To investigate in detail whether well-controlled diabetes mellitus (DM) without neuropathy, retinopathy, or nephropathy affects lower urinary tract symptoms (LUTS) and function.
Methods
Of treatment-naïve men with LUTS, those with DM but with good glycemic control (hemoglobin A1c [HbA1c] < 7.0%) and no obvious DM-related complications were included in the DM group. The patients matched to the DM group for backgrounds that might affect lower urinary tract function, including age and prostate volume, were set as the non-DM group, and urodynamic parameters were compared between the groups. In addition, clinical factors associated with bladder dysfunction were examined within the DM group.
Results
A total of 139 men were included in each group (DM group: mean age 73.3 years, prostate volume 38.8 mL, HbA1c 6.6%, DM duration 122 months). Although bladder outlet obstruction index did not differ significantly between the two groups, bladder voiding efficiency, maximum flow rate, and bladder contractility index were significantly lower in the DM group. Notably, the proportion of patients with detrusor underactivity (DU) was significantly higher in the DM group (41.7% vs. 25.9%, p = 0.005). Furthermore, in the DM group, a longer duration of DM and smaller prostate size were significant factors associated with the development of DU.
Conclusions
A significant decrease in detrusor contractility was observed in men with DM even with good glucose control. Among men with LUTS, even with well-controlled DM, those with a longer disease duration and smaller prostate size are at a high risk of LUTS due to bladder dysfunction.
Trial Registration
UMIN000056036
目的：详细探讨无神经病变、视网膜病变或肾病的控制良好的糖尿病（DM）是否影响下尿路症状和功能。方法：treatment-naïve合并糖尿病但血糖控制良好的LUTS男性（血红蛋白A1c [HbA1c]）。结果：每组共纳入139例男性（糖尿病组：平均年龄73.3岁，前列腺体积38.8 mL, HbA1c 6.6%，糖尿病持续时间122个月）。两组膀胱出口阻塞指数无显著差异，但DM组膀胱排尿效率、最大流量、膀胱收缩指数明显低于DM组。值得注意的是，DM组患者逼尿肌活动不足（DU）的比例明显高于DM组（41.7% vs. 25.9%, p = 0.005）。此外，在DM组中，DM持续时间较长和前列腺体积较小是DU发生的重要因素。结论：即使血糖控制良好，糖尿病患者的逼尿肌收缩力也明显下降。在LUTS患者中，即使DM控制良好，病程较长且前列腺体积较小的患者由于膀胱功能障碍而发生LUTS的风险较高。试验注册号：UMIN000056036。
{"title":"Hidden Bladder Dysfunction in Well-Controlled Diabetes: A Urodynamic Study of Men With Lower Urinary Tract Symptoms","authors":"Yoshihisa Matsukawa, Shun Takai, Tsuyoshi Majima, Yushi Naito, Shohei Ishida, Tomokazu Kimura, Momokazu Gotoh, Shusuke Akamatsu","doi":"10.1111/luts.70042","DOIUrl":"10.1111/luts.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate in detail whether well-controlled diabetes mellitus (DM) without neuropathy, retinopathy, or nephropathy affects lower urinary tract symptoms (LUTS) and function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Of treatment-naïve men with LUTS, those with DM but with good glycemic control (hemoglobin A1c [HbA1c] < 7.0%) and no obvious DM-related complications were included in the DM group. The patients matched to the DM group for backgrounds that might affect lower urinary tract function, including age and prostate volume, were set as the non-DM group, and urodynamic parameters were compared between the groups. In addition, clinical factors associated with bladder dysfunction were examined within the DM group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 139 men were included in each group (DM group: mean age 73.3 years, prostate volume 38.8 mL, HbA1c 6.6%, DM duration 122 months). Although bladder outlet obstruction index did not differ significantly between the two groups, bladder voiding efficiency, maximum flow rate, and bladder contractility index were significantly lower in the DM group. Notably, the proportion of patients with detrusor underactivity (DU) was significantly higher in the DM group (41.7% vs. 25.9%, <i>p</i> = 0.005). Furthermore, in the DM group, a longer duration of DM and smaller prostate size were significant factors associated with the development of DU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A significant decrease in detrusor contractility was observed in men with DM even with good glucose control. Among men with LUTS, even with well-controlled DM, those with a longer disease duration and smaller prostate size are at a high risk of LUTS due to bladder dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN000056036</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ischaemia has been considered a primary cause of lower urinary tract symptoms (LUTS). The existing concept is that ischaemic LUTS develops subsequent to structural narrowing of feeder arteries of the LUT due to atherosclerosis. However, the distribution of blood flow within each LUT organ that is regulated by intramural microvasculature should also be considered. Thus, the blood supply of the mucosal and detrusor smooth muscle (DSM) in the bladder and the blood flow of the mucosal, smooth muscle and striated muscle in the urethra need to be adjusted to meet their differing energy consumption. Sympathetic overdrive that is commonly seen in aged populations and patients with metabolic syndrome enhances arteriolar constrictions resulting in a disturbed intramural flow distribution so that cell populations with a higher energy demand are more readily affected. In addition to endothelial nitric oxide (NO) that plays a pivotal role in regulating vasocontractility, NO released from perivascular parasympathetic nerves appears to counteract sympathetic activity (sympatholysis) in the LUT. Thus, any diminished neuronally released NO would cause sympathetic overactivity. Capillary rarefaction, the reduced density/function of capillaries, the site of blood-tissue exchange, would also be critically involved in the pathogenesis of LUTS. In the bladder, capillary pericytes appear to function as pacemaker cells driving arteriolar vasomotion facilitating capillary perfusion and may also play a role in maintaining suburothelial homeostasis. Considering the fundamental roles of the intramural microvasculature in maintaining LUT functions, enhanced NO-mediated sympatholysis and/or capillary revascularization could have therapeutic and preventive potential for the ischaemic LUT.
{"title":"Intramural Blood Vessels as a Primary Site of Vascular LUTS","authors":"Hikaru Hashitani, Retsu Mitsui","doi":"10.1111/luts.70041","DOIUrl":"10.1111/luts.70041","url":null,"abstract":"<p>Ischaemia has been considered a primary cause of lower urinary tract symptoms (LUTS). The existing concept is that ischaemic LUTS develops subsequent to structural narrowing of feeder arteries of the LUT due to atherosclerosis. However, the distribution of blood flow within each LUT organ that is regulated by intramural microvasculature should also be considered. Thus, the blood supply of the mucosal and detrusor smooth muscle (DSM) in the bladder and the blood flow of the mucosal, smooth muscle and striated muscle in the urethra need to be adjusted to meet their differing energy consumption. Sympathetic overdrive that is commonly seen in aged populations and patients with metabolic syndrome enhances arteriolar constrictions resulting in a disturbed intramural flow distribution so that cell populations with a higher energy demand are more readily affected. In addition to endothelial nitric oxide (NO) that plays a pivotal role in regulating vasocontractility, NO released from perivascular parasympathetic nerves appears to counteract sympathetic activity (sympatholysis) in the LUT. Thus, any diminished neuronally released NO would cause sympathetic overactivity. Capillary rarefaction, the reduced density/function of capillaries, the site of blood-tissue exchange, would also be critically involved in the pathogenesis of LUTS. In the bladder, capillary pericytes appear to function as pacemaker cells driving arteriolar vasomotion facilitating capillary perfusion and may also play a role in maintaining suburothelial homeostasis. Considering the fundamental roles of the intramural microvasculature in maintaining LUT functions, enhanced NO-mediated sympatholysis and/or capillary revascularization could have therapeutic and preventive potential for the ischaemic LUT.</p>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12611186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the perioperative safety and functional outcomes of high-power holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and long-term indwelling urinary catheter (IUC) use, with a specific focus on the impact of catheter duration on postoperative outcomes.
Methods
A retrospective analysis was conducted on 380 patients who underwent HoLEP between 2016 and 2022, stratified into two groups based on catheter duration: long-term (≥ 28 days; Group 1) and short-term catheterization (Group 2). Demographic, intraoperative, and follow-up data were collected. Functional outcomes, including International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual (PVR), were assessed preoperatively and during follow-up at 3 and 12 months.
Results
Both groups demonstrated significant and sustained improvement in voiding function and symptom scores following HoLEP. Although perioperative metrics, such as operative time, hospital stay, and catheter removal time, were comparable, Group 1 had longer enucleation times (p = 0.02). No difference in postoperative complication rate was noted. At 3 months, Group 2 exhibited superior symptom relief (IPSS: 10 vs. 12, p = 0.01), though Qmax and PVR were similar. No patients in either group required re-catheterization postoperatively. By 12 months, functional outcomes converged between groups. Multivariate analysis showed that catheter duration predicted poorer symptomatic recovery one year after surgery (OR 0.786, p < 0.001).
Conclusion
HoLEP is effective and safe for patients with BPH and preoperative catheterization. However, prolonged catheterization negatively impacts early symptom recovery. Early surgical intervention should be considered to optimize long-term outcomes and prevent catheter-related complications.
目的：本研究旨在评估高功率钬激光前列腺摘除（HoLEP）治疗良性前列腺增生（BPH）患者长期留置导尿管（IUC）的围手术期安全性和功能结局，特别关注导尿管持续时间对术后预后的影响。方法：回顾性分析2016年至2022年期间380例HoLEP患者，根据导管持续时间分为长期（≥28天）组和短期（2组）组。收集人口统计学、术中及随访资料。术前及随访3个月和12个月时评估功能结局，包括国际前列腺症状评分（IPSS）、最大尿流率（Qmax）和空腔残留（PVR）。结果：两组在HoLEP治疗后，排尿功能和症状评分均有显著且持续的改善。虽然围手术期指标，如手术时间、住院时间和拔管时间具有可比性，但第1组的去核时间更长（p = 0.02）。两组术后并发症发生率无差异。在3个月时，2组表现出更好的症状缓解（IPSS: 10 vs. 12, p = 0.01），尽管Qmax和PVR相似。两组患者均无需术后再置管。到12个月时，两组之间的功能结果趋于一致。多因素分析显示，导管持续时间预测术后1年症状恢复较差（OR 0.786, p）。结论：HoLEP对BPH患者术前置管有效且安全。然而，延长导尿时间会对早期症状的恢复产生负面影响。应考虑早期手术干预以优化长期预后并预防导管相关并发症。
{"title":"Impact of Preoperative Catheter Duration on Perioperative Safety and Functional Outcomes Following Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia: Results From a Single-Center Series","authors":"Carlo Giulioni, Federico Falsetti, Matteo Tallè, Alessio Papaveri, Francesco Mengoni, Roberto Orciani, Valentina Maurizi, Felice Crocetto, Daniele Castellani, Vineet Gauhar, Angelo Cafarelli","doi":"10.1111/luts.70039","DOIUrl":"10.1111/luts.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to evaluate the perioperative safety and functional outcomes of high-power holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and long-term indwelling urinary catheter (IUC) use, with a specific focus on the impact of catheter duration on postoperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 380 patients who underwent HoLEP between 2016 and 2022, stratified into two groups based on catheter duration: long-term (≥ 28 days; Group 1) and short-term catheterization (Group 2). Demographic, intraoperative, and follow-up data were collected. Functional outcomes, including International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual (PVR), were assessed preoperatively and during follow-up at 3 and 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both groups demonstrated significant and sustained improvement in voiding function and symptom scores following HoLEP. Although perioperative metrics, such as operative time, hospital stay, and catheter removal time, were comparable, Group 1 had longer enucleation times (<i>p</i> = 0.02). No difference in postoperative complication rate was noted. At 3 months, Group 2 exhibited superior symptom relief (IPSS: 10 vs. 12, <i>p</i> = 0.01), though Qmax and PVR were similar. No patients in either group required re-catheterization postoperatively. By 12 months, functional outcomes converged between groups. Multivariate analysis showed that catheter duration predicted poorer symptomatic recovery one year after surgery (OR 0.786, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HoLEP is effective and safe for patients with BPH and preoperative catheterization. However, prolonged catheterization negatively impacts early symptom recovery. Early surgical intervention should be considered to optimize long-term outcomes and prevent catheter-related complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Detrusor underactivity (DUA) increasingly affects aging male patients with voiding symptoms, while its management remains challenging, with less favorable surgical outcomes compared to bladder outlet obstruction. Our aim was to evaluate the efficacy of TURP in male patients with urinary retention and unfavorable urodynamic findings.
Materials and Methods
This retrospective, single-center study included 67 male patients undergoing TURP between September 2021 and September 2024 after a failed trial of voiding. Patients were divided into three groups labeled as detrusor acontractility (DA, n = 18, voided without detrusor contraction), DUA (n = 19, voided with BCI < 100 and BOOI < 20), or non-voiders (n = 30, failed to urinate and lacked measurable detrusor contractions on pressure-flow study). Surgical success was defined as successful voiding with post-void residual (PVR) < 150 mL at 3 months. Baseline parameters (PSA, prostate volume, cystoscopy and urodynamic findings), rate of surgical success, Patient Global Impression of Improvement (PGI-I) score and adverse events (subsequent surgeries and urinary tract infection) were registered and analyzed.
Results
Overall 37 (55.2%) patients became catheter-free within 3 months. The mean follow-up duration was 25.4 ± 9.6 months. Surgical success was achieved in DA, DUA, and non-voider groups in 6 (33%), 13 (68.4%), and 18 (60%) cases, respectively, and a PGI-I score greater than 4 was reported by 35 (52.2%) patients. Multivariate analysis showed higher prostate volume as an independent predictor for failure (OR: 1.7; 95% CI: 1.010–2.940; p = 0.046). Two patients developed stress urinary incontinence, and three required additional surgical intervention due to urethral stricture. Urinary tract infections occurred more frequently in the treatment failure group: Nine patients (30%) were hospitalized, and 16 (53%) required more than two antibiotic prescriptions within a 6-month period. In contrast, among the success group, only two patients (5.4%) were hospitalized, and none required frequent antibiotic therapy.
Conclusion
TURP offers a reasonable chance for catheter discontinuation in case of unfavorable urodynamic parameters. With careful patient selection in mind, surgery remains a viable option even in this patient population.
目的：逼尿肌活动不足（DUA）越来越多地影响有排尿症状的老年男性患者，而其治疗仍然具有挑战性，与膀胱出口梗阻相比，手术效果较差。我们的目的是评估TURP在男性尿潴留和尿动力学表现不佳的患者中的疗效。材料和方法：这项回顾性的单中心研究纳入了67名男性患者，他们在2021年9月至2024年9月期间接受了TURP手术，此前他们的排尿试验失败。患者分为逼尿肌收缩组（DA, n = 18，无逼尿肌收缩）和DUA组（n = 19，无逼尿肌收缩）。结果：37例（55.2%）患者在3个月内无置管。平均随访时间25.4±9.6个月。DA组、DUA组和非voider组分别有6例（33%）、13例（68.4%）和18例（60%）手术成功，其中35例（52.2%）患者的PGI-I评分大于4分。多因素分析显示前列腺体积增大是治疗失败的独立预测因子（OR: 1.7; 95% CI: 1.010-2.940; p = 0.046）。2例患者出现应激性尿失禁，3例因尿道狭窄需要额外的手术干预。治疗失败组尿路感染发生率更高：9名患者（30%）住院，16名患者（53%）在6个月内需要两次以上抗生素处方。相比之下，在成功组中，只有两名患者（5.4%）住院，没有人需要频繁的抗生素治疗。结论：在尿动力学参数不利的情况下，TURP为导管的停置提供了合理的机会。考虑到仔细的病人选择，手术仍然是一个可行的选择，即使在这个病人群体。
{"title":"Efficacy of Transurethral Resection of the Prostate in Male Patients With Impaired Detrusor Contractile Function and Urinary Retention","authors":"Balázs Kenyeres, Alexandra Helmeczi, Ákos Pytel","doi":"10.1111/luts.70040","DOIUrl":"10.1111/luts.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Detrusor underactivity (DUA) increasingly affects aging male patients with voiding symptoms, while its management remains challenging, with less favorable surgical outcomes compared to bladder outlet obstruction. Our aim was to evaluate the efficacy of TURP in male patients with urinary retention and unfavorable urodynamic findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This retrospective, single-center study included 67 male patients undergoing TURP between September 2021 and September 2024 after a failed trial of voiding. Patients were divided into three groups labeled as detrusor acontractility (DA, <i>n</i> = 18, voided without detrusor contraction), DUA (<i>n</i> = 19, voided with BCI < 100 and BOOI < 20), or non-voiders (<i>n</i> = 30, failed to urinate and lacked measurable detrusor contractions on pressure-flow study). Surgical success was defined as successful voiding with post-void residual (PVR) < 150 mL at 3 months. Baseline parameters (PSA, prostate volume, cystoscopy and urodynamic findings), rate of surgical success, Patient Global Impression of Improvement (PGI-I) score and adverse events (subsequent surgeries and urinary tract infection) were registered and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall 37 (55.2%) patients became catheter-free within 3 months. The mean follow-up duration was 25.4 ± 9.6 months. Surgical success was achieved in DA, DUA, and non-voider groups in 6 (33%), 13 (68.4%), and 18 (60%) cases, respectively, and a PGI-I score greater than 4 was reported by 35 (52.2%) patients. Multivariate analysis showed higher prostate volume as an independent predictor for failure (OR: 1.7; 95% CI: 1.010–2.940; <i>p</i> = 0.046). Two patients developed stress urinary incontinence, and three required additional surgical intervention due to urethral stricture. Urinary tract infections occurred more frequently in the treatment failure group: Nine patients (30%) were hospitalized, and 16 (53%) required more than two antibiotic prescriptions within a 6-month period. In contrast, among the success group, only two patients (5.4%) were hospitalized, and none required frequent antibiotic therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TURP offers a reasonable chance for catheter discontinuation in case of unfavorable urodynamic parameters. With careful patient selection in mind, surgery remains a viable option even in this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Betül Kuz, Mustafa Ertuğrul Yaşa, Rıza Sonkaya, Selman Aktaş
{"title":"Reply to the Letter to the Editor: “Unraveling the Links Between Posture and Urinary Symptoms in Parkinson's Disease: Missing Pieces to Consider”","authors":"Betül Kuz, Mustafa Ertuğrul Yaşa, Rıza Sonkaya, Selman Aktaş","doi":"10.1111/luts.70036","DOIUrl":"10.1111/luts.70036","url":null,"abstract":"","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xuexue Hao, Zhunan Xu, Song Li, Chengrui Zhang, Xiaoqiang Liu
Background
Overactive bladder (OAB) is a common urinary condition, with multiple contributing factors. Dietary factors affecting inflammation and oxidative stress are increasingly recognized as significant triggers. This study investigates the associations between the Dietary Inflammatory Index (DII), the Comprehensive Dietary Antioxidant Index (CDAI), and OAB in adults.
Methods
Data from the 2011–2018 National Health and Nutrition Examination Survey (NHANES) was analyzed. The DII and CDAI were calculated based on nutrient intake, and OAB was assessed using the Overactive Bladder Symptom Score (OABSS). Weighted multivariable logistic regression models were applied to evaluate associations, and subgroup analysis and restricted cubic spline (RCS) analysis were used to explore potential interactions and dose–response relationships. Additional analyses were performed to examine the associations of DII and CDAI with dry and wet OAB subtypes.
Results
Patients with OAB exhibited higher DII scores and lower CDAI scores. Increased DII was significantly associated with an elevated risk of OAB, particularly in the highest quartile (OR = 1.55, 95% CI: 1.19–2.02, p = 0.001). In contrast, higher CDAI was associated with a reduced risk of OAB (OR = 0.68, 95% CI: 0.53–0.88, p = 0.004). Subgroup analysis revealed significant interactions with age and alcohol intake. RCS analysis confirmed a positive linear relationship between DII and OAB risk, and a negative linear relationship between CDAI and OAB risk. Further stratified analysis showed that the association between DII and OAB was stronger in wet OAB than in dry OAB, whereas CDAI showed no significant association with either subtype.
Conclusion
A diet with low inflammatory potential and rich in antioxidants may reduce the risk of OAB, particularly in younger individuals and heavy drinkers. Dietary modification presents a practical approach for OAB management, warranting further research to establish causality and inform intervention strategies.
背景：膀胱过动症（OAB）是一种常见的泌尿系统疾病，有多种致病因素。影响炎症和氧化应激的饮食因素越来越被认为是重要的触发因素。本研究探讨了成人膳食炎症指数（DII）、综合膳食抗氧化指数（CDAI）和OAB之间的关系。方法：对2011-2018年全国健康与营养检查调查（NHANES）数据进行分析。根据营养摄入计算DII和CDAI，使用膀胱过度活动症状评分（OABSS）评估OAB。采用加权多变量logistic回归模型评估相关性，并采用亚组分析和限制性三次样条（RCS）分析探索潜在的相互作用和剂量-反应关系。进一步分析了DII和CDAI与干湿OAB亚型的关系。结果：OAB患者具有较高的DII评分和较低的CDAI评分。DII增加与OAB风险升高显著相关，特别是在最高四分位数（OR = 1.55, 95% CI: 1.19-2.02, p = 0.001）。相反，较高的CDAI与OAB风险降低相关（OR = 0.68, 95% CI: 0.53-0.88, p = 0.004）。亚组分析显示与年龄和酒精摄入量有显著的相互作用。RCS分析证实DII与OAB风险呈线性正相关，CDAI与OAB风险呈线性负相关。进一步的分层分析表明，DII与OAB在湿OAB中的相关性强于干OAB，而CDAI与两种亚型均无显著相关性。结论：低炎症潜力和富含抗氧化剂的饮食可以降低OAB的风险，特别是在年轻人和酗酒者中。饮食调整是OAB管理的实用方法，需要进一步研究以确定因果关系并为干预策略提供信息。
{"title":"Associations of Dietary Inflammation Index and Composite Dietary Antioxidant Index With Overactive Bladder in Adults: NHANES 2011–2018","authors":"Xuexue Hao, Zhunan Xu, Song Li, Chengrui Zhang, Xiaoqiang Liu","doi":"10.1111/luts.70038","DOIUrl":"10.1111/luts.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Overactive bladder (OAB) is a common urinary condition, with multiple contributing factors. Dietary factors affecting inflammation and oxidative stress are increasingly recognized as significant triggers. This study investigates the associations between the Dietary Inflammatory Index (DII), the Comprehensive Dietary Antioxidant Index (CDAI), and OAB in adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the 2011–2018 National Health and Nutrition Examination Survey (NHANES) was analyzed. The DII and CDAI were calculated based on nutrient intake, and OAB was assessed using the Overactive Bladder Symptom Score (OABSS). Weighted multivariable logistic regression models were applied to evaluate associations, and subgroup analysis and restricted cubic spline (RCS) analysis were used to explore potential interactions and dose–response relationships. Additional analyses were performed to examine the associations of DII and CDAI with dry and wet OAB subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with OAB exhibited higher DII scores and lower CDAI scores. Increased DII was significantly associated with an elevated risk of OAB, particularly in the highest quartile (OR = 1.55, 95% CI: 1.19–2.02, <i>p</i> = 0.001). In contrast, higher CDAI was associated with a reduced risk of OAB (OR = 0.68, 95% CI: 0.53–0.88, <i>p</i> = 0.004). Subgroup analysis revealed significant interactions with age and alcohol intake. RCS analysis confirmed a positive linear relationship between DII and OAB risk, and a negative linear relationship between CDAI and OAB risk. Further stratified analysis showed that the association between DII and OAB was stronger in wet OAB than in dry OAB, whereas CDAI showed no significant association with either subtype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A diet with low inflammatory potential and rich in antioxidants may reduce the risk of OAB, particularly in younger individuals and heavy drinkers. Dietary modification presents a practical approach for OAB management, warranting further research to establish causality and inform intervention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unraveling the Links Between Posture and Urinary Symptoms in Parkinson's Disease: Missing Pieces to Consider","authors":"Christian Messina","doi":"10.1111/luts.70034","DOIUrl":"10.1111/luts.70034","url":null,"abstract":"","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mechanistic Insights From Reduced Bladder Preparations: A Necessary Complement to In Vivo Models","authors":"Bin Feng, George A. Kuchel","doi":"10.1111/luts.70035","DOIUrl":"10.1111/luts.70035","url":null,"abstract":"","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ebtesam Almajed, Norah Alqntash, Badriyah AlDejain, Noura AlQurashi, Mohammed Alshehri, Ali AbdelRaheem, Nojoud Alamri
Objectives
Urinary incontinence (UI) is prevalent and often underreported due to various barriers affecting healthcare-seeking behavior. This study aimed to identify barriers preventing patients from seeking help for UI, assess the influence of sociodemographic and clinical factors on these barriers, and determine the associations between UI types and barriers in Saudi Arabia.
Methods
A nationwide, cross-sectional study was conducted from June 2024 to April 2025 among individuals aged ≥ 18 years who experienced UI and had not sought medical consultation. Participants completed a questionnaire that comprised sociodemographic data, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and a modified Barriers to Incontinence Care Seeking Questionnaire (BICS-Q). Data were analyzed using descriptive statistics, independent t-tests, ANOVA, and binary logistic regression.
Results
Of 505 eligible participants, 80.6% were female, predominantly aged 31–45 (40.0%), and the most common UI type was mixed UI (37.2%). The most significant barriers were embarrassment (33.3%), logistical inconvenience (appointments scheduled too far in advance, 36.8%), and provider-related issues (lack of available providers, 12.3%). Gender, obesity, residency region, and type of UI significantly influenced barrier perception. Fear-related barriers were notably higher in nocturnal UI, whereas embarrassment and cultural concerns were highest among those with mixed UI.
Conclusion
This study highlights significant embarrassment, inconvenience, and provider-related barriers deterring healthcare-seeking among UI patients in Saudi Arabia. Findings emphasize the need for culturally tailored interventions, improved healthcare accessibility, and targeted public awareness campaigns.
{"title":"Barriers to Seeking Medical Consultation for Urinary Incontinence: A Nationwide Population-Based Study in Saudi Arabia","authors":"Ebtesam Almajed, Norah Alqntash, Badriyah AlDejain, Noura AlQurashi, Mohammed Alshehri, Ali AbdelRaheem, Nojoud Alamri","doi":"10.1111/luts.70033","DOIUrl":"https://doi.org/10.1111/luts.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Urinary incontinence (UI) is prevalent and often underreported due to various barriers affecting healthcare-seeking behavior. This study aimed to identify barriers preventing patients from seeking help for UI, assess the influence of sociodemographic and clinical factors on these barriers, and determine the associations between UI types and barriers in Saudi Arabia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationwide, cross-sectional study was conducted from June 2024 to April 2025 among individuals aged ≥ 18 years who experienced UI and had not sought medical consultation. Participants completed a questionnaire that comprised sociodemographic data, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and a modified Barriers to Incontinence Care Seeking Questionnaire (BICS-Q). Data were analyzed using descriptive statistics, independent <i>t</i>-tests, ANOVA, and binary logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 505 eligible participants, 80.6% were female, predominantly aged 31–45 (40.0%), and the most common UI type was mixed UI (37.2%). The most significant barriers were embarrassment (33.3%), logistical inconvenience (appointments scheduled too far in advance, 36.8%), and provider-related issues (lack of available providers, 12.3%). Gender, obesity, residency region, and type of UI significantly influenced barrier perception. Fear-related barriers were notably higher in nocturnal UI, whereas embarrassment and cultural concerns were highest among those with mixed UI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights significant embarrassment, inconvenience, and provider-related barriers deterring healthcare-seeking among UI patients in Saudi Arabia. Findings emphasize the need for culturally tailored interventions, improved healthcare accessibility, and targeted public awareness campaigns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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