Metabolic Syndrome and Overactive Bladder Syndrome May Share Common Pathophysiologies

Rising Prevalence of Urinary Incontinence and Nocturia Amid the COVID-19 Pandemic

BACKGROUND

Urinary incontinence (UI) and nocturia are common lower urinary tract symptoms (LUTS) that significantly affect quality of life. The COVID-19 pandemic has introduced behavioral, psychological, and physiological disruptions that may have exacerbated the prevalence of these conditions. Additionally, these changes may also be influenced by long-term sequelae of COVID-19 infection or other concurrent factors. However, large-scale investigations into these trends are limited.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023 were used to analyze the prevalence of LUTS, including stress urinary incontinence (SUI), urgency urinary incontinence (UUI), mixed urinary incontinence (MUI), and nocturia, before (2017-2020) and during the pandemic (2021-2023). Age-adjusted prevalence trends were analyzed overall and by sex and race/ethnicity. Sensitivity analysis included data from 2013 to 2016 to differentiate natural trends from pandemic-related impacts.

RESULTS

The prevalence of SUI, UUI, MUI, and nocturia significantly increased during the pandemic compared to pre-pandemic levels (p < 0.0001). SUI rose from 24.89% to 29.65%, UUI from 20.80% to 28.65%, MUI from 9.17% to 16.83%, and nocturia from 26.96% to 34.78%. These trends were consistent across sexes and racial groups. Sensitivity analysis confirmed that these increases exceeded natural trends, suggesting a potential pandemic-related effect.

CONCLUSION

This study reveals a significant rise in the prevalence of LUTS, including SUI, UUI, MUI, and nocturia, during the COVID-19 pandemic. Further research is needed to determine whether these changes stem from the direct physiological effects of COVID-19 infection or are influenced by broader pandemic-related factors such as lifestyle changes, healthcare disruptions, and psychological stress.

Association of the Triglyceride Glucose Index with Symptoms of Overactive Bladder in American Female Adults: A Cross-Sectional Study

INTRODUCTION AND HYPOTHESIS

To investigate the potential correlation between the triglyceride-glucose (TyG) index and overactive bladder (OAB) symptoms within the female population.

METHODS

This study used data from 7941 individuals obtained from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 dataset. The following equation is used to calculate the TyG index: TyG = Ln [fasting triglycerides (mg/dL) * fasting glucose (mg/dL)/2]. The symptoms of OAB were based on individuals' self-reported comprehensive score. Weighted logistic regression models, encompassing both univariable and multivariable analyses, were employed to evaluate the relationship between the TyG index and OAB in women.

RESULTS

After conducting extensive modifications, the multivariable logistic regression model revealed a significant correlation between the TyG index and mild OAB among American female adults (OR 1.36, 95% CI 1.09-1.70, P = 0.006). Upon categorizing the TyG index into 4 grades (Q1-Q4), a positive increase in OR values corresponding to higher TyG index grades can be observed.

CONCLUSIONS

In this study, our findings reveal a significantly positive relationship between elevated TyG index values and an increased prevalence of mild OAB among female adults. These findings suggest that metabolic dysregulation may drive early-stage OAB, while severe OAB symptoms may be more dependent on non-metabolic pathological changes. Further investigation is warranted to elucidate the underlying mechanisms in female adults.

Elevated cardiometabolic index as a potential risk factor for female Urinary incontinence

BACKGROUND

Urinary incontinence (UI) is closely related to metabolic conditions. The cardiometabolic index (CMI) is a novel and easily obtainable indicator used to assess metabolic status. This study aims to explore the potential relationship between CMI and female UI.

METHODS

Data from the NHANES spanning seven consecutive survey cycles from 2005 to 2018 were used, including adult women who self-reported UI and had complete CMI calculation information. The CMI calculation formula is triglycerides(TG)/high-density lipoprotein cholesterol (HDL-C) × waist-to-height ratio (WHtR, WHtR = waist circumference/height). A multivariate logistic regression model was used to examine the linear relationship between CMI and UUI, SUI, and MUI, and subgroup analyses were conducted to explore potential influencing factors. Additionally, RCS curves were used to plot and analyze nonlinear relationships and threshold effects.

RESULTS

A total of 6,628 adult women were enrolled in this study. Multivariate logistic regression showed that in the fully adjusted model, compared to subjects with the lowest CMI, those with the highest CMI had an increased association with UUI, SUI, and MUI by 1.14 times (OR = 2.14; 95 % CI, 1.83-2.50, P < 0.0001), 0.38 times (OR = 1.38; 95 % CI, 1.17-1.63, P = 0.0001), and 0.83 times (OR = 1.83; 95 % CI, 1.49-2.23, P < 0.0001), respectively. Subgroup analysis revealed significant interaction between multiple subgroups and UUI, SUI, and MUI. Additionally, the association between CMI and UUI, SUI, and MUI was nonlinear, with inflection points at 2.98, 3.21, and 2.98, respectively.

CONCLUSIONS

Elevated CMI levels are closely associated with UI and suggest that CMI may serve as a useful reference indicator for assessing UI risk; however, larger prospective cohort studies are needed to validate these findings and clarify the causal relationship between CMI and UI to advance its potential clinical application.

Association of weight-adjusted waist index (WWI) with overactive bladder (OAB): a cross-sectional study from NHANES 2005-2018

The overactive bladder (OAB) is associated with obesity and inflammation. The weight-adjusted waist index (WWI) has emerged as a novel and more accurate measure of obesity compared to traditional indices, while the Dietary Inflammatory Index (DII) quantifies the inflammatory potential of one's diet. However, the relationship between WWI, DII, and OAB remains unclear. This study aims to elucidate the association between WWI and OAB and to determine whether this relationship is mediated by dietary inflammation. Data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018, comprising 10,176 participants, were analyzed in this study. The association between WWI and OAB was examined using multivariate logistic regression models, smooth curve fitting, and subgroup analysis. Furthermore, the predictive capabilities of various anthropometric indices-including WWI, body roundness index (BRI), body mass index (BMI), waist circumference, body fat percentage (BF%), and weight-on OAB incidence were assessed using Receiver Operating Characteristic (ROC) curve analysis. Finally, a mediation analysis was conducted to explore whether the DII mediates the relationship between WWI and OAB. There was a significant positive association between WWI and OAB. After adjusting for covariates, for each unit increase in WWI, there was a 40% increase in the prevalence of OAB (OR 1.40, 95% CI 1.25-1.58, P < 0.001). This positive correlation persisted when WWI was categorized into quartiles. The dose-response curve showed a significant linear positive correlation between WWI and OAB. The correlation between WWI and OAB persisted in subgroup analysis. The ROC curve analysis revealed that WWI had a superior predictive capability compared to traditional obesity indices, with an area under the curve (AUC) of 0.661 (95% CI 0.648-0.674, all P < 0.001). The results of the mediation analysis showed that 5.02% of the association between WWI and OAB was mediated by DII (P = 0.016). Our findings suggest that individuals with higher WWI may have an increased risk of OAB. Additionally, an anti-inflammatory diet may be beneficial in preventing OAB. Given the cross-sectional nature of this study, we cannot establish a causal relationship. Future longitudinal studies are needed to validate this association and investigate the potential biological mechanisms underlying this relationship.

The association between magnesium depletion score (MDS) and overactive bladder (OAB) among the U.S. population

OBJECTIVE

This study aimed to assess the relationship between magnesium depletion score (MDS) and overactive bladder (OAB) prevalence.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Multivariate logistic regression was employed to investigate the association between MDS and OAB. Restricted cubic spline (RCS) analysis explored the linear or non-linear relationship between MDS and OAB. Interaction analyses were conducted on subgroups to validate the findings.

RESULTS

There was a significant positive association between MDS and OAB. After adjusting for covariates, with each unit increase in MDS, there was an 11% increase in the prevalence of infertility (P < 0.001). In addition, the incidence of OAB was significantly increased in the higher MDS group compared to the low MDS group (MDS = 0) (P for trend < 0.001). The dose-response curve indicated a linear association between MDS and OAB, with higher MDS associated with higher OAB.

CONCLUSION

The results of this study show a strong positive correlation between MDS and the prevalence of OAB. These findings suggest that monitoring and managing magnesium status may be a potential strategy for reducing the risk of OAB.

Bladder dysfunction in hypoestrogenic rats with metabolic syndrome can be ameliorated after amniotic fluid stem cell treatment

BACKGROUND

Bladder dysfunction may occur with high frequency in postmenopausal women with metabolic syndrome (MetS). This study evaluated the therapeutic effects of human amniotic fluid stem cells (hAFSCs) on bladder dysfunction in ovariectomized rats with MetS.

MATERIALS AND METHODS

Forty-eight female rats were divided into 4 groups: normal control, ovariectomy (OVX), and OVX and MetS without (OVX + MetS) and with hAFSCs treatment (OVX + MetS + hAFSCs). We assessed cystometric parameters, serum biochemistry parameters, wall thickness of iliac artery, apoptotic cells and collagen volume in bladder tissues, and the expressions of purinergic and muscarinic receptors, apoptosis-associated mitochondrial proteins, and markers of inflammation, fibrosis, and oxidative stress at posttreatment 1 and 3 months.

RESULTS

OVX + MetS rats showed significant dysfunction of bladder storage, including reduced intercontraction intervals and bladder capacity, along with increased residual urine volume and nonvoiding contractions. There was a significant increase in iliac artery wall thickness, bladder collagen volume, and number of apoptotic cells. Also, there were elevated expressions of P2X3 purinergic and M2/M3 muscarinic receptors, pro-apoptotic proteins, and markers of inflammation, fibrosis, and oxidative stress, with a concurrent decrease in anti-apoptotic protein, Bcl-2. Treatment with hAFSCs helped restoring bladder function, ameliorating histological abnormalities, and reducing pathological markers at 1 and/or 3 months.

CONCLUSION

These findings suggest that hAFSCs can effectively mitigate bladder dysfunction in rats with ovarian hormone deficiency and MetS by modulating oxidative stress and mitochondrial apoptotic pathways.

Atherogenic Index of Plasma mediates the association between Life's Crucial 9 with overactive bladder: a secondary data analysis from NHANES

Background

Some studies suggest a potential link between cardiovascular health, lipid, and overactive bladder (OAB). Life's Crucial 9 (LC9) is a recently developed method for assessing cardiovascular health, while the Atherogenic Index of Plasma (AIP) represents a novel marker of atherosclerotic lipid profiles. However, the relationship between Life's Crucial 9 and overactive bladder and the role of Atherogenic Index of Plasma in the relationship between Life's Crucial 9 and overactive bladder is unclear. This study investigates the relationship between Life's Crucial 9 and overactive bladder and evaluates whether Atherogenic Index of Plasma influences this association.

Methods

This study conducted a cross-sectional analysis of 25,628 U.S. participants in the NHANES database from 2005-2018. Firstly, we used multivariate logistic regression to investigate the relationship between Life's Crucial 9 and overactive bladder. Subsequently, subgroup analysis and restricted cubic splines (RCS) were further used to verify their relationship. Additionally, mediation analysis was conducted to explore the potential role of Atherogenic Index of Plasma levels in the association between Life's Crucial 9 and overactive bladder.

Results

A total of 25,628 participants were included in this study, among whom 5,150 reported overactive bladder events. After using multivariate logistic regression to adjust for age, sex, race, marital status, education level, poverty-to-income ratio (PIR), smoking, alcohol consumption, hypertension, diabetes, and hypercholesterolemia, a 10-unit increase in Life's Crucial 9 was associated with a 28% reduction in overactive bladder incidence (OR = 0.72, 95% CI: 0.69-0.76), while a 1-unit increase in Atherogenic Index of Plasma was associated with a 7% increase in overactive bladder incidence (OR = 1.07, 95% CI: 1.01-1.14). Similar results were obtained when Life's Crucial 9 and Atherogenic Index of Plasma were categorized into tertiles, with a significant trend (P for trend < 0.05). Restricted cubic spline analysis revealed a linear negative correlation between Life's Crucial 9 and overactive bladder incidence. Mediation analysis further indicated that 6.49% of the relationship between Life's Crucial 9 and overactive bladder was mediated by Atherogenic Index of Plasma (P = 0.014).

Conclusion

This study found a significant negative correlation between Life's Crucial 9 and overactive bladder, with Atherogenic Index of Plasma partially mediating this relationship. These findings highlight the potential link between cardiovascular health and overactive bladder, underscoring the role of Life's Crucial 9 in reducing overactive bladder incidence, possibly through its effects on lowering lipid levels.

Disproportionality analysis of vibegron-associated adverse events using the FDA adverse event reporting system (FAERS): a real-world pharmacovigilance study

BACKGROUND

Overactive bladder (OAB) syndrome has a significant impact on quality of life, and vibegron has emerged as a therapeutic option. This study aims to evaluate the safety profile of vibegron in a disproportionality analysis by analyzing adverse event (AE) reports from the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

METHODS

We conducted a retrospective analysis of the FAERS database from January 2021 to September 2023. After duplicate removal and thorough screening, 1137 vibegron-related AE reports were identified. We analyzed these reports for demographic and clinical characteristics, signal detection at the system organ class (SOC) level, and specific AEs.

RESULTS

Females comprised a higher percentage (67.72%) of AE reports compared to males. The elderly population (age > 64 years) accounted for 15.84% of the cases. The majority (95.69%) of the reports originated from the USA. Signal detection revealed significant findings across 19 organ systems with notable SOCs, including renal and urinary disorders (ROR = 7.72, 95%CI 6.83-8.72), gastrointestinal disorders (ROR = 1.38, 95%CI 1.21-1.58), and respiratory, thoracic, and mediastinal disorders (ROR = 1.21, 95%CI 1.01-1.45). In addition, several unexpected AEs were identified, such as dry mouth, hot flush, constipation, and increased blood pressure.

CONCLUSIONS

This study provides comprehensive insights into vibegron's safety profile, revealing both known and unexpected AEs. The findings highlight the need for careful patient selection and monitoring, especially among females and the elderly. The results advocate for ongoing pharmacovigilance and further research to ensure vibegron's safe and effective use in OAB treatment.

Adiponectin signaling regulates urinary bladder function by blunting smooth muscle purinergic contractility

Lower urinary tract symptoms (LUTS) affect approximately 50% of the population over 40 years of age and are strongly associated with obesity and metabolic syndrome. Adipose tissue plays a key role in obesity/metabolic syndrome by releasing adipokines that regulate systemic energy/lipid metabolism, insulin resistance, and inflammation. Adiponectin (ADPN), the most abundant adipokine, modulates energy/metabolism homeostasis through its insulin-sensitizing and antiinflammatory effects. Human plasma ADPN levels are inversely associated with obesity and diabetes. To the best of our knowledge, the role of adipokines such as ADPN in the LUTS associated with obesity/metabolic syndrome remains unknown. We have tested such a possible role in a global ADPN-knockout (Adpn-/-) mouse model. Adpn-/- mice exhibited increased voiding frequency, small voids, and reduced bladder smooth muscle (BSM) contractility, with absence of purinergic contraction. Molecular examination indicated significantly altered metabolic and purinergic pathways. The ADPN receptor agonist AdipoRon was found to abolish acute BSM contraction. Intriguingly, both AMPK activators and inhibitors also abolished BSM purinergic contraction. These data indicate the important contribution of what we believe is a novel ADPN signaling pathway to the regulation of BSM contractility. Dysregulation of this ADPN signaling pathway might be an important mechanism leading to LUTS associated with obesity/metabolic syndrome.

Tadalafil Ameliorates Chronic Ischemia-Associated Bladder Overactivity in Fructose-Fed Rats by Exerting Pelvic Angiogenesis and Enhancing p-eNOS Expression

Metabolic syndrome (MetS) can contribute to a chronic ischemia-relative overactive bladder (OAB). Using fructose-fed rats (FFRs), a rat model of MetS, we investigated the effects of tadalafil (a phosphodiesterase-5 inhibitor) on MetS-associated chronic bladder ischemia and bladder overactivity. Phenotypes of the OAB, including increased micturition frequency and a shortened intercontractile interval in cystometry, were observed in FFRs, together with reduced bladder blood perfusion (in empty bladders) via laser color Doppler imaging and elevated serum nitrite levels, suggesting chronic ischemia-related bladder dysfunction. Treatment with tadalafil (2 mg/kg) promoted pelvic angiogenesis, as shown by magnetic resonance imaging, and increased VEGF and p-eNOS overexpression in the bladder. This treatment restored bladder perfusion and alleviated bladder overactivity without significantly altering most MetS parameters. At the molecular level, FFRs exhibited increased ischemia markers (NGF, HIF-2α, and AMPK-α2) and decreased p-AMPK-α2, along with elevated proinflammatory mediators (ICAM-1, nuclear NF-κB, COX-2, IL-1β, IL-6, and TNF-α), enhanced mitochondria biogenesis (PGC-1α, TFAM, and mitochondria DNA copy number), oxidative stress (decreased nuclear NRF2, increase MnSOD and 8-OHdG staining), and tissue fibrosis (increased TGF-β1, collagen I, and fibronectin). Tadalafil treatment improved these effects. Together, these findings suggest that tadalafil may promote VEGF-associated angiogenesis, enhance p-eNOS staining in the bladder vasculature, normalize bladder perfusion in microcirculation, and reduce serum nitrite levels. Consequently, tadalafil mitigates the adverse effects of chronic ischemia/hypoxia, improving bladder overactivity. We elucidated the mechanisms underlying the tadalafil-mediated amelioration of MetS-associated OAB symptoms.

The Association Between Anthropometric Indices and Overactive Bladder (OAB): A Cross-Sectional Study From the NHANES 2005-2018

BACKGROUND

The association between different anthropometric indices, including body mass index (BMI), a body shape index (ABSI), lipid accumulation product (LAP), visceral adiposity index (VAI), waist circumference-triglyceride index (WTI), weight-adjusted waist index (WWI), body roundness index (BRI) and the prevalence of overactive bladder (OAB) is unclear. This investigation aims to explore the association among different anthropometric indices and overactive bladder as well as confounding variables.

METHODS

Data were obtained from the USA National Health and Nutrition Examination Survey (NHANES) data set between 2005 and 2018, and 15231 participants were included in the study. Multivariable logistic regression was used to investigate the correlation among anthropometric indices mentioned in our study and overactive bladder. Subgroup analyses, smooth curve fitting and area under curve (AUC curve) were also performed.

RESULTS

There was a positive correlation between BMI, LAP, WTI, WWI, BRI and overactive bladder. The results were significant even after taking into account every covariate (p < 0.05). Fitting smooth curves demonstrated that when anthropometric indices were used as a predictor to predict the occurrence of OAB, the probability of female patients suffering from OAB was higher than that of male patients. Additionally, WWI had better predictive power (AUC = 0.6780) and VAI had the worst predictive power (AUC = 0.5558).

CONCLUSION

Our results suggest a substantial positive relationship between some of the anthropometric indices, including BMI, LAP, WTI, WWI, BRI, and overactive bladder.

Association between novel anthropometric indices and overactive bladder: a population-based study

Background

Abdominal obesity is recognized as a key risk factor for developing OAB. However, traditional measures of obesity, such as the waist-to-height ratio (WHtR), waist circumference, and body mass index (BMI), may not sufficiently capture fat distribution in the body. This study aims to evaluate the relationship between novel anthropometric indices and OAB, providing a more accurate assessment of obesity-related risk factors.

Methods

The National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018 were utilized, comprising 27,560 participants. To assess the association and discriminative ability of novel anthropometric indices, including the Body Roundness Index (BRI), A Body Shape Index (ABSI), Waist-to-Weight Index (WWI), and Relative Fat Mass (RFM), with OAB, we employed multivariable logistic regression, restricted cubic spline (RCS) analysis, subgroup analysis, and receiver operating characteristic (ROC) curve methods.

Results

Multivariable logistic regression analysis indicated that higher levels of novel anthropometric indices were positively associated with OAB prevalence. One z-score increase in WWI, BRI, RFM, and ABSI was associated with a 16, 31, 57, and 5% higher likelihood of OAB, respectively. RCS analysis revealed a non-linear relationship between RFM and OAB. ROC analysis indicated that WWI (AUC = 0.680) and RFM (AUC = 0.661) provided better diagnostic accuracy than traditional measures such as BMI (AUC = 0.599). Subgroup analyses supported the robustness of these findings.

Conclusion

Novel anthropometric indices were positively associated with OAB prevalence. WWI and RFM demonstrated significantly better diagnostic value for OAB than BMI and WHtR. Future studies should investigate the potential of combining multiple anthropometric indices to improve predictive accuracy and conduct prospective studies to determine causality.

Association between Life's Crucial 9 and overactive bladder: the mediating role of weight-adjusted-waist index

Background

Research suggests a potential connection between cardiovascular health, obesity, and overactive bladder (OAB). However, the mechanisms by which obesity influences the relationship between cardiovascular health and OAB remain unclear. Life's Crucial 9 (LC9) is a recently proposed method for assessing cardiovascular health, while the weight-adjusted waist index (WWI) is a novel and more accurate measure of obesity. This study investigates the relationship between LC9 and OAB and assesses whether WWI moderates this relationship.

Methods

Data for this study came from the National Health and Nutrition Examination Survey (NHANES). We used subgroup analyses, restricted cubic spline curves (RCS), and multivariate logistic regression to explore the relationship between LC9 and OAB. Additionally, mediation analysis was conducted to investigate the potential association between WWI levels and the relationship between LC9 and OAB.

Results

A total of 25,319 participants were included in this study, among which 5,038 reported incidents of OAB. After adjusting for all variables using multivariable logistic regression, an increase of 10 units in LC9 was associated with a 28% reduction in the incidence of OAB (OR = 0.72, 95% CI: 0.69, 0.76), while an increase of one unit in WWI was associated with a 40% increase in the incidence of OAB (OR = 1.40, 95% CI: 1.29, 1.51). Consistent results were also observed when LC9 and WWI were categorized into quartiles, with a P for trend <0.001. The analysis using restricted cubic splines indicated a linear negative correlation between the incidence of OAB and LC9. Mediation analysis revealed that 13.89% of the relationship between LC9 and OAB was mediated by WWI (p = 0.002).

Conclusion

This study found a significant negative correlation between LC9 and OAB, with WWI acting as a partial mediator in this relationship. This study provides new insights for future research into the relationship between LC9 and OAB and the role of WWI as a mediator.

Review of simultaneous treatment with intradetrusor onabotulinumtoxinA injections during transurethral prostate surgery for men with bladder outlet obstruction and overactive bladder

Bladder outlet obstruction (BOO) is common in males with benign prostate enlargement (BPE) and often presents with different lower urinary tract symptoms. Overactive bladder (OAB) has been reported to be related to BOO, although it can also be idiopathic. The storage symptoms of BOO are often similar to those of OAB. The etiology and pathophysiology of both BPE and OAB are multifactorial with metabolic syndrome known as one of the factors. As of today, transurethral prostate surgery remains the gold standard for treating BOO associated with BPE. Intradetrusor onabotulinumtoxinA (BoNT-A) injections have been shown to be effective in treating OAB. However, they are usually administered after transurethral prostate surgery. In view of the strong therapeutic effects of both surgery and injections, the feasibility of combining them in one setting to increase patient comfort, convenience, and possibly results while decreasing costs is appealing to physicians. However, patient safety and possible complications have to be considered. In this article, we review available studies of concurrent intradetrusor BoNT-A injections during transurethral prostate surgery. Although there is no definitive evidence supporting the concurrent use of intradetrusor BoNT-A during transurethral prostate surgery, there are no reports of increased complications too. Further large-scale randomized controlled trials would be necessary to validate the feasibility of combining the treatments in one setting and observe for possible complications.

The mechanism of action of neuromodulation in the treatment of overactive bladder

Neuromodulation has been used in the treatment of various pelvic organ dysfunctions for almost 40 years and several placebo-controlled studies have confirmed its clinical effect. Many neuromodulation methods using different devices and stimulation parameters, targeting different neural structures have been introduced, but only a limited number have been adopted into routine clinical use. A substantial volume of basic research and clinical studies addressing specific effects of neuromodulation in the treatment of overactive bladder (OAB) have been published to date; however, their mechanistic implications have not been comprehensively summarized. Thus, our understanding of the mechanism of action of neuromodulation in OAB treatment is mainly based on postulated theories. Results from animal experiments suggest that different neuromodulation methods used to treat OAB share the same basic principles. The most likely explanation for the effect of neuromodulation in OAB therapy is the suppression of bladder afferent signalling, promotion of spinal guarding reflexes and modulation of non-specific supraspinal regulatory circuits.

Relationship between METS-IR and ABSI index and the prevalence of nocturia: a cross-sectional analysis from the 2005-2020 NHANES data

Nocturia, marked by frequent nighttime urination, significantly impacts quality of life. This study explores the association of METS-IR (Metabolic Score for Insulin Resistance) and ABSI (A Body Shape Index) with nocturia, using data from the National Health and Nutrition Examination Survey (NHANES). A cross-sectional analysis of NHANES data from 2005 to 2020 was performed. Multivariable logistic regression assessed the associations between METS-IR, ABSI, and nocturia, adjusting for demographic characteristics, chronic diseases, and lifestyle factors. Generalized additive models and smoothing splines were used to describe relationship dynamics. Among the 16,450 participants, both METS-IR (OR = 1.15, 95% CI: 1.11-1.20, p < 0.0001) and ABSI (OR = 1.14, 95% CI: 1.10-1.19, p < 0.0001) were significantly associated with nocturia based on z-scores. An incremental rise in the quartiles of METS-IR and ABSI was associated with a higher risk of nocturia. Specifically, compared to the lowest quartile (Q1), participants in the highest quartile (Q4) had an OR of 1.45 (95% CI: 1.30-1.61, p < 0.0001) for METS-IR and 1.38 (95% CI: 1.23-1.55, p < 0.0001) for ABSI. Subgroup analyses showed a stronger association between ABSI and nocturia among individuals living alone and those aged 20-38 years. Nonlinear modeling indicated a threshold effect for ABSI, with nocturia risk significantly increasing when ABSI exceeded 76.2. Higher METS-IR and ABSI indices are closely linked to a greater prevalence of nocturia, indicating that these indices can be valuable in clinical assessments for evaluating nocturia risk and supporting preventive strategies.

Relationship Between Tooth Loss Due to Chronic Periodontitis and Lower Urinary Tract Symptoms

Background and Objectives: This study aimed to investigate the relationship between lower urinary tract symptoms (LUTS) and tooth loss due to chronic periodontitis. Materials and Methods: A total of 232 patients aged 40 years or older with LUTS were evaluated. The number of remaining teeth and the severity of LUTS were assessed using the overactive bladder symptom score, international prostate symptom score, and urodynamic tests. Statistical analyses, including multivariate and propensity score matching, were conducted to determine the relationship between tooth loss and overactive bladder (OAB). Results: Compared with the non-OAB group, the OAB group had significantly fewer remaining teeth (p < 0.001). A negative correlation was observed between the number of remaining teeth and the severity of LUTS, with symptoms such as urgency, frequency, and nocturia being more severe in patients with fewer teeth (all p < 0.001). Objective measures, including bladder capacity and maximum flow rate, were also significantly lower in patients with fewer teeth. Additionally, having fewer than 21 teeth was identified as a significant risk factor for LUTS. Multivariate analysis confirmed that tooth loss was an independent risk factor for OAB, even after adjusting for age and comorbidities (p < 0.001). Propensity score matching further validated the association between the number of remaining teeth and OAB (p = 0.022), highlighting a clear connection between dental health and urinary function. Conclusions: Tooth loss due to chronic periodontitis is strongly associated with the severity of LUTS, including storage and voiding symptoms. Maintaining good oral health may help reduce the risk of OAB and related urinary symptoms. This study underscores the importance of dental care in managing and preventing LUTS, suggesting that improving oral health could play a key role in mitigating these conditions.

Adiponectin Signaling Regulates Urinary Bladder Function by Blunting Smooth Muscle Purinergic Contractility

Lower urinary tract symptoms (LUTS) affect ∼ 50% of the population aged >40 years and are strongly associated with obesity and metabolic syndrome. Adipose tissue plays a key role in obesity/metabolic syndrome by releasing adipokines that regulate systemic energy/lipid metabolism, insulin resistance, and inflammation. Adiponectin (ADPN), the most abundant adipokine, modulates energy/metabolism homeostasis through its insulin-sensitizing and anti-inflammatory effects. Human plasma ADPN levels are inversely associated with obesity and diabetes. The role of adipokines such as ADPN in the LUTS associated with obesity/metabolic syndrome remains unknown. We have tested such a possible role in a global ADPN knockout mouse model ( Adpn -/- ). Adpn -/- mice exhibited increased voiding frequency, small voids, and reduced bladder smooth muscle (BSM) contractility with absence of purinergic contraction. Molecular examination indicated significantly altered metabolic and purinergic pathways. The ADPN receptor agonist AdipoRon was found to abolish acute BSM contraction. Intriguingly, both AMPK activators and inhibitors also abolished BSM purinergic contraction. These data indicate the important contribution of a novel ADPN signaling pathway to the regulation of BSM contractility. Dysregulation of this ADPN signaling pathway might be an important mechanism leading to LUTS associated with obesity/metabolic syndrome.

ARTICLE HIGHLIGHTS

Lower urinary tract symptom (LUTS) is strongly associated with obesity and metabolic syndrome, however, the underlying molecular mechanisms are missing. Dysregulation of adipokine signaling could be the link for this association.Whether adiponectin, the most abundant adipokine, plays a role in regulating bladder function and dysfunction.Mice null for adiponectin exhibited increased voiding frequency, small voids, and reduced bladder smooth muscle contractility, with corresponding metabolic and purinergic pathway changes.Dysregulation of adiponectin signaling might be an important mechanism leading to LUTS associated with obesity/metabolic syndrome.

Nocturia, nocturnal polyuria, and nocturnal enuresis in adults: What we know and what we do not know

Nocturia is defined as the nocturnal frequency of one or more voiding episodes per night. It increases with aging and has an impact on sleep quality and the risks of falling and mortality. Nocturia disorder involves nighttime frequency, nocturnal polyuria, and nocturnal enuresis. In older adults with nocturia disorder, multiple factors could contribute to nocturia severity and characteristics, including poor sleep quality, lower urinary tract dysfunction, and excessive fluid output. Several nonurological medical diseases have been found to result in nocturia, such as hypertension, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, metabolic syndrome, and diabetes. Urological and medical assessments should be performed to diagnose nocturia disorder. A frequency volume chart to evaluate the nocturnal polyuria index, functional bladder capacity, and urodynamic study can reveal the presence of nocturnal polyuria and lower urinary tract dysfunction. Treatment should be based on multiple nocturia etiologies, and a combination of multiple therapies for individual pathophysiology will achieve a better treatment outcome.

Associations of overactive bladder (OAB) with suicidal ideation incidence and all-cause mortality among the U.S. population

BACKGROUND

Few studies have explored the correlation between overactive bladder (OAB) and suicidal ideation. This study aims to investigate the association between OAB and suicidal ideation, as well as the relationship between OAB and all-cause mortality among individuals with suicidal ideation.

METHODS

Data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed using cross-sectional and cohort study designs. Weighted multivariable logistic regression models were used to examine the association between OAB and suicidal ideation. Kaplan-Meier curves and weighted multivariable Cox proportional hazards models assessed the relationship between OAB and all-cause mortality among those with suicidal ideation. Interaction analyses on subgroups were conducted to validate the findings. Mediation analysis was performed to examine the effect of depression on the relationship between OAB and suicidal ideation.

RESULTS

Among 33,426 participants aged ≥ 20 years, 1,290 (3.8%) reported suicidal ideation. After adjusting for potential confounders, participants with OAB were 2.57 times more likely to have suicidal ideation (P < 0.001). Over an average follow-up of 87 months, 197 participants with suicidal ideation died. The Cox model revealed that participants with OAB had a 3.08 times higher risk of death (P = 0.006). Kaplan-Meier curves indicated higher survival rates for non-OAB participants. Mediation analysis indicates that depression significantly mediates the relationship between OAB and suicidal ideation, with a mediation proportion of 75.25% (P < 0.001).

CONCLUSIONS

OAB is positively associated with the incidence of suicidal ideation and all-cause mortality among participants with suicidal ideation. Additionally, the association between OAB and suicidal ideation is mediated by depression.

Correlation Between Metabolic Dysfunction-Associated Steatotic Liver Disease and the Risk of Urinary Incontinence in Adult Women

Objective

This study examined the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and urinary incontinence in adult women and evaluated the potential contribution of the fatty liver index (FLI) in this context.

Methods

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) database, spanning from 2001 to 2018. The study included 17,221 adult female participants. Individuals exhibiting FLI values of 60 or greater were diagnosed with hepatic steatosis. Incontinence type and MASLD status were evaluated by analyzing questionnaire data and calculating the FLI. Logistic regression models were employed to examine the correlation between FLI, MASLD, and urinary incontinence, with potential confounding variables controlled through multivariate adjustment models. Furthermore, restricted cubic spline curve (RCS) modeling and subgroup analysis were employed to elucidate the relationship between variables further.

Results

The median age of participants in the MASLD group was higher than that of the non-MASLD group (53 vs 46 years, P < 0.001). The findings indicated a positive association between FLI and MASLD and the risk of urinary incontinence. Specifically, the risk of stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI) all increased significantly with increasing quartiles of FLI (OR 2.44, 1.91, 2.30, respectively, P < 0.001). In the multivariate-adjusted model, SUI, UUI, and MUI risk was 76%, 50%, and 69% higher in patients with MASLD than those without MASLD. RCS analysis demonstrated a significant nonlinear positive correlation between FLI and the risk of SUI, UUI, and MUI, respectively.

Conclusion

This study's findings indicate a significant association between MASLD and the risk of developing urinary incontinence. Additionally, the results suggest that FLI and MASLD may act as independent risk factors for urinary incontinence.

Causal effects of gut microbiota on risk of overactive bladder symptoms: a two-sample Mendelian randomization study

Background

Clinical observations indicate a correlation between the gut microbiota and overactive bladder (OAB) symptoms. Nevertheless, the causal relationship and mechanisms between gut microbiota and OAB symptoms remain elusive.

Methods

Two-sample Mendelian randomization (MR) analyses were performed to assess the association between gut microbiota and OAB symptoms, including urinary incontinence (UI). Data were obtained from the MiBioGen International Consortium genome-wide association studies (GWAS) dataset and the IEU GWAS database. The inverse variance weighted method was used as the primary approach in the MR analysis, with the weighted median, MR-Egger, and weighted mode methods as supplementary approaches. Sensitivity analyses were employed to assess potential violations of the MR assumptions.

Results

Our analysis identified seven gut bacterial taxa with a causal relationship to OAB and nine gut bacterial taxa associated with UI. Genera Eubacteriumfissicatenumgroup, LachnospiraceaeNK4A136group, and Romboutsia were identified as protective factors against OAB, while genera Barnesiella, FamilyXIIIAD3011group, Odoribacter, and RuminococcaceaeUCG005 were associated with an increased risk of OAB. A higher abundance of the genus Coprococcus3, order Burkholderiales, and phylum Verrucomicrobia predicted a lower risk of UI. Conversely, the class Mollicutes, genus Ruminococcus gauvreauii group, order Mollicutes RF9, and phylum Firmicutes and Tenericutes were positively correlated with UI risk. The sensitivity analysis excluded the influence of potential heterogeneity and horizontal pleiotropy.

Conclusion

This study revealed a causal relationship between gut microbiota and OAB symptoms, providing new insights and a theoretical foundation to identify biomarkers and therapeutic targets for patients with OAB symptoms.

What is the best first choice oral drug therapy for OAB?

AIMS

The management of overactive bladder (OAB) involves lifestyle changes and conservative measures in the first instance with the use of liquid/dietary advice, weight loss, and bladder training. Thereafter oral pharmacotherapy is instigated in symptomatic patients. Antimuscarinics and beta 3 agonists form the main classes of drug therapy in this field. Views on what is the best first line OAB treatment is changing based on recent evidence and adverse event profiles of these medications.

METHODS

At the ICI-RS meeting 2023, Bristol, UK this topic was discussed and debated as a proposal. The following article summarizes the concepts presented that day as well as the interactive discussion that took place thereafter.

RESULTS

OAB guidelines are moving in many circumstances to an either antimuscarinic or beta 3 agonist approach based on patient factors. Several studies have raised concerns on the long-term impact of antimuscarinics, in relation to cognition, dementia, cardiovascular events, and mortality all related to antimuscarinic load. Neither antimuscarinics nor beta 3 agonists have good persistence and adherence rates in the medium to long term. Several barriers also exist to prescribing including guidelines recommending utilizing drugs with the lowest acquisition cost and "step therapy." A newer approach to managing OAB is personalized therapy in view of the many possible etiological factors and phenotypes. These concepts are highlighted in this article.

CONCLUSIONS

Current oral pharmacotherapy in managing OAB is limited by adverse events, adherence and persistence problems. Both antimuscarinics and beta 3 agonists are efficacious but most clinical trials demonstrate significant placebo effects in this field. Personalizing treatment to the individual seems a logical approach to OAB. There is a need for better treatments and further studies are required of existing treatments with high quality longer term outcomes.

How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1

INTRODUCTION

Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction.

OBJECTIVES

The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment.

METHODS

A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment.

RESULTS AND CONCLUSIONS

The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.

An atlas of human vector-borne microbe interactions reveals pathogenicity mechanisms

Vector-borne diseases are a leading cause of death worldwide and pose a substantial unmet medical need. Pathogens binding to host extracellular proteins (the "exoproteome") represents a crucial interface in the etiology of vector-borne disease. Here, we used bacterial selection to elucidate host-microbe interactions in high throughput (BASEHIT)-a technique enabling interrogation of microbial interactions with 3,324 human exoproteins-to profile the interactomes of 82 human-pathogen samples, including 30 strains of arthropod-borne pathogens and 8 strains of related non-vector-borne pathogens. The resulting atlas revealed 1,303 putative interactions, including hundreds of pairings with potential roles in pathogenesis, including cell invasion, tissue colonization, immune evasion, and host sensing. Subsequent functional investigations uncovered that Lyme disease spirochetes recognize epidermal growth factor as an environmental cue of transcriptional regulation and that conserved interactions between intracellular pathogens and thioredoxins facilitate cell invasion. In summary, this interactome atlas provides molecular-level insights into microbial pathogenesis and reveals potential host-directed targets for next-generation therapeutics.

Association between body roundness index and overactive bladder: results from the NHANES 2005-2018

BACKGROUND AND AIM

An increasing amount of research has indicated obesity greatly affects individuals with overactive bladder (OAB). However, traditional anthropometric methods present challenges in accurately assessing the likelihood of OAB. Hence, this study's objective was to identify the correlation between the body roundness index (BRI) and OAB.

METHODS

The research included 12,401 individuals who participated in the National Health and Nutrition Examination Survey spanning 2005-2018. The correlation between BRI and OAB was explored by using weighted multiple logistic regression and weighted restricted cubic spline (RCS). Subgroup analyses showed the associations based on different population types. The study also analyzed the predictive capability of various anthropometric indices, including BRI, body mass index, waist circumference, and weight, in assessing the likelihood of OAB through Receiver-operating characteristic (ROC) curves.

RESULTS

An independent positive correlation between OAB and BRI was identified after adjusting for potential confounders in weighted multivariate logistic models[odds ratio (OR) = 1.15, 95% confidence interval (CI), 1.12-1.17]. Weighted RCS analysis found a positive dose-response correlation between OAB and BRI. The effect size of BRI on OAB remained stable across all prespecified subgroups (all P for interactions > 0.05). In ROC analysis, BRI showed better discriminatory ability for OAB compared with other anthropometric measures for both genders (all P < 0.01). The best BRI cutoff for predicting OAB was lower for men (5.151) than for women (5.383), suggesting that men were more susceptible to changes in BRI than women.

CONCLUSIONS

This study demonstrated that a raised BRI is correlated with a higher likelihood of OAB. Due to the effectiveness and non-invasiveness of BRI in predicting OAB, it is expected to become the preferred method for early detection and management strategies.

Emerging therapies for overactive bladder: preclinical, phase I and phase II studies

INTRODUCTION

Overactive bladder syndrome is a common chronic condition with a significant impact on quality of life and economic burden. Persistence with pharmacologic therapy has been limited by efficacy and side effects. A greater understanding of the pathophysiology of overactive bladder has led to the initial evaluation of several drugs affecting ion channels, the autonomic nervous system, and enzymes which may provide useful alternatives for the management of overactive bladder.

AREAS COVERED

A comprehensive review was performed using PubMed and Cochrane databases as well as reviewing clinical trials in the United States. The current standard of care for overactive bladder will be discussed, but this paper focuses on investigational drugs currently in preclinical studies and phase I and II clinical trials.

EXPERT OPINION

Current therapies for overactive bladder have limitations in efficacy and side effects. A greater understanding of the pathophysiology of overactive bladder has identified the role(s) of other pathways in the overactive bladder syndrome. Targeting alternative pathways including ion channels and enzymes may provide alternative therapies of overactive bladder and a more tailored approach to the management of overactive bladder.

Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process

INTRODUCTION

Overactive bladder (OAB) is a prevalent urological condition characterized by urinary urgency, with or without urgency urinary incontinence, accompanied by increased daytime frequency and nocturia. However, the current definition of OAB lacks a specified time frame, hindering our understanding of the temporal aspects and transitions that occur within the OAB spectrum.

METHODS

A modified Delphi study was conducted in three rounds, involving a panel of international experts in functional urology, urogynaecology, geriatrics, transitional medicine, and pediatric urology. The study took place between February 2023 and June 2023 and employed two sequential rounds of online surveys, followed by a final hybrid group discussion session in June 2023.

RESULTS

The Delphi process resulted in a consensus definition of lifelong OAB as a persistent and continuous condition that may manifest differently from birth and evolve over time, with varying levels of clinical perception. The course of its progression is influenced by transition periods and modifying factors, mainly anatomical, hormonal, and psychosocial/stressors. Three main transition periods were identified: achievement of daytime continence, adulthood to elderly, and transition to frail elderly. The panel also considered the therapeutic and diagnostic implications of lifelong OAB, as well as future research prospects in terms of importance and feasibility.

CONCLUSIONS

Future longitudinal research is needed to develop this concept and further identify transitions and temporal dynamics.

The association between overactive bladder and systemic immunity-inflammation index: a cross-sectional study of NHANES 2005 to 2018

Current research indicate that inflammation is linked to the development of overactive bladder (OAB). The aim of this study was to examine the correlation between OAB and the systemic immunity-inflammation index (SII) in the USA. We analyzed data from 31,881 participants in the National Health and Nutrition Examination Survey 2005-2018. SII, calculated as platelet count × neutrophil count/lymphocyte count, was categorized into quartiles. OAB was defined by the presence of urge urinary incontinence and nocturia. Weighted logistic regression models were used to examine the independent relationship between SII and OAB, adjusting for demographic factors, kidney function, and diabetes status. The results showed that each tenfold increase in log-transformed SII was associated with an 18% higher odds of OAB (OR 1.18, 95% CI 1.08-1.28) in the fully adjusted model. Compared to the lowest SII quartile, the highest quartile had a 28% increased OAB risk (OR 1.28, 95% CI 1.12-1.47). The positive association between SII and OAB risk was consistently observed across subgroups stratified by age, sex, race, marital status, education, and poverty level. Our study reveals a positive correlation between SII levels and OAB, indicating that higher SII levels are associated with an increased likelihood of developing OAB.

Association between life's essential 8 and overactive bladder

Limited research has explored the relationship between overactive bladder (OAB) and cardiovascular health (CVH). We aim to examine the correlation between OAB and CVH in American adults, utilizing the Life's Essential 8 (LE8). We included 70,190 individuals from the National Health and Nutrition Examination Survey spanning from 2005 to 2018. In our study, the independent variable is LE8 score, where higher scores denote better CVH. The dependent variable is the presence of OAB. We employed multivariable logistic regression along with restricted cubic splines to evaluate the association between LE8 and OAB. Additionally, we performed interaction analyzes on subgroups to validate the findings. There is a significant negative correlation between LE8 scores and OAB. Upon adjusting for all covariates, a 10-point increase in LE8 total score correlated with a 17% decrease in the odds of OAB [0.83 (95% CI 0.78, 0.89)]. Compared to participants with lower LE8 scores, those with higher LE8 scores had a 46% lower probability of developing OAB. Consistent results were also observed in the association between scores of four health behaviors and four health factors and OAB. Furthermore, a notable interaction was observed between LE8 scores and smoking status. This study showed a significant negative correlation between LE8 scores and OAB prevalence.

Abdominal obesity as assessed by anthropometric measures associates with urinary incontinence in females: findings from the National Health and Nutrition Examination Survey 2005-2018

BACKGROUND

Urinary incontinence (UI) is significantly link to abdominal obesity. This study aimed to assess the association between anthropometric indices of abdominal obesity, including body roundness index (BRI), conicity index (CI), and waist-to-height ratio (WHtR), and UI risk in adult females.

METHODS

We analyzed data from 10, 317 adult females in the National Health and Nutrition Examination Survey (NHANES) database (2005-2018). Weighted multivariable-adjusted regression analysis was conducted to determine the odds ratio (OR) and 95% confidence intervals (CI) for the association between BRI, CI, WHtR, and UI. Stratified analyses revealed the association based on the population type. Receiver operating characteristic curve (ROC) analyses were used to assess the predictive value of UI.

RESULTS

All indices of abdominal obesity investigated were positively and independently associated with the prevalence and severity of three types of UI. After adjusting for all relevant confounding variables, a significantly positive association between BRI and the prevalence of UI were observed (OR quartile 4 vs. quartile 1: urge UI (UUI): 1.93, 95% CI 1.61-2.30; stress UI (SUI): 2.29, 95% CI 1.94-2.70; mixed UI (MUI): 2.26, 95% CI 1.82-2.82; all P < 0.0001, P for trend < 0.0001, respectively), as well as WHtR and CI, which particularly prominent for female in premenopausal. Moreover, a one-unit increment of BRI was significantly associated with an increased severity index of UUI (β: 0.06, 95% CI 0.04-0.09, P < 0.0001), SUI (β: 0.10, 95% CI 0.07-0.13, P < 0.0001) and MUI (β: 0.07, 95% CI 0.04-0.10, P < 0.0001), which this trend was also observed in each subtype of UI for WHtR and CI. Furthermore, the ROC analysis demonstrated a higher diagnostic efficacy of BRI and WHtR compared with BMI in discriminating UI with an AUC of 0.600 for SUI, 0.617 for UUI, and 0.622 for MUI (all P < 0.05).

CONCLUSIONS

An increased BRI, CI, and WHtR are significantly associated with higher prevalence and severity of UI in females.

Joint Effect of Physical Activity and Sedentary Behavior with the Female Urinary Incontinence: An Analysis of NHANES 2011-2016

INTRODUCTION

Our study aimed to assess the independent and joint effects of leisure-time physical activity and sedentary behavior with urinary incontinence (UI).

METHODS

Data were obtained from the National Health and Nutrition Examination Survey 2011-2016. The primary endpoint was the risk of different subtypes of UI, including stress UI, urgency UI, and mixed UI. The primary exposures were leisure-time physical activity and sedentary behavior. Sedentary behavior was assessed by screen time. Weighted univariate and multivariate logistic regression models were used to observe the independent and joint relationship of leisure-time physical activity and sedentary behavior with UI risk (including stress UI, urgency UI, and mixed UI).

RESULTS

In total, 6,927 female participants were included in this analysis. 3,377 females did not have UI, 1,534 had stress UI, 836 had urgency UI, and 1,180 had mixed UI. Screen time with ≥5 h/day was associated with increased odds of urgency UI (odds ratio [OR] = 1.31, 95% confidence intervals (CI): 1.06-1.61), which indicated the relationship of sedentary behavior and urgency UI. Engaging in leisure-time physical activity with of ≥750 metabolic equivalent (MET)·min/week was found to be significantly associated with reduced likelihood of mixed UI (OR = 0.68, 95% CI: 0.55-0.85). Additionally, the interaction term of leisure-time physical activity<750 MET·min/week and screen time ≥5 h/day was observed to be linked with increased odds of urgency and mixed UI.

CONCLUSION

Participants experiencing a lower level of leisure-time physical activity and a higher level of sedentary behavior together might enhance the urgency and mixed UI risk.

A Bird's-Eye View of the Pathophysiologic Role of the Human Urobiota in Health and Disease: Can We Modulate It?

For a long time, urine has been considered sterile in physiological conditions, thanks to the particular structure of the urinary tract and the production of uromodulin or Tamm-Horsfall protein (THP) by it. More recently, thanks to the development and use of new technologies, i.e., next-generation sequencing and expanded urine culture, the identification of a microbial community in the urine, the so-called urobiota, became possible. Major phyla detected in the urine are represented by Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. Particularly, the female urobiota is largely represented by Lactobacillus spp., which are very active against urinary pathogenic Escherichia (E.) coli (UPEC) strains via the generation of lactic acid and hydrogen peroxide. Gut dysbiosis accounts for recurrent urinary tract infections (UTIs), so-called gut-bladder axis syndrome with the formation of intracellular bacterial communities in the course of acute cystitis. However, other chronic urinary tract infections are caused by bacterial strains of intestinal derivation. Monomicrobial and polymicrobial infections account for the outcome of acute and chronic UTIs, even including prostatitis and chronic pelvic pain. E. coli isolates have been shown to be more invasive and resistant to antibiotics. Probiotics, fecal microbial transplantation, phage therapy, antimicrobial peptides, and immune-mediated therapies, even including vaccines for the treatment of UTIs, will be described.

The impact of diabetes on overactive bladder presentations and associations with health-seeking behavior in China, South Korea, and Taiwan: Results from a cross-sectional, population-based study

BACKGROUND

This study aimed to explore the impact of diabetes on overactive bladder (OAB) presentations and related predictors of healthcare-seeking behavior among adults aged ≥ 40 years in China, Taiwan, and South Korea.

METHODS

An internet-based survey was conducted to assess the prevalence of diabetes, OAB presentations, and self-perceived urinary symptoms by a multi-national sample of 8284 individuals who completed the survey between June 2, 2015 and July 31, 2015. Independent associations with health-seeking behavior for urinary symptoms were estimated with odds ratio (OR) with 95% confidence interval (95% CI) using multivariate logistic regression.

RESULTS

Diabetes was reported in 13.6% of participants and OAB was 20.8%. Diabetic participants were older than non-diabetic participants in both sexes. Participants with diabetes reported a higher rate of OAB (43.1%) and increased bothersome symptoms associated with OAB than those without diabetes. Participants with diabetes (OR, 3.07 [2.39-3.96]], urgent incontinence (OR, 2.38 [1.86-3.03]), frequency (OR, 1.86 [1.45-2.38]), and nocturia (OR, 1.14 [1.05-1.24]) were associated with healthcare-seeking behavior.

CONCLUSION

The proportion of diabetic participants with OAB was 2.5-fold higher than those without diabetes. Diabetes, urinary frequency, nocturia, and urgent incontinence are predictors of medical treatment-seeking behavior, but the key symptom of OAB-urgency is not a predictor of treatment-seeking behavior. It is important for clinicians to recognize the interplay between diabetes and OAB and to early identify various bothersome urinary symptoms for better health outcomes in daily practice.

A positive association between food insecurity and the prevalence of overactive bladder in U.S. adults

Objective

This study aims to examine the correlation between overactive bladder (OAB) and food insecurity.

Methods

We conducted a cross-sectional analysis utilizing extensive population data derived from the National Health and Nutrition Examination Survey 2007-2018. The status of Household food insecurity is evaluated by the US Food Security Survey Module. To explore the relationship between food insecurity and OAB, three multivariable logistic regression models were carried out. Additionally, interaction and stratified analyses were also performed to find whether some factors have the potential to alter the correlation.

Results

There were 29,129 participants enrolled in the study. Compared to the other three groups, individuals with full food security exhibited a lower proportion of nocturia, urinary urgency incontinence, and OAB. In the fully-adjusted model, it was found that people experiencing food insecurity have a significantly higher prevalence of OAB compared to those with food security in the fully-adjusted model (OR = 1.540, 95%CI 1.359-1.745). Additionally, there was a significant association between the levels of food insecurity and an increased risk of OAB prevalence was also observed (marginal food security: OR = 1.312, low food security: OR = 1.559, and very low food security: OR = 1.759). No significant interaction was seen in the fully-adjusted model.

Conclusion

There is a strong positive correlation between food insecurity and the prevalence of OAB. Similarly, the correlation between levels of food insecurity and OAB also indicates the same trend. Namely, the more insecure food, the higher risk of OAB prevalence in the population.

Association of detrusor underactivity with aging and metabolic syndrome: suggestions from animal models

Detrusor underactivity, a condition in which the bladder muscle does not contract strongly or long enough to empty the bladder completely or within the normal time frame, is a common cause of lower urinary tract symptoms in older individuals of both sexes. Although aging is a known risk factor for detrusor underactivity, its pathophysiological mechanisms are not fully understood. Therefore, establishing animal models that closely mimic the pathophysiology of detrusor underactivity in humans is necessary to elucidate these mechanisms. Metabolic syndrome is a cluster of several risk factors, including obesity, hyperlipidemia, hyperglycemia, and hypertension, which are associated with the development of diabetes, cardiovascular disease, and lower urinary tract dysfunction in both sexes. Notably, bladder dysfunction resulting from detrusor underactivity is observed at an earlier age in animal models with diabetes mellitus than in those without. Recently, detrusor underactivity-like phenotypes have been observed at a relatively early age in animal models with metabolic syndrome, involving obesity, hyperlipidemia, and hypertension, compared with those without. Therefore, this review introduces the association of detrusor underactivity with aging and metabolic syndrome, as well as possible pathophysiological mechanisms for detrusor underactivity from reports of various animal models. Notably, metabolic syndrome may accelerate the onset of age-related detrusor underactivity, and further analysis of old animal models with metabolic syndrome may help elucidate the pathogenesis of detrusor underactivity in humans.

Flat Magnetic Stimulation for Urge Urinary Incontinence

Background and Objectives: Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods: This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results: Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 (p < 0.001) and ICIQ-UI SF scores (p < 0.001) and an improvement in sexual function (p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusions: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.

Associations between exposure to organophosphate esters and overactive bladder in U.S. adults: a cross-sectional study

Background

The relationship between exposure to organophosphate esters (OPEs) and the risk of developing overactive bladder (OAB) is uncertain. The purpose of this study is to examine the potential link between urinary metabolites of organophosphate esters and OAB.

Method

Data from the National Health and Nutrition Examination Survey (NHANES) database of the 2011-2016 cycles were utilized. Four urinary metabolites of organophosphate esters: diphenyl phosphate (DPHP), bis (1,3-dichloro-2-propyl) phosphate (BDCPP), bis (2-chloroethyl) phosphate (BCEP), and dibutyl phosphate (DBUP) were included in the study. Multivariate logistic regression and restricted cubic spline (RCS) were used to evaluate the relationship between urinary OPEs metabolites and OAB. Interaction analysis was conducted on subgroups to confirm the findings.

Results

A total of 3,443 United States (US) adults aged 20 years or older were included in the study, of whom 597 participants were considered to have OAB. After adjusting for potential confounding factors, we found a positive association between DPHP and the risk of overactive bladder. The risk of overactive bladder increased with increasing DPHP concentrations compared with quartile 1 (quartile 2, OR = 1.19, 95% CI, 0.82-1.73, P = 0.34; quartile 3, OR = 1.67, 95% CI, 1.10-2.53, P = 0.02; Q4, OR = 1.75, 95% CI, 1.26-2.43, P = 0.002). However, after dividing the participants by gender, only the female group retained consistent results. Additionally, restricted cubic spline analysis revealed a nonlinear dose-response correlation between DPHP and OAB in female participants. In the subgroup analysis based on age, race, body mass index (BMI), recreational activity, smoking status, drinking status, hypertension, diabetes, and stroke, the interaction analysis revealed that the findings were uniform.

Conclusion

Our findings indicate that exposure to DPHP could elevate the risk of OAB in US adult females. Further experimental studies are needed to explore the underlying mechanism in the future.

COVID-associated cystitis: the culprit behind the bladder woes post-COVID infection? A review

PURPOSE

SARS-CoV-2 had a significant impact on public health since its declaration as a pandemic. It is linked to a high rate of multiple organ dysfunction syndrome (MODS) and a slew of long-term symptoms that are yet to be thoroughly investigated. Among these, genitourinary symptoms of an overactive bladder (increased frequency, urgency, and nocturia) have recently been identified and labeled as COVID-associated cystitis (CAC). This current research is performed to review this phenomenon.

METHODS

A literature search was performed in MEDLINE, Cochrane, and Google Scholar databases and 185 articles were obtained in total, including reviews and trials involving CAC, which were screened using various methods, and 42 articles were gathered for the review.

RESULTS

Among its multitude of symptoms, overactive bladder (OAB) leads to poorer outcomes. The inflammatory mediator-based theory and the ACE-2 receptor-based theory are two probable theories for how it harms the bladder urothelium. The expression of ACE-2 receptors during the pathogenesis of CAC warrants further investigation as ACE modulation may reveal more information about COVID-19 complications. Other comorbidities, immunocompromised patients, or patients with a history of urinary tract infections can also exacerbate this condition.

CONCLUSION

The scarce literature collected related to CAC gives us an insight into the symptomatology, pathophysiology, and possible treatment plans. Treatment choices are diverse among COVID-19-afflicted and unaffected patients for treating urinary symptoms which highlights the importance to distinguish between the two. CAC shows greater prevalence and morbidity when linked to other conditions, thereby warranting future developments in it.

Current optimal pharmacologic therapies for overactive bladder

INTRODUCTION

Overactive bladder (OAB) is a common syndrome in adults. Current pharmacologic treatment includes antimuscarinic agents and β-3 adrenoceptor agonists. For non-responders to oral medication, intravesical injection of botulinum toxin A (BoNT-A) is an effective option. However, these treatments have potential adverse events and should be cautiously selected for appropriate patients. This review presents the recently published results of clinical trials and studies for patients with OAB and the underlying pathophysiology of OAB. Appropriate medical therapy based on pathophysiology of OAB is also presented.

AREAS COVERED

Literature search from Pubmed from 2001 to 2023 including clinical background, pharmacology, and clinical studies for OAB medications.

EXPERT OPINION

Treatment of OAB syndrome with any antimuscarinic or β-3 adrenoceptor agonist is feasible as a first-line approach. For patients with suboptimal therapeutic effect to full-dose antimuscarinics or mirabegron, combination with both drugs can improve efficacy. Intravesical BoNT-A 100-U injection provides therapeutic effects for refractory OAB. Patients who are refractory to initial pharmacotherapies should be investigated for the underlying pathophysiology; then an appropriate medication can be added, such as an α1-blocker or anti-inflammatory agents. Patient education about behavioral modification and therapies should always be provided with oral medication or BoNT-A injection for OAB patients.

A positive association between the prevalence of circadian syndrome and overactive bladder in United States adults

Objective

To explore the association between the prevalence of circadian syndrome (CircS) and overactive bladder (OAB).

Materials and methods

Cross-section analysis was based on the National Health and Nutrition Examination Survey 2005-2018. Data regarding OAB was collected from questionnaires. The association between the prevalence of CircS and OAB was elucidated using three multivariable logistic regression models. Stratified and interaction analyses were performed to find whether some factors can modify the association.

Results

Totally 8,033 males and 8,065 females were included. People with CircS had a significantly higher prevalence of OAB compared to the non-CircS group in the fully-adjusted model (OR = 1.238, 95%CI 1.080-1.419). A significant positive correlation between the number of CircS components and the prevalence of OAB was observed when the components were ≥ 6 (OR = 1.975, 95%CI 1.463-2.665). No significant interaction was seen in the three models.

Conclusion

There is a positive association between the prevalence of CircS and OAB. When the number of components is ≥6, the prevalence of OAB shows a strongly positive correlation with the number of CircS components.

Pelvic floor dysfunction and obesity

Obesity is a growing condition within the society and more patients, who have underlying obesity, are presenting with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction (PFD). The effect of obesity on general health has been well documented, and its impact on the cardiovascular, endocrine, and musculoskeletal systems has been extensively studied. There is now a growing body of evidence on the effects of obesity on the female urogenital system. It seems to influence the prevalence, presentation, assessment, management, and outcome of various types of LUTS and PFD. A holistic approach is needed to assess and manage these patients. A clear understanding of the functions of the pelvic floor and the way it can be affected by obesity is essential in providing holistic care to this group. A frank discussion about patient weight is required in the clinics handling PFD. A multimodal approach to weight loss would help improve PFD symptoms and progression. Patients with obesity should still be offered standard treatment options for all PFDs and should not be forced to lose weight as a prerequisite before starting treatment. However, they should also be made aware of the impediments that being overweight adds to their care and their expectations should be managed accordingly.

Differences in the Urinary Microbiome of Patients with Overactive Bladder Syndrome with and without Detrusor Overactivity on Urodynamic Measurements

INTRODUCTION

It has been hypothesized that the urinary microbiome might play an important role in OAB. Studies have been conducted on the association between OAB symptoms and the microbiome, although a possible causality still has to be determined.

MATERIAL AND METHODS

In this study, 12 female patients, ≥18 years of age, with 'OAB DO+' and 9 female patients with 'OAB DO-' were included. Patients were excluded if they met one of the following exclusion criteria: bladder tumors and previous bladder operations; sacral neuromodulation; injection of Botox in the bladder; and TOT or TVT operations. Urine samples were collected and stored with patient informed consent and with the approval of the Hospital Ethical Review Board (Arnhem-Nijmegen). All OAB patients underwent urodynamics before collecting urine samples, and the diagnosis of detrusor overactivity was confirmed by two individual urologists. In addition, samples from 12 healthy controls who did not undergo urodynamic evaluation were analyzed. The 16S rRNA V1-V2 region amplification and gel electrophoresis were used to determine the microbiota.

RESULTS

12 of the OAB patients had DO shown on their urodynamic studies; the remaining 9 patients had a normoactive detrusor on their urodynamic measurements. Overall, there were no substantial differences among the demographic characteristics of the subjects. The samples were classified as the following: 180 phyla, 180 classes, 179 orders, 178 families, 175 genera, and 138 species. The least commonly observed phyla were Proteobacteria, with an average presence of 10%, followed by Bacteroidetes with 15%, Actinobacteria with 16%, and Firmicutes with 41%. Most of the sequences could be classified according to the genus level for each sample.

DISCUSSION

Significant differences were observed in the urinary microbiome of patients with overactive bladder syndrome who have detrusor overactivity on urodynamics compared to OAB patients without detrusor overactivity and matched controls. OAB patients with detrusor overactivity have a significantly less diverse microbiome and show a higher proportion of Lactobacillus, particularly Lactobacillus iners. The results imply that the urinary microbiome could be involved in the pathogenesis of a specific phenotype of OAB. The urinary microbiome could be a new starting point to study the causes and treatments of OAB.

Age-specific effect of transurethral holmium laser enucleation of the prostate on overactive bladder in men with benign prostatic hyperplasia: An investigation using an overactive bladder symptom score

OBJECTIVES

To investigate the age-specific effect of transurethral holmium laser enucleation of the prostate (HoLEP) on overactive bladder (OAB).

METHODS

A total of 186 consecutive patients who underwent HoLEP were included. They were divided into three groups: patients aged less than 65 years, between 65 and 74, and 75 or older. The OAB symptom score as well as other relevant variables of lower urinary tract symptoms and function were assessed before and 1, 3, 6, and 12 months after surgery. Age-specific prevalence of OAB, the proportion of resolution of OAB, and de novo OAB were evaluated.

RESULTS

The mean age of patients was 70.7 years, and the mean total prostate volume was 75.8 ml. The mean OAB symptom scores before surgery of patients aged less than 65 years, between 65 and 74, and 75 or older were 6.0, 5.2, and 5.7, respectively. At 12 months after surgery, the scores for the respective groups had significantly decreased to 2.1, 2.5, and 3.5. The prevalence of OAB based on the score in the respective groups was 45.8%, 56.9%, and 54.0% (p = .6391) preoperatively and 9.1%, 11.3%, and 15.8% at 12 months after the surgery (p = .7613). Of those with preoperative OAB, 75.0%, 79.2%, and 75.0% of the respective groups showed resolution of OAB at 12 months postoperatively (p = .9427).

CONCLUSIONS

In candidates for surgical deobstruction of benign prostatic hyperplasia, HoLEP has potential to improve OAB symptoms regardless of age.

Urinary ATP Levels Are Controlled by Nucleotidases Released from the Urothelium in a Regulated Manner

Adenosine 5′-triphosphate (ATP) is released in the bladder lumen during filling. Urothelial ATP is presumed to regulate bladder excitability. Urinary ATP is suggested as a urinary biomarker of bladder dysfunctions since ATP is increased in the urine of patients with overactive bladder, interstitial cystitis or bladder pain syndrome. Altered urinary ATP might also be associated with voiding dysfunctions linked to disease states associated with metabolic syndrome. Extracellular ATP levels are determined by ATP release and ATP hydrolysis by membrane-bound and soluble nucleotidases (s-NTDs). It is currently unknown whether s-NTDs regulate urinary ATP. Using etheno-ATP substrate and HPLC-FLD detection techniques, we found that s-NTDs are released in the lumen of ex vivo mouse detrusor-free bladders. Capillary immunoelectrophoresis by ProteinSimple Wes determined that intraluminal solutions (ILS) collected at the end of filling contain ENTPD3 > ENPP1 > ENPP3 ≥ ENTPD2 = NT5E = ALPL/TNAP. Activation of adenylyl cyclase with forskolin increased luminal s-NTDs release whereas the AC inhibitor SQ22536 had no effect. In contrast, forskolin reduced and SQ22536 increased s-NTDs release in the lamina propria. Adenosine enhanced s-NTDs release and accelerated ATP hydrolysis in ILS and lamina propria. Therefore, there is a regulated release of s-NTDs in the bladder lumen during filling. Aberrant release or functions of urothelial s-NTDs might cause elevated urinary ATP in conditions with abnormal bladder excitability.

Vinpocetine Ameliorates Metabolic-Syndrome-Associated Bladder Overactivity in Fructose-Fed Rats by Restoring Succinate-Modulated cAMP Levels and Exerting Anti-Inflammatory Effects in the Bladder Detrusor Muscle

Succinate and its receptor, the G protein-coupled receptor 91 (GPR91), have pathological implications in metabolic syndrome (MetS) and its associated bladder dysfunction, particularly in decreasing bladder cAMP levels and promoting proinflammation. Using fructose-fed rats (FFRs), a rat model of MetS, we investigate the effects of vinpocetine (a phosphodiesterase-1 inhibitor) and celecoxib (a selective cyclooxygenase-2 inhibitor) on MetS-associated bladder overactivity. Phenotypes of the overactive bladder, including increased micturition frequency and a shortened intercontractile interval in cystometry, were observed in FFRs, together with elevated succinate levels in the liver and serum and the downregulation of GPR91 in the liver and urinary bladder. Treatments with vinpocetine and celecoxib improved tissue fibrosis and ameliorated the overexpression of the inflammatory cytokines, such as IL-1β, in the liver and bladder. In bladder organ bath studies, vinpocetine, but not celecoxib, treatment restored the contraction and relaxation responses of the detrusor muscle strip in response to KCl, carbachol, and forskolin stimulation. At a molecular level, vinpocetine and celecoxib treatments modulated the downstream messengers of GPR91 (i.e., ERK1/2 and JNK), suppressed NF-κB and IL-1β expressions in the bladder, and prevented the fibrogenesis observed in FFRs. The exogenous application of succinate to a bladder organ bath significantly reduced the forskolin-induced cAMP production by the detrusor muscle, which was notably restored in the presence of vinpocetine. Together, these results suggest that vinpocetine may alleviate the MetS-associated bladder overactivity by restoring the succinate-modulated detrusor cAMP production and exerting the anti-inflammatory effects in the bladder detrusor muscle.