Abstract
We appreciate the reviewer's supportive comments. As they stated, identifying a bidirectional causality between systemic and urologic disease states would be novel and extraordinarily impactful. Doing this in a statistically valid way would likely be in the realm of big data. Our more modest goal is focused on the ability to counsel patients on the likelihood of meaningful impact of our urologic therapies in the context of their broader systemic health. A transurethral resection of prostate may not help urinary frequency in an uncontrolled diabetic on high dose diuretics. Testosterone replacement may not help fatigue in untreated sleep apnea. Engaging the patient in their medical care to improve their urologic symptoms may be aided by the use of the anxiety, cardiovascular, testosterone deficiency, insulin (diabetes), obesity, neurologic, and sleep apnea phenotype. Similarly, we hope that the urologic community sees their time with male patients as an opportunity to improve their general health in addition to their urologic health. The urologic conditions studied in this paper affect quality of life not quantity of life in a direct manner. Quality of life impact is an impetuous for patients to seek medical care, therefore the urologist may serve as a gatekeeper for patients, particularly when they are young and their systemic conditions are modifiable.
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