The relationship between mental health disorders and LUTS.

Sleep Related Problems and Urological Symptoms: Testing the Hypothesis of Bidirectionality in a Longitudinal, Population Based Study

Lower urinary tract symptoms (LUTS) are defined as symptoms related to the lower urinary tract or referred from similarly innervated anatomy. No specific criteria are used to precisely define LUTS owing to its multiorgan involvement instead of organ-centric (urethra and bladder). In the past decade, the prevalence of LUTS dramatically increased owing to low health care seeking behaviors. Initially, patients with LUTS seemed to not actively look for medical opinions because of cultural or ethnic barriers. Raising awareness of the significance of medical opinions may contribute to increasing health care seeking behaviors for LUTS. In addition to the association between LUTS and mental illness, a temporal relationship exists, that is, LUTS may cause mental illness and vice versa. This bidirectional correlation relationship was demonstrated by a nationwide observational study. The impacts of LUTS vary among different age groups. Older adults have higher LUTS prevalence, whereas younger ones with LUTS have higher risks of developing anxiety and depression. Similarly, the impacts of LUTS differ between men and women. Women have higher LUTS prevalence; however, men with LUTS have higher risks of developing anxiety and depression. In conclusion, significant association and temporal bidirectional relationship exist between LUTS and mental health. Our findings suggested that patients with LUTS also receive mental illness–related health care; similarly, patients with mental illness may have risks of developing subsequent LUTS.

Background:Lower urinary tracts symptoms (LUTS) – voiding symptoms, storage symptoms, or post-micturition symptoms – and psychiatric disorders are often comorbid conditions in patients. However, no systematic review on the association between urological symptoms and psychiatric symptoms in a broad sense had yet been presented. We aim to systematically review the literature on the association of lower urinary tract symptoms with psychiatric symptoms or disorders. Methods:This systematic review and meta-analysis is conducted according to the PRISMA guidelines. We searched MEDLINE, Embase (Ovid interface), CINAHL and PsycINFO (EBSCO interface) for studies published between database inception and Oct 7th, 2021. The quality of the studies was assessed with Newcastle Ottawa Quality Assessment scale. This review is registered in the PROSPERO register (CRD42021207308). Results:Of 1974 records identified, 77 studies fulfilled the inclusion criteria. 68 of these had a risk of overall bias of middle or low in the NOS bias assessment scale (Lo et al., 2014; Hamling et al., 2008) [1,2]. A positive association was found between; LUTS with depression in 31 studies, and with anxiety in 11 studies; OAB with depression in 12 studies, and with anxiety in 13 studies; nocturia with depression in 6 studies; urinary incontinence (both stress and urge) with depression in 13 studies; and voiding dysfunction with depression and anxiety in 7 studies. Conclusion:To our knowledge, this systematic review is the first to research the full range of lower urinary tract symptoms in association with psychiatrics symptoms or disorders. Results show an association between LUTS and psychiatric symptoms in a broad sense, however, most studies report on LUTS in association with depression and anxiety, and less studies report on other psychiatric symptoms or disorders. Further research to specify this will be needed to make a valid statement on specific psychiatric disorders in association with LUTS.

Background:Poorer performance on standardized tests of cognitive function is associated with urinary incontinence (UI), overactive bladder, and poorer bladder health among people aged 40 and older.Objective:To examine whether self-rated deficits in executive function domains (organization/problem solving, inhibitory control/self-restraint, self-regulation of emotions) are associated with lower urinary tract symptoms (LUTS), perceived bladder health and function, and adaptive behaviors to prevent or manage UI among adult women across the life course.Methods:Surveys were administered as part of the RISE FOR HEALTH population-based study of women (19-100 years, mean=50 years) in the United States. In this cross-sectional analysis, LUTS, perceived bladder health and function, and adaptive behaviors were regressed on individual executive function subscales and a composite measure (analytic sample n=1551).Results:Self-rated deficits in all evaluated domains of executive function were significantly associated with greater numbers and frequency of LUTS, including urgency and urgency UI; poorer perceived bladder health and function; and a greater tendency to locate bathrooms when entering new places. Associations were of similar magnitude across age categories ranging from emerging to older adulthood.Conclusions:Findings demonstrate an association between self-rated executive function deficits and bladder function. Further research should test brain-bladder communication as a potential mechanism linking deficits in executive function to greater numbers and frequency of LUTS, poorer perceived bladder health and function, and greater engagement in adaptive behaviors to prevent or manage UI. Research is also needed to further evaluate whether associations between executive function and LUTS differ by life course stage.

Some reports showed that urinary incontinence (UI) or female lower urinary tract symptoms (LUTS) affect life quality and sexual activity. In clinical practice, it is commonly found that not only the symptoms of UI but also overactive bladder (OAB) syndrome affect daily lifestyle and sexual activity, especially in women in the most active era in their social and personal life. However, there is lack of data proving the effect of OAB syndrome on sexual activity or sexual life quality in sexually active age group. This study aimed at evaluating the effect of OAB syndrome and UI on the sexual activity and on the sexual quality of life (QoL) of Korean women age from 20s to 40s. We investigated 3372 women aged between 20 and 49 y, enrolled via a multicenter internet survey. A structured questionnaire was used to collect data about their LUTS and sexual activities. The prevalence of OAB syndrome and UI in 3372 women was 12.7 and 21.0%, respectively. Mean subject age was 26.4+/-4.8 y and 79.5% of subjects were 20-29 y old. Having OAB syndrome or UI were found to be significant predictors of sexual life problems (OAB syndrome: OR=5.08, 95% CI=3.68-7.01; UI: OR=4.16, 95% CI=3.06-5.67). Sexual activity was significantly reduced in OAB syndrome and UI versus the asymptomatic group (OAB syndrome: OR=4.8, 95% CI=3.14-6.83; UI: OR=3.9, 95% CI=2.81-5.27). This study is the first internet-based study concerning the sexual QoL in UI and OAB syndrome. In this study, OAB syndrome was found to cause a greater deterioration in the sexual QoL than UI. These results suggest that these symptoms have a significant impact upon women's personal and social lives and markedly affect the QoL.

It remains uncertain to what extent lower urinary tract (LUT) symptom (LUTS) is a comorbidity of myasthenia gravis (MG). We prospectively administered a LUTS questionnaire devised for detecting neurogenic pelvic organ dysfunction (not validated) in an MG group and a healthy control group and compared the results. The MG group comprised 21 patients: 15 women and 6 men, with age range 22–73 (mean 47) years, illness duration range 0.2–8 (mean 3.5) years, median Myasthenia Gravis Foundation of America (MGFA) grade 2, all walking independently. Therapies included thymectomy in 17, predonisolone 5–20 mg/day in 10, and pyridostigmine bromide 60–180 mg/day in 9 patients. The control group, who were undergoing an annual health survey, comprised 235 consecutive subjects: 120 women and 115 men, with age range 30–69 (mean 48) years. The questionnaire had 9 questions. Each question was scored from 0 (none) to 3 (severe) with an additional quality of life (QOL) index scored from 0 (satisfied) to 3 (extremely dissatisfied). Statistical analysis was made using Student’s t test. Compared with the control subjects, the frequency of LUTSs in the MG patients was significantly higher for daytime frequency (43%; p < 0.01), nocturia (24%; p < 0.01), and urinary incontinence (43%; p < 0.05). The LUTS-related QOL index for the MG patients was significantly higher for MG patients as a whole than that for all control patients (29%) (p < 0.05). In conclusion, our study results showed that MG patients had significantly more LUTSs (overactive bladder) than healthy control subjects and had worse LUTS-related QOL; therefore, amelioration of LUTS in MG is important.

Prevalence of Urinary Incontinence in Men: Results From the National Health and Nutrition Examination Survey

Lower urinary tract (LUT) symptoms are reported in more than 80% of patients with multiple sclerosis (MS), most commonly an overactive bladder (OAB). The relationship between brain white matter (WM) changes in MS and OAB symptoms is poorly understood. We aim to evaluate (i) microstructural WM differences across MS patients (pwMS) with OAB symptoms, patients without LUT symptoms, and healthy subjects using diffusion tensor imaging (DTI), and (ii) associations between clinical OAB symptom scores and DTI indices. Twenty-nine female pwMS [mean age (SD) 43.3 years (9.4)], including seventeen with OAB [mean age (SD) 46.1 years (8.6)] and nine without LUT symptoms [mean age (SD) 37.5 years (8.9)], and fourteen healthy controls (HCs) [mean age (SD) 48.5 years (20)] were scanned in a 3T MRI with a DTI protocol. Additionally, clinical scans were performed for WM lesion segmentation. Group differences in fractional anisotropy (FA) were evaluated using tract-based spatial statistics. The Urinary Symptom Profile questionnaire assessed OAB severity. A statistically significant reduction in FA (p = 0.004) was identified in microstructural WM in pwMS, compared with HCs. An inverse correlation was found between FA in frontal and parietal WM lobes and OAB scores (p = 0.021) in pwMS. Areas of lower FA, although this did not reach statistical significance, were found in both frontal lobes and the rest of the non-dominant hemisphere in pwMS with OAB compared with pwMS without LUT symptoms (p = 0.072). This study identified that lesions affecting different WM tracts in MS can result in OAB symptoms and demonstrated the role of the WM in the neural control of LUT functions. By using DTI, the association between OAB symptom severity and WM changes were identified, adding knowledge to the current LUT working model. As MS is predominantly a WM disease, these findings suggest that regional WM involvement, including of the anterior corona radiata, anterior thalamic radiation, superior longitudinal fasciculus, and superior frontal-occipital fasciculus and a non-dominant prevalence in WM, can result in OAB symptoms. OAB symptoms in MS correlate with anisotropy changes in different white matter tracts as demonstrated by DTI. Structural impairment in WM tracts plays an important role in LUT symptoms in MS.

Modifiable Risk Factors for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms: New Approaches to Old Problems

Over the past decade, it has become clear many of the age-related health problems of men, that have hitherto been treated using different medical disciplines, are actually inter-related and require a more integrative approach in the aging male. Lower urinary tract symptoms (LUTS) may serve as an example. LUTS consists of storage, voiding, and post micturition symptoms affecting the lower urinary tract. Storage symptoms (daytime frequency, nocturia, urgency, incontinence) are experienced during the storage phase of the bladder. Voiding symptoms (weak stream, splitting or spraying, abdominal straining, hesitancy, intermittency, terminal dribble) are experienced during the voiding phase. Post-micturition symptoms (feeling of incomplete emptying, post micturition dribble) are experienced immediately after micturition. Individuals with LUTS often experience urinary incontinence (UI) or overactive bladder (OAB) symptoms. OAB is a subset of storage LUTS defined as urgency, with or without urgency UI, usually with frequency and nocturia. Men may report one or any combination of the symptoms and LUTS, including UI and OAB, have detrimental effects on health-related quality of life. The prevalence of LUTS increases from 8% in the fourth decade of life to more than 70% in the seventh decade. In a large population-based cross-sectional survey the prevalence of storage LUTS (men, 51.3%; women, 59.2%) was greater than that for voiding (men, 25.7%; women, 19.5%) and post micturition (men, 16.9%; women, 14.2%) symptoms combined (Irwin et al., 2008). Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating. LUTS may point to serious pathology of the urogenital tract but are often nonspecific and large studies of patients have failed to show any correlation between LUTS and a specific diagnosis. An allencompassing view of LUTS that focuses on the lower urinary tract as an integrated functional unit, but simultaneously reflects pathophysiology in the body as a whole, is more likely to improve a clinician’s ability to manage the symptoms and therefore improve patient outcomes. Benign prostatic hyperplasia (BPH), which occurs more frequently with aging, is the most common cause of LUTS in middle-aged and elderly men, although many other diseases such as detrusor muscle weakness and/or instability, urinary tract infection, chronic prostatitis, urinary stone, prostate cancer, bladder cancer, neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome, and cardiac and renal diseases may accompany LUTS.

A higher incidence of lower urinary tract symptoms (LUTS) in people with schizophrenia compared to the general population is often suggested. However, it is not clear whether this is a genuine association, and whether it is a direct result of schizophrenia itself, or a side-effect of certain antipsychotics. We undertook a narrative review evaluating how the published literature reports the relationship between LUTS and schizophrenia and its treatments. We searched Embase, Ovid Emcare, and Ovid MEDLINE(R) ALL to August 2022, limited to the English language. We selected the following search terms: schizophrenia, schizophrenic, LUTS, overactive bladder, urinary urgency, urinary incontinence, overactive bladder, enuresis, nocturnal enuresis, and voiding dysregulation. We identified seven domains for assessment in advance of commencing the review. These were the categorization, description, and treatment status of schizophrenia; evaluation of LUTS; categorization of LUTS confounders; recapturing of the disease states of both schizophrenia and LUTS after therapies; assessment of the association between LUTS and schizophrenia and/or antipsychotics. The association between LUTS and schizophrenia was poorly described. The evidence was low quality and focused predominantly on urinary incontinence as an antipsychotic side effect, neglecting other LUTS. The status of schizophrenia was often incompletely characterized, and no papers made use of a bladder diary or LUTS-specific questionnaires to assess symptoms. No papers collected information about LUTS in patients not on antipsychotics, nor did any thoroughly evaluate the influence of confounding variables. Despite the tendency of symptoms and severity of both conditions to fluctuate over time, no studies fully assessed the status of both schizophrenia and LUTS at baseline, therapy initiation, and follow-up. It is not possible to state whether there is an association between LUTS and schizophrenia or its treatments. This review highlights the need to improve research and clinical management of the urinary tract in schizophrenia, with meticulously designed longitudinal studies.

Lower Urinary Tract Dysfunction in Male Iraq and Afghanistan War Veterans: Association With Mental Health Disorders: A Population-based Cohort Study

Continence Care Literature Review 2012

Overactive Bladder is a Dynamic Syndrome

A Cross-Sectional, Population-Based, Multinational Study of the Prevalence of Overactive Bladder and Lower Urinary Tract Symptoms: Results from the EPIC Study