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Xu Z, Elrashidy RA, Li B, Liu G. Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases. Front Med (Lausanne) 2022; 9:812967. [PMID: 35360727 PMCID: PMC8960172 DOI: 10.3389/fmed.2022.812967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Aging and major chronic diseases are risk factors for lower urinary tract symptoms (LUTS). On the other hand, oxidative stress (OS) is one of the fundamental mechanisms of aging and the development of chronic diseases. Therefore, OS might be a candidate mechanism linking these two clinical entities. This article aims to summarize the studies on the prevalence of LUTS, the role of OS in aging and chronic diseases, and the potential mechanisms supporting the putative link. A comprehensive literature search was performed to identify recent reports investigating LUTS and OS in major chronic diseases. In addition, studies on the impact of OS on the lower urinary tract, including bladder, urethra, and prostate, were collected and summarized. Many studies showed LUTS are prevalent in aging and major chronic diseases, including obesity, metabolic syndrome, diabetes, cardiovascular disease, hypertension, obstructive sleep apnea, autoimmune diseases, Alzheimer’s disease, and Parkinson’s disease. At the same time, OS is a key component in the pathogenesis of those chronic diseases and conditions. Recent studies also provided evidence that exacerbated OS can cause functional and/or structural changes in the bladder, urethra, and prostate, leading to LUTS. The reviewed data support the concept that OS is involved in multiple risk factors-associated LUTS, although further studies are needed to confirm the causative relationship. The specific ROS/RNS and corresponding reactions/pathways involved in chronic diseases and associated LUTS should be identified in the future and could serve as therapeutic targets.
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Affiliation(s)
- Zhenqun Xu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Rania A. Elrashidy
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Bo Li
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- *Correspondence: Guiming Liu,
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Faure Walker N, Gall R, Gall N, Feuer J, Harvey H, Taylor C. The Postural Tachycardia Syndrome (PoTS) Bladder-Urodynamic Findings. Urology 2021; 153:107-112. [PMID: 33676954 DOI: 10.1016/j.urology.2021.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the urodynamics (UDS) of patients with postural tachycardia syndrome (PoTS). METHODS Patients with a confirmed diagnosis of PoTS referred by the department of neuro-cardiology to the neuro-urology were identified and their UDS were retrospectively reviewed. RESULTS In total, 50 patients (47 = 94.0% female) with confirmed PoTS and available UDS were identified. Mean age of females and males was 32.4 and 28.2 years, P = .15. Intermittent self-catheterisation was being used by 15/47 (31.9%) females at assessment. Detrusor overactivity was observed in 6 females (12.8%) (all at end fill and associated with urgency). In total, 14 (29.8%) females had no sensation of filling. No patients had an "unsafe" bladder. In total, 15/47 (31.9%) of women were unable to void with UDS catheters. Straining was reported in 22/35 (68.8%) of females. The female bladder outflow obstruction index = PDetQmax - 2.2(Qmax) was over 5 in 10/28 (35.7%) and over 18 in 5 (17.9%). The bladder contractility index = PDetQmax + 5Qmax was under 100 in 18/28 (28.6%) women. CONCLUSION The UDS of patients with "PoTS bladder" often demonstrate a poorly sensate but stable and safe bladder with functional obstruction and impaired bladder contractility that may necessitate straining or intermittent self-catheterisation.
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Affiliation(s)
| | - Robert Gall
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Nicholas Gall
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jane Feuer
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Hannah Harvey
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Claire Taylor
- King's College Hospital NHS Foundation Trust, London, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
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The Pharmacological Mechanism of Diabetes Mellitus-Associated Overactive Bladder and Its Treatment with Botulinum Toxin A. Toxins (Basel) 2020; 12:toxins12030186. [PMID: 32188046 PMCID: PMC7150832 DOI: 10.3390/toxins12030186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/15/2020] [Indexed: 12/29/2022] Open
Abstract
Diabetes mellitus (DM) is an independent risk factor for overactive bladder (OAB). The pathophysiology of DM-associated OAB is multifactorial and time-dependent. Diabetic bladder dysfunction is highly associated with diabetic complications, mainly including diabetic neuropathy and atherosclerosis. Chronic systemic inflammation and bladder urothelial inflammation may contribute to the onset of OAB. Intravesical botulinum toxin A (BoNT-A) injection has proved to be a successful treatment for idiopathic and neurogenic OAB. BoNT-A can inhibit the efferent pathways of the bladder as well as the chronic inflammation and hypersensitivity via the afferent pathways. We conducted a review of the published literature in Pubmed using a combination of two keywords, namely “botulinum toxin A” (BoNT-A) and “overactive bladder”, with or without the additional keywords “detrusor overactivity”, “diabetes mellitus”, “inflammation”, and “urodynamic study”. We also reviewed the experience of our research teams, who have published several studies of the association between DM and OAB. Since limited data support the effectiveness and safety of BoNT-A for treating patients with DM-associated OAB, a comprehensive evaluation of diabetic complications and urodynamic study is needed before treatment. In the future, it is imperative to explore the clinical characteristics and inflammatory biomarkers of diabetes as determining predictors of the treatment efficacy.
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Majima T, Matsukawa Y, Funahashi Y, Takai S, Kato M, Yamamoto T, Gotoh M. Urodynamic analysis of the impact of diabetes mellitus on bladder function. Int J Urol 2019; 26:618-622. [PMID: 30887604 DOI: 10.1111/iju.13935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyze sequential changes of diabetic cystopathy based on urodynamic data in patients with diabetes mellitus. METHODS Participants included male diabetes patients who underwent a pressure flow study at Nagoya University Graduate School of Medicine, Nagoya, Japan, from April 2005 to October 2016. Patients with a previous history of lower urinary tract dysfunction were excluded. Bladder dysfunction was categorized into four urodynamic patterns: (i) normal; (ii) detrusor overactivity with normal detrusor contractility; (iii) detrusor hyperreflexia/impaired contractility; and (iv) detrusor underactivity. The urodynamic patterns were evaluated according to the presence of diabetic retinopathy and nephropathy, which was correlated to diabetes mellitus duration. Furthermore, the association of clinical factors with voiding function, as well as sensory function, was investigated. RESULTS A total of 57 patients were enrolled. Detrusor overactivity with normal detrusor contractility patterns was seen only in cases with neither diabetic retinopathy nor diabetic nephropathy, whereas the prevalence of detrusor hyperreflexia/impaired contractility pattern was highest in cases with diabetic retinopathy. Detrusor underactivity pattern was found with the highest frequency in cases with both diabetic retinopathy and diabetic nephropathy. On multivariate analysis, the existence of diabetic retinopathy was only significantly correlated with bladder contractility index. Furthermore, multivariate analysis showed that first desire volume and maximum cystometric capacity were significantly positively correlated with post-void residual urine volume, and also negatively correlated with voiding efficiency independent of bladder contractility index. CONCLUSIONS Diabetes patients have diverse progressive bladder dysfunction according to the diabetes stage. An optimal screening program is necessary to detect and manage diabetic cystopathy at an early stage.
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Affiliation(s)
- Tsuyoshi Majima
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhito Funahashi
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shun Takai
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tokunori Yamamoto
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Daneshgari F, Liu G, Hanna-Mitchell AT. Path of translational discovery of urological complications of obesity and diabetes. Am J Physiol Renal Physiol 2017; 312:F887-F896. [PMID: 28052873 DOI: 10.1152/ajprenal.00489.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/15/2016] [Accepted: 01/01/2017] [Indexed: 01/07/2023] Open
Abstract
Diabetes mellitus (DM) is a prevalent chronic disease. Type 1 DM (T1DM) is a metabolic disorder that is characterized by hyperglycemia in the context of absolute lack of insulin, whereas type 2 DM (T2DM) is due to insulin resistance-related relative insulin deficiency. In comparison with T1DM, T2DM is more complex. The natural history of T2DM in most patients typically involves a course of obesity to impaired glucose tolerance, to insulin resistance, to hyperinsulinemia, to hyperglycemia, and finally to insulin deficiency. Obesity is a risk factor of T2DM. Diabetes causes some serious microvascular and macrovascular complications, such as retinopathy, nephropathy, neuropathy, angiopathy and stroke. Urological complications of obesity and diabetes (UCOD) affect quality of life, but are not well investigated. The urological complications in T1DM and T2DM are different. In addition, obesity itself affects the lower urinary tract. The aim of this perspective is to review the available data, combined with the experience of our research teams, who have spent a good part of last decade on studies of association between DM and lower urinary tract symptoms (LUTS) with the aim of bringing more focus to the future scientific exploration of UCOD. We focus on the most commonly seen urological complications, urinary incontinence, bladder dysfunction, and LUTS, in obesity and diabetes. Knowledge of these associations will lead to a better understanding of the pathophysiology underlying UCOD and hopefully assist urologists in the clinical management of obese or diabetic patients with LUTS.
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Affiliation(s)
- Firouz Daneshgari
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Ann T Hanna-Mitchell
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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Furukawa S, Sakai T, Niiya T, Miyaoka H, Miyake T, Yamamoto S, Kanzaki S, Maruyama K, Tanaka K, Ueda T, Senba H, Torisu M, Minami H, Onji M, Tanigawa T, Matsuura B, Hiasa Y, Miyake Y. Macrovascular Complications and Prevalence of Urgency Incontinence in Japanese Patients with Type 2 Diabetes Mellitus: The Dogo Study. Intern Med 2017; 56:889-893. [PMID: 28420835 PMCID: PMC5465403 DOI: 10.2169/internalmedicine.56.8063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective Macrovascular diseases and urgency incontinence are common among Japanese patients with type 2 diabetes mellitus. However, little evidence exists regarding the association between stroke and urgency incontinence among patients with type 2 diabetes mellitus. We examined the associations between macrovascular complications and urgency incontinence among Japanese patients with type 2 diabetes mellitus. Methods The study subjects were 818 Japanese patients with type 2 diabetes mellitus. Urgency incontinence was defined as present when a subject answered "once a week or more" to the question: "Within one week, how often do you leak urine because you cannot defer the sudden desire to urinate?" We adjusted our analyses for sex, age, body mass index, duration of type 2 diabetes, current smoking, current drinking, hypertension, dyslipidemia, glycated hemoglobin, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy. Results The prevalence of urgency incontinence was 9.2%. Stroke was independently positively associated with urgency incontinence, with an adjusted odds ratio of 2.34 (95% confidence interval: 1.03-4.95). The associations between ischemic heart disease or peripheral artery disease and the prevalence of urgency incontinence were not significant. Conclusion In Japanese patients with type 2 diabetes mellitus, stroke, but not ischemic heart diseases or peripheral artery disease, was independently positively associated with urgency incontinence.
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Affiliation(s)
- Shinya Furukawa
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Japan
- Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Japan
| | - Takenori Sakai
- Department of Internal Medicine, Yawatahama General City Hospital, Japan
| | - Tetsuji Niiya
- Department of Internal Medicine, Matsuyama Shimin Hospital, Japan
| | - Hiroaki Miyaoka
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Japan
| | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Shin Yamamoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Sayaka Kanzaki
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Koutatsu Maruyama
- Department of Public Health, Juntendo University School of Medicine, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Japan
- Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Japan
| | - Teruhisa Ueda
- Department of Internal Medicine, Ehime Prefectural Central Hospital, Japan
| | - Hidenori Senba
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Japan
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Masamoto Torisu
- Department of Internal Medicine, Saiseikai Saijo Hospital, Japan
| | - Hisaka Minami
- Department of Internal Medicine, Ehime Niihama Hospital, Japan
| | - Morikazu Onji
- Department of Internal Medicine, Saiseikai Imabari Hospital, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University School of Medicine, Japan
| | - Bunzo Matsuura
- Department of Lifestyle-related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Japan
- Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Japan
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Association Between Overactive Bladder and Polyneuropathy in Diabetic Patients. Int Neurourol J 2016; 20:232-239. [PMID: 27706007 PMCID: PMC5083825 DOI: 10.5213/inj.1632508.254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/16/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose Diabetes mellitus (DM) is a chronic metabolic disorder that often leads to complications. We aimed to correlate two complications of DM, polyneuropathy and hyperactive bladder syndrome, using noninvasive measures, such as screening tests. Methods We included 80 female and 40 male type 2 diabetic patients in this prospective study. Diabetic polyneuropathy evaluations were conducted using the Douleur Neuropathique 4 Questions (DN4), and overactive bladder (OAB) evaluations were performed using the Overactive Bladder Questionnaire (OAB-V8). The patients were also evaluated for retinopathy and nephropathy. The diabetic male and female patients with or without OAB were chosen and compared for microvascular complications (polyneuropathy, retinopathy, and nephropathy). Results There were no significant correlations between OAB and retinopathy as well as between OAB and nephropathy among diabetic patients (female patients, P>0.05; male patients, P>0.05). However, the patients with OAB were significantly more likely to develop polyneuropathy (female patients, P<0.05; male patients, P<0.05). Conclusions In diabetic patients, OAB and diabetic peripheral neuropathy are significantly correlated. These correlations were demonstrated using short, understandable, valid, and reliable disease-specific tests without invasive measures. Using these screening tests, both neurologists and urologists can easily diagnose these complications.
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Wu L, Zhang X, Xiao N, Huang Y, Kavran M, Elrashidy RA, Wang M, Daneshgari F, Liu G. Functional and morphological alterations of the urinary bladder in type 2 diabetic FVB(db/db) mice. J Diabetes Complications 2016; 30:778-85. [PMID: 27037041 PMCID: PMC4912852 DOI: 10.1016/j.jdiacomp.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
AIMS Diabetic bladder dysfunction (DBD) has been extensively studied in animal models of type 1 diabetes. We aimed to examine the functional and morphological alterations of the urinary bladder in a type 2 diabetes model, FVB(db/db) mice. METHODS FVB(db/db) mice and age-matched FVB/NJ control mice were tested at either 12, 24 or 52weeks of age. Body weight, blood glucose and glycated hemoglobin (HbA1c) levels were measured. Bladder function was assessed by measurement of 24-h urination behavior and conscious cystometry. Bladder was harvested for Masson's Trichrome staining and morphometric analysis. RESULTS The body weights of FVB(db/db) mice were twice as those of FVB/NJ control mice. The blood glucose and HbA1c levels were higher in FVB(db/db) mice at 12 and 24weeks, but not at 52weeks. A significant increase in the mean volume per void, but decrease in the voiding frequency, in FVB(db/db) mice was observed. Cystometry evaluation showed increased bladder capacity, voided volume, and peak micturition pressure in FVB(db/db) mice compared with FVB/NJ mice. Morphometric analysis revealed a significant increase in the areas of detrusor muscle and urothelium in FVB(db/db) mice. In addition, some FVB(db/db) mice, especially males at 12 and 24weeks, showed small-volume voiding during 24-h urination behavior measurement, and detrusor overactivity in the cystometry measurement. CONCLUSIONS The FVB(db/db) mouse, displaying DBD characterized by not only increased bladder capacity, void volume, and micturition pressure, but also bladder overactivity, is a useful model to further investigate the mechanisms of type 2 diabetes-related bladder dysfunction.
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Affiliation(s)
- Liyang Wu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PRC
| | - Xiaodong Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PRC
| | - Nan Xiao
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Lanzhou University Second Hospital, Lanzhou, PRC
| | - Yexiang Huang
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, The First Affiliated Hospital, China Medical University, Shenyang, PRC
| | - Michael Kavran
- Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rania A Elrashidy
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Mingshuai Wang
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PRC
| | - Firouz Daneshgari
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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Lu SY, Yang CM, Fan YH, Lin ATL, Chen KK. Intravesical prostatic protrusion correlates well with storage symptoms in elderly male patients with non-neurogenic overactive bladder. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2015.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Futyma K, Nowakowski Ł, Bogusiewicz M, Ziętek A, Wieczorek AP, Rechberger T. Use of uroflow parameters in diagnosing an overactive bladder-Back to the drawing board. Neurourol Urodyn 2015; 36:198-202. [PMID: 26451870 DOI: 10.1002/nau.22898] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/15/2015] [Indexed: 02/03/2023]
Abstract
AIMS The aim of our study was to analyze whether uroflowmetry parameters are helpful in diagnosing overactive bladder (OAB). The working hypothesis was that the flow curves of patients with OAB symptoms would appear as a sharp peak flow rate with a short duration and high amplitude, lasting only for a short period during urgency sensation, followed by reduced urine flow. We introduced a new parameter called flow index (FI) defined as an average divided by maximal urine flow rates as a potential marker for diagnosing OAB. METHODS We conducted a retrospective study analyzing 757 urodynamic studies performed in women with lower urinary tract symptoms between 2007-2014. Based on subjective clinical symptoms patients were divided into four groups (pure OAB, mixed urinary incontinence with predominant OAB [MUI-OAB], mixed urinary incontinence with predominant SUI [MUI-SUI], and pure SUI patients). RESULTS When comparing FI between pure OAB and pure SUI patients, a strong statistically significant difference was found (mean 0.45 ± 0.08 vs. 0.53 ± 0.09, respectively; P < 0.001). Similar results were found when comparing the patients with pure OAB and MUI-OAB versus patients with pure SUI and MUI-SUI (mean 0.47 ± 0.11 vs. 0.53 ± 0.09, respectively; P < 0.001). On the other hand, we did not find a statistically significant difference in the FI value between mixed urinary incontinence where SUI is the predominant factor and pure SUI groups (median 0.51 ± 0.09 vs. 0.53 ± 0.09, respectively; P > 0.5). CONCLUSIONS FI may be used as an additional marker for OAB diagnosis. Neurourol. Urodynam. 36:198-202, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Konrad Futyma
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Łukasz Nowakowski
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Michał Bogusiewicz
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Alicja Ziętek
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Andrzej P Wieczorek
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Rechberger
- 2nd Department of Gynecology, Medical University of Lublin, Lublin, Poland
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Abstract
Several physiopathologic conditions lead to the manifestation of overactive bladder (OAB). These conditions include ageing, diabetes mellitus, bladder outlet obstruction, spinal cord injury, stroke and brain injury, Parkinson's disease, multiple sclerosis, interstitial cystitis, stress and depression. This review has discussed research findings in human and animal studies conducted on the above conditions. Several structural and functional changes under these conditions have not only been observed in the lower urinary tract, but also in the brain and spinal cord. Significant changes were observed in the following areas: neurotransmitters, prostaglandins, nerve growth factor, Rho-kinase, interstitial cells of Cajal, and ion and transient receptor potential channels. Interestingly, alterations in these areas showed great variation in each of the conditions of the OAB, suggesting that the pathophysiology of the OAB might be different in each condition of the disease. It is anticipated that this review will be helpful for further research on new and specific drug development against OAB.
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Affiliation(s)
- Phani B Patra
- King of Prussia, Drexel University College of Medicine, Philadelphia, Pa., USA
| | - Sayani Patra
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pa., USA
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Karoli R, Bhat S, Fatima J, Priya S. A study of bladder dysfunction in women with type 2 diabetes mellitus. Indian J Endocrinol Metab 2014; 18:552-557. [PMID: 25143916 PMCID: PMC4138915 DOI: 10.4103/2230-8210.137518] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Diabetes mellitus has been associated with an earlier onset and increased severity of urologic diseases that often result in debilitating urologic complications. Diabetic bladder dysfunction refers to a group of bladder symptoms occurring in patients with diabetes mellitus ranging from bladder over activity to impaired bladder contractility. AIM Bladder dysfunction is an under evaluated issue in women with diabetes. Aim of our study was to investigate prevalence of bladder dysfunction and its relation with other chronic complications of diabetes in women with type 2 diabetes. MATERIALS AND METHODS In a hospital-based cross sectional study, a cohort of women with type 2 diabetes mellitus who had lower urinary tract symptoms (LUTS) were enrolled. We used the American Urological Association Symptom Index (AUA-SI) to assess the severity of LUTS and the Indevus Urgency Severity Scale (IUSS) to assess presence of overactive bladder (OAB). Age-BMI- matched controls that did not have diabetes but had lower urinary tract symptoms were also studied and compared with women with type 2 diabetes. Urodynamic evaluation was done in willing patients. RESULTS LUTS attributable to bladder dysfunction were reported in 67% of women with type 2 diabetes after exclusion of other causes. Out of them, 36% had moderate to severe LUTS (total AUA-SI score >7). Prevalence of OAB was 53%. Urodynamic evaluation revealed presence of stress urinary incontinence in 48% patients and changes of detrusor over activity and detrusor under activity in 23% and 11% patients, respectively. Among the chronic complications of diabetes, peripheral neuropathy, nephropathy, and presence of metabolic syndrome were significantly associated with moderate to severe LUTS and OAB. CONCLUSION Bladder dysfunction is a highly prevalent complication in women with diabetes. Chronic complications of diabetes especially neuropathy, nephropathy, and presence of metabolic syndrome are important predictors of bladder dysfunction.
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Affiliation(s)
- Ritu Karoli
- Department of Medicine, Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
| | - Sanjay Bhat
- Department of Surgery (Urology), Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
| | - Jalees Fatima
- Department of Medicine, Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
| | - S. Priya
- Department of Medicine, Era's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
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Lee WC, Wu HC, Huang KH, Wu HP, Yu HJ, Wu CC. Hyposensitivity of C-fiber afferents at the distal extremities as an indicator of early stages diabetic bladder dysfunction in type 2 diabetic women. PLoS One 2014; 9:e86463. [PMID: 24466107 PMCID: PMC3900526 DOI: 10.1371/journal.pone.0086463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/10/2013] [Indexed: 12/01/2022] Open
Abstract
Purpose To investigate the relationship between distal symmetric peripheral neuropathy and early stages of autonomic bladder dysfunction in type 2 diabetic women. Materials and Methods A total of 137 diabetic women with minimal coexisting confounders of voiding dysfunction followed at a diabetes clinic were subject to the following evaluations: current perception threshold (CPT) tests on myelinated and unmyelinated nerves at the big toe for peroneal nerve and middle finger for median nerve, uroflowmetry, post-void residual urine volume, and overactive bladder (OAB) symptom score questionnaire. Patients presenting with voiding difficulty also underwent urodynamic studies and intravesical CPT tests. Results Based on the OAB symptom score and urodynamic studies, 19% of diabetic women had the OAB syndrome while 24.8% had unrecognized urodynamic bladder dysfunction (UBD). The OAB group had a significantly greater mean 5 Hz CPT test value at the big toe by comparison to those without OAB. When compared to diabetic women without UBD, those with UBD showed greater mean 5 Hz CPT test values at the middle finger and big toe. The diabetic women categorized as C-fiber hyposensitivity at the middle finger or big toe by using CPT test also had higher odds ratios of UBD. Among diabetic women with UBD, the 5 Hz CPT test values at the big toe and middle finger were significantly associated with intravesical 5 Hz CPT test values. Conclusions Using electrophysiological evidence, our study revealed that hyposensitivity of unmyelinated C fiber afferents at the distal extremities is an indicator of early stages diabetic bladder dysfunction in type 2 diabetic women. The C fiber dysfunction at the distal extremities seems concurrent with vesical C-fiber neuropathy and may be a sentinel for developing early diabetic bladder dysfunction among female patients.
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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
- Graduate Institution of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Ching Wu
- Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Huey-Peir Wu
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Jeng Yu
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Chia-Ching Wu
- Department of International Business, College of Commerce and Management, Cheng Shiu University, Kaohsiung, Taiwan
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Overactive bladder in diabetes mellitus patients: a questionnaire-based observational investigation. World J Urol 2013; 32:1021-5. [DOI: 10.1007/s00345-013-1175-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 09/24/2013] [Indexed: 10/26/2022] Open
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15
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Al Taweel W. Contemporary Evaluation and Management of Diabetic Cystopathy. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Chen YC, Kuo HC. Clinical and video urodynamic characteristics of adult women with dysfunctional voiding. J Formos Med Assoc 2012; 113:161-5. [PMID: 24630033 DOI: 10.1016/j.jfma.2012.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE Dysfunctional voiding (DV) is an abnormality of bladder emptying in neurologically normal individuals where the external sphincter activity increases during voiding. This study investigated the clinical presentations and videourodynamic characteristics of adult women with DV. METHODS A total of 1605 women with lower urinary tract symptoms (LUTS) were investigated with videourodynamic (VUD) studies from 1997 to 2010. The clinical urinary symptoms and VUD characteristics of DV were compared with a group of urodynamically normal controls. Antimuscarinic or alpha-blocker treatment according to the chief complaint of storage or voiding LUTS was respectively given. RESULTS There were 168 women diagnosed with DV. Detrusor overactivity (DO) occurred in 69% of women with DV. Patients with DV had significantly lower cystometric bladder capacity, higher detrusor pressure, lower maximum flow rate, and larger post-void residual volume than the controls. A total of 114 (67.9%) patients had storage symptoms and 54 (32.1%) had voiding symptoms as their chief complaints among those with DV. Among them, urinary frequency (n = 69, 41.1%) was the most common chief complaint, followed by dysuria (n = 53, 32.1%), and urgency incontinence (n = 26, 15.5%). The incidence of urgency incontinence and dysuria were significantly greater than that in the control group, however, the incidence of frequency, urgency, or nocturia showed no significant difference between DV and control groups. The success rates were 41.2% (n = 47) for antimuscarinic therapy and 51.9% (n = 28) for alpha-blocker therapy in patients with storage and voiding LUTS, respectively (p = 0.366). CONCLUSION DO and storage LUTS commonly occurred in women with DV, suggesting DO could be one of the etiology in the pathophysiology of DV. VUD studies yielded a high diagnostic rate for DV in women with LUTS.
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Affiliation(s)
- Yih-Chou Chen
- Department of Urology, Hualien General Hospital, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
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Gomez CS, Kanagarajah P, Gousse AE. Bladder dysfunction in patients with diabetes. Curr Urol Rep 2012; 12:419-26. [PMID: 21894526 DOI: 10.1007/s11934-011-0214-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With diabetes mellitus (DM) reaching epidemic proportions, the identification of voiding dysfunction as a common and burdensome complication of this disease is critical. Research into diabetic voiding dysfunction significantly lags behind other complications of DM, such as retinopathy and nephropathy. Recent studies have revealed that DM predisposes patients to a wide range of lower urinary tract dysfunction, from the classic diabetic cystopathy of incomplete emptying to urgency incontinence. In this review, we discuss the current concepts of diabetic voiding dysfunction with a critical analysis of the available evidence.
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Affiliation(s)
- Christopher S Gomez
- Bladder Health and Reconstructive Urology Institute, Memorial Hospital Miramar, 1951 Southwest 172nd Avenue, Suite #408, Miramar, FL 33029, USA
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Ho CH, Chang TC, Guo YJ, Chen SC, Yu HJ, Huang KH. Lower urinary tract symptoms and urinary flow rates in female patients with hyperthyroidism. Urology 2011; 77:50-4. [PMID: 21195824 DOI: 10.1016/j.urology.2010.07.479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/14/2010] [Accepted: 07/19/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate lower urinary tract symptoms (LUTS) and voiding function in a cohort of hyperthyroid women. The autonomic nervous system (ANS) imbalance has been thought to cause LUTS in hyperthyroidism. METHODS Between January 2008 and December 2008, 65 newly diagnosed, untreated female hyperthyroid patients were enrolled in this study. Another 62 age-matched healthy women were enrolled as a control group. Demographics, LUTS, urinary flow rates, hyperthyroid symptoms, and serum levels of thyroid hormones were recorded before and after the medical treatment for hyperthyroidism. RESULTS Compared with the control group, the hyperthyroid patients had a higher mean symptom score of frequency (1.15 ± 1.75 vs 0.31 ± 1.05, P = .01), incomplete emptying (0.91 ± 1.47 vs 0.29 ± 1.12, P = .02), straining (1.05 ± 0.85 vs 0.27 ± 0.51, P <.01), voiding symptoms (3.05 ± 3.28 vs 1.06 ± 2.63, P <.01), and total symptoms (5.88 ± 6.17 vs 2.76 ± 4.65, P <.01). Fifty-three (81.5%) of them had an IPSS of <8, while only 12 (18.5%) had an International Prostate Symptom Score (IPSS) of ≥8. Hyperthyroid women demonstrated a lower mean peak flow rate (25.0 ± 5.3 vs 28.6 ± 6.1 mL/s, P = .02). After treatment, both LUTS and flow rates improved significantly. The severity of LUTS was associated with neither serum levels of thyroid hormone nor other hyperthyroid symptoms. CONCLUSIONS Hyperthyroid women have worse LUTS and lower peak flow rates than healthy controls. However, the severity of LUTS is only mild (IPSS <8) in the majority, and only 18.5% have moderate-to-severe LUTS. Both LUTS and flow rates improve after the treatment for hyperthyroidism. The exact mechanisms of LUTS and/or lower urinary tract dysfunction in hyperthyroidism require further investigation.
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Affiliation(s)
- Chen-Hsun Ho
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Golbidi S, Laher I. Bladder dysfunction in diabetes mellitus. Front Pharmacol 2010; 1:136. [PMID: 21833175 PMCID: PMC3153010 DOI: 10.3389/fphar.2010.00136] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 10/29/2010] [Indexed: 12/15/2022] Open
Abstract
Diabetic cystopathy is a well-recognized complication of diabetes mellitus, which usually develops in middle-aged or elderly patients with long-standing and poorly controlled disease. It may have broad spectrum clinical presentations. Patients may be asymptomatic, or have a wide variety of voiding complaints from overactive bladder and urge incontinence to decreased bladder sensation and overflow incontinence. This review focuses on pathophysiological mechanisms responsible for urologic complications of diabetes and emphasizing on recent developments in our understanding of this condition. We also tried to shed some light on therapeutic modalities like behavioral, pharmacological, and surgical approaches.
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Affiliation(s)
- Saeid Golbidi
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
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