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Re: Non-Alcoholic Fatty Liver Disease is Associated with Benign Prostate Hyperplasia in Men and with Overactive Bladder in Women
2038
BENIGN PROSTATIC HYPERPLASIA
revealed that TURP improves nocturia by about 1 to 1.4 points on the nocturia question of the International Prostate Symptom Score. Moreover, nocturia seems to lag behind other components of the International Prostate Symptom Score after TURP. This study is notable in that it disconnects changes in nocturnal frequency from quality of sleep. In this cohort nocturia significantly decreased from 3.0 to 1.9. However, sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) did not change. The PSQI is a 7-component measure in which each component is scored from 0 to 3 and a total score of 5.5 or higher is considered to indicate a sleep disorder. An overall decrease of 2 is considered significant. PSQI decreased by only 1.1 in this group of men after TURP. Of the 20 men with a preoperative sleep disorder 16 (80%) had persistence after TURP. It is noteworthy that there is often a disconnect between changes in nocturnal frequency and sleep quality. Persistent sleep disorders may be related to storage symptoms, ie overactive bladder, and may respond to antimuscarinic agents. The take home message is that we must be cautious in discussing potential improvements in sleep quality in prospective patients with lower urinary tract symptoms considering surgery. While nocturnal frequency might decrease, quality of sleep might not. It would be prudent to do a large prospective series to gain greater insight into which men have combined improvement in nocturnal frequency and sleep quality after TURP. Steven A. Kaplan, MD
Suggested Reading Homma Y, Yamaguchi T, Kondo Y et al: Significance of nocturia in the International Prostate Symptom Score for benign prostatic hyperplasia. J Urol 2002; 167: 172.
Re: Non-Alcoholic Fatty Liver Disease is Associated with Benign Prostate Hyperplasia in Men and with Overactive Bladder in Women € € Zorba, S. Yazar and M. Kalkan ullar, H. Unal, H. Uzun, S. Og O. U. an University, Rize, Turkey Department of Urology, School of Medicine, Recep Tayyip Erdog Scand J Urol 2013; 47: 497e502.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.020 available at http://jurology.com/ Editorial Comment: The recognition that men and women around the world are gaining weight at an alarming rate is indisputable. One can look at a map of the United States and see more than 10 states in which at least a third of the population is obesednot just overweight, but obese! Concomitant with obesity is a marked increase in the rates of diabetes and metabolic syndrome (MetS). MetS increases rates of mortality and is associated with other concomitant processes, such as coronary artery disease, polycystic ovaries and Alzheimer disease. It is also recognized that nonalcoholic fatty liver disease (NAFLD) is the hepatic component of MetS. NAFLD is heralded by its progressive and inflammatory nature and can result in wide ranging liver damage, including cirrhosis. We are also aware that MetS and obesity are associated with higher rates of benign prostatic hyperplasia in men and overactive bladder (OAB) in women. Is there an association of lower urinary tract dysfunction and NAFLD? If so, is there a common pathological pathway? The data reported herein suggest that 1) prostate volume is significantly greater in men with NAFLD and 2) OAB is present in 75.8% of women with NAFLD vs 52.4% of women without NAFLD. What are the potential common pathological mechanisms? Putative causes include increased insulin resistance, activation of an insulin-like growth factor receptor and chronic inflammation. Insulin resistance is associated with sympathetic overactivity, a risk factor for prostate growth and a major risk factor for neuropathological changes in females with OAB.
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
The bottom line is that urologists need to be keenly aware of how obesity and MetS can impact pelvic function in men and women. Furthermore, we should be readily engaged in discussing how to ameliorate symptoms based on a more holistic approach of diet, exercise and stress management. Steven A. Kaplan, MD
Suggested Reading 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.
Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Morbidity and Mortality after Benign Prostatic Hyperplasia Surgery: Data from the American College of Surgeons National Surgical Quality Improvement Program N. Bhojani, G. Gandaglia, A. Sood, A. Rai, D. Pucheril, S. L. Chang, P. I. Karakiewicz, M. Menon, K. Olugbade, Jr., N. Ruhotina, J. D. Sammon, S. Sukumar, M. Sun, K. R. Ghani, M. Schmid, B. Varda, A. S. Kibel, K. C. Zorn and Q. D. Trinh Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l’Universite´ de Montre´al, Montreal, Quebec, Canada J Endourol 2014; 28: 831e840.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.008 available at http://jurology.com/ Editorial Comment: The authors reviewed the NSQIP (National Surgical Quality Improvement Program) database between 2006 and 2011 to compare outcomes from transurethral resection, laser vaporization and laser enucleation of the prostate in the treatment of patients with benign prostatic hyperplasia. All 3 modalities appear to be safe. Advanced age and nonwhite race were independent predictors of morbidity. Preoperative hematocrit and albumin levels were also reliable markers for adverse events. Richard K. Babayan, MD
2039
BENIGN PROSTATIC HYPERPLASIA
revealed that TURP improves nocturia by about 1 to 1.4 points on the nocturia question of the International Prostate Symptom Score. Moreover, nocturia seems to lag behind other components of the International Prostate Symptom Score after TURP. This study is notable in that it disconnects changes in nocturnal frequency from quality of sleep. In this cohort nocturia significantly decreased from 3.0 to 1.9. However, sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) did not change. The PSQI is a 7-component measure in which each component is scored from 0 to 3 and a total score of 5.5 or higher is considered to indicate a sleep disorder. An overall decrease of 2 is considered significant. PSQI decreased by only 1.1 in this group of men after TURP. Of the 20 men with a preoperative sleep disorder 16 (80%) had persistence after TURP. It is noteworthy that there is often a disconnect between changes in nocturnal frequency and sleep quality. Persistent sleep disorders may be related to storage symptoms, ie overactive bladder, and may respond to antimuscarinic agents. The take home message is that we must be cautious in discussing potential improvements in sleep quality in prospective patients with lower urinary tract symptoms considering surgery. While nocturnal frequency might decrease, quality of sleep might not. It would be prudent to do a large prospective series to gain greater insight into which men have combined improvement in nocturnal frequency and sleep quality after TURP. Steven A. Kaplan, MD
Suggested Reading Homma Y, Yamaguchi T, Kondo Y et al: Significance of nocturia in the International Prostate Symptom Score for benign prostatic hyperplasia. J Urol 2002; 167: 172.
Re: Non-Alcoholic Fatty Liver Disease is Associated with Benign Prostate Hyperplasia in Men and with Overactive Bladder in Women € € Zorba, S. Yazar and M. Kalkan ullar, H. Unal, H. Uzun, S. Og O. U. an University, Rize, Turkey Department of Urology, School of Medicine, Recep Tayyip Erdog Scand J Urol 2013; 47: 497e502.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.020 available at http://jurology.com/ Editorial Comment: The recognition that men and women around the world are gaining weight at an alarming rate is indisputable. One can look at a map of the United States and see more than 10 states in which at least a third of the population is obesednot just overweight, but obese! Concomitant with obesity is a marked increase in the rates of diabetes and metabolic syndrome (MetS). MetS increases rates of mortality and is associated with other concomitant processes, such as coronary artery disease, polycystic ovaries and Alzheimer disease. It is also recognized that nonalcoholic fatty liver disease (NAFLD) is the hepatic component of MetS. NAFLD is heralded by its progressive and inflammatory nature and can result in wide ranging liver damage, including cirrhosis. We are also aware that MetS and obesity are associated with higher rates of benign prostatic hyperplasia in men and overactive bladder (OAB) in women. Is there an association of lower urinary tract dysfunction and NAFLD? If so, is there a common pathological pathway? The data reported herein suggest that 1) prostate volume is significantly greater in men with NAFLD and 2) OAB is present in 75.8% of women with NAFLD vs 52.4% of women without NAFLD. What are the potential common pathological mechanisms? Putative causes include increased insulin resistance, activation of an insulin-like growth factor receptor and chronic inflammation. Insulin resistance is associated with sympathetic overactivity, a risk factor for prostate growth and a major risk factor for neuropathological changes in females with OAB.
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
The bottom line is that urologists need to be keenly aware of how obesity and MetS can impact pelvic function in men and women. Furthermore, we should be readily engaged in discussing how to ameliorate symptoms based on a more holistic approach of diet, exercise and stress management. Steven A. Kaplan, MD
Suggested Reading 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.
Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Morbidity and Mortality after Benign Prostatic Hyperplasia Surgery: Data from the American College of Surgeons National Surgical Quality Improvement Program N. Bhojani, G. Gandaglia, A. Sood, A. Rai, D. Pucheril, S. L. Chang, P. I. Karakiewicz, M. Menon, K. Olugbade, Jr., N. Ruhotina, J. D. Sammon, S. Sukumar, M. Sun, K. R. Ghani, M. Schmid, B. Varda, A. S. Kibel, K. C. Zorn and Q. D. Trinh Cancer Prognostics and Health Outcomes Unit, Centre Hospitalier de l’Universite´ de Montre´al, Montreal, Quebec, Canada J Endourol 2014; 28: 831e840.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.008 available at http://jurology.com/ Editorial Comment: The authors reviewed the NSQIP (National Surgical Quality Improvement Program) database between 2006 and 2011 to compare outcomes from transurethral resection, laser vaporization and laser enucleation of the prostate in the treatment of patients with benign prostatic hyperplasia. All 3 modalities appear to be safe. Advanced age and nonwhite race were independent predictors of morbidity. Preoperative hematocrit and albumin levels were also reliable markers for adverse events. Richard K. Babayan, MD
2039