Alcohol, Smoking, Physical Activity, Protein, and Lower Urinary Tract Symptoms: Prospective Longitudinal Cohort

Association between air pollution exposure and lower urinary tract symptoms in Korean men

The purpose of this study was to investigate the association between long-term air pollution exposure and Low Urinary Tract Symptoms (LUTS) in Korean men. This study included 7,979 adult men who underwent health checkups. Each subject's annual average air pollution exposure levels were estimated using the Community Multiscale Air Quality model. LUTS were evaluated using the International Prostate Symptom Score (IPSS) questionnaire, and the IPSS values were analyzed for their association with LUTS severity. The study population had an average age of 56.1 years, with a prevalence of LUTS at 39.8%. None of the air pollutants were significantly associated with overall LUTS prevalence after adjusting for potential confounders. Interestingly, when divided into two symptoms of LUTS, exposures to particulate matter ≤ 2.5 μm in diameter (PM2.5) and particulate matter ≤ 10 μm in diameter (PM10) were significantly associated with an increased prevalence of voiding symptoms, but not with storage symptoms. Regarding the LUTS severity, PM2.5 and sulfur dioxide (SO2) exposures were closely related to an increased severity of overall LUTS. We report for the first time that long-term exposure to ambient air pollution, such as particulate matter, is associated with a higher prevalence and severity of LUTS, particularly voiding symptoms.

The association between depressive symptoms and lower urinary tract symptoms and impact among women: Investigating behavioural, cognitive and physiological pathways

OBJECTIVE

Mechanistic studies are needed to understand why depressive symptoms are associated with poorer physical health. The objective of this study was to examine whether behavioural, cognitive and physiological factors mediated an association between depressive symptoms, measured in early adulthood, and lower urinary tract symptoms (LUTS) and their impact, a composite variable measured in mid-life adulthood, among women in the Coronary Artery Risk Development in Young Adults study, conducted in four regions of the United States.

DESIGN

Prospective cohort study.

METHODS

Data were examined for 871 women. Depressive symptoms were measured and averaged across Years 5, 10 and 15. Year 20 health behaviour combined information about smoking, physical activity and diet. Year 25 cognitive function combined performance on different cognitive tests. Year 25 metabolic syndrome combined standard risk criteria for waist circumference, triglycerides, high-density lipoprotein, blood pressure and glucose. A cluster analysis of urinary incontinence, other LUTS and impact data-collected two years after Year 25-was used to group women into one of four categories: no or very mild symptoms with no impact (bladder health) versus mild, moderate or severe symptoms/impact.

RESULTS

Structural equation modelling showed a statistically significant direct path between depressive symptoms and LUTS/impact. Tests of indirect paths showed that health behaviours, cognitive function and metabolic syndrome did not mediate the association between depressive symptoms and LUTS/impact.

CONCLUSIONS

Depressive symptoms in early adulthood appear to be associated with LUTS and their impact in mid-life adulthood over and above health behaviours, cognitive function and metabolic syndrome.

Higher Physical Activity is Associated with Reduced Lower Urinary Tract Symptoms in Korean Men

PURPOSE

Identifying and managing risk factors for lower urinary tract symptoms (LUTS) is crucial because it impacts the quality of life of elderly individuals. Lifestyle factors, including physical activity (PA), and their relationship with LUTS have not been well studied. This objective of this study was to investigate the association between PA and LUTS.

MATERIALS AND METHODS

A total of 7,296 men were included in this cross-sectional study. PA was quantified in metabolic equivalent (MET)-hours per week, and LUTS severity was assessed using the international prostate symptom score. Logistic regression was used to analyze the association between PA and LUTS, including voiding and storage symptoms.

RESULTS

The average age of the participants was 57.8 years, and the prevalence of LUTS was 41.3%. After adjusting for potential confounders, PA was inversely associated with the prevalence and severity of moderate-to-severe LUTS, showing a dose-response pattern (all p for trend <0.01). Compared to the minimal activity group, which engaged in <5 MET-hours per week of PA, the odds ratios for moderate to severe LUTS were 0.83 (95% confidence interval [CI]: 0.72-0.97) for men engaging in 15-30 MET-hours per week, 0.82 (95% CI: 0.71-0.95) for 30-60 MET-hours per week, and 0.72 (95% CI: 0.62-0.84) for ≥60 MET-hours per week. The possible protective effect of PA was still observed in the additional analysis for voiding and storage symptoms showing the same dose-response pattern (all p for trend <0.01).

CONCLUSIONS

A higher PA level was associated with a lower prevalence and severity of total, voiding, and storage LUTS in a dose-dependent manner in Korean men.

Relationship between Mental Disorders, Smoking or Alcoholism and Benign Prostate Disease

INTRODUCTION

Mental disorders, smoking, or alcoholism and benign prostate disease are highly prevalent in men.

AIMS

To identify the relationship between mental disorders, smoking, or alcoholism and benign prostate disease.

METHODOLOGY

A prospective multicenter study that evaluated prostate health status in 558 men from the community. Groups: GP-men who request a prostate health examination and whose medical history includes a mental disorder, smoking, or alcoholism prior to a diagnosis of benign prostate disease; GU-men who request a prostate health examination and whose medical history includes a benign prostate disease prior to a diagnosis of mental disorder, smoking, or alcoholism.

VARIABLES

age, body mass index (BMI), prostate specific antigen (PSA), follow-up of the mental disorder, smoking or alcoholism, time elapsed between urological diagnosis and the mental disorder, smoking or alcoholism diagnosis, status of the urological disease (cured or not cured), concomitant diseases, surgical history, and concomitant treatments. Descriptive statistics, Student's t-test, Chi2, multivariate analysis.

RESULTS

There were no mental disorders, smoking, or alcoholism in 51.97% of men. Anxiety, smoking, major depressive disorder, pathological insomnia, psychosis, and alcoholism were identified in 19.71%, 13.26%, 5.73%, 4.30%, 2.87%, and 2.15% of individuals, respectively. Nonbacterial prostatitis (31.54%), urinary tract infection (other than prostatitis, 24.37%), prostatic intraepithelial neoplasia (13.98%), and prostatodynia (1.43%) were prostate diseases. Unresolved symptomatic benign prostate disease was associated with anxiety, depression, and psychosis (p = 0.002). Smoking was the disorder that men managed to eliminate most frequently. The dominant disorder in patients with symptomatic benign prostatic disease was alcoholism (p = 0.006).

CONCLUSIONS

Unresolved symptomatic benign prostatic disease is associated with anxiety, depression, and psychosis. Alcoholism is associated with a worse prognosis in the follow-up of symptomatic benign prostatic disease.

BPH nomogram using IPSS, prostate volume, peak flow rate, PSA and median lobe protrusion for predicting the need for intervention: development and internal validation

OBJECTIVE

The aim of the present study was to develop a nomogram to accurately predict the need for intervention in patients suffering from LUTS due to benign prostatic hyperplasia (BPH) and internally validate it.

MATERIAL AND METHODS

The data was collected from the community subjects from the state of Gujarat in western India. All the demographic data, physical examination, PSA, uroflowmetry and prostatic ultrasound was collected in 92 subjects and were followed up after 2 years. The data was analyzed and logistic regression model was used to build a predictive model. A nomogram was build using R software. Nomogram was internally validated using 50 subjects.

RESULTS

92 subjects were analyzed for developing the nomogram. Out of these, 17 patients needed intervention. 8 patients were started on medical therapy and 9 patients were taken up for surgical intervention. Of all the statistically significant predictors, peak flow rate was the most significant and was followed by median lobe enlargement, PSA, prostate volume and IPSS. These variables were used to develop a prediction model for the intervention required using reduced logistic regression model. The predictive accuracy of the model was 95.65% with a sensitivity of 88.28%, a specificity of 97.33%, a positive predictive value (PPV) of 88.24%, and a negative predictive value (NPV) of 97.33%. The AUC of the model was 0.799. Internal validation was done on 50 subjects which had sensitivity, specificity and AUC of the model at 89.66%, 90.48% and 0.968 respectively.

CONCLUSION

The study demonstrates the clinical application of nomogram which uses IPSS, PSA, peak flow rate, prostate volume and median lobe enlargement (intravesical prostatic volume). It has a sensitivity of 88.24%, specificity of 97.33%. It predicts the need for intervention in BPH patients with accuracy of 95.65% which was internally validated with an accuracy of 90%.

Drinking Frequency but not Years may be Associated with Lower Urinary Tract Symptoms: Result from a Large Cross-Sectional Survey in Chinese Men

Objective

To evaluate the effect of the drinking frequency and years on lower urinary tract symptoms (LUTS) in a large Chinese male population.

Methods

The current data were obtained from a consecutive series of 3,229 men aged 18–79 who participated in a routine physical examination in Fangchenggang First People’s Hospital, Guangxi, China. During a face-to-face interview, the detailed demographic variables about alcohol consumption, potential confounding factors were collected. LUTS were assessed by International Prostate Symptom Score (IPSS) and defined as total LUTS, irritative (IRR) and obstructive (OBS) symptoms, respectively. Multivariate logistic regression analysis was used to evaluate the risk of total LUTS, IRR and OBS symptoms affected by alcohol consumption.

Results

The prevalence of moderate to severe LUTS was 8.3% and apparently increased with age (P<0.001). A significant distribution presented in age, alcohol consumption, BMI, cigarette smoking, education attainment and hypertension among different strata of LUTS severity (P<0.05). Men who drank 1–2 times per week were less likely to have OBS symptoms (OR=0.45, 95%CI=0.29–0.70) regardless of age (OR=0.52, 95%CI=0.33–0.82) or multivariate adjusted (OR=0.52, 95%CI=0.33–0.83). Nevertheless, we did not observe a significant negative or positive association presented between drinking years and the risk of total LUTS, OBS and IRR symptoms.

Conclusion

The current results imply that moderate drinking frequency may be protective against LUTS, and drinking years did not relate to worsening or improving LUTS.

Do Lifestyle Factors Affect Lower Urinary Tract Symptoms? Results from the Korean Community Health Survey

PURPOSE

To evaluate the relationships between lower urinary tract symptoms (LUTS) and lifestyle factors (physical activity, smoking, alcohol consumption, body mass index, and stress) in Korean men.

METHODS

We analyzed the survey results of South Korean men (n=64,439) who were 40 years of age or older among whom interviews were conducted using questionnaires. Trained interviewers performed face-to-face surveys using computer-assisted personal interviewing, the International Prostate Symptom Score (IPSS), and standard questions. We assessed the relationships of lifestyle factors (physical activity, cigarette smoking, alcohol intake, height, weight, and stress) with LUTS.

RESULTS

We observed higher IPSS scores in participants who engaged in no exercise (n=46,008 [71.7%], IPSS=3.19±5.36) than in those who engaged in vigorous physical activity (n=10,657 [17.6%], IPSS=2.28±4.15). Former smokers showed higher total, storage, and voiding symptom IPSS scores than current smokers and nonsmokers. Nondrinkers had higher IPSS scores than current alcohol drinkers. In multivariable logistic regression analysis, we detected no relationship between LUTS and current alcohol drinking in the moderate and severe LUTS groups, using the mild LUTS group as a reference (moderate: 0.91; 95% confidence interval [CI], 0.91-0.91; P<0.001, severe: 0.78; 95% CI, 0.78-0.78; P<0.001). Participants with moderate to severe stress showed higher total IPSS scores than those with no or mild stress (3.38±5.77 vs. 2.88±4.90), with significant relationships between stress and LUTS found in the moderate and severe LUTS groups. In logistic regression analysis, stronger relationships were found for storage and voiding symptoms in the moderate and severe stress groups compared to the mild stress group.

CONCLUSION

A history of smoking, low levels of physical activity, low body mass index, and moderate to severe stress were associated with a greater severity of LUTS. Moderate to severe stress was also related to voiding symptoms. However, there was no association between alcohol intake and LUTS severity.

Beyond prostate, beyond surgery and beyond urology: The "3Bs" of managing non-neurogenic male lower urinary tract symptoms

Lower urinary tract symptoms (LUTS), consisting storage, voiding and post-micturition symptoms, is a comprehensive definition involving symptoms that may occur due to several causes. Instead of simply focusing on the enlarged prostate, more attention has to be paid to the entire urinary tract as well as multiple system comorbidities. Therefore, prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required. Based on current literature, this paper proposes the "3Bs" concept for managing non-neurogenic male LUTS, namely, "beyond prostate", "beyond surgery" and "beyond urology". The clinical application of the "3Bs" enables urologists to carry out integrated, individualized and precise medical care for each non-neurogenic male LUTS patient.

The prevalence of lower urinary tract symptoms in population aged 40 years or over, in South Korea

PURPOSE

Lower urinary tract symptoms (LUTS) can be distressing and socially isolating, and the economic impact can be substantial. Further data to characterize the epidemiology and effects of LUTS in South Korea would be beneficial.

MATERIALS AND METHODS

In an international, internet-based survey, the prevalence and impact of LUTS was evaluated in adults aged ≥40 years. Questions related to International Continence Society (ICS) symptom definitions and the bother associated with each symptom. The international prostate symptom score (IPSS) and the overactive bladder symptom score (OABSS) were assessed.

RESULTS

Of the 2,080 participants from South Korea, 1,090 (52.4%) were women and 740 (35.6%) were aged ≥60 years. The prevalence of LUTS according to ICS criteria was 68.2% (men, 70.6%; women, 66.0%). LUTS prevalence increased significantly with age (p=0.01 in men and women). Storage symptoms only were reported in 16.2% of men and 30.5% of women, making this the most common ICS symptom group overall. Individual symptoms with the highest prevalence in the overall population were nocturia, frequency, and weak stream (36%, 30%, and 29%, respectively). IPSS results showed that 40.1% of participants had at least moderate symptoms. The prevalence of OABSS-defined overactive bladder was 19.7% (men, 19.5%; women, 19.9%). Fourteen percent of individuals with any LUTS visited healthcare professionals regarding urinary symptoms.

CONCLUSIONS

LUTS affect the majority of adults aged ≥40 years in South Korea. The low percentage of individuals with LUTS consulting healthcare professionals regarding urinary symptoms indicates a need to improve rates of diagnosis and treatment.

Metabolic syndrome and benign prostatic hyperplasia: An update

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities related to central adiposity and insulin resistance. Its importance is increasingly recognized as it associates with increased risks of metabolic and cardiovascular diseases. These metabolic aberrations of MetS may lead to development of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in men. A 26.5%-55.6% prevalence of MetS in men with LUTS was reported in worldwide studies. Although the exact biological pathway is not clear yet, insulin resistance, increased visceral adiposity, sex hormone alterations and cellular inflammatory reactions played significant roles in the related pathophysiological processes. Clinician should recognize the cardiovascular and metabolic impacts of MetS in men with LUTS, early risk factors optimization and use of appropriate medical therapy may possibly alter or slower the progression of LUTS/BPH, and potentially avoid unnecessary morbidities and mortalities from cardiovascular and metabolic diseases for those men.

Development of Decision Support Formulas for the Prediction of Bladder Outlet Obstruction and Prostatic Surgery in Patients With Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia: Part I, Development of the Formula and its Internal Validation

PURPOSE

As the elderly population increases, a growing number of patients have lower urinary tract symptom (LUTS)/benign prostatic hyperplasia (BPH). The aim of this study was to develop decision support formulas and nomograms for the prediction of bladder outlet obstruction (BOO) and for BOO-related surgical decision-making, and to validate them in patients with LUTS/BPH.

METHODS

Patient with LUTS/BPH between October 2004 and May 2014 were enrolled as a development cohort. The available variables included age, International Prostate Symptom Score, free uroflowmetry, postvoid residual volume, total prostate volume, and the results of a pressure-flow study. A causal Bayesian network analysis was used to identify relevant parameters. Using multivariate logistic regression analysis, formulas were developed to calculate the probabilities of having BOO and requiring prostatic surgery. Patients between June 2014 and December 2015 were prospectively enrolled for internal validation. Receiver operating characteristic curve analysis, calibration plots, and decision curve analysis were performed.

RESULTS

A total of 1,179 male patients with LUTS/BPH, with a mean age of 66.1 years, were included as a development cohort. Another 253 patients were enrolled as an internal validation cohort. Using multivariate logistic regression analysis, 2 and 4 formulas were established to estimate the probabilities of having BOO and requiring prostatic surgery, respectively. Our analysis of the predictive accuracy of the model revealed area under the curve values of 0.82 for BOO and 0.87 for prostatic surgery. The sensitivity and specificity were 53.6% and 87.0% for BOO, and 91.6% and 50.0% for prostatic surgery, respectively. The calibration plot indicated that these prediction models showed a good correspondence. In addition, the decision curve analysis showed a high net benefit across the entire spectrum of probability thresholds.

CONCLUSIONS

We established nomograms for the prediction of BOO and BOO-related prostatic surgery in patients with LUTS/BPH. Internal validation of the nomograms demonstrated that they predicted both having BOO and requiring prostatic surgery very well.

Pathophysiology of benign prostate enlargement and lower urinary tract symptoms: Current concepts

Lower urinary tract symptoms (LUTS) are highly prevalent in the aging population, particularly in men. Historically, prostate enlargement was thought to be responsible for most cases of male LUTS. Several risk factors for the development of benign prostate enlargement/hyperplasia (BPE/BPH) have been identified, including age, genetics, hormones, growth factors, inflammation, and lifestyle factors. However, as our knowledge continues to evolve, male LUTS are no longer managed entirely in a prostate-centric fashion. In this article, we review current concepts in the epidemiology, etiology, and pathophysiology of BPE/BPH and male LUTS.