Progression Of Lower Urinary Tract Symptoms Research Articles

Serum Testosterone and Dihydrotestosterone and Incidence and Progression of Lower Urinary Tract Symptoms: Results From the REDUCE Study.

Though the pathogenesis of benign prostatic hyperplasia is unclear, it was previously believed that increasing androgen levels contributed, though not all data support this idea. We tested if elevated serum testosterone or dihydrotestosterone were risk factors for lower urinary tract symptoms incidence in asymptomatic men and for lower urinary tract symptoms progression in symptomatic men. A post hoc analysis of REDUCE was performed in 3009 asymptomatic men and in 2145 symptomatic men. REDUCE was a randomized trial of dutasteride for prostate cancer prevention in men with an elevated prostate-specific antigen and negative prestudy biopsy. We estimated multivariable adjusted hazard ratios and 95% confidence intervals using Cox models to test the association between quintiles of serum testosterone and dihydrotestosterone at baseline and lower urinary tract symptoms incidence and progression and tested for interaction by treatment arm (dutasteride vs placebo). In asymptomatic men, there was no evidence serum testosterone or dihydrotestosterone were related to lower urinary tract symptoms incidence (P = .9, P = .4). In symptomatic men, there was no evidence serum testosterone or dihydrotestosterone were related to lower urinary tract symptoms progression (P = .9, P = .7). Results were similar in both placebo and dutasteride arms (all P interaction ≥ .3). In REDUCE, higher serum testosterone and higher serum dihydrotestosterone were not associated with either lower urinary tract symptoms incidence in asymptomatic men or lower urinary tract symptoms progression in symptomatic men. These data do not support the hypothesis that serum androgens in middle-aged men are associated with lower urinary tract symptoms.

Smoking and lower urinary tract symptoms in Reduction by Dutasteride of Prostate Cancer EventsTrial.

Benign prostatic hyperplasia is common in older men, with many developing lower urinary tract symptoms (LUTS) that impair quality of life. Smoking has many well-established adverse effects, but its effects on benign prostatic hypertrophy(BPH) and associated LUTS are unclear. We sought to determine if smoking is a risk factor for the incidence of LUTS in asymptomatic men and for the progression of LUTS in symptomatic men. We performed a post-hoc analysis of Reduction by Dutasteride of Prostate Cancer Events in 3060 "asymptomatic" men with baseline International Prostate Symptom Score (IPSS) < 8 and in 2198 symptomatic men with baseline IPSS ≥ 8 not taking 5α-reductase inhibitors or α-blockers. We used multivariable Cox regression models to assess associations between smoking status at baseline and LUTS incidence and progression. Among asymptomatic men, incident LUTS was defined as the first report of medical or surgical treatment for BPH, or sustained clinically significant LUTS (two reports of IPSS > 14). Among symptomatic men, LUTS progression was defined as IPSS increase of ≥4 points from baseline, surgical intervention for BPH, or starting a new BPH drug. Of 3060 asymptomatic men, 15% (n = 467) were current, 40% (n = 1231) former, and 45% (n = 1362) never-smokers. Of 2198 symptomatic men, 14% (n = 320) were current, 39% (n = 850) former, and 47% (n = 1028) never-smokers. In asymptomatic men, compared with never-smokers, current and former smoking at baseline were not associated with LUTS incidence (adjusted hazard ratio [adj-HR] = 1.08; 95% confidence interval [95%CI]: 0.78-1.48 and adj-HR = 1.01; 95% CI: 0.80-1.30). In symptomatic men, compared with never-smokers, current and former smoking at baseline were not associated with the progression of LUTS (adj-HR = 1.11; 95% CI: 0.92-1.33 and adj-HR = 1.03; 95% CI: 0.90-1.18). In REDUCE, smoking status was not associated with either incident LUTS in asymptomatic men or progression of LUTS in symptomatic men.

PD02-06 SERUM TESTOSTERONE AND DIHYDROTESTOSTERONE AND INCIDENCE AND PROGRESSION OF LOWER URINARY TRACT SYMPTOMS IN REDUCTION BY DUTASTERIDE OF PROSTATE CANCER EVENTS TRIAL

You have accessJournal of UrologyCME1 Apr 2023PD02-06 SERUM TESTOSTERONE AND DIHYDROTESTOSTERONE AND INCIDENCE AND PROGRESSION OF LOWER URINARY TRACT SYMPTOMS IN REDUCTION BY DUTASTERIDE OF PROSTATE CANCER EVENTS TRIAL James Daniels, James Mirocha, Daniel Moreira, Gerald Andriole, and Stephen Freedland James DanielsJames Daniels More articles by this author , James MirochaJames Mirocha More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , Gerald AndrioleGerald Andriole More articles by this author , and Stephen FreedlandStephen Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003219.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) is common in older men, with many developing lower urinary tract symptoms (LUTS) that impair quality of life. Though the pathogenesis of BPH is unclear, it was previously believed that increasing androgen levels had a role, though not all data support this idea. We tested if elevated serum testosterone and elevated serum DHT are risk factors for LUTS incidence in asymptomatic men and for LUTS progression in symptomatic men. METHODS: A post-hoc analysis of REDUCE was carried out in 3009 asymptomatic men with baseline International Prostate Symptom Score (IPSS) <8 and in 2145 symptomatic men with baseline IPSS≥8 not taking α-blockers or 5α-reductase inhibitor medications. The Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial was a randomized trial of dutasteride for prostate cancer prevention in men with an elevated PSA and negative pre-study biopsy. IPSS was measured every 6 months over the 4-year study. We estimated multivariable adjusted hazard ratios (adj-HRs) and 95% confidence intervals (CIs) using Cox models to test the association between quintiles of serum testosterone and quintiles of serum dihydrotestosterone (DHT) at baseline and LUTS incidence and progression. Among asymptomatic men, incident LUTS was defined as the first report of medical treatment, surgery or sustained clinically significant LUTS (i.e., 2 reports of IPSS>14). Among symptomatic men, LUTS progression was defined as an IPSS increase of ≥4 points from baseline, any surgical procedure for BPH, or the start of a new BPH medication. RESULTS: In asymptomatic men, relative to the lowest quantile, all quintiles of serum testosterone and all quintiles of DHT were unrelated to LUTS incidence (all p≥0.25). In symptomatic men, relative to the lowest quantile, all quintiles of serum testosterone and all quintiles of DHT were unrelated to LUTS progression (all p≥0.17). There was no significant interaction between treatment with dutasteride and serum testosterone or DHT when predicting LUTS; as such, data were not stratified by treatment assignment. CONCLUSIONS: In the REDUCE study, higher serum testosterone and higher serum DHT were not associated with either incident LUTS in asymptomatic men or progression of LUTS in symptomatic men. These data do not support the hypothesis that serum androgen levels in middle-aged men are associated with LUTS. Source of Funding: Dr. Daniels is funded by the NIH grants TL1 DK132768 and U2C DK129496 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e71 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Daniels More articles by this author James Mirocha More articles by this author Daniel Moreira More articles by this author Gerald Andriole More articles by this author Stephen Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...

Statin Use and Lower Urinary Tract Symptoms Incidence and Progression in Reduction by Dutasteride of Prostate Cancer Events (REDUCE) Trial.

Benign prostatic hyperplasia (BPH) is a common disease often manifested by lower urinary tract symptoms (LUTS). We previously found statins were associated with modest attenuations in prostate growth over time in REDUCE. We tested whether statins were associated with LUTS incidence in asymptomatic men and LUTS progression in symptomatic men. We performed a post-hoc analysis of REDUCE in 3,060 "asymptomatic" men with baseline International Prostate Symptom Score (IPSS) <8 and in 2,198 symptomatic men with baseline IPSS ≥8 not taking α-blockers or 5α-reductase inhibitors. We used multivariable Cox regression models to assess associations between statin use at baseline and LUTS incidence and progression. Among asymptomatic men, incident LUTS was defined as the first reported medical or surgical treatment for BPH or sustained clinically significant LUTS (2 reports of IPSS >14). Among symptomatic men, LUTS progression was defined as IPSS increase ≥4 points from baseline, any surgical procedure for BPH, or initiation of a BPH drug. Among asymptomatic and symptomatic men, 550 (18%) and 392 (18%) used statins at baseline, respectively. On multivariable analysis, statin use was not associated with LUTS incidence (HR 1.05; 95% CI 0.78-1.41, p=0.74) in asymptomatic men, or with LUTS progression (HR 1.13; 95% CI 0.96-1.33, p=0.15) in symptomatic men. Similar results were seen in the dutasteride and placebo arms when stratified by treatment assignment. In REDUCE, statin use was not associated with either incident LUTS in asymptomatic men or LUTS progression in symptomatic men. These data do not support a role for statins in LUTS prevention or management.

MP28-08 SMOKING AND INCIDENCE AND PROGRESSION OF LOWER URINARY TRACT SYMPTOMS (LUTS) IN THE REDUCTION BY DUTASTERIDE OF PROSTATE CANCER EVENTS (REDUCE) TRIAL

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation (MP28)1 Sep 2021MP28-08 SMOKING AND INCIDENCE AND PROGRESSION OF LOWER URINARY TRACT SYMPTOMS (LUTS) IN THE REDUCTION BY DUTASTERIDE OF PROSTATE CANCER EVENTS (REDUCE) TRIAL Jordan J. Kramer, Illona Csizmadi, Lin Gu, Daniel Moreira, Gerald Andriole, and Stephen J. Freedland Jordan J. KramerJordan J. Kramer More articles by this author , Illona CsizmadiIllona Csizmadi More articles by this author , Lin GuLin Gu More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , Gerald AndrioleGerald Andriole More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002025.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) is common in older men, with many developing lower urinary tract symptoms (LUTS) that impair quality of life. Smoking has many well-established adverse effects, but its effects on BPH and associated LUTS are unclear. We sought to determine if smoking is a risk factor for the incidence of LUTS in asymptomatic men and for the progression of LUTS in symptomatic men. METHODS: A post-hoc analysis of REDUCE was carried out in 3060 asymptomatic/minimally symptomatic (aka “asymptomatic”) men with baseline International Prostate Symptom Score (IPSS) <8 and in 2198 symptomatic men with baseline IPSS ≥8 not taking α-blockers or 5α-reductase inhibitor medications. We estimated multivariable adjusted hazard ratios (adj-HRs) and 95% confidence intervals (CIs) using Cox proportional hazard models to assess the association between smoking at baseline and LUTS incidence and progression. Among asymptomatic men, incident LUTS was defined as the first report of medical treatment, surgery or sustained clinically significant LUTS (i.e. 2 reports of IPSS>14). Among symptomatic men, LUTS progression was defined as an IPSS increase of ≥4 points from baseline, any surgical procedure for BPH, or the start of a new BPH drug. RESULTS: Of 3060 asymptomatic men, 15% (n=467) were current, 40% (n=1231) former and 45% (n=1362) never-smokers. Of 2198 symptomatic men, 14% (n=320) were current, 39% (n=850) former and 47% (n=1028) never-smokers. In asymptomatic men, compared with never-smokers, current and former smoking at baseline was not associated with LUTS incidence (adj-HR=1.08; 95% CI: 0.78-1.48 and adj-HR=1.01; 95% CI: 0.80-1.30, for current and former smoking status, respectively). In symptomatic men, compared with never-smokers, current and former smoking at baseline was not associated with the progression of LUTS (adj-HR=1.11; 95% CI: 0.92-1.33 and adj-HR=1.03; 95% CI: 0.90-1.18, for current and former smoking status, respectively). Similar results were seen in dutasteride and placebo arms in data stratified by treatment assignment. CONCLUSIONS: In the REDUCE study, smoking status was not associated with either incident LUTS in asymptomatic men or progression of LUTS in symptomatic men. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e483-e484 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan J. Kramer More articles by this author Illona Csizmadi More articles by this author Lin Gu More articles by this author Daniel Moreira More articles by this author Gerald Andriole More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement Loading ...

A multi-omic investigation of male lower urinary tract symptoms: Potential role for JC virus.

Male lower urinary tract symptoms (LUTS) comprise a common syndrome of aging that negatively impacts quality of life. The etiology of LUTS is multifactorial, involving benign prostatic hyperplasia, smooth muscle and neurologic dysfunction, inflammation, sexually transmitted infections, fibrosis, and potentially dysbiosis, but this aspect remains poorly explored. We investigated whether the presence of infectious agents in urine might be associated with LUTS by combining next-generation DNA sequencing for virus discovery, microbiome analysis for characterization of bacterial communities, and mass spectrometry-based metabolomics. In urine from 29 LUTS cases and 9 controls from Wisconsin, we found a statistically significant association between a diagnosis of LUTS and the presence of JC virus (JCV), a common neurotropic human polyomavirus (Polyomaviridae, Betapolyomavirus) linked to severe neurologic disease in rare cases. This association (based on metagenomics) was not borne out when specific polymerase chain reaction (PCR) testing was applied to this set of samples, likely due to the greater sensitivity of PCR. Interestingly, urine metabolomics analysis identified dysregulation of metabolites associated with key LUTS processes. Microbiome analysis found no evidence of microbial community dysbiosis in LUTS cases, but JCV-positive samples contained more Anaerococcus species, which are involved in polymicrobial infections of the urinary tract. Neither age nor body mass index were significantly associated with the presence of urinary JCV—in the initial group or in an additional, regionally distinct group. These data provide preliminary support the hypothesis that viruses such as JCV may play a role in the development or progression of LUTS, together with other infectious agents and host metabolic responses.

A Prospective Study of Physical Activity, Sedentary Behavior, and Incidence and Progression of Lower Urinary Tract Symptoms.

Lower urinary tract symptoms (LUTS), often secondary to benign prostatic hyperplasia, are a common problem for older men. Lifestyle factors, including physical activity and sedentariness, may be important LUTS risk factors and suitable targets for intervention. To determine whether physical activity and sedentariness are associated with LUTS incidence and progression. The Health Professionals Follow-up Study is a prospective cohort of men that began in 1986. Follow-up for LUTS is complete through 2008. Men aged 40-75years at enrollment and members of health professions. Total weekly metabolic equivalent of task (MET)-hour scores were calculated and were categorized (< 9, 9 to < 21, 21 to < 42, 42 to < 63, ≥ 63 MET-hours/week). Participants reported their average time/week spent sitting watching television as a measure of sedentariness, which was categorized (< 1, 1-3, 4-10, 11-29, ≥ 30h/week). Participants completed the International Prostate Symptom Score survey and reported treatments for LUTS periodically. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HR) of physical activity and television watching with LUTS incidence and progression. After multivariable adjustment, including for body mass index (BMI), men with the highest physical activity were 19% (HR = 0.81, 95% CI = 0.74-0.89; p trend < 0.0001) less likely to develop incident moderate or worse LUTS than men in the lowest category. Men who watched television ≥ 30h/week were 24% (HR = 1.24, 95% CI = 1.05-1.45; p trend = 0.004) more likely to develop incident moderate or worse LUTS than men who watched < 1h/week. These associations persisted after mutual adjustment. We observed no associations with LUTS progression. In this large prospective study, more activity and less sedentariness were associated with lower risk of incident LUTS independent of one another and BMI. Physical inactivity and sedentariness were not associated with LUTS worsening. Increasing physical activity and reducing sedentariness may be strategies for preventing LUTS in addition to their well-established benefits for other diseases.

91. Lichen Sclerosus in Prepubertal Girls

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that is associated with bladder/bowel pathology in postmenopausal women. Lower urinary tract symptoms (LUTS) have higher prevalence in adult women diagnosed with LS. There are few studies examining the relationship between LUTS and LS in premenarchal girls. We aim to characterize baseline characteristics, clinical presentation, and progression of LUTS in prepubertal girls diagnosed and treated for LS.

Co-treatment of lower urinary tract symptoms and cardiovascular disease - where do we stand?

IntroductionThe relationship between cardiovascular disease (CVD) and lower urinary tract symptoms (LUTS) is well established. A healthy lifestyle with a good quality diet and regular physical activity is important for reducing the severity of LUTS.Material and methodsA literature search was performed on the subject of association between LUTS and cardiovascular risk.ResultsThe recent data indicates that therapy for cardiovascular risk reduction might also reduce the severity of LUTS (e.g. statins reduce the risk of benign prostatic hyperplasia [BPH] and slow down the progression of LUTS in patients with hyperlipidaemia). Hypertensive patients treated with angiotensin II receptor blockers have a lower severity of LUTS. This paper shortly discusses the relationship between the occurrence of LUTS and CVD and the potential clinical implications regarding the management of the patients.ConclusionsPatients with lower urinary tract symptoms require a holistic approach and cooperation of a urologist and cardiologist to diagnose concomitant cardiovascular diseases as early as possible and implement appropriate treatment. Antihypertensive, antithrombotic, hypolipemic therapies and healthy lifestyles reduce not only cardiovascular mortality, but also might reduce the severity of LUTS.

Re: Serum Cholesterol and Risk of Lower Urinary Tract Symptoms Progression: Results from the Reduction by Dutasteride of Prostate Cancer Events Study.

Re: Serum Cholesterol and Risk of Lower Urinary Tract Symptoms Progression: Results from the Reduction by Dutasteride of Prostate Cancer Events Study.

The effects of statins on benign prostatic hyperplasia and the lower urinary tract symptoms: A Meta-analysis.

The aim of this meta-analysis was to understand the relationship between statin with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). A systematic literature search was conducted using PubMed, Embase, Cochrane Library, Chinese Medical and Biological Literature Database, China HowNet, Vip, and Wanfang. We calculated pooled odds ratios (OR) and 95% CI and standardized mean difference (SMD). Using Stata 12.0 and Review 5.3 for meta-analysis. This meta-analysis included 11 articles and 49,128 participants. Results show statins could not reduce the incidence of BPH [OR = 0.77 (0.57, 1.03, P = .08]. For patients over 60 years old, statins could reduce the incidence of BPH [OR = 0.35 (0.22, 0.55), P < .0001]. Statins can slow down the progression of LUTS in BPH [SMD = -0.32 (-0.54, -0.10), P = .004], but there is no significant correlation between them in patients taking drugs for less than 1 year. Statins have no significant effect on the incidence of BPH, but statins can reduce the risk of BPH for patients over 60 years old. For patients with hyperlipidemia, the duration of medication is more than 1 year, which can slow down the progression of LUTS. However, more high-quality and large sample size studies are needed to further improve and verify.

Sleep Problems are Associated with Development and Progression of Lower Urinary Tract Symptoms: Results from REDUCE

Although lower urinary tract symptoms and sleep problems often develop together, to our knowledge it is unknown whether sleep disturbances are linked to lower urinary tract symptoms development and progression. As measured by the 6-item MOS-Sleep (Medical Outcomes Study Sleep Scale) survey we examined the relationship between sleep problems, and the development and progression of lower urinary tract symptoms in the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) study. REDUCE was a randomized trial testing prostate cancer chemoprevention with dutasteride in men with prostate specific antigen 2.5 to 10 ng/ml and a negative biopsy. At baseline men completed MOS-Sleep and a scaled average was used to calculate the sleep score. Men were followed for 4 years and I-PSS (International Prostate Symptom Score) was completed at baseline and every 6 months. Asymptomatic men had I-PSS less than 8 while symptomatic men had I-PSS 8 or greater. In the placebo arm of 2,588 men not receiving α-blockers or 5α-reductase inhibitors at baseline we tested the association between sleep problems and lower urinary tract symptom development and progression using Cox models. During followup lower urinary tract symptoms developed in 209 of 1,452 asymptomatic men (14%) and 580 of 1,136 (51%) with lower urinary tract symptoms demonstrated progression. On multivariable analysis higher sleep scores were suggestively associated with increased lower urinary tract symptoms in asymptomatic men (quartile 4 vs 1 HR 1.41, 95% CI 0.92-2.17, p = 0.12) and with lower urinary tract symptom progression in symptomatic men (per 10 points of sleep score HR 1.06, 95% CI 1.01-1.12, p = 0.029). Among men with lower urinary tract symptoms worse sleep scores were associated with the progression of lower urinary tract symptoms and among asymptomatic men worse sleep scores were suggestively associated with the development of lower urinary tract symptoms. If confirmed, these data suggest that sleep problems may precede such symptoms. Whether treating sleep problems would improve lower urinary tract symptoms requires further testing.

Serum cholesterol and risk of lower urinary tract symptoms progression: Results from the Reduction by Dutasteride of Prostate Cancer Events study.

To determine if cholesterol is a risk factor for the development of lower urinary tract symptoms in asymptomatic men. A post-hoc analysis of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study was carried out in 2323 men with baseline International Prostate Symptom Score <8 and not taking benign prostatic hyperplasia or cholesterol medications. Cox proportion models were used to test the association between cholesterol, high-density lipoprotein, low-density lipoprotein and the cholesterol : high-density lipoprotein ratio with incident lower urinary tract symptoms, defined as first report of medical treatment, surgery or two reports of an International Prostate Symptom Score >14. A total of 253 men (10.9%) developed incident lower urinary tract symptoms. On crude analysis, higher high-density lipoprotein was associated with a decreased lower urinary tract symptoms risk (hazard ratio 0.89, P = 0.024), whereas total cholesterol and low-density lipoprotein showed no association. After multivariable adjustment, the association between high-density lipoprotein and incident lower urinary tract symptoms remained significant (hazard ratio 0.89, P = 0.044), whereas no association was observed for low-density lipoprotein (P = 0.611). There was a trend for higher cholesterol to be linked with higher lower urinary tract symptoms risk, though this was not statistically significant (hazard ratio 1.04, P = 0.054). A higher cholesterol : high-density lipoprotein ratio was associated with increased lower urinary tract symptoms risk on crude (hazard ratio 1.11, P = 0.016) and adjusted models (hazard ratio 1.12, P = 0.012). Among asymptomatic men participating in the REDUCE study, higher cholesterol was associated with increased incident lower urinary tract symptoms risk, though the association was not significant. A higher cholesterol : high-density lipoprotein ratio was associated with increased incident lower urinary tract symptoms, whereas higher high-density lipoprotein was protective. These findings suggest dyslipidemia might play a role in lower urinary tract symptoms progression.

MP35-13 SERUM CHOLESTEROL AND RISK OF LOWER URINARY TRACT SYMPTOMS PROGRESSION: RESULTS FROM THE REDUCE STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation1 Apr 2016MP35-13 SERUM CHOLESTEROL AND RISK OF LOWER URINARY TRACT SYMPTOMS PROGRESSION: RESULTS FROM THE REDUCE STUDY Tom Feng, Lauren Howard, Adriana Vidal, Daniel Moreira, Ramiro Castro-Santamaria, Gerald Andriole, and Stephen Freedland Tom FengTom Feng More articles by this author , Lauren HowardLauren Howard More articles by this author , Adriana VidalAdriana Vidal More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , Ramiro Castro-SantamariaRamiro Castro-Santamaria More articles by this author , Gerald AndrioleGerald Andriole More articles by this author , and Stephen FreedlandStephen Freedland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1605AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of serum cholesterol levels on lower urinary tract symptoms (LUTS) progression remains unclear. Our aim was to evaluate the association between serum cholesterol levels and incident LUTS using the REDUCE study. METHODS REDUCE was a 4-year, multi-center, randomized, double-blind, placebo-controlled study that followed biopsy-negative men with protocol-dictated biopsies testing dutasteride for prostate cancer risk reduction. Total serum cholesterol, LDL, and HDL levels were measured at baseline. During the 4 year study period, participants completed the International Prostate Symptom Score (IPSS) every 6 months. Exclusion criteria included men on BPH medical therapy, baseline IPSS≥8, or on statins. Incident LUTS was defined as the first report of medical treatment, surgery, or sustained clinically significant BPH symptoms defined as two reports of IPSS>14. Men who progressed within 30 days of study enrollment were also excluded. Cox proportional hazards analysis was used to test whether cholesterol, HDL, and LDL levels as well as the cholesterol:HDL ratio independently predicted time to incident LUTS. Secondary analyses were conducted to test for interactions between cholesterol and BMI, smoking, and diabetes. RESULTS Of the 2,323 men who met study enrollment criteria, 253 progressed to incident LUTS. On crude analysis, higher HDL was associated with a decreased risk of LUTS progression (HR 0.89, p=0.024) while total cholesterol and LDL showed no association. After multivariable adjustment, the association between HDL and incident LUTS remained significant (HR 0.89, p=0.044) while no association was observed for LDL (p=0.611). There was a trend for higher cholesterol to be associated with higher incident LUTS risk, though this did not reach statistical significance (HR 1.04, p=0.054). Higher cholesterol:HDL ratio was associated with increased risk of LUTS on crude (HR 1.11, p=0.016) and adjusted models (HR 1.12, p=0.012). There were no significant interactions between cholesterol and BMI, smoking, and diabetes (p>0.303). CONCLUSIONS Among men in REDUCE, higher cholesterol was associated with higher risk of incident LUTS, though the association was modest and of borderline statistical significance. Higher cholesterol to HDL ratio was significantly associated with increased incident LUTS while higher HDL was protective. If confirmed in future studies, these findings suggest cholesterol may play a role in LUTS progression and cholesterol reduction may be a target for LUTS prevention. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e485 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Tom Feng More articles by this author Lauren Howard More articles by this author Adriana Vidal More articles by this author Daniel Moreira More articles by this author Ramiro Castro-Santamaria More articles by this author Gerald Andriole More articles by this author Stephen Freedland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lifestyle and lower urinary tract symptoms: what is the correlation in men?

The primary purpose of this review is to provide an overview of the current evidence linking lifestyle factors and lower urinary tract symptoms (LUTS), and their relevance in men. An extensive literature search from January 2013 to August 2014 was conducted, reviewed, and summarized in conjunction with key prior evidence. The main findings from this review include 1) epidemiological data repeatedly show a favorable relationship between a healthy eating habits and regular physical activity level and a lower risk for LUTS or progression of LUTS, 2) certain specific nutrients or dietary factors may contribute to the link between diet and LUTS because of their anti-inflammatory potential, and 3) very little research has been conducted to test the epidemiological findings in randomized controlled trials. Rigorously designed clinical trials are needed to confirm the association between lifestyle factors and LUTS and the effect of lifestyle modification on the development or progression of LUTS. Nevertheless, a healthy lifestyle is known to closely relate with chronic diseases such as cardiovascular disease and diabetes. Thus, promoting a healthy lifestyle with good quality diet and regular physical activity is beneficial not only for potentially improving or reducing LUTS but also for cardiovascular and overall health. Clinicians are encouraged to include healthy lifestyle counseling in their routine care for patients with LUTS.

Associations between supplemental or dietary intake of vitamin C and severity of lower urinary tract symptoms

To examine the association between long-term dietary vitamin C intake and recent use of vitamin C supplements with the progression and severity of lower urinary tract symptoms (LUTS). Baseline and 5-year follow-up interviews were completed by 2825 black, Hispanic or white men and women aged 30-79 years in the Boston Area Community Health survey. Dietary and supplemental vitamin C intake was assessed using a validated food frequency questionnaire. LUTS were assessed using the validated American Urological Association Symptom Index. Multivariable models were used to test the associations between baseline vitamin C and progression of LUTS over the follow-up period, and between recent vitamin C intake and LUTS severity. In multivariable models, baseline dietary vitamin C was associated with lower odds of progression of daytime storage symptoms in men (e.g. quartile 4 vs 1, odds ratio [OR] = 0.63, 95% confidence interval [CI]: 0.41-0.97), or urgency symptoms in women (P trend = 0.02). Recent vitamin C intake at follow-up was also associated with better symptom scores among men. In contrast, among women, vitamin C supplement intake was associated with worse symptom scores, particularly daytime storage problems (500 mg/day vs none, OR = 1.66, 95% CI: 1.18-2.35, P trend = 0.01). Recent dietary vitamin C was not associated with LUTS in women. Vitamin C intake from foods and beverages was inversely associated with progression of daytime urinary storage symptoms in men or urgency symptoms in women at 5-year follow-up, therefore, the present results do not support a widespread avoidance for patients with LUTS of foods and beverages naturally rich in vitamin C. Supplemental vitamin C use above recommended daily intake levels was associated with higher odds of daytime urinary storage symptoms in women, and this finding is worthy of further attention and confirmation in future clinical trials.

A Prospective Study of Obesity, and the Incidence and Progression of Lower Urinary Tract Symptoms

We prospectively evaluated the association between adiposity and the risk of lower urinary tract symptoms incidence and progression in the Health Professionals Followup Study (HPFS). At baseline participants reported current height and weight, and weight at age 21 years. A year later they reported waist and hip circumferences, and every 2 years thereafter they reported weight. Participants periodically completed the International Prostate Symptom Score (I-PSS) and reported surgery or medication use for lower urinary tract symptoms. We used Cox proportional hazards regression to estimate the multivariable adjusted association between adiposity and lower urinary tract symptoms incidence and progression. The incidence analytical cohort of 18,055 men had no lower urinary tract symptoms at baseline. A total of 6,461 men entered the progression analytical cohort when they first experienced lower urinary tract symptoms. The risk of lower urinary tract symptoms in 4,088 cases increased with increasing body mass index (35 kg/m(2) or greater vs 23 to less than 25 HR 1.61, 95% CI 1.31-1.99), waist circumference (greater than 42 inches vs 33 or less HR 1.39, 95% CI 1.19-1.63) and weight gain since age 21 years (50 pounds or greater vs stable weight HR 1.31, 95% CI 1.17-1.46, each p trend <0.0001). The risk of lower urinary tract symptom progression in 1,691 cases increased with body mass index (35 kg/m(2) or greater vs 23 to less than 25 HR 1.44, 95% CI 1.04-2.00, p trend <0.0001), weight gain since age 21 years (50 pounds or greater vs stable weight HR 1.35, 95% CI 1.14-1.60, p trend <0.0001) and waist circumference (greater than 42 inches vs 33 or less HR 1.32, 95% CI 0.95-1.85, p trend 0.005). Men with higher total and abdominal adiposity and those who gained weight were more likely to have lower urinary tract symptoms develop or progress. Our findings support the notion that obesity may be an important target for lower urinary tract symptom prevention and intervention.

A Prospective Study of Statin Drug Use and Lower Urinary Tract Symptoms in Older Men

Dyslipidemia and chronic inflammation may play a role in the cause of lower urinary tract symptoms (LUTS) in older men. Use of statin drugs, which are prescribed to lower cholesterol and appear to reduce inflammation, may decrease the incidence or progression of LUTS. The associations of statin drug use with LUTS incidence and progression were prospectively evaluated in the Health Professionals Follow-up Study from 1992 to 2008. Hazard ratios and 95% confidence intervals of incident LUTS (from no or a low International Prostate Symptom Score (IPSS) of 0-7 to a moderate or worse IPSS of ≥15; n = 5,790 cases in 24,715 men) and of LUTS progression (from modest IPSS of 8-14 to severe IPSS of ≥20; n = 2,238 cases in 8,709 men) were calculated comparing current statin use with nonuse. The hazard ratios of LUTS incidence and progression comparing current use to nonuse were greater than 1. However, when comparisons were restricted to participants who used drugs to treat hypertension (a surrogate for uptake of medical care), statin use was not associated with LUTS incidence (hazard ratio = 1.02, 95% confidence interval: 0.94, 1.12) or progression (hazard ratio = 0.98, 95% confidence interval: 0.85, 1.13). Thus, statin use is unlikely to beneficially influence the development or course of LUTS. The present study highlights a methodological issue (confounding) that must be addressed in observational studies on the use of common drugs for indications other than the primary use.

Treatment Status and Progression or Regression of Lower Urinary Tract Symptoms in a General Adult Population Sample

We report progression and regression of lower urinary tract symptoms in a population based cohort by race/ethnicity, gender, age and lower urinary tract symptom medication use. The BACH (Boston Area Community Health) Survey enrolled 5,502 participants 30 to 79 years old of black, Hispanic or white race/ethnicity. The 5-year followup interviews were completed by 1,610 men and 2,534 women for a conditional response rate of 80%. Population weighted estimates of lower urinary tract symptoms severity were assessed using the AUASI (American Urological Association symptom index) and analyzed using multivariate models. Symptom progression (increase in AUASI score of 3 or more points) was reported by 21% to 33% of participants and regression (decrease 3 or greater) by 30% to 44% of participants, most commonly women and Hispanic participants. Age and higher body mass index were associated with progression (p <0.01), but not with regression. Lower urinary tract symptom medication use at baseline only was associated with improved symptoms scores 5 years later (multivariate adjusted OR 3.10, 95% CI 1.28-7.51, compared to nonusers), whereas using medication at baseline and followup was associated with similar rates of progression and regression as observed among participants not using lower urinary tract symptom medication at either point. Lower urinary tract symptoms persisted at followup for approximately half of the population experiencing symptoms at baseline, including many men and women using lower urinary tract symptom medications. However, overall lower urinary tract symptom medication use and surgical treatment appeared beneficial for symptom control at 5-year followup. Age and body mass index were associated with symptom worsening, and Hispanic ethnicity was associated with greater symptom fluctuation. Clinicians should consider the higher likelihood of lower urinary tract symptom progression for older or heavier patients, and monitor responsiveness to lower urinary tract symptom medication.

Intake of Caffeinated, Carbonated, or Citrus Beverage Types and Development of Lower Urinary Tract Symptoms in Men and Women

Evidence to substantiate recommendations for restriction of caffeinated or acidic beverages as self-management for lower urinary tract symptoms (LUTS) is limited. We examined longitudinal and acute associations between beverage intake and LUTS in the Boston Area Community Health (BACH) cohort (n = 4,144) between 2002 and 2010. Multivariable models tested associations between baseline intakes and progression of LUTS at 5-year follow-up, between follow-up intakes and International Prostate Symptom Scores at follow-up, and between 5-year intake changes and LUTS progression. Greater coffee or total caffeine intake at baseline increased the odds of LUTS progression in men (coffee: >2 cups/day vs. none, odds ratio = 2.09, 95% confidence interval: 1.29, 3.40, P-trend = 0.01; caffeine: P-trend < 0.001), particularly storage symptoms. Women who increased coffee intake by at least 2 servings/day during follow-up (compared with categories of decreased or unchanged intakes) had 64% higher odds of progression of urgency (P= 0.003). Women with recently increased soda intake, particularly caffeinated diet soda, had higher symptom scores, urgency, and LUTS progression. Citrus juice intake was associated with 50% lower odds of LUTS progression in men (P= 0.02). Findings support recommendations to limit caffeinated beverage intake for LUTS, and in men, they suggest benefits of citrus juice consumption. Further clinical research is warranted, particularly of the precise role of sodas containing artificial sweeteners in bladder sensations and urological function.