666646 DOI: 10.3389/fpubh.2023.1186848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background The relationship between exposure to organophosphate esters (OPEs) and the risk of developing overactive bladder (OAB) is uncertain. The purpose of this study is to examine the potential link between urinary metabolites of organophosphate esters and OAB. Method Data from the National Health and Nutrition Examination Survey (NHANES) database of the 2011-2016 cycles were utilized. Four urinary metabolites of organophosphate esters: diphenyl phosphate (DPHP), bis (1,3-dichloro-2-propyl) phosphate (BDCPP), bis (2-chloroethyl) phosphate (BCEP), and dibutyl phosphate (DBUP) were included in the study. Multivariate logistic regression and restricted cubic spline (RCS) were used to evaluate the relationship between urinary OPEs metabolites and OAB. Interaction analysis was conducted on subgroups to confirm the findings. Results A total of 3,443 United States (US) adults aged 20 years or older were included in the study, of whom 597 participants were considered to have OAB. After adjusting for potential confounding factors, we found a positive association between DPHP and the risk of overactive bladder. The risk of overactive bladder increased with increasing DPHP concentrations compared with quartile 1 (quartile 2, OR = 1.19, 95% CI, 0.82-1.73, P = 0.34; quartile 3, OR = 1.67, 95% CI, 1.10-2.53, P = 0.02; Q4, OR = 1.75, 95% CI, 1.26-2.43, P = 0.002). However, after dividing the participants by gender, only the female group retained consistent results. Additionally, restricted cubic spline analysis revealed a nonlinear dose-response correlation between DPHP and OAB in female participants. In the subgroup analysis based on age, race, body mass index (BMI), recreational activity, smoking status, drinking status, hypertension, diabetes, and stroke, the interaction analysis revealed that the findings were uniform. Conclusion Our findings indicate that exposure to DPHP could elevate the risk of OAB in US adult females. Further experimental studies are needed to explore the underlying mechanism in the future.
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Affiliation(s)
- Weilong Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, Guangdong, China
| | - Haoxu Wang
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, Guangdong, China
| | - Zesong Wu
- Clinical Medicine Science, Shantou University Medical College, Shantou, Guangdong, China
| | - Wei Zhang
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, Guangdong, China
- The First Affiliated Hospital of Shantou University Medical College Hao Jiang Hospital, Shantou, Guangdong, China
| | - Ming-En Lin
- The First Affiliated Hospital of Shantou University Medical College, Medical College of Shantou University, Shantou, Guangdong, China
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Dhawan A, Ganduboina R, Dutta P, Gandrakota G, Kumar Y, Palagati K, Avvaru SN, Sreekumar A, Mylavarapu S, Nizami A, Babu AT, Alam M. COVID-associated cystitis: the culprit behind the bladder woes post-COVID infection? A review. Int Urol Nephrol 2023; 55:2367-2372. [PMID: 37410305 DOI: 10.1007/s11255-023-03700-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE SARS-CoV-2 had a significant impact on public health since its declaration as a pandemic. It is linked to a high rate of multiple organ dysfunction syndrome (MODS) and a slew of long-term symptoms that are yet to be thoroughly investigated. Among these, genitourinary symptoms of an overactive bladder (increased frequency, urgency, and nocturia) have recently been identified and labeled as COVID-associated cystitis (CAC). This current research is performed to review this phenomenon. METHODS A literature search was performed in MEDLINE, Cochrane, and Google Scholar databases and 185 articles were obtained in total, including reviews and trials involving CAC, which were screened using various methods, and 42 articles were gathered for the review. RESULTS Among its multitude of symptoms, overactive bladder (OAB) leads to poorer outcomes. The inflammatory mediator-based theory and the ACE-2 receptor-based theory are two probable theories for how it harms the bladder urothelium. The expression of ACE-2 receptors during the pathogenesis of CAC warrants further investigation as ACE modulation may reveal more information about COVID-19 complications. Other comorbidities, immunocompromised patients, or patients with a history of urinary tract infections can also exacerbate this condition. CONCLUSION The scarce literature collected related to CAC gives us an insight into the symptomatology, pathophysiology, and possible treatment plans. Treatment choices are diverse among COVID-19-afflicted and unaffected patients for treating urinary symptoms which highlights the importance to distinguish between the two. CAC shows greater prevalence and morbidity when linked to other conditions, thereby warranting future developments in it.
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Affiliation(s)
| | - Rohit Ganduboina
- NRI Institute of Medical Sciences, Sangivalasa, Visakhapatnam, 531162, India.
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Jiang YH, Kuo HC. Current optimal pharmacologic therapies for overactive bladder. Expert Opin Pharmacother 2023; 24:2005-2019. [PMID: 37752121 DOI: 10.1080/14656566.2023.2264183] [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: 08/16/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Overactive bladder (OAB) is a common syndrome in adults. Current pharmacologic treatment includes antimuscarinic agents and β-3 adrenoceptor agonists. For non-responders to oral medication, intravesical injection of botulinum toxin A (BoNT-A) is an effective option. However, these treatments have potential adverse events and should be cautiously selected for appropriate patients. This review presents the recently published results of clinical trials and studies for patients with OAB and the underlying pathophysiology of OAB. Appropriate medical therapy based on pathophysiology of OAB is also presented. AREAS COVERED Literature search from Pubmed from 2001 to 2023 including clinical background, pharmacology, and clinical studies for OAB medications. EXPERT OPINION Treatment of OAB syndrome with any antimuscarinic or β-3 adrenoceptor agonist is feasible as a first-line approach. For patients with suboptimal therapeutic effect to full-dose antimuscarinics or mirabegron, combination with both drugs can improve efficacy. Intravesical BoNT-A 100-U injection provides therapeutic effects for refractory OAB. Patients who are refractory to initial pharmacotherapies should be investigated for the underlying pathophysiology; then an appropriate medication can be added, such as an α1-blocker or anti-inflammatory agents. Patient education about behavioral modification and therapies should always be provided with oral medication or BoNT-A injection for OAB patients.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Xiao Y, Yin S, Wang J, Cui J, Yang Z, Wang J, Bai Y. A positive association between the prevalence of circadian syndrome and overactive bladder in United States adults. Front Public Health 2023; 11:1137191. [PMID: 37637821 PMCID: PMC10449362 DOI: 10.3389/fpubh.2023.1137191] [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: 01/06/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To explore the association between the prevalence of circadian syndrome (CircS) and overactive bladder (OAB). Materials and methods Cross-section analysis was based on the National Health and Nutrition Examination Survey 2005-2018. Data regarding OAB was collected from questionnaires. The association between the prevalence of CircS and OAB was elucidated using three multivariable logistic regression models. Stratified and interaction analyses were performed to find whether some factors can modify the association. Results Totally 8,033 males and 8,065 females were included. People with CircS had a significantly higher prevalence of OAB compared to the non-CircS group in the fully-adjusted model (OR = 1.238, 95%CI 1.080-1.419). A significant positive correlation between the number of CircS components and the prevalence of OAB was observed when the components were ≥ 6 (OR = 1.975, 95%CI 1.463-2.665). No significant interaction was seen in the three models. Conclusion There is a positive association between the prevalence of CircS and OAB. When the number of components is ≥6, the prevalence of OAB shows a strongly positive correlation with the number of CircS components.
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Affiliation(s)
- Yunfei Xiao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jiahao Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianwei Cui
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenzhen Yang
- Department of Clinical Laboratory, Nanchong Central Hospital, Nanchong, China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Chilaka C, Toozs-Hobson P, Chilaka V. Pelvic floor dysfunction and obesity. Best Pract Res Clin Obstet Gynaecol 2023; 90:102389. [PMID: 37541114 DOI: 10.1016/j.bpobgyn.2023.102389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023]
Abstract
Obesity is a growing condition within the society and more patients, who have underlying obesity, are presenting with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction (PFD). The effect of obesity on general health has been well documented, and its impact on the cardiovascular, endocrine, and musculoskeletal systems has been extensively studied. There is now a growing body of evidence on the effects of obesity on the female urogenital system. It seems to influence the prevalence, presentation, assessment, management, and outcome of various types of LUTS and PFD. A holistic approach is needed to assess and manage these patients. A clear understanding of the functions of the pelvic floor and the way it can be affected by obesity is essential in providing holistic care to this group. A frank discussion about patient weight is required in the clinics handling PFD. A multimodal approach to weight loss would help improve PFD symptoms and progression. Patients with obesity should still be offered standard treatment options for all PFDs and should not be forced to lose weight as a prerequisite before starting treatment. However, they should also be made aware of the impediments that being overweight adds to their care and their expectations should be managed accordingly.
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Affiliation(s)
| | | | - Victor Chilaka
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar.
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Javan Balegh Marand A, Baars C, Heesakkers J, van den Munckhof E, Ghojazadeh M, Rahnama'i MS, Janssen D. Differences in the Urinary Microbiome of Patients with Overactive Bladder Syndrome with and without Detrusor Overactivity on Urodynamic Measurements. Life (Basel) 2023; 13:life13051199. [PMID: 37240844 DOI: 10.3390/life13051199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION It has been hypothesized that the urinary microbiome might play an important role in OAB. Studies have been conducted on the association between OAB symptoms and the microbiome, although a possible causality still has to be determined. MATERIAL AND METHODS In this study, 12 female patients, ≥18 years of age, with 'OAB DO+' and 9 female patients with 'OAB DO-' were included. Patients were excluded if they met one of the following exclusion criteria: bladder tumors and previous bladder operations; sacral neuromodulation; injection of Botox in the bladder; and TOT or TVT operations. Urine samples were collected and stored with patient informed consent and with the approval of the Hospital Ethical Review Board (Arnhem-Nijmegen). All OAB patients underwent urodynamics before collecting urine samples, and the diagnosis of detrusor overactivity was confirmed by two individual urologists. In addition, samples from 12 healthy controls who did not undergo urodynamic evaluation were analyzed. The 16S rRNA V1-V2 region amplification and gel electrophoresis were used to determine the microbiota. RESULTS 12 of the OAB patients had DO shown on their urodynamic studies; the remaining 9 patients had a normoactive detrusor on their urodynamic measurements. Overall, there were no substantial differences among the demographic characteristics of the subjects. The samples were classified as the following: 180 phyla, 180 classes, 179 orders, 178 families, 175 genera, and 138 species. The least commonly observed phyla were Proteobacteria, with an average presence of 10%, followed by Bacteroidetes with 15%, Actinobacteria with 16%, and Firmicutes with 41%. Most of the sequences could be classified according to the genus level for each sample. DISCUSSION Significant differences were observed in the urinary microbiome of patients with overactive bladder syndrome who have detrusor overactivity on urodynamics compared to OAB patients without detrusor overactivity and matched controls. OAB patients with detrusor overactivity have a significantly less diverse microbiome and show a higher proportion of Lactobacillus, particularly Lactobacillus iners. The results imply that the urinary microbiome could be involved in the pathogenesis of a specific phenotype of OAB. The urinary microbiome could be a new starting point to study the causes and treatments of OAB.
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Affiliation(s)
- Aida Javan Balegh Marand
- Department of Urology, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Cléo Baars
- Department of Urology, Radboud University, 6525 GA Nijmegen, The Netherlands
| | - John Heesakkers
- Department of Urology, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Ellen van den Munckhof
- Research Center for Evidence-Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran
| | - Morteza Ghojazadeh
- Viroclinics-DDL Diagnostic Laboratory, 2288 ER Rijswijk, The Netherlands
| | | | - Dick Janssen
- Department of Urology, Radboud University, 6525 GA Nijmegen, The Netherlands
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Takeuchi Y, Sawada Y, Watanabe S, Ni-Itsu Y, Sekido N. Age-specific effect of transurethral holmium laser enucleation of the prostate on overactive bladder in men with benign prostatic hyperplasia: An investigation using an overactive bladder symptom score. Low Urin Tract Symptoms 2023; 15:38-49. [PMID: 36507559 DOI: 10.1111/luts.12469] [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: 10/07/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the age-specific effect of transurethral holmium laser enucleation of the prostate (HoLEP) on overactive bladder (OAB). METHODS A total of 186 consecutive patients who underwent HoLEP were included. They were divided into three groups: patients aged less than 65 years, between 65 and 74, and 75 or older. The OAB symptom score as well as other relevant variables of lower urinary tract symptoms and function were assessed before and 1, 3, 6, and 12 months after surgery. Age-specific prevalence of OAB, the proportion of resolution of OAB, and de novo OAB were evaluated. RESULTS The mean age of patients was 70.7 years, and the mean total prostate volume was 75.8 ml. The mean OAB symptom scores before surgery of patients aged less than 65 years, between 65 and 74, and 75 or older were 6.0, 5.2, and 5.7, respectively. At 12 months after surgery, the scores for the respective groups had significantly decreased to 2.1, 2.5, and 3.5. The prevalence of OAB based on the score in the respective groups was 45.8%, 56.9%, and 54.0% (p = .6391) preoperatively and 9.1%, 11.3%, and 15.8% at 12 months after the surgery (p = .7613). Of those with preoperative OAB, 75.0%, 79.2%, and 75.0% of the respective groups showed resolution of OAB at 12 months postoperatively (p = .9427). CONCLUSIONS In candidates for surgical deobstruction of benign prostatic hyperplasia, HoLEP has potential to improve OAB symptoms regardless of age.
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Affiliation(s)
- Yasuharu Takeuchi
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshitomo Sawada
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shoutarou Watanabe
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuo Ni-Itsu
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
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21
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Urinary ATP Levels Are Controlled by Nucleotidases Released from the Urothelium in a Regulated Manner. Metabolites 2022; 13:metabo13010030. [PMID: 36676954 PMCID: PMC9862892 DOI: 10.3390/metabo13010030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Adenosine 5′-triphosphate (ATP) is released in the bladder lumen during filling. Urothelial ATP is presumed to regulate bladder excitability. Urinary ATP is suggested as a urinary biomarker of bladder dysfunctions since ATP is increased in the urine of patients with overactive bladder, interstitial cystitis or bladder pain syndrome. Altered urinary ATP might also be associated with voiding dysfunctions linked to disease states associated with metabolic syndrome. Extracellular ATP levels are determined by ATP release and ATP hydrolysis by membrane-bound and soluble nucleotidases (s-NTDs). It is currently unknown whether s-NTDs regulate urinary ATP. Using etheno-ATP substrate and HPLC-FLD detection techniques, we found that s-NTDs are released in the lumen of ex vivo mouse detrusor-free bladders. Capillary immunoelectrophoresis by ProteinSimple Wes determined that intraluminal solutions (ILS) collected at the end of filling contain ENTPD3 > ENPP1 > ENPP3 ≥ ENTPD2 = NT5E = ALPL/TNAP. Activation of adenylyl cyclase with forskolin increased luminal s-NTDs release whereas the AC inhibitor SQ22536 had no effect. In contrast, forskolin reduced and SQ22536 increased s-NTDs release in the lamina propria. Adenosine enhanced s-NTDs release and accelerated ATP hydrolysis in ILS and lamina propria. Therefore, there is a regulated release of s-NTDs in the bladder lumen during filling. Aberrant release or functions of urothelial s-NTDs might cause elevated urinary ATP in conditions with abnormal bladder excitability.
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22
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Lee WC, Yu HR, Tain YL, Wu KL, Chuang YC, Chan JY. Vinpocetine Ameliorates Metabolic-Syndrome-Associated Bladder Overactivity in Fructose-Fed Rats by Restoring Succinate-Modulated cAMP Levels and Exerting Anti-Inflammatory Effects in the Bladder Detrusor Muscle. Biomedicines 2022; 10:2716. [PMID: 36359236 PMCID: PMC9687486 DOI: 10.3390/biomedicines10112716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/03/2023] Open
Abstract
Succinate and its receptor, the G protein-coupled receptor 91 (GPR91), have pathological implications in metabolic syndrome (MetS) and its associated bladder dysfunction, particularly in decreasing bladder cAMP levels and promoting proinflammation. Using fructose-fed rats (FFRs), a rat model of MetS, we investigate the effects of vinpocetine (a phosphodiesterase-1 inhibitor) and celecoxib (a selective cyclooxygenase-2 inhibitor) on MetS-associated bladder overactivity. Phenotypes of the overactive bladder, including increased micturition frequency and a shortened intercontractile interval in cystometry, were observed in FFRs, together with elevated succinate levels in the liver and serum and the downregulation of GPR91 in the liver and urinary bladder. Treatments with vinpocetine and celecoxib improved tissue fibrosis and ameliorated the overexpression of the inflammatory cytokines, such as IL-1β, in the liver and bladder. In bladder organ bath studies, vinpocetine, but not celecoxib, treatment restored the contraction and relaxation responses of the detrusor muscle strip in response to KCl, carbachol, and forskolin stimulation. At a molecular level, vinpocetine and celecoxib treatments modulated the downstream messengers of GPR91 (i.e., ERK1/2 and JNK), suppressed NF-κB and IL-1β expressions in the bladder, and prevented the fibrogenesis observed in FFRs. The exogenous application of succinate to a bladder organ bath significantly reduced the forskolin-induced cAMP production by the detrusor muscle, which was notably restored in the presence of vinpocetine. Together, these results suggest that vinpocetine may alleviate the MetS-associated bladder overactivity by restoring the succinate-modulated detrusor cAMP production and exerting the anti-inflammatory effects in the bladder detrusor muscle.
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Affiliation(s)
- Wei-Chia Lee
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Hong-Ren Yu
- Department of Paediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - You-Lin Tain
- Department of Paediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Kay L.H. Wu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Yao-Chi Chuang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Julie Y.H. Chan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
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