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AUTONOMIC NERVOUS SYSTEM OVERACTIVITY IN MEN WITH LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA

2005; Lippincott Williams & Wilkins; Volume: 174; Issue: 4 Part 1 Linguagem: Inglês

10.1097/01.ju.0000173072.73702.64

1527-3792

Kevin T. McVary, Alfred Rademaker, Granville L. Lloyd, Peter H. Gann,

Prostate Cancer Diagnosis and Treatment

No AccessJournal of UrologyAdult Urology: Voiding Dysfunction1 Oct 2005AUTONOMIC NERVOUS SYSTEM OVERACTIVITY IN MEN WITH LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA KEVIN T. McVARY, ALFRED RADEMAKER, GRANVILLE L. LLOYD, and PETER GANN KEVIN T. McVARYKEVIN T. McVARY More articles by this author , ALFRED RADEMAKERALFRED RADEMAKER More articles by this author , GRANVILLE L. LLOYDGRANVILLE L. LLOYD More articles by this author , and PETER GANNPETER GANN More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000173072.73702.64AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The relationship of lower urinary tract symptoms (LUTS) to objective measures of benign prostatic hyperplasia (BPH), such as prostatic size and urodynamic parameters, has proved difficult to evaluate. Studies in animal models of BPH suggest that autonomic nervous system (ANS) activity is an important determinant of prostatic growth. We investigated the relationship of ANS activity to LUTS as well as to objective measures of BPH in men with BPH. Materials and Methods: This study was done in 3,047 men with LUTS secondary to BPH during screening for enrolment at 1 center in a large, multicenter, double-blind, placebo controlled trial designed to assess the long-term effects of medical therapy on BPH progression. A total of 38 men with an American Urological Association (AUA) symptom score of 8 or greater and a maximum urinary flow rate of 4 to less than 15 ml per second had ANS activity assessed based on heart rate, blood pressure, the response to circulatory stress via tilt table, and plasma and urinary catecholamine. These ANS related variables were compared with subjective measures of LUTS (AUA symptom score, quality of life score and BPH impact index), overall health measures (RAND 36-Item Health Survey) and objective clinical measures of BPH (prostate size, post-void residual volume and maximum urinary flow rate). Pearson correlation coefficients were calculated for each ANS variable vs each LUTS and BPH variable. These correlations were further assessed using stepwise multiple regression analysis to determine which BPH and LUTS variables were independently related to the ANS variable. Relationships that were identified as significant then underwent final multiple regression analysis together with control variables to exclude known extraneous and confounding influences on ANS activity. Results: After adjusting for extrinsic influences on ANS activity AUA symptom score (p <0.01), BPH impact index score (p <0.001) and quality of life score (p <0.05) were independently associated with the change in systolic and diastolic blood pressure 1 and 5 minutes after tilt. Additionally, prostate transition zone volume (p <0.001) and the RAND 36-Item Health Survey mental subscale score (p <0.001) were independently associated with the plasma norepinephrine response to tilt. Conclusions: ANS hyperactivity is significantly associated with the most commonly used measures of LUTS, namely AUA symptom score and BPH impact index score. Also, the magnitude of the serum norepinephrine increase after tilt predicts prostate size. These relationships persist after controlling for extrinsic influences on ANS activity. 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Abstract, Google Scholar From the Departments of Urology and Epidemiology, Feinberg School of Medicine, Northwestern University Chicago, Illinois© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byKupelian V, Araujo A, Wittert G and McKinlay J (2014) Association of Moderate to Severe Lower Urinary Tract Symptoms with Incident Type 2 Diabetes and Heart DiseaseJournal of Urology, VOL. 193, NO. 2, (581-586), Online publication date: 1-Feb-2015.Griebling T (2014) Re: Lower Urinary Tract Symptoms Improve with Testosterone Replacement Therapy in Men with Late-Onset Hypogonadism: 5-Year Prospective, Observational and Longitudinal Registry StudyJournal of Urology, VOL. 192, NO. 5, (1496-1496), Online publication date: 1-Nov-2014.Griebling T (2014) Re: Lower Urinary Tract Symptoms Improve with Testosterone Replacement Therapy in Men with Late-Onset Hypogonadism: 5-Year Prospective, Observational and Longitudinal Registry StudyJournal of Urology, Araujo A, Yaggi H, Yang M, McVary K, Fang S and Bliwise D (2013) Sleep Related Problems and Urological Symptoms: Testing the Hypothesis of Bidirectionality in a Longitudinal, Population Based StudyJournal of Urology, VOL. 191, NO. 1, (100-106), Online publication date: 1-Jan-2014.Barbosa J, Muracca E, Nakano É, Assalin A, Cordeiro P, Paranhos M, Cury J, Srougi M and Antunes A (2013) Interactions between Lower Urinary Tract Symptoms and Cardiovascular Risk Factors Determine Distinct Patterns of Erectile Dysfunction: A Latent Class AnalysisJournal of Urology, VOL. 190, NO. 6, (2177-2182), Online publication date: 1-Dec-2013.Thurmon K, Breyer B and Erickson B (2012) Association of Bowel Habits with Lower Urinary Tract Symptoms in Men: Findings from the 2005–2006 and 2007–2008 National Health and Nutrition Examination SurveyJournal of Urology, VOL. 189, NO. 4, (1409-1414), Online publication date: 1-Apr-2013.Sarma A, Parsons J, McVary K and Wei J (2009) Diabetes and Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms—What do We Know?Journal of Urology, VOL. 182, NO. 6S, (S32-S37), Online publication date: 1-Dec-2009.Chang I, Oh S and Kim S (2009) A Possible Relationship Between Testosterone and Lower Urinary Tract Symptoms in MenJournal of Urology, VOL. 182, NO. 1, (215-220), Online publication date: 1-Jul-2009.Laven B, Orsini N, Andersson S, Johansson J, Gerber G and Wolk A (2008) Birth Weight, Abdominal Obesity and the Risk of Lower Urinary Tract Symptoms in a Population Based Study of Swedish MenJournal of Urology, VOL. 179, NO. 5, (1891-1896), Online publication date: 1-May-2008.Sugaya K, Nishijima S, Tasaki S, Kadekawa K, Miyazato M and Ogawa Y (2007) Mechanisms by Which a Phytotherapeutic Drug Influences Bladder Activity in RatsJournal of Urology, VOL. 179, NO. 2, (770-774), Online publication date: 1-Feb-2008.Franco I (2007) Overactive Bladder in Children. 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Volume 174Issue 4 Part 1October 2005Page: 1327-1333 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsurodynamicsprostatic hyperplasiaprostateautonomic nervous systemquestionnairesMetricsAuthor Information KEVIN T. McVARY More articles by this author ALFRED RADEMAKER More articles by this author GRANVILLE L. LLOYD More articles by this author PETER GANN More articles by this author Expand All Advertisement PDF downloadLoading ...