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Yoneyama F, Okamoto T, Tamura Y, Ishii N, Togashi K, Soma O, Fujita N, Yamamoto H, Hatakeyama S, Kobayashi W, Ohyama C. Association between oral frailty and lower urinary tract symptoms among middle-aged and older adults in community-dwelling individuals: a cross-sectional study. Int Urol Nephrol 2024; 56:1803-1810. [PMID: 38216828 DOI: 10.1007/s11255-023-03878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/04/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE We assessed the association between oral frailty risk and LUTS among middle-aged and older adults in a community-dwelling population. METHODS This cross-sectional study was conducted among 586 subjects aged ≥ 40 years who participated in the Iwaki Health Promotion Project in Hirosaki, Japan. We used the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS) to assess LUTS. LUTS was defined as an IPSS score of 8 or higher or meeting diagnostic criteria for OAB. Oral frailty risk was defined as experiencing two or more of the following: decreased chewing ability, decreased biting force, and dry mouth sensation. Physical performance (10-m gait speed and grip strength) was used for analysis. The association between oral frailty risk and LUTS was examined using multivariate logistic regression analyses. RESULTS The study included 218 men and 370 women, of whom 140 had LUTS. The mean age of this cohort was 59 years. Significant differences were observed between the LUTS and non-LUTS groups, including age, hypertension, history of CVD, depressive status, sleep disturbance, and 10 m gait speed. The prevalence of oral frailty risk was significantly higher in the LUTS group than in the non-LUTS group (26% vs. 11%, P < 0.001). Multivariate analysis revealed that age, male gender, and oral frailty risk (odds ratio: 2.67, 95% confidence interval: 1.57-4.51, P < 0.001) were independent factors for LUTS. Moreover, oral frailty risk was an independent factor in both participants aged < 65 years and participants aged ≥ 65 years. CONCLUSIONS Oral frailty was independently associated with LUTS.
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Affiliation(s)
- Fumiya Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan.
| | - Yoshihiro Tamura
- Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Noritaka Ishii
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Kyo Togashi
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Osamu Soma
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Wataru Kobayashi
- Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Chou, Hirosaki, 036-8562, Japan
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Liu TT, Pascal LE, Bauer SR, Miles HN, Panksepp JB, Lloyd GL, Li L, DeFranco DB, Ricke WA. Age-Dependent Effects of Voluntary Wheel Running Exercise on Voiding Behavior and Potential Age-Related Molecular Mechanisms in Mice. J Gerontol A Biol Sci Med Sci 2024; 79:glae007. [PMID: 38198648 PMCID: PMC11079951 DOI: 10.1093/gerona/glae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Older men frequently develop lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH). Risk factors for LUTS/BPH include sedentary lifestyle, anxiety/depression, obesity, and frailty, which all increase with age. Although physical exercise may reduce the progression and/or severity of LUTS/BPH, the age-related mechanisms responsible remain unknown. METHODS Voiding symptoms, body mass, and frailty were assessed after 4-weeks of voluntary wheel running in 2-month (n = 10) and 24-month (n = 8) old C57Bl/6J male mice. In addition, various social and individual behaviors were examined in these cohorts. Finally, cellular and molecular markers of inflammation and mitochondrial protein expression were assessed in prostate tissue and systemically. RESULTS Despite running less (aged vs young X¯ = 12.3 vs 30.6 km/week; p = .04), aged mice had reduced voiding symptoms (X¯ = 67.3 vs 23.7; p < .0001) after 1 week of exercise, which was sustained through week 4 (X¯ = 67.3 vs 21.5; p < .0001). Exercise did not affect voiding symptoms in young mice. Exercise also increased mobility and decreased anxiety in both young and aged mice (p < .05). Exercise decreased expression of a key mitochondrial protein (PINK1; p < .05) and inflammation within the prostate (CD68; p < .05 and plasminogen activator inhibitor-1; p < .05) and in the serum (p < .05). However, a frailty index (X¯ = 0.17 vs 0.15; p = .46) and grip strength (X¯ = 1.10 vs 1.19; p = .24) were unchanged after 4 weeks of exercise in aged mice. CONCLUSIONS Voluntary aerobic exercise improves voiding behavior and mobility, and decreases prostatic mitochondrial protein expression and inflammation in aged mice. This promising model could be used to evaluate molecular mechanisms of aerobic exercise as a novel lifestyle intervention for older men with LUTS/BPH.
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Affiliation(s)
- Teresa T Liu
- Department of Urology, George M. O’Brien Center of Research Excellence, University of Wisconsin – Madison, Madison, Wisconsin, USA
| | - Laura E Pascal
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Scott R Bauer
- Department of Medicine, Urology, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Hannah N Miles
- Department of Urology, George M. O’Brien Center of Research Excellence, University of Wisconsin – Madison, Madison, Wisconsin, USA
- School of Pharmacy, University of Wisconsin – Madison, Madison, Wisconsin, USA
| | - Jules B Panksepp
- Waisman Center, University of Wisconsin – Madison, Madison, Wisconsin, USA
| | - Granville L Lloyd
- Division of Urology, Department of Surgery, Rocky Mountain Regional VA Medical Center, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Lingjun Li
- School of Pharmacy, University of Wisconsin – Madison, Madison, Wisconsin, USA
- Department of Chemistry, University of Wisconsin – Madison, Madison, Wisconsin, USA
| | - Donald B DeFranco
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William A Ricke
- Department of Urology, George M. O’Brien Center of Research Excellence, University of Wisconsin – Madison, Madison, Wisconsin, USA
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Jones CP, Shaw NM, Mena J, Breyer BN, Walter LC, Baussan C, Quanstrom K, Allen IE, Dohan D, Hampson LA. The relationship between frailty, incontinence severity, and treatment decisions for men with post-prostatectomy stress urinary incontinence: a mixed methods analysis. Transl Androl Urol 2023; 12:840-848. [PMID: 37305619 PMCID: PMC10251103 DOI: 10.21037/tau-22-839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/28/2023] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Frailty is common among urology patients in general as well as among men seeking evaluation for stress urinary incontinence (SUI), with 6.1% of men undergoing artificial urinary sphincter placement considered frail. It is unclear if and how patient views on frailty and incontinence severity impact decision-making with regards to SUI treatment. METHODS We undertook a mixed methods analysis to evaluate the intersection of frailty, incontinence severity, and treatment decision-making is presented. To do so, we utilized a previously published cohort of men undergoing evaluation for SUI at the University of California, San Francisco between 2015 and 2020, selecting those who had evaluation with timed up and go test (TUGT), objective measures of incontinence, and patient-reported outcome measures (PROMs). A subset of these participants had additionally undergone semi-structured interviews, and these interviews were re-examined to thematically code them with a focus on the impact of frailty and incontinence severity on SUI treatment decision-making. RESULTS Among the original cohort of 130 patients, 72 had an objective measure of frailty and were included in our analysis; 18 of these individuals had corresponding qualitative interviews. Common themes identified included (I) impact of incontinence severity on decision-making; (II) the interaction between frailty and incontinence; (III) the impact of comorbidity on treatment decision-making; and (IV) age as a construct of frailty and impact on surgical choice and/or recovery. Direct quotations regarding each theme provides insight into patients' views and drivers of SUI treatment decision-making. CONCLUSIONS The impact of frailty on treatment decision-making for patients with SUI is complex. This mixed methods study highlights the variety of patient views on frailty with regards to surgical intervention for male SUI. Urologists should make a concerted effort to personalize patient counseling for SUI management and take time to understand each patient's perspective in order to individualize SUI treatment decision-making. More research is needed to help identify factors that influence decision-making for frail male patients with SUI.
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Affiliation(s)
- Charles P. Jones
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nathan M. Shaw
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jorge Mena
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N. Breyer
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Louise C. Walter
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Caitlin Baussan
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn Quanstrom
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - I. Elaine Allen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Dohan
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lindsay A. Hampson
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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