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Re: Prevalence and Risk Factors for Nocturia in Middle-Aged and Elderly People from Public Health Centers in Taiwan
1816
GERIATRICS
Editorial Comment: This article does a great service by providing referenced citations for articles dealing with the pharmacological management of patients with neurological disease or injury who have overactive bladder symptoms and/or detrusor overactivity. As the authors point out, there is a relative paucity of such series compared to those dealing with overactive bladder in patients without apparent neurological disease. As the abstract points out, urodynamic data are listed along with a qualitative statement that better results are achieved with drugs than placebo, although there are no specifics regarding urgency reduction (in those with sensation), incontinence episode reduction or frequency reduction. There is not even a division between spinal cord injury patients and patients with other neurogenic etiologies. One might expect long-term compliance in these patients (continued use of drug) to be better than in the nonneurogenic population but there is no information about this parameter either. Hopefully some of these questions will be answered subsequently. Alan J. Wein, M.D., Ph.D. (hon.)
Re: The Prevalence and Natural History of Urinary Symptoms among Recreational Ketamine Users A. R. Winstock, L. Mitcheson, D. A. Gillatt and A. M. Cottrell Addiction CAG, South London and Maudsley NHS Foundation Trust, St. George’s Hospital Medical School, London, United Kingdom BJU Int 2012; 110: 1762e1766.
Abstract available at http://jurology.com/ Editorial Comment: Ketamine is a popular recreational drug. Urinary tract symptoms have been reported in more than 25% of regular users, with a dose and frequency and response relationship established. Symptoms include urinary frequency, urgency and suprapubic pain, dysuria and hematuria. This particular compilation of data was collected among nontreatment seeking users. Recognition of the association is particularly important for primary care providers, as well as recognition of the fact that between a third and half of patients report resolution/improvement in symptoms after stopping usage. Long-term effects are unknown. Alan J. Wein, M.D., Ph.D. (hon.)
Geriatrics Re: Prevalence and Risk Factors for Nocturia in Middle-Aged and Elderly People from Public Health Centers in Taiwan M. H. Huang, A. F. Chiu, C. C. Wang and H. C. Kuo Department of Nursing, Meiho University, Pingtung, Taiwan Int Braz J Urol 2012; 38: 818e824.
Abstract available at http://jurology.com/ Editorial Comment: Nocturia is common in older adults and has been linked to negative health outcomes such as poor sleep quality, fatigue, depression and increased rates of mortality. This study demonstrated a 38.1% prevalence of nocturia (defined as 2 or more episodes nightly) in a cohort of 1,011 middle-aged and elderly people presenting to public health clinics in Taiwan. The authors confirmed that the associated health conditions in this population are similar to those seen in Western countries. Identified risk factors included increased age, hypertension, diabetes and obesity. A history of cardiovascular disease and stroke increased the risk of nocturia but did not
GERIATRICS
1817
reach statistical significance. This study had a number of limitations, including potential selection and recall bias among the participants, and lack of voiding diaries to substantiate self-reported nocturia and voiding symptoms. However, these findings highlight the association between multiple comorbidity variables and nocturia in middle-aged and older adults. These conditions may be the ultimate source of previously described associations between nocturia and increased risks of mortality in this population. Tomas L. Griebling, M.D., M.P.H.
Suggested Reading Fitzgerald MP, Litman HJ, Link CL et al: The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J Urol 2007; 177: 1385. van Doorn B, Kok ET, Blanker MH et al: Mortality in older men with nocturia. A 15-year followup of the Krimpen study. J Urol 2012; 187: 1727.
Re: Association between Nocturia and Falls-Related Long-Term Mortality Risk in the Elderly G. Galizia, A. Langellotto, F. Cacciatore, F. Mazzella, G. Testa, D. Della-Morte, G. Gargiulo, A. Ungar, N. Ferrara, F. Rengo and P. Abete Istituto Scientifico di Veruno (Novara), Divisione di Recupero e Rieducazione Funzionale, Fondazione Salvatore Maugeri, Veruno (Novara), Italy J Am Med Dir Assoc 2012; 13: 640e644.
Abstract available at http://jurology.com/ Editorial Comment: Most studies regarding the relationship between nocturia and falls in older adults start from the perspective of nocturia. This study was unique in that it started by classifying the cross-sectional cohort based on history of falls (172 subjects) or no falls (1,110 subjects) at baseline. Subjects were then stratified regarding nocturia. This study is important because it is the first to examine these interactions in a longitudinal fashion. It was interesting that the results showed falls to be predictive of long-term mortality in those with but not without nocturia. Overall 16% of subjects with nocturia experienced at least 1 fall. Fractures, a common complication of falls in older adults, were not associated with the increased mortality in those with nocturia in this analysis. The authors correctly note that nocturia may be a clinical symptom of other underlying comorbidities such as congestive heart failure, diabetes, other urinary disorders and autonomic dysfunction, all of which could lead to the increased mortality outcome. Depression, cognitive impairment, polypharmacy and lower levels of social support were also associated with nocturia and falls, and could be additional contributors to increased mortality. Clinicians should be aware of the link between falls, nocturia and mortality risk among their elderly patients. Additional research may help identify preventive strategies to help decrease risks. Tomas L. Griebling, M.D., M.P.H.
Suggested Reading Nakagawa H, Niu K, Hozawa A et al: Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J Urol 2010; 184: 1413. Kupelian V, Fitzgerald MP, Kaplan SA et al: Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol 2011; 185: 571.
1818
BENIGN PROSTATIC HYPERPLASIA
Re: The Impact of Organizational Factors on the Urinary Incontinence Care Quality in Long-Term Care Hospitals: A Longitudinal Correlational Study J. Y. Yoon, J. Y. Lee, B. J. Bowers and D. R. Zimmerman School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin Int J Nurs Stud 2012; 49: 1544e1551.
Abstract available at http://jurology.com/ Editorial Comment: Rates of urinary incontinence (UI) in nursing home settings approach 50% to 70% in most published series. Multiple factors contribute to the increased prevalence of UI in nursing home residents. Numerous intervention studies have been published that examine methods to improve continence care in this often frail, vulnerable geriatric population. Evaluation and management of UI have been designated as quality measures for nursing homes in the United States and many other countries. This study from South Korea examined facility factors that contribute to alterations in UI rates in nursing homes. After controlling for patient specific variables, geographic location and staffing levels were statistically associated with rates of UI. Nursing homes in rural locations had a higher overall prevalence of UI compared to those in more urban areas. Additionally less improvement in continence rates was observed in the rural compared to urban facilities. Nursing homes with higher registered nurse-to-overall staff ratios demonstrated better rates of continence improvement and maintenance of continence among elderly residents. Professional nurse staffing remains a widespread challenge facing many nursing home facilities. This study demonstrates that factors associated with continence in this setting are complex, and are often associated with staffing and infrastructure issues rather than simply individual patient variables. Tomas L. Griebling, M.D., M.P.H.
Benign Prostatic Hyperplasia Re: Constitutional, Organopathic and Combined Homeopathic Treatment of Benign Prostatic Hypertrophy: A Clinical Trial A. K. Hati, B. Paital, K. N. Naik, A. K. Mishra, G. B. Chainy and L. K. Nanda Dr. Abhin Chandra Homeopathic Medical College and Hospital, Bhubaneswar, Odisha, India Homeopathy 2012; 101: 217e223.
Abstract available at http://jurology.com/ Editorial Comment: One cannot listen to the radio or watch cable television without hearing an advertisement for some miraculous remedy that treats the prostate, improves sexual function and turns a 70-year-old man into a modern day Casanova. Too bad rigorous data are not needed to support these claims. Nevertheless, this is the reality we have to deal with. In this study the authors compare organopathic medications (selected on the basis of “person diagnosis vs disease diagnosis,” eg Solidago, Triticum, picric acid) and constitutional medications (selected on the basis of physical and mental attributes of each individual, eg Thuja, Tuberculinum, Natrum) and a combination of both. Interestingly men 30 to 90 years were included in the series, which is not the typical benign prostatic hyperplasia study population. Not surprisingly, in this nonplacebo controlled trial there was symptom improvement in all 3 groups (magnitude greater than 50%), and peak flow rate improved by as much as 13 ml per second in the combination group. However, prostate size remained the same. Notwithstanding the uneven followup of men and the fact that men received different preparations, the data are simply not believable. Flow rate improvements were better than with open prostatectomy, ie drops of unevenly described concoctions were better than a resectoscope. Unfortunately that
GERIATRICS
Editorial Comment: This article does a great service by providing referenced citations for articles dealing with the pharmacological management of patients with neurological disease or injury who have overactive bladder symptoms and/or detrusor overactivity. As the authors point out, there is a relative paucity of such series compared to those dealing with overactive bladder in patients without apparent neurological disease. As the abstract points out, urodynamic data are listed along with a qualitative statement that better results are achieved with drugs than placebo, although there are no specifics regarding urgency reduction (in those with sensation), incontinence episode reduction or frequency reduction. There is not even a division between spinal cord injury patients and patients with other neurogenic etiologies. One might expect long-term compliance in these patients (continued use of drug) to be better than in the nonneurogenic population but there is no information about this parameter either. Hopefully some of these questions will be answered subsequently. Alan J. Wein, M.D., Ph.D. (hon.)
Re: The Prevalence and Natural History of Urinary Symptoms among Recreational Ketamine Users A. R. Winstock, L. Mitcheson, D. A. Gillatt and A. M. Cottrell Addiction CAG, South London and Maudsley NHS Foundation Trust, St. George’s Hospital Medical School, London, United Kingdom BJU Int 2012; 110: 1762e1766.
Abstract available at http://jurology.com/ Editorial Comment: Ketamine is a popular recreational drug. Urinary tract symptoms have been reported in more than 25% of regular users, with a dose and frequency and response relationship established. Symptoms include urinary frequency, urgency and suprapubic pain, dysuria and hematuria. This particular compilation of data was collected among nontreatment seeking users. Recognition of the association is particularly important for primary care providers, as well as recognition of the fact that between a third and half of patients report resolution/improvement in symptoms after stopping usage. Long-term effects are unknown. Alan J. Wein, M.D., Ph.D. (hon.)
Geriatrics Re: Prevalence and Risk Factors for Nocturia in Middle-Aged and Elderly People from Public Health Centers in Taiwan M. H. Huang, A. F. Chiu, C. C. Wang and H. C. Kuo Department of Nursing, Meiho University, Pingtung, Taiwan Int Braz J Urol 2012; 38: 818e824.
Abstract available at http://jurology.com/ Editorial Comment: Nocturia is common in older adults and has been linked to negative health outcomes such as poor sleep quality, fatigue, depression and increased rates of mortality. This study demonstrated a 38.1% prevalence of nocturia (defined as 2 or more episodes nightly) in a cohort of 1,011 middle-aged and elderly people presenting to public health clinics in Taiwan. The authors confirmed that the associated health conditions in this population are similar to those seen in Western countries. Identified risk factors included increased age, hypertension, diabetes and obesity. A history of cardiovascular disease and stroke increased the risk of nocturia but did not
GERIATRICS
1817
reach statistical significance. This study had a number of limitations, including potential selection and recall bias among the participants, and lack of voiding diaries to substantiate self-reported nocturia and voiding symptoms. However, these findings highlight the association between multiple comorbidity variables and nocturia in middle-aged and older adults. These conditions may be the ultimate source of previously described associations between nocturia and increased risks of mortality in this population. Tomas L. Griebling, M.D., M.P.H.
Suggested Reading Fitzgerald MP, Litman HJ, Link CL et al: The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J Urol 2007; 177: 1385. van Doorn B, Kok ET, Blanker MH et al: Mortality in older men with nocturia. A 15-year followup of the Krimpen study. J Urol 2012; 187: 1727.
Re: Association between Nocturia and Falls-Related Long-Term Mortality Risk in the Elderly G. Galizia, A. Langellotto, F. Cacciatore, F. Mazzella, G. Testa, D. Della-Morte, G. Gargiulo, A. Ungar, N. Ferrara, F. Rengo and P. Abete Istituto Scientifico di Veruno (Novara), Divisione di Recupero e Rieducazione Funzionale, Fondazione Salvatore Maugeri, Veruno (Novara), Italy J Am Med Dir Assoc 2012; 13: 640e644.
Abstract available at http://jurology.com/ Editorial Comment: Most studies regarding the relationship between nocturia and falls in older adults start from the perspective of nocturia. This study was unique in that it started by classifying the cross-sectional cohort based on history of falls (172 subjects) or no falls (1,110 subjects) at baseline. Subjects were then stratified regarding nocturia. This study is important because it is the first to examine these interactions in a longitudinal fashion. It was interesting that the results showed falls to be predictive of long-term mortality in those with but not without nocturia. Overall 16% of subjects with nocturia experienced at least 1 fall. Fractures, a common complication of falls in older adults, were not associated with the increased mortality in those with nocturia in this analysis. The authors correctly note that nocturia may be a clinical symptom of other underlying comorbidities such as congestive heart failure, diabetes, other urinary disorders and autonomic dysfunction, all of which could lead to the increased mortality outcome. Depression, cognitive impairment, polypharmacy and lower levels of social support were also associated with nocturia and falls, and could be additional contributors to increased mortality. Clinicians should be aware of the link between falls, nocturia and mortality risk among their elderly patients. Additional research may help identify preventive strategies to help decrease risks. Tomas L. Griebling, M.D., M.P.H.
Suggested Reading Nakagawa H, Niu K, Hozawa A et al: Impact of nocturia on bone fracture and mortality in older individuals: a Japanese longitudinal cohort study. J Urol 2010; 184: 1413. Kupelian V, Fitzgerald MP, Kaplan SA et al: Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol 2011; 185: 571.
1818
BENIGN PROSTATIC HYPERPLASIA
Re: The Impact of Organizational Factors on the Urinary Incontinence Care Quality in Long-Term Care Hospitals: A Longitudinal Correlational Study J. Y. Yoon, J. Y. Lee, B. J. Bowers and D. R. Zimmerman School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin Int J Nurs Stud 2012; 49: 1544e1551.
Abstract available at http://jurology.com/ Editorial Comment: Rates of urinary incontinence (UI) in nursing home settings approach 50% to 70% in most published series. Multiple factors contribute to the increased prevalence of UI in nursing home residents. Numerous intervention studies have been published that examine methods to improve continence care in this often frail, vulnerable geriatric population. Evaluation and management of UI have been designated as quality measures for nursing homes in the United States and many other countries. This study from South Korea examined facility factors that contribute to alterations in UI rates in nursing homes. After controlling for patient specific variables, geographic location and staffing levels were statistically associated with rates of UI. Nursing homes in rural locations had a higher overall prevalence of UI compared to those in more urban areas. Additionally less improvement in continence rates was observed in the rural compared to urban facilities. Nursing homes with higher registered nurse-to-overall staff ratios demonstrated better rates of continence improvement and maintenance of continence among elderly residents. Professional nurse staffing remains a widespread challenge facing many nursing home facilities. This study demonstrates that factors associated with continence in this setting are complex, and are often associated with staffing and infrastructure issues rather than simply individual patient variables. Tomas L. Griebling, M.D., M.P.H.
Benign Prostatic Hyperplasia Re: Constitutional, Organopathic and Combined Homeopathic Treatment of Benign Prostatic Hypertrophy: A Clinical Trial A. K. Hati, B. Paital, K. N. Naik, A. K. Mishra, G. B. Chainy and L. K. Nanda Dr. Abhin Chandra Homeopathic Medical College and Hospital, Bhubaneswar, Odisha, India Homeopathy 2012; 101: 217e223.
Abstract available at http://jurology.com/ Editorial Comment: One cannot listen to the radio or watch cable television without hearing an advertisement for some miraculous remedy that treats the prostate, improves sexual function and turns a 70-year-old man into a modern day Casanova. Too bad rigorous data are not needed to support these claims. Nevertheless, this is the reality we have to deal with. In this study the authors compare organopathic medications (selected on the basis of “person diagnosis vs disease diagnosis,” eg Solidago, Triticum, picric acid) and constitutional medications (selected on the basis of physical and mental attributes of each individual, eg Thuja, Tuberculinum, Natrum) and a combination of both. Interestingly men 30 to 90 years were included in the series, which is not the typical benign prostatic hyperplasia study population. Not surprisingly, in this nonplacebo controlled trial there was symptom improvement in all 3 groups (magnitude greater than 50%), and peak flow rate improved by as much as 13 ml per second in the combination group. However, prostate size remained the same. Notwithstanding the uneven followup of men and the fact that men received different preparations, the data are simply not believable. Flow rate improvements were better than with open prostatectomy, ie drops of unevenly described concoctions were better than a resectoscope. Unfortunately that