Overactive bladder in men as a marker of cardiometabolic risk

Wittert, Gary A; Martin, Sean; Sutherland, Peter; Hall, Susan; Kupelian, Varant; Araujo, Andre

doi:10.5694/mja11.11318

Topics

Overactive bladder may be a marker of obstructive sleep apnoea or cardiometabolic risk

The lower urinary tract symptoms (LUTS) nocturia, urgency and frequency are grouped as “storage symptoms”. When troublesome, the presence of urgency plus one other symptom constitute overactive bladder (OAB).1 Dysfunction or irritability of the detrusor muscle of the urinary bladder is a primary cause of these symptoms, although coexistent prostatic disorders may be contributory. Based on American Urological Association symptom index scores, OAB affects about 25% of Australian men over the age of 40 years, and almost 50% of Australian men over the age of 70.2 It is associated with significant distress and very high direct and indirect costs.3

1 University of Adelaide, Adelaide, SA.
2 Royal Adelaide Hospital, Adelaide, SA.
3 Epidemiology, New England Research Institutes, Watertown, Mass, USA.

Correspondence: gary.wittert@adelaide.edu.au

Acknowledgements:

This work was supported by the National Health and Medical Research Council (Project Grant No. 627227).

Competing interests:

Peter Sutherland is a member of the Lilly and Pfizer advisory boards and has received research funding and speaking fees from both. Gary Wittert is the Independent Chair of the Weight Management Council Australia and receives research support from Weight Watchers.

1. Irwin DE, Abrams P, Milsom I, et al. Understanding the elements of overactive bladder: questions raised by the EPIC study. BJU Int 2008; 101: 1381-1387.
2. Martin SA, Haren MT, Marshall VR, et al. Prevalence and factors associated with uncomplicated storage and voiding lower urinary tract symptoms in community-dwelling Australian men. World J Urol 2011; 29: 179-184.
3. Irwin DE, Mungapen L, Milsom I, et al. The economic impact of overactive bladder syndrome in six Western countries. BJU Int 2009; 103: 202-209.
4. Holden CA, McLachlan RI, Pitts M, et al. Determinants of male reproductive health disorders: the Men in Australia Telephone Survey (MATeS). BMC Public Health 2010; 10: 96.
5. Kupelian V, McVary KT, Kaplan SA, et al. Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston Area Community Health Survey. J Urol 2009; 182: 616-624.
6. Rohrmann S, Smit E, Giovannucci E, Platz EA. Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III). Int J Obes (Lond) 2005; 29: 310-316.
7. Kirby MG, Wagg A, Cardozo L, et al. Overactive bladder: is there a link to the metabolic syndrome in men? Neurourol Urodyn 2010; 29: 1360-1364.
8. Tong YC, Cheng JT. Alterations of M2,3-muscarinic receptor protein and mRNA expression in the bladder of the fructose fed obese rat. J Urol 2007; 178: 1537-1542.
9. Kupelian V, McVary KT, Barry MJ, et al. Association of C-reactive protein and lower urinary tract symptoms in men and women: results from Boston Area Community Health survey. Urology 2009; 73: 950-957.
10. Chung SD, Liu HT, Lin H, Kuo HC. Elevation of serum C-reactive protein in patients with OAB and IC/BPS implies chronic inflammation in the urinary bladder. Neurourol Urodyn 2011; 30: 417-420.
11. Kupelian V, Rosen RC, Roehrborn CG, et al. Association of overactive bladder and C-reactive protein levels. Results from the Boston Area Community Health (BACH) Survey. BJU Int 2012; 110: 401-407. doi: 10.1111/j.1464-410X.2011.10769.x.
12. Raison CL, Miller AH. Is depression an inflammatory disorder? Curr Psychiatry Rep 2011; 13: 467-475.
13. Hall SA, Chiu GR, Link CL, et al. Are statin medications associated with lower urinary tract symptoms in men and women? Results from the Boston Area Community Health (BACH) Survey. Ann Epidemiol 2011; 21: 149-155.
14. Yoshida M, Masunaga K, Nagata T, et al. The effects of chronic hyperlipidemia on bladder function in myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits. Neurourol Urodyn 2010; 29: 1350-1354.
15. Kemmer H, Mathes AM, Dilk O, et al. Obstructive sleep apnea syndrome is associated with overactive bladder and urgency incontinence in men. Sleep 2009; 32: 271-275.
16. Tsujimura A, Takao T, Miyagawa Y, et al. Urgency is an independent factor for sleep disturbance in men with obstructive sleep apnea. Urology 2010; 76: 967-970.
17. Maserejian NN, Giovannucci EL, McKinlay JB. Dietary macronutrients, cholesterol, and sodium and lower urinary tract symptoms in men. Eur Urol 2009; 55: 1179-1189.
18. Maserejian NN, Giovannucci EL, McVary KT, McKinlay JB. Dietary, but not supplemental, intakes of carotenoids and vitamin C are associated with decreased odds of lower urinary tract symptoms in men. J Nutr 2011; 141: 267-273.
19. Ekundayo OJ, Markland A, Lefante C, et al. Association of diuretic use and overactive bladder syndrome in older adults: a propensity score analysis. Arch Gerontol Geriatr 2009; 49: 64-68.
20. Steers WD, Clemow DB, Persson K, et al. The spontaneously hypertensive rat: insight into the pathogenesis of irritative symptoms in benign prostatic hyperplasia and young anxious males. Exp Physiol 1999; 84: 137-147.
21. Hubeaux K, Deffieux X, Ismael SS, et al. Autonomic nervous system activity during bladder filling assessed by heart rate variability analysis in women with idiopathic overactive bladder syndrome or stress urinary incontinence. J Urol 2007; 178: 2483-2487.
22. Piantadosi C, Worthley M, Nelson A, et al. Effects of diet-induced weight loss in obese males on cardiac and vascular function [abstract]. Atheroscler Suppl 2009; 10: e358.
23. Khoo J, Piantadosi C, Duncan R, et al. Comparing effects of a low-energy diet and a high-protein low-fat diet on sexual and endothelial function, urinary tract symptoms, and inflammation in obese diabetic men. J Sex Med 2011; 8: 2868-2875.
24. Khoo J, Piantadosi C, Worthley S, Wittert GA. Effects of a low-energy diet on sexual function and lower urinary tract symptoms in obese men. Int J Obes (Lond) 2010; 34: 1396-1403.
25. Margel D, Shochat T, Getzler O, et al. Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea. Urology 2006; 67: 974-977.
26. Dixon JB, Schachter LM, O’Brien PE. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes (Lond) 2005; 29: 1048-1054.
27. Neves C, Tufik S, Monteiro MA, et al. The effect of sildenafil on sleep respiratory parameters and heart rate variability in obstructive sleep apnea. Sleep Med 2010; 11: 545-551.
28. Perimenis P, Giannitsas K. Safety of sildenafil in the treatment of erectile dysfunction in patients with obstructive sleep apnoea. Expert Opin Drug Saf 2007; 6: 423-430.

Online responses are no longer available. Please refer to our instructions for authors page for more information.