Evolution of major non-HIV-related comorbidities in HIV-infected patients in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) Foundation Study cohort in the period 2004-2014.

OBJECTIVES: The management of HIV disease is complicated by the incidence of a new spectrum of comorbid noncommunicable diseases (NCDs). It is important to document changes in the prevalence of NCDs over time. The aim of the study was to describe the impact of ageing on HIV markers and on the prevalence of NCDs in people living with HIV (PLWHIV) in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) seen for care in 2004-2014. METHODS: Analyses were conducted separately for a closed cohort (same people seen at both times) and an open cohort (all people under follow-up). We used the χ2 test for categorical factors and the Wilcoxon test for quantitative factors to compare profiles over time. RESULTS: The closed cohort included 1517 participants and the open cohort 3668 under follow-up in 2004 and 6679 in 2014. The median age of the open cohort was 41 [interquartile range (IQR) 37-46] years in 2004 and 44 (IQR 36-52) years in 2014. Analysis of the closed cohort showed an increase in the prevalence of some NCDs [the prevalence of dyslipidaemia increased from 75% in 2004 to 91% in 2014, that of hypertension from 67 to 84%, and that of cardiovascular disease (CVD) from 18 to 32%] and a decrease in renal function (5% with eGFR < 60 mL/min per 1.73 m2 in 2004 versus 30% in 2014); the percentage of people in the high-risk group for the Framingham CHD score more than tripled (from 13 to 45%). Results in the open cohort were similar. CONCLUSIONS: The burden of NCDs in our PLWHIV population markedly worsened over a 10-year time-span, which is likely to be a result of the effects of both ageing and HIV infection as well as their interaction. Special attention must be given to the management and prevention of NCDs.

How can we measure bladder volumes in women with advanced pelvic organ prolapse?

OBJECTIVES: To compare bladder volumes determined by three different formulae using measurements obtained from two-dimensional translabial ultrasound (2D-US), with true bladder volumes, in women with advanced pelvic organ prolapse (POP). METHODS: This was a prospective observational multicenter study of consecutive women on the waiting list for prolapse surgery in 24 gynecology departments. All women had a symptomatic genital prolapse Stage 2 or higher according to the Pelvic Organ Prolapse Quantification System (POP-Q). Bladder volumes were calculated before and after spontaneous voiding by 2D-US, and true bladder volumes were determined by micturition and catheterization. Volumes determined by US were calculated using three formulae (Haylen, Dietz and Dicuio). Correlation was calculated between the volume determined by US measurement before micturition and the true volume, and also between the volume determined by US measurements after micturition and the true volume. Correlations (Spearman's rho) and concordance (intraclass correlation coefficient (ICC)) were estimated for each of the three formulae considered. RESULTS: One-hundred and eighty-six women with POP were included in the study. A total of 349 bladder volumes (186 before micturition and 163 after micturition) were obtained. Good correlation (rho, 0.818-0.849) and concordance (ICC, 0.827-0.898) were found between total measured volume (volume of spontaneous bladder voiding + volume obtained from catheterization) and the volume determined by US using the three different formulae, as well as between the post-void residual volume measured by catheterization and the post-void volume calculated by US using the three formulae (rho, 0.739-0.777; ICC, 0.840-0.877). CONCLUSIONS: Bladder volumes in women with advanced POP can be measured easily by 2D-US. Volumes determined using the three different formulae show good correlations and concordance with true bladder volume.

Hiperplasia benigna de próstata y su tratamiento: impacto en calidad de vida y función sexual / Bening Prostatic Hyperplasia and its Treatment: Impact on Quality of Life and Sexual Function

Objetivos: Evaluar el impacto en la calidad de vida relacionada con la salud (CVRS) y en la función sexual de la hiperplasia benigna de próstata (HBP) y su tratamiento, en pacientes con síntomas urinarios (STUI/HBP) moderados-graves en tratamiento con bloqueadores alfa; estudiar las diferencias asociadas a la edad, la gravedad de síntomas urinarios y el tiempo con tratamiento. Material y métodos: Se reclutaron 1.580 pacientes diagnosticados de HBP y con STUI/HBP en tratamiento con bloqueadores alfa, en consultas de urología de toda España. Se recogieron datos sociodemográficos, clínicos y de gravedad de STUI/HBP (cuestionario IPSS) y las respuestas al cuestionario EQ-5D y el Sexual Function Index (SFI). Se realizó un análisis estadístico descriptivo, contrastes por edad, gravedad de STUI/HBP y tiempo de tratamiento y se ajustaron modelos lineales de regresión múltiple para las respuestas al EQ-5D y SFI. Resultados: Se analizaron datos de 1.514 pacientes. La media (DE) de edad fue 63 (5,5) años (26,75%<60 años), de tiempo de tratamiento 1,8 (2,0) años (51,19%<1 año), para IPSS 17,29 (5,66) puntos (65,85% síntomas moderados), para EQ-5D 90 (14) puntos. Las dimensiones del SFI más dañadas fueron satisfacción y deseo. El 52,58% de los pacientes mostraron afectación en la CVRS (IPSS-ítem 8). Edad, gravedad de síntomas y tiempo en tratamiento mostraron asociación con la CVRS y función sexual. Conclusiones: La HBP y su tratamiento impactan negativamente en la CVRS y en la función sexual, siendo el deterioro mayor en pacientes con síntomas STU/HBP graves, en los de mayor edad y en los que llevaban más de un año de tratamiento (AU)

Objectives: To evaluate the impact of bening prostatic hyperplasia (BPH) on health related quality of life (HRQoL) and sexual function, in patients with moderate-severe lower tract urinary symptoms (LUTS/BPH) under treatment with alpha-blockers; to study differences associated to age, urinary symptom severity and time under treatment. Material and methods: 1580 patients diagnosed of BPH and LUTS/BPH, and in treatment with alpha-blockers were recruited in urology practices all around Spain. Socio-demographic- and clinic-data together with LUTS/HBP severity assessment (IPSS questionnaire) and responses to EQ-5D and the Sexual Function Index Questionnaire (SFI) were collected. A descriptive statistical analysis was performed, as well as test to contrast the results by age, LUTS/HBP severity and time under treatment; multiple linear regression models were adjusted for the answers to EQ-5D and SFI. Results: Analysis database contained information of 1514 patients. Mean age (SD) was 63 (5.5) years (26.75% under 60 years), mean treatment time 1.8 (2.09) years (51.19% under one year). Mean questionnaire scores were: IPSS 17.29 (5.66) (65.85% moderate symptoms), EQ-5D 90 (14). The SFI-domains with worse scores were satisfaction and sexual drive. 52.58% of patients presented deteriorated HRQoL (IPSS-item 8). Age, symptom severity and time under treatment showed association with HRQoL and sexual function. Conclusions: BPH and its treatment impact negatively on HRQOL and sexual function, with a more pronounced deterioration in patients with severe LUTS/HBP, in older patients and in patients in treatment over a year (AU)

[Benign prostatic hyperplasia and its treatment: impact on quality of life and sexual function]. / Hiperplasia benigna de próstata y su tratamiento: impacto en calidad de vida y función sexual.

OBJECTIVES: To evaluate the impact of benign prostatic hyperplasia (BPH) on health related quality of life (HRQoL) and sexual function, in patients with moderate-severe lower tract urinary symptoms (LUTS/BPH) under treatment with alpha-blockers; to study differences associated to age, urinary symptom severity and time under treatment. MATERIAL AND METHODS: 1580 patients diagnosed of BPH and LUTS/BPH, and in treatment with alpha-blockers were recruited in urology practices all around Spain. Socio-demographic- and clinic-data together with LUTS/HBP severity assessment (IPSS questionnaire) and responses to EQ-5D and the Sexual Function Index Questionnaire (SFI) were collected. A descriptive statistical analysis was performed, as well as test to contrast the results by age, LUTS/HBP severity and time under treatment; multiple linear regression models were adjusted for the answers to EQ-5D and SFI. RESULTS: Analysis database contained information of 1514 patients. Mean age (SD) was 63 (5.5) years (26.75% under 60 years), mean treatment time 1.8 (2.09) years (51.19% under one year). Mean questionnaire scores were: IPSS 17.29 (5.66) (65.85% moderate symptoms), EQ-5D 90 (14). The SFI-domains with worse scores were satisfaction and sexual drive. 52.58% of patients presented deteriorated HRQoL (IPSS-item 8). Age, symptom severity and time under treatment showed association with HRQoL and sexual function. CONCLUSIONS: BPH and its treatment impact negatively on HRQOL and sexual function, with a more pronounced deterioration in patients with severe LUTS/HBP, in older patients and in patients in treatment over a year.

Impacto del tratamiento de la vejiga hiperactiva en las comorbilidades asociadas / Impact of Overactive Bladder Treatment on Associated Comorbidities

Objetivos: Analizar el manejo de pacientes con vejiga hiperactiva (VH) de nuevo diagnóstico y el impacto del tratamiento en las comorbilidades asociadas. Material y métodos: Se reclutaron 1.434 pacientes mayores de 60 años con VH de nuevo diagnóstico y al menos una patología asociada (infecciones urinarias o de piel del área genital, trastornos del sueño, depresión, hipertensión) en 300 consultas de urología/ginecología de España. Inicialmente se recogieron datos sociodemográficos y clínicos y se pautó tratamiento para VH según la práctica clínica habitual; 4-6 meses después se reevaluó la sintomatología. Se realizó un análisis estadístico descriptivo, contrastes por sexos (Chi2/Mann-Whitney) y para la evolución entre visitas (McNemar). Resultados: Se presentan datos de 1.274 pacientes válidos en visita 1 y 1.153 en visita 2. La edad media fue 68,17 (6,19) años y el 71,51% de la muestra fueron mujeres. El 66,41% presentó urgencia miccional, con o sin incontinencia urinaria (IU) de urgencia y el 33,59% urgencia asociada a IU de esfuerzo. Las patologías asociadas más frecuentes fueron trastornos de sueño (56,44%) e infecciones urinarias (53,14%). Las infecciones urinarias y genitales y el tratamiento para la depresión fueron más frecuentes en mujeres; los trastornos del sueño e hipertensión, en varones. Los tratamientos más frecuentemente indicados fueron anticolinérgicos (95,45%) y recomendaciones sobre pautas de estilo de vida (85,32%). En la segunda visita se detectó mejora significativa en los síntomas de las comorbilidades asociadas. Conclusiones: La identificación y tratamiento de los síntomas de VH es importante para reducir el impacto de la enfermedad y de las patologías asociadas (AU)

Objectives: To analyze the management of patients newly diagnosed with overactive bladder (OAB) and to assess the impact of treatment on associated comorbidities. Material and methods: 1,434 patients over 60 years with newly diagnosed OAB and at least one associated comorbidity (urinary tract infections, genital skin infections, sleep disturbances, depression, and hypertension) were recruited in 300 urology/gynecology surgeries in Spain. In the first visit sociodemographic and clinic data were recorded, and treatment for OAB following usual practice was prescribed. 4-6 months later symptoms were reevaluated. A descriptive statistical analysis was performed, variables were compared by gender (Chi2/Mann-Whitney) and between visits (McNemar). Results: Data for 1,274 valid patients in visit 1 and 1,153 in visit 2 are presented. Mean age in the sample was 68.17(6.19) years, 71.51% were women. 66.41% presented urgency, with or without urge urinary incontinence, and 33.59% presented urgency related to stress urinary incontinence. The most frequent associated pathologies were sleep disturbances (56.44%) and urinary tract infections (53.14%). Urinary tract infections and genital skin infections and treatment for depression were more frequent in women; sleep disturbances and hypertension in men. Treatments more frequently prescribed were anticholinergics (95.45%) and guidance for lifestyle changes (85.32%). Statistically significant improvement in symptoms of associated comorbidities was detected in visit 2. Conclusions: Detection and treatment of OAB symptoms is relevant to reduce both the impact of the affection and of associated pathologies (AU)

[Impact of overactive bladder treatment on associated comorbidities]. / Impacto del tratamiento de la vejiga hiperactiva en las comorbilidades asociadas.

OBJECTIVES: To analyze the management of patients newly diagnosed with overactive bladder (OAB) and to assess the impact of treatment on associated comorbidities. MATERIAL AND METHODS: 1,434 patients over 60 years with newly diagnosed OAB and at least one associated comorbidity (urinary tract infections, genital skin infections, sleep disturbances, depression, and hypertension) were recruited in 300 urology/gynecology surgeries in Spain. In the first visit sociodemographic and clinic data were recorded, and treatment for OAB following usual practice was prescribed. 4-6 months later symptoms were reevaluated. A descriptive statistical analysis was performed, variables were compared by gender (Chi(2)/Mann-Whitney) and between visits (McNemar). RESULTS: Data for 1,274 valid patients in visit 1 and 1,153 in visit 2 are presented. Mean age in the sample was 68.17(6.19) years, 71.51% were women. 66.41% presented urgency, with or without urge urinary incontinence, and 33.59% presented urgency related to stress urinary incontinence. The most frequent associated pathologies were sleep disturbances (56.44%) and urinary tract infections (53.14%). Urinary tract infections and genital skin infections and treatment for depression were more frequent in women; sleep disturbances and hypertension in men. Treatments more frequently prescribed were anticholinergics (95.45%) and guidance for lifestyle changes (85.32%). Statistically significant improvement in symptoms of associated comorbidities was detected in visit 2. CONCLUSIONS: Detection and treatment of OAB symptoms is relevant to reduce both the impact of the affection and of associated pathologies.