Is overactive bladder microvasculature disease a component of systemic atheroscleorosis?

AIMS: To evaluate the relationship between overactive bladder (OAB) and systemic atherosclerosis in a cohort of women. METHODS: In this case-control study, we assessed atherosclerosis indicators, such as Framingham risk scores and carotid and femoral artery intima-media thickness, and evaluated possible bladder wall responses to atherosclerosis using endovaginal color Doppler ultrasound and the detection of urinary cytokines in women with OAB and in controls. Quantitative assessment of blood perfusion at the bladder neck was performed using a method that allows for the dynamic monitoring of flow in a predefined region of interest at every point of the cardiac cycle. The independent samples t-test was used to evaluate the relationship between OAB and the atherosclerotic findings when parametric conditions were met, and the Mann-Whitney U test was used when parametric conditions were not met. Kendall's Tau was used to assess the correlation between OAB severity and the atherosclerotic variables. P < 0.05 was considered statistically significant. RESULTS: There were 74 OAB patients and 73 controls; in total, 147 women were evaluated. We found that all atherosclerosis indicators were significantly associated with OAB and that there was a significant relationship between OAB and decreased bladder neck perfusion. Additionally, there were correlations of OAB severity with systemic atherosclerosis and impaired vascular perfusion of the bladder. CONCLUSIONS: Decreased perfusion at the bladder neck, the Framingham scores in severe OAB, and the correlation between them suggest that OAB microvascular disease may be a component of systemic atherosclerosis rather than a separate process.

Systemic atherosclerosis and voiding symptom.

OBJECTIVE: To evaluate the effect of atherosclerosis on the storage and voiding symptoms of the bladder in women with overactive bladder (OAB). STUDY DESIGN: We retrospectively reviewed the charts of women with OAB who were evaluated between 2013 and 2015 in our urogynecology unit. Charts were assessed for history, examination findings, urinary diary, quality of life (QOL) questionnaires, urodynamic studies (UDSs), and four main risk factors for atherosclerosis: hypertension, diabetes mellitus, smoking, and hyperlipidemia. In a previous study, these were defined as vascular risk factors. Cases were excluded for insufficient data, diabetes mellitus with dysregulated blood glucose, or prolapse greater than 1cm to avoid confusing bladder outlet obstruction. We included 167 eligible cases in this study. We evaluated storage and voiding symptoms such as frequency, nocturia, residual urine volume, and voiding difficulties and UDS findings such as maximum bladder capacity, first desire, strong desire, detrusor overactivity, and bladder contractility index. The vascular risk score was categorized as "no risk" if the woman did not have any of the four risk factors and "at risk" if she had any of the factors. Independent sample t-test and chi-square tests were performed for analyses. RESULTS: Among the participants (n=167), 71.9% had at least one vascular risk factor. Those who were at risk were facing significantly more wet-type OAB (p=0.003) and nocturia (p=0.023). Moreover, mean age (p=0.008) and mean gravidity (p=0.020) were significantly higher in the at-risk group, whereas mean total nocturia QOL questionnaire scores (p=0.029) were significantly lower. CONCLUSION: Our findings suggest that aging and atherosclerosis may be associated with severe OAB and poorer QOL. Nocturia and related parameters of poor quality can be explained by impaired bladder neck perfusion. Future trials need to assess vascular and molecular changes in women with OAB.