In order to gain insight into the physicians' awareness of and attitude towards management of overactive bladder (OAB) in males, we performed a nationwide survey of the current strategies that urologists use to diagnose and manage OAB in male patients.
Materials and Methods
A probability sample was taken from the Korean Urological Association Registry of Physicians, and a random sample of 289 Korean urologists were mailed a structured questionnaire that explored how they manage benign prostatic hyperplasia (BPH).
A total of 185 completed questionnaires were returned. The consent rate in the survey was 64.5%. Eighty-one (44%) urologists believed that of all males with lower urinary tract symptoms (LUTS), 20% or more had OAB and 72 (39%) believed that 10-20% had OAB. Half of the urologists surveyed believed that the most bothersome symptom in male OAB patients was nocturia. Seventy-three percent of respondents reported that they prescribed alpha blockers with anticholinergics for first line management, while 19% of urologists prescribed alpha blocker monotherapy but not anticholinergics for OAB patients. Though acute urinary retention (AUR) was considered the anticholinergic adverse event of most concern, the most frequently observed adverse event was dry mouth (95%).
The present study provides insights into urologist views of male OAB. There is a discrepancy between the awareness of urologists and actual patterns of diagnosis and treatment of male OAB. This finding indicates the need to develop further practical guidelines based on solid clinical data.
Overactive bladder; physician's practice patterns; bladder outlet obstruction; benign prostatic hyperplasia; anticholinergics
Overactive bladder (OAB) represents a disorder with overall increasing prevalence in the American population. However, gender-specific characteristics of OAB and how it relates to the general practitioner are not well described. We sought to determine the distribution and characteristics of OAB in women in a primary care setting.
Self-administered questionnaires were distributed to patients visiting a family medicine outpatient center. The modified questionnaire included eight questions on evidence of lower urinary tract symptoms (LUTS, OAB-validated 8-question screener [OAB-V8]), two questions on stress urinary incontinence, and one question on incomplete emptying. The questionnaire included demographic characteristics and relevant medical and surgical history. Body mass index was calculated based on weight and height. Chi-square test and risk ratio analysis were used to analyze the relationship between OAB and other independent variables.
Of 1025 questionnaires administered, 386 were completed. Patients ranged from 16 to 97 years, the majority were African American (78.2%), and 49.7% were premenopausal while 50.3% were postmenopausal. OAB was present in 46.4% of premenopausal women and 41.7% of postmenopausal women. OAB was significantly associated with overweight status (body mass index 25.0–29.9, P = 0.042) and obesity (body mass index ≥30, P < 0.001). Overall, obese women were twice as likely to have OAB (relative risk = 1.99, 1.31–3.04) than women with normal weight. OAB was not shown to correlate with race, cigarette use, history of hysterectomy, or parity.
OAB was evident in 44% of all female patients surveyed, which is much higher than previously reported estimates. In addition, overweight women were more likely to have OAB. Increased awareness of OAB in the primary care setting should be considered for women’s general health.
overactive bladder; incontinence; women; primary care
Lower urinary tract symptoms (LUTS), overactive bladder syndrome (OAB) and detrusor overactivity (DO) are all conditions that can have major effects on quality of life and social functioning. Antimuscarinic drugs are first-line treatment–they often have good initial response rates, but adverse effects and decreasing efficacy cause long-term compliance problems, and alternatives are needed. The recognition of the functional contribution of the urothelium, the spontaneous myocyte activity during bladder filling, and the diversity of nerve transmitters has sparked interest in both peripheral and central modulation of LUTS/OAB/DO pathophysiology. There may be several new possibilities to treat LUTS/OAB/DO. β3-AR agonists (YM178), PDE 5 inhibitors (sildenafil, tadalafil, vardenafil), vitamin D analogs (elocalcitol), combinations (α1-AR antagonist + antimuscarinic), and drugs with a central mode of action (tramadol, aprepitant) all have Randomized controlled trial (RCT) documented efficacy. Which of these therapeutic principles will be developed to clinically useful treatments remains to be established.
incontinence; detrusor overactivity; drug treatment
Objectives. To investigate the add-on effect of solifenacin for Japanese men with remaining overactive bladder (OAB) symptoms after tamsulosin monotherapy for lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) in real-life clinical practice. Methods. Patients aged ≥ 50 having remaining OAB symptoms (≥ 3 of OAB symptom score (OABSS) with ≥2 of urgency score) after at least 4 weeks treatment by 0.2 mg of tamsulosin for BPO/LUTS received 2.5 or 5.0 mg of solifenacin for 12 weeks. The International Prostate Symptom Score (IPSS), QOL index and OABSS, maximum flow rate (Qmax) and postvoid residual urine volume (PVR) were determined. Results. A total of 48 patients (mean age 72.5 years) completed the study. There were significant improvement in IPSS (15.1 to 11.2) and QOL index (4.2 to 3.0) by add-on of solifenacin. Although the IPSS storage symptom score was significantly improved, there were no changes observed in the IPSS voiding symptom score. The OABSS showed significant improvement (8.0 to 4.8). No changes were observed in Qmax and PVR. Conclusions. Under the supervision of an experienced urologist, the additional administration of solifenacin to patients with BPO/LUTS treated with tamsulosin, is effective in controlling remaining OAB symptoms.
Overactive bladder syndrome (OAB) is a highly prevalent urinary
dysfunction, with considerable economic and human costs. Clinical diagnosis of OAB is still based on subjective symptoms. A new
accurate, objective and noninvasive test to diagnose OAB and assess therapeutic outcome is lacking. Recent studies in lower
urinary tract (LUT) dysfunctions, particularly in OAB patients, indicate that urinary proteins (neurotrophins, prostaglandins, and
cytokines), serum C reactive protein, and detrusor wall thickness are altered, and such changes could be used as biomarkers of the
disease. Nowadays, increasing emphasis has been given to the role of urinary neurotrophins, namely nerve growth factor (NGF) and
brain derived neurotrophic factor (BDNF), as key players in some urinary dysfunctions. Although recently considered to be a bladder
dysfunction biomarker, urinary NGF presents low sensitivity and specificity. Preliminary results suggest that BDNF may serve as a
more efficient biomarker. Even though we have to wait for future studies to confirm the potential role of NGF and BDNF as OAB
biomarkers, it is already clear that neurotrophins will contribute to elucidate the physiopathological basis of OAB. Herein are
reviewed the latest advances in this new and exciting field, the detection and clinical application of emerging OAB biomarkers.
Lower urinary tract symptoms (LUTS) can have multiple causes in men. Overactive bladder (OAB) is an empirical diagnosis used as the basis for initial management after assessing symptoms, physical findings, urinalysis and other indicated evaluations. In men, the diagnosis is complicated by the potential of benign prostatic hyperplasia (BPH), which is a histological diagnosis. Although storage symptoms (i.e., those associated with OAB) are the most bothersome group of LUTS in men with BPH, these patients are usually treated with BPH rather than OAB drugs. The standard pharmacologic treatment of patients with bothersome voiding and storage LUTS at low risk of progression should be an α1-AR antagonist. The combination α1-AR antagonist + antimuscarinic agent is an appropriate and valid option for male patients with voiding symptoms and persistent storage symptoms.
A number of aspects of neural control are potentially important in the control of bladder function, including both sensory and motor and peripheral and central pathways. It is likely that a combination of disorders of both central and peripheral neural mechanisms is important in the genesis of urgency and the other symptoms of the overactive bladder (OAB). Given the number of potential pathways involved, potential pharmacologic targets for OAB exist in the CNS (central nervous system; cerebral cortex, midbrain, spinal cord) and periphery (LUT; lower urinary tract). Antimuscarinics are still the mainstay of OAB treatment, but there are also a number of other potentially efficacious drugs that may also provide benefit against the neurologic components of OAB. This review discusses the impact of neurological abnormalities on lower urinary tract symptoms and the potential for treatments targeting these pathways to improve symptoms.
The epidemiology of benign prostatic hyperplasia (BPH) and male lower urinary tract symptoms (LUTS) has evolved considerably during the past several years. The term LUTS describes a distinct phenotype and allows for a broad epidemiologic description of urinary symptoms at a population level. Although it is becoming the preferred term for studying urinary symptoms in populations, LUTS remains interconnected with BPH in the literature. The incidence and prevalence of BPH and LUTS are increasing rapidly as the US population ages. BPH and LUTS are associated with serious medical morbidities, an increased risk of falls, depression, diminished health-related quality of life, and billions of dollars in annual health care costs. Although age and genetics play important roles in the etiology of BPH and LUTS, recent insights at the population level have revealed that modifiable risk factors are likely key components as well. Serum dihydrotestosterone, obesity, elevated fasting glucose, diabetes, fat and red meat intake, and inflammation increase the risk; vegetables, regular alcohol consumption, exercise, and NSAIDs decrease the risk.
Benign prostatic hyperplasia; Lower urinary tract symptoms; American Urological Association Symptom Index; BPH; LUTS; Epidemiology; Risk factor; Exercise; Physical activity; Metabolic syndrome; Modifiable; Obesity; Diabetes
Lower urinary tract symptoms (LUTS), which encompass storage, voiding, and postmicturition symptoms, are highly prevalent and recognized globally. Based on a nationwide population-based database, this study tests the hypothesis that medical attendance for LUTS is associated with a subsequent increase in the number of outpatient visits and hospitalizations, with differences among medical specialties and age groups.
Participants were selected from a random population sample of approximately one million people as a representative cohort of National Health Insurance (NHI) enrollees in Taiwan. Participants had at least three outpatient service claims with a coding of LUTS during the recruitment period 2001–2004. Both the LUTS group and non-LUTS control group were monitored for subsequent outpatient visits and hospitalizations, excluding LUTS-related healthcare services, for 2 years following the index date. The results were categorized based on medical specialty and age group.
The outpatient visit rates (no. per person-year) and adjusted incidence rate ratios (IRRs) (95% confidence interval (CI) were significantly higher in urology (4.51, 95%CI 4.15–4.91) and gynecology (1.82, 95%CI 1.76–1.89) for the LUTS group. They were also significantly high in other departments, including internal medicine (1.25), general practice (1.13), Chinese medicine (1.77), family medicine (1.19), surgery (1.38), and psychiatry (1.98). Similarly, the hospitalization rate (no. per 1000 person-year) and adjusted IRRs (95% CI) were significantly higher in urology (5.50, 95% CI = 4.60–6.50) and gynecology (1.60, 95% CI = 1.35–1.90), as well as in internal medicine (1.55) and surgery (1.56), but not in psychiatry (1.12). Furthermore, the IRRs differed among 3 age groups.
A significantly higher number of outpatient visits and hospitalizations were observed for individuals with LUTS, compared to the control group, and the effects differed with the advancement of age. This study broadens understanding of LUTS by viewing their impact on healthcare services with multiple and overlapping systems, rather than considering them exclusively as symptoms of traditional diseases of the bladder and urethra.
To investigate the association between overactive bladder (OAB) and C-reactive protein (CRP) in a population-based sample of men and women.
SUBJECTS AND METHODS
Epidemiological survey of urological symptoms among men and women aged 30–79 years. A multi-stage stratified cluster design was used to randomly sample 5503 adults from the city of Boston. Analyses were conducted on 1898 men and 1854 women with available CRP levels.
The International Continence Society defines OAB as ‘Urgency with or without urge incontinence, usually with frequency and nocturia.’ OAB was defined as: (1) urgency, (2) urgency with frequency, and (3) urgency with frequency and nocturia.
Odds ratios (OR) and 95% confidence intervals (95% CI) of the CRP and OAB association were estimated using logistic regression.
Prevalence of OAB increased with CRP levels in both men and women.
In men, adjusted ORs (95% CI) per log10(CRP) levels were 1.90 (1.26–2.86) with OAB defined as urgency, 1.65 (1.06–2.58) with OAB defined as urgency and frequency, and 1.92 (1.13–3.28) with OAB defined as urgency, frequency and nocturia.
The association was more modest in women with ORs (95% CI) of 1.53 (1.07–2.18) for OAB as defined urgency, 1.51 (1.02–2.23) for OAB defined as urgency and frequency, and 1.34 (0.85–2.12) for OAB defined as urgency, frequency and nocturia.
Results show a consistent association of increasing CRP levels and OAB among both men and women.
These results support our hypothesis for the role of inflammation in the development of OAB and a possible role for anti-inflammatory agents in its treatment.
C-reactive protein; epidemiology; inflammation; overactive bladder
Nocturia is usually considered to be just one of the symptoms included with lower urinary tract symptoms (LUTS) and is treated with therapy based on LUTS. Recent research suggests, however, that nocturia is not merely a simple symptom of LUTS but is a multifactorial condition with many contributing etiological factors. The causes of nocturia can be classified into bladder storage problems, increased urine output, sleep disturbance problems, and other potential diseases. The frequency-volume chart (FVC) is very important in evaluating and diagnosing nocturia. Patients usually record the volume and timing of voids for a period of 1 to 3 days on the FVC. The FVC data can provide information on voiding patterns and clues about the etiology and treatment of nocturia. It is doubtful that alpha-blockers will have clinical significance for treatment because the difference in nocturia episodes between treatment with alpha-blockers and placebo is too small. Antimuscarinics also exert no effect on nocturnal polyuria, and the evidence supporting the efficacy of antimuscarinics for the treatment of nocturia is limited. However, several randomized placebo-controlled trials have shown the efficacy of oral desmopressin in the treatment of adults with nocturia. Short-acting hypnotics may be helpful for patients with sleep disturbances. Although surgical or interventional therapy is not indicated for nocturia, transurethral resection of the prostate appears to confer a greater improvement in benign prostatic hyperplasia symptoms including nocturia. The management of nocturia may require a team approach by making optimal use of multidisciplinary expertise.
Epidemiology; Evaluation; Nocturia; Pathophysiology; Treatment
To examine differences in the prevalence of lower urinary tract symptom (LUTS) among users of five common antihypertensive (AHT) classes compared to non-users, adjusted for LUTS risk factors in a large, representative sample.
Subjects and Methods
Data were from the Boston Area Community Health Survey, a population-based study of community-dwelling male and female (30–79y) residents of Boston, MA for whom prescription drug information was collected (2002–2005). The urologic symptoms of storage, voiding, and nocturia were assessed using interviewer-administered questionnaires and the American Urologic Association Symptom Index. This analysis was conducted among 1,865 participants with an AHT indication. Associations of angiotensin-converting enzyme inhibitors, beta blockers, calcium channel blockers (CCBs), loop and thiazide diuretics with the three groups of LUTS were estimated using odds ratios (ORs) and 95% confidence intervals (CIs) from multivariate logistic regression (referent group=untreated hypertension). Overlap in use was accounted for using monotherapy and combination therapy exposure categories.
Among women, monotherapy with CCBs was associated with increased prevalence of nocturia (OR=2.65, 95% CI: 1.04–6.74) and voiding symptoms (OR=3.84, 95% CI: 1.24–11.87); these results were confined to women aged <55. Among men of all ages, positive associations were observed for thiazides and voiding symptoms (monotherapy OR=2.90, 95% CI: 1.17–7.19), and loop diuretics and nocturia (combination therapy OR=2.55, 95% CI: 1.26–5.14).
Results are consistent with the hypothesis that certain AHTs may aggravate LUTS. The presence of new or worsening LUTS among AHT users suggests review of medications and consideration of a change in AHT class.
urination disorders; antihypertensive agents; epidemiology
The prevalence of lower urinary tract symptoms (LUTS) varies among different populations but the rate of seeking medical advice is consistently low. Little is known about the reasons for this low rate. In the city of Macau, China, primary healthcare is free and easily accessible to all citizens. We aim to study the patients' rate of consulting for LUTS and their reasons for not consulting under a free healthcare system.
A convenience sample of 549 male patients aged 40-85 years in a government health centre filled in the International Prostate Symptoms Scale (IPSS) questionnaire. They were also asked if they had consulted doctors for LUTS, and if not, why not.
Of the whole sample, 64 men (11.7%) had ever consulted doctors for LUTS. Of 145 with moderate to severe LUTS, 35 (24.1%) consulted. Of 73 who were dissatisfied with their quality of life, 22 (30.1%) consulted. Regarding the symptoms as normal or not problematic was the main reason for not consulting. Advancing age and duration of symptoms were the significant factors for consulting.
Primary care doctors could help many of LUTS patients by sensitively initiating the discussion when these patients consult for other problems.
LUTS; IPSS; help-seeking behaviour; primary care; free healthcare
There is evidence for a role of inflammation in the etiology of lower urinary tract symptoms (LUTS), raising the possibility that use of nonsteroidal antiinflammatory drugs (NSAIDs) may inhibit the development or progression of LUTS. The authors examined the association between use of prescription and over-the-counter NSAIDs and LUTS among 1,974 men and 2,661 women in the Boston Area Community Health Survey (2002–2005). Multivariable-adjusted logistic regression was used to estimate odds ratios and 95% confidence intervals for LUTS, voiding symptoms, storage symptoms, and nocturia. There was no clear association between use of prescription or over-the-counter NSAIDs (compared with no NSAID use) and overall LUTS, voiding symptoms, or nocturia in men or women. However, over-the-counter NSAID use was positively associated with storage symptoms in women (odds ratio = 1.37, 95% confidence interval: 1.03, 1.83), and there was a positive association between over-the-counter NSAID use and overall LUTS among women with a history of arthritis (odds ratio = 2.09, 95% confidence interval: 1.20, 3.64). These results do not provide strong support for an association between NSAIDs and LUTS. However, the associations between over-the-counter NSAID use and certain urologic symptoms, particularly among women with arthritis, and the potential mechanisms involved should be evaluated in future studies.
analgesics; anti-inflammatory agents; non-steroidal; cyclooxygenase 2 inhibitors; nocturia; urination disorders
Overactive bladder (OAB), as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. OAB syndrome has an incidence reported from six European countries ranging between 12-17%, while in the United States; a study conducted by the National Overactive Bladder Evaluation program found the incidence at 17%. In Asia, the prevalence of OAB is reported at 53.1%. In about 75%, OAB symptoms are due to idiopathic detrusor activity; neurological disease, bladder outflow obstruction (BOO) intrinsic bladder pathology and other chronic pelvic floor disorders are implicated in the others. OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat.
Antimuscarinics; bladder training; overactive bladder
To estimate the prevalence of post-micturition symptoms (a feeling of incomplete emptying following urination and post-micturition dribble) in a population-based sample of men and women, and to examine overlap with storage and voiding LUTS and associations with health-related quality of life (HRQL).
Patients and methods
Data were obtained by in-person interview in the Boston Area Community Health survey, a population-based random sample of 2301 men and 3202 women aged 30–79 years in the USA.
Lower urinary tract symptoms (LUTS) were defined using the International Prostate Symptom Score and standardized terminology.
Multivariate linear regression was used to evaluate associations between urological symptoms and validated HRQL measures (SF-12 and activities interference) cross-sectionally.
The overall prevalence of post-micturition symptoms was 11.8% in men and 8.5% in women.
The prevalence increased with age in men but not women.
In men, post-void dribbling contributed to much of the post-micturition symptoms, whereas, in women, incomplete emptying was more common.
For both genders, over 50% with voiding symptoms also had post-micturition symptoms, compared to less than 50% of respondents who reported storage symptoms.
The presence of post-micturition symptoms, particularly incomplete emptying, was indicative of mildly impaired physical HRQL and activities interference in men and women, and mental HRQL in men (P < 0.01).
Post-micturition symptoms were more prevalent than any individual voiding symptom and commonly overlapped with other LUTS.
Over half of men and women with a voiding symptom also had a post-micturition symptom.
The presence of post-micturition symptoms was indicative of impaired HRQL.
urological diseases; urination disorders; urinary incontinence; urinary retention; prevalence; post-micturition symptoms; health-related quality of life
To evaluate the association between dietary quality and the prevalence of lower urinary tract symptoms (LUTS).
We used urinary symptom and dietary data obtained from the 2000-2001 National Health and Nutrition Examination Survey (NHANES) for the study. Dietary quality was assessed using the 10-component United States Department of Agriculture (USDA) Healthy Eating Index (HEI). We used bivariate methods to examine rates of LUTS among men with poor versus good diets. Multivariable logistic regression was used to calculate odds ratios after applying sample weights and controlling for age, race/ethnicity, smoking status, diabetes, alcohol intake, and exercise.
Our study cohort consisted of 1385 men aged ≥40 years, of whom 279 (21.1%) reported LUTS. We found higher rates of LUTS among men with poor dietary intake of dairy (22.4% vs 16.4%, P = .013) and among men with poor intake of protein (24.6% vs 17.9%, P = .012) as well as among those with overall poor diet (25.8 vs 17.8%, P = .018) with little dietary variety (26.1 vs 17.6%, P = .001). On multivariate analysis, an unhealthy diet (odds ratios [OR] = 1.7; 95% confidence interval [CI] = 1.05-2.90) was associated with more LUTS, whereas alcohol intake was protective from LUTS (OR = 0.67; 95% CI = 0.48-0.93).
In an analysis of NHANES data, we found that poor diet quality was independently associated with patient-reported LUTS.
The objective of this study is to assess the impact of nocturia on sleep in patients with lower urinary tract symptoms (LUTS)/benign prostatic enlargement (BPE) (nocturia≥2).
798 urologists and general practitioners randomly selected from the overall population of urologists and general practitioners of every French region.
A total of 2179 LUTS/BPE men (aged 67.5±7.5 years old) were recruited.
Primary and secondary outcome measures
Validated patients' self-administered questionnaires were used to assess the severity of LUTS/BPE (the International Prostate Symptom Score), sleep characteristics (sleep log) and sleep disorders (the International Classification of Sleep Disorders (ICSD-2) and the DSM-IV). Sleepiness was assessed with the Epworth Sleepiness Scale (ESS). The volume of 24 h diuresis (1500 ml) was measured.
Participants had on average 2.9±0.9 nocturia episodes (three or more episodes in 67%) and the International Prostate Symptom Score of 15.8±5.7; 60.9% complained of insomnia according to the ICSD-2, 7.9% of restless leg syndrome and 6.4% of obstructive sleep apnoea. 32.3% had excessive sleepiness (ESS >10) and 3.1% severe excessive sleepiness (ESS >16). Insomnia was mainly nocturnal awakenings with an average wake after sleep onset of 89±47 min. The number of episodes of nocturia per night correlated significantly with wake after sleep onset and ESS but not with total sleep time and sleep latency.
Nocturia is significantly associated with sleep maintenance insomnia and sleepiness in men with BPE.
Complaint of nocturia and its links with excessive sleepiness.
Assessment of the impact of nocturia on sleep.
By being disruptive to sleep, the nocturia episodes affected sleep efficiency and quality.
The number of nocturia episodes was associated with an increased sleepiness in men with benign prostatic hyperplasia.
Strengths and limitations of this study
This is a cross-sectional study. It would have been more convincing to compare our subjects to a similar group of older people with no benign prostatic hyperplasia. However, our study focused on the frequency of insomnia and on the correlates between benign prostatic hyperplasia and insomnia.
The objective was to examine the effects of testosterone administration on symptom scores of lower urinary tract symptoms (LUTS).
The literatures on the epidemiological association between the metabolic syndrome, erectile failure and (LUTS) were reviewed.
In men with the metabolic syndrome and erectile failure, often lower-than-normal testosterone levels are found. This is less clear for men with LUTS, but the relationship between testosterone and LUTS might be indirect and based on the association of the metabolic syndrome with an overactivity of autonomic nervous system. This overactivity may play a key role in increasing the severity of LUTS above an intrinsic basal intensity that is determined by the genitourinary factors in aging men. Androgen receptors are present in the epithelium of the urethra and the bladder. Testosterone may play a role in the reflex activity of the autonomic nervous system in the pelvis, or may interact with postsynaptic non-genomic receptors suppressing detrusor activity. Human neurons in the wall of the bladder contain nitric oxide synthase. Similar to the penis, testosterone has an impact on nitric oxide synthase.
Some studies investigating the effects of normalizing testosterone levels in elderly men have found a positive effect on variables of the metabolic syndrome and, simultaneously, on scores of the International Prostate Symptoms Score (IPSS) which is worthy of further investigation in randomized, controlled and sufficiently powered clinical trials.
Lower urinary-tract symptoms; Aging; Testosterone; Phospho-diesterase type 5
To support trials testing lifestyle interventions for lower urinary tract symptoms (LUTS), often a consequence of benign prostatic hyperplasia (BPH), we estimated LUTS incidence and progression rates in US men unselected for BPH.
We studied men in the Health Professionals Follow-up Study who we asked to report periodically by mailed survey whether they had had surgery or used medications for LUTS and to complete the International Prostate Symptom Score (IPSS) survey. For incidence, we included 25,879 men with an IPSS of 0–7 and no surgery history, who were followed 1992–2008. Incident “moderate or worse” LUTS (N=6,058) was defined as IPSS of ≥15, surgery, or medication use. “Modest or worse” LUTS was similarly defined but with IPSS≥8 (N=11,352). For progression, we included 9,628 men with an IPSS of 8–14 and no surgery, who were followed from when they first reported an IPSS of 8–14 to 2008. Progression to “severe” LUTS (N=2,557) was defined as IPSS of ≥20, surgery, or medication use. We estimated age-specific and age-standardized rates.
Incidence and progression rates increased with age (P-trend<0.0001); progression rates were higher than incidence rates. The age-standardized rates were: incidence of moderate to worse LUTS 18.5; incidence of modest to worse LUTS 40.5; and progression to severe LUTS 44.9 per 1,000 man-years.
LUTS incidence and progression rates are high and rise steeply as men age. These rates may be used for planning adequately powered trials to test lifestyle interventions for LUTS well before surgical or pharmacologic treatment is indicated.
Lower urinary tract symptoms; incidence; progression; men
Whether lower urinary tract symptoms (LUTS), including voiding, storage, and urinary incontinence, are affected by dietary micronutrients is uncertain.
To test the hypothesis that carotenoid, vitamin C, zinc, and calcium intakes are associated with LUTS and urinary incontinence in women.
Design, setting, and participants
During an observational, cross-sectional, population-based epidemiologic study of 2060 women (30–79 yr of age) in the Boston Area Community Health (BACH) survey (2002–2005), data were collected by validated food frequency questionnaire and in-person interviews and analyzed using multivariate regression.
LUTS, storage, and voiding symptoms were assessed using the American Urological Association Symptom Index (AUASI) and a validated severity index for urinary incontinence.
Results and limitations
Women who consumed high-dose vitamin C from diet and supplements were more likely to report storage symptoms, especially combined frequency and urgency (>500 vs <50 mg/d; odds ratio [OR]: 3.42; 95% confidence interval [CI], 1.44–8.12). However, greater consumption of dietary vitamin C or β-cryptoxanthin was inversely associated with voiding symptoms (ptrend < 0.01). Both dietary and supplemental calcium were positively associated with storage symptoms (eg, supplement >1000 mg/d vs none; OR: 2.04; 95% CI, 1.35–3.09; ptrend = 0.0002). No consistent associations were observed for β-carotene, lycopene, or other carotenoids, although smokers using β-carotene supplements were more likely to report storage problems. Whether the observed associations represent direct causes of diet on LUTS is uncertain.
High-dose intakes of vitamin C and calcium were positively associated with urinary storage or incontinence, whereas vitamin C and β-cryptoxanthin from foods and beverages were inversely associated with voiding symptoms. Results indicate that micronutrient intakes may contribute to LUTS in dose-dependent and symptom-specific ways. Further study is needed to confirm these findings and their relevance to clinical treatment decisions.
Ascorbic acid; Calcium; dietary; Carotenoids; Diet; Micronutrients; Nutrition; Lower urinary tract symptoms; Urinary bladder; overactive; Urinary incontinence; Urination disorders; Zinc
To examine associations between macronutrient and total energy intakes with lower urinary tract symptoms (LUTS) in women.
Cross-sectional analysis of 2,060 women aged 30–79 years in the population-based Boston Area Community Health Survey (2002–2005). Data were collected by validated food frequency questionnaire and in-person interviews. Outcomes for multivariate logistic regression were moderate-to-severe total LUTS, storage, voiding, and post-micturition symptoms.
Greater total energy intake was positively associated with LUTS, specifically among women with lower waist circumferences (<76 cm, P=0.005, pinteraction=0.01). Increased saturated fat intake was associated with post-micturition symptoms (Quintile 5 vs. 1, OR 3.94, 95% CI 1.57, 9.89, ptrend =0.04). High protein intake was positively associated with storage symptoms (ptrend =0.03), particularly nocturia. No consistent associations were observed for carbohydrate, monounsaturated or polyunsaturated fat intakes.
Among women with low waist circumferences, high total daily calorie intake was associated with moderate-to-severe LUTS. While greater saturated fat intake was linked to post-micturition symptoms, the possibility that post-micturition symptoms in women represent more extensive or severe conditions should be explored in future research. These novel results indicate that dietary contributors to LUTS in women are distinct from those in men and may depend on symptom subtype and body size.
Diet; Energy intake; Nutrition; Urination disorders; Lower urinary tract symptoms; Urinary tract; Fatty acids; saturated; Dietary fats; Dietary proteins
The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population.
Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation.
Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009).
Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.
Background: The micturition reflex is under the tonic influence of suprapontine structures including the anteromedial frontal cortex, basal ganglia, and hypothalamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans.
Objective: To investigate LUT function in patients with pituitary adenomas.
Methods: Urodynamic studies were carried out in three patients with LUT symptoms who had pituitary adenomas extending upwards to the hypothalamus.
Results: All three male patients (age 28 to 62 years) developed LUT symptoms (urinary urgency and frequency (3); urinary incontinence (3); voiding difficulty and retention (2)) along with weight loss, psychiatric symptoms, unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate secretion of antidiuretic hormone, but none had diabetes insipidus. Two had resection of the tumour and subsequent radiation therapy, but LUT dysfunction persisted. The third patient had partial resection of the tumour to ameliorate hydrocephalus. Urodynamic studies showed detrusor overactivity during the storage phase in all patients; during the voiding phase there was underactive detrusor in two and non-relaxing sphincter in one.
Conclusions: Hypothalamic lesions can cause severe LUT dysfunction in both the storage and voiding phases of micturition. This may reflect the crucial role of the hypothalamus in regulating micturition in humans.
Lower urinary tract dysfunction is a major cause of morbidity and decreased
quality of life in older men. Most urinary dysfunctions in the elderly are
multifactorial in origin and associated with a broad spectrum of mental and
physical conditions. In this population, it is essential to have a comprehensive
assessment of the lower urinary tract, functional impairments and concurrent
medical diseases. A holistic and individualized approach to management is
important. Urodynamic studies (UDS) are objective tests which provide a major
contribution to our understanding of the pathophysiology of lower urinary tract
symptoms (LUTS). Urodynamic findings in older men may include common diagnoses
such as bladder outlet obstruction and urinary incontinence. However, coexisting
conditions such as detrusor overactivity and impaired detrusor contractility are
common in older men. The identification of these conditions is necessary to
appropriately counsel patients regarding treatment options. Simple urodynamic
tests should be used whenever possible such as uroflowmetry and residual volume
estimation. However, in complicated cases more invasive tests such as pressure
flow studies are important to help choose the best treatment.
urodynamic studies; older men; lower urinary tract symptoms