The Relationships between Thyroid Hormone Levels and Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia

PURPOSE: We examined the association between thyroid hormone and lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 5,708 middle aged men were included. LUTS/BPH were assessed using the international prostate symptom score (IPSS), total prostate volume (TPV), maximal flow rate (Qmax), and a full metabolic workup. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were measured using chemiluminescence immunoassay. We divided participants into quartiles based on their TSH and FT4 levels: first to fourth quartile (Q1–Q4). RESULTS: There was a significant increase in the percentage of men with IPSS>7, Qmax7 were significantly different between FT4 quartile groups (ORs; [5–95 percentile interval], p; TPV≥30 mL, Q1: 0.000 [references]; Q2: 1.140 [0.911–1.361], p=0.291; Q3: 1.260 [1.030–1.541], p=0.025; Q4: 1.367 [1.122–1.665], p=0.002; IPSS>7: Q1: 0.000 [references]; Q2: 0.969 [0.836–1.123], p=0.677; Q3: 1.123 [0.965–1.308], p=0.133; Q4: 1.221 [1.049–1.420], p=0.010). In men with above median levels of testosterone, the FT4 correlated positively with TPV, even after adjusting for confounders. However, the FT4 was not correlated with TPV in men with below median levels of testosterone. TSH was not related to LUTS/BPH measurements. CONCLUSIONS: TPV, IPSS, and Qmax were significantly related to FT4. TPV and IPSS were significantly and independently related to FT4. Additionally, the relationship between FT4 and TPV was distinct when testosterone levels are high.

Constipation and LUTS: how do they affect each other?

CONTEXT: Urinary bladder and rectum share a common embryological origin. Their autonomic and somatic innervations have close similarities. Moreover, the close proximity of these two organ systems could suggest that dysfunction in one may influence, also mechanically, the function of the other. Therefore, it is not surprising that defecation problems and lower urinary tract symptoms (LUTS) occur together, as reported in the literature. OBJECTIVE: To study the relationship between constipation and LUTS focusing on what is evidence-based. EVIDENCE ACQUISITION: We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) database in February 2010 to retrieve English language studies (from 1997 to 2009) and the 2005, 2006 and 2007 abstract volumes of the European Association of Urology (EAU), American Urological Association (AUA) and International Continence Society (ICS). EVIDENCE SYNTHESIS: We present the findings according to the studied population in four groups: (a) children, (b) middle-aged women, (c) elderly and (d) neuropathic patients. Most published studies that correlated rectal and bladder dysfunction were carried out in children or in young women. On the other hand, there are few studies regarding the association between constipation and LUTS in the elderly and in neuropathic patients. CONCLUSIONS: Several studies in children documented that constipation is linked to urinary tract problems, including infections, enuresis, vesicoureteral reflux and upper renal tract dilatation. The underlying pathophysiology of these findings has not yet been clearly defined. Studies in middle-aged women also support a high prevalence of constipation among patients suffering from urinary tract dysfunction. Furthermore, an association between constipation and urinary incontinence, as well as between constipation and pelvic organ prolapse, has been suggested. The only prospective study in constipated elderly with concomitant LUTS demonstrates that the medical relief of constipation also significantly improves LUTS. Finally, the available data on neuropathic patients suggest that stool impaction in the rectum may mechanically impede bladder emptying. However, most of the studies only include a small number of patients, are not prospective and are uncontrolled. Therefore, there is a need for large-scale, controlled studies to further improve evidence and to provide a valid recommendation for all groups, especially for the elderly and neuropathic patients.

Analysis of rhythmic rectal contractions during filling cystometry in women

Purpose: Rhythmic or random rectal contractions independent of bladder activity are frequently observed during cystometry and usually attributed either to a neurological disease, or to ageing. The aim of our study was to search for an association of rhythmic rectal contractions (RRCs) with a specific lower urinary tract symptom or/and an urodynamic diagnosis. Materials and Methods: The population consisted of 534 consecutive women with lower urinary tract symptoms and without specific gastro-intestinal disease referred for urodynamics; 382 (non-ND) had no history of neurological disease and 152 (ND) a history of neurological disease. Cystometries were performed according to ICS recommendations. Rectal pressure was measured using a punctured balloon filled with 2 mL of saline. RRCs were defined as rhythmic changes in the rectal pressure of at least 3 cm H2O independent of the total vesical pressure. Results: RRCs were observed in 69 patients, with no difference in neurological status or age (non-ND: 12.3 percent and 65.5y; ND: 14.5 percent and 62.7y). Patients with RRCs were significantly older than the negative population (p = 0.0002). RRCs had a low frequency: 1 - 4/min; their amplitude was ¡Ü 15 cm H2O in 67 patients. RRCs were associated with urgency (35 patients) whatever the neurological status and with detrusor overactivity only in the neurological patients. Conclusions: RRCs cannot be considered as artefactual events during cystometry in women, occur in the older population, are frequently associated with urgency but not with detrusor overactivity or neurological disease. Occurrence of RRCs should prompt the physician to look at the possible causes of urgency (colonic or bladder).

Neurogenic bladder dysfunction and upper urinary tract deterioration in children / 中华泌尿外科杂志

Objective To evaluate the risk urodynamic factors of upper urinary tract deterioration in children with neurogenic bladder dysfunction secondary to myelodysplasia. Methods Urodynamic and imaging studies were performed in 32 children with myelodysplasia. Results 18 patients had ureterohydronephrosis and 4 of them had vesicoureteric reflux.Of 19 children with detrusor leak point pressure higher than 40 cmH 2O and bladder compliance less than 40ml/cmH 2O, upper tract deterioration was revealed in 17.In contrast,of 13 patients with detrusor leak point pressure less than 40 cmH 2O and bladder compliance higher than 40 ml/cmH 2O, only one had bilateral ureteral dilatation( P