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Re: Prevalence of Urinary Incontinence and Associated Factors in Nursing Home Residents
GERIATRICS
733
Re: Can Treatment of Nocturia Increase Testosterone Level in Men with Late Onset Hypogonadism? J. W. Kim, J. Y. Chae, J. W. Kim, C. Y. Yoon, M. M. Oh, H. S. Park, J. J. Kim and D. G. Moon Department of Urology, Korea University Medical Center, Seoul, Republic of Korea Urology 2014; 83: 837e842.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.042 available at http://jurology.com/ Editorial Comment: Nocturia in older adults is associated with a multitude of negative clinical outcomes. Elderly men with nocturia have an increased prevalence of late onset hypogonadism compared to men without nocturia due to the effects of sleep deprivation on natural hormone excretion. This study examined the effect of desmopressin administration to treat nocturia in 62 men (mean age 68.4 years) with nocturia and symptomatic hypogonadism followed prospectively during 12 weeks of treatment. Participants were divided into 2 groups based on normal or low baseline serum testosterone (T) level. During desmopressin treatment serum T levels increased substantially in those with low baseline T and were unchanged in those with normal baseline T levels. These findings suggest that this therapy may help to correct abnormalities of pulsatile T secretion caused by nocturia, which disrupts sleep and natural circadian rhythms. It will be interesting to see if other types of treatment for nocturia yield similar results in terms of androgen production. Tomas L. Griebling, MD, MPH
Suggested Reading H€akkinen JT, Hakama M, Shiri R et al: Incidence of nocturia in 50 to 80-year-old Finnish men. J Urol 2006; 176: 2541. Chang IH, Oh SY and Kim SC: A possible relationship between testosterone and lower urinary tract symptoms in men. J Urol 2009; 182: 215.
Re: Prevalence of Urinary Incontinence and Associated Factors in Nursing Home Residents J. Jerez-Roig, M. M. Santos, D. L. B. Souza, F. L J. S. Amaral and K. C. Lima Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Lagoa Nova, Natal-RN, Brazil, and Rehabilitation Service, Hospital Can Misses, Ibiza, Balearic Islands, Spain Neurourol Urodyn 2014; Epub ahead of print.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.043 available at http://jurology.com/ Editorial Comment: Urinary incontinence (UI) and behavioral issues associated with dementia are often cited among the most common factors necessitating nursing home placement for older adults. This study examined UI prevalence in 321 elderly nursing home residents (mean age 81.5 years) in a large Brazilian city. Overall UI prevalence was 58.88%. Multiple variables were associated with an increased rate of UI, including white race, physical inactivity, stroke, mobility impairment and cognitive decline. Although urgency UI tends to be the most common form in community dwelling older adults, functional incontinence due to mobility or cognitive impairment was most common in this cohort. It is noteworthy that only 8% of these incontinent nursing home residents were treated with structured toileting programs and the only type offered was prompted voiding, despite an abundance of research demonstrating the efficacy of various types of programs in nursing homes. Unfortunately most not-for-profit nursing homes in Brazil lack physicians or physician oversight, which might influence these results. In addition, higher UI rates were seen in white subjects, which was likely a reflection of increased debility. This finding was likely due to disparities in nursing home placement by race and ethnicity in this community. Thus, race was a proxy marker for socioeconomic status
BENIGN PROSTATIC HYPERPLASIA
734
because more affluent individuals tended not to be admitted to nursing homes until they were quite debilitated and suffered more severe UI. It will be interesting to see if this sociocultural trend occurs in other countries. Tomas L. Griebling, MD, MPH
Re: Urinary Incontinence and Prevalence of High Depressive Symptoms in Older Black versus White Women M. K. Townsend, V. A. Minassian, O. I. Ikereke, N. M. Resnick and F. Grodstein Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts Int Urogynecol J 2014; 25: 823e829.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.044 available at http://jurology.com/ Editorial Comment: Multiple studies have identified an association between urinary incontinence (UI) and depression, particularly in older adults. Causation can be difficult to determine and the etiology may be bidirectional. Those with incontinence are at risk for decreased activity and social isolation, and negative body image, which can lead to depression. Those with baseline depression also tend to have lower circulating levels of serotonin, which can predispose to urinary incontinence. Treatment of either condition may lead to improvements in the other. This series examined racial and ethnic difference in these conditions in women enrolled in the Nurses’ Health Study, a large epidemiological study of multiple health parameters. A cross-sectional sample of 934 black and 71,161 white women (mean age 70 years) was analyzed. UI in black women was statistically associated with higher rates of depression, which increased with more frequent weekly episodes of urinary leakage. Those with mixed UI also tended to have higher rates of depression compared to those with stress or urgency UI. These results suggest that sociocultural factors may have an important role in this process beyond changes in genitourinary pathophysiology, and additional research on this topic is warranted. Suggested Reading
Tomas L. Griebling, MD, MPH
Ragins AI, Shan J, Thom DH et al: Effects of urinary incontinence, comorbidity and race on quality of life outcomes in women. J Urol 2008; 179: 651. Diokno AC, Brown MB, Brock BM et al: Clinical and cystometric characteristics of continent and incontinent noninstitutionalized elderly. J Urol 1988; 140: 567.
Benign Prostatic Hyperplasia
Re: Relationship between Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms and Total Serum Testosterone Level in Healthy Middle-Aged Eugonadal Men J. H. Lee, Y. Kim, Y. W. Park and D. G. Lee Department of Urology, National Police Hospital, Seoul, Korea J Sex Med 2014; 11: 1309e1315.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.029 available at http://jurology.com/ Editorial Comment: The role of testosterone in aging men has undergone an almost 180-degree turn during the last decade. What was once thought to be the scourge of prostate disease and verboten as a supplement is now one of the most commonly prescribed and used products in the United States. In fact, the “fountain of youth” is a major recruitment tool being used by the
733
Re: Can Treatment of Nocturia Increase Testosterone Level in Men with Late Onset Hypogonadism? J. W. Kim, J. Y. Chae, J. W. Kim, C. Y. Yoon, M. M. Oh, H. S. Park, J. J. Kim and D. G. Moon Department of Urology, Korea University Medical Center, Seoul, Republic of Korea Urology 2014; 83: 837e842.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.042 available at http://jurology.com/ Editorial Comment: Nocturia in older adults is associated with a multitude of negative clinical outcomes. Elderly men with nocturia have an increased prevalence of late onset hypogonadism compared to men without nocturia due to the effects of sleep deprivation on natural hormone excretion. This study examined the effect of desmopressin administration to treat nocturia in 62 men (mean age 68.4 years) with nocturia and symptomatic hypogonadism followed prospectively during 12 weeks of treatment. Participants were divided into 2 groups based on normal or low baseline serum testosterone (T) level. During desmopressin treatment serum T levels increased substantially in those with low baseline T and were unchanged in those with normal baseline T levels. These findings suggest that this therapy may help to correct abnormalities of pulsatile T secretion caused by nocturia, which disrupts sleep and natural circadian rhythms. It will be interesting to see if other types of treatment for nocturia yield similar results in terms of androgen production. Tomas L. Griebling, MD, MPH
Suggested Reading H€akkinen JT, Hakama M, Shiri R et al: Incidence of nocturia in 50 to 80-year-old Finnish men. J Urol 2006; 176: 2541. Chang IH, Oh SY and Kim SC: A possible relationship between testosterone and lower urinary tract symptoms in men. J Urol 2009; 182: 215.
Re: Prevalence of Urinary Incontinence and Associated Factors in Nursing Home Residents J. Jerez-Roig, M. M. Santos, D. L. B. Souza, F. L J. S. Amaral and K. C. Lima Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Lagoa Nova, Natal-RN, Brazil, and Rehabilitation Service, Hospital Can Misses, Ibiza, Balearic Islands, Spain Neurourol Urodyn 2014; Epub ahead of print.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.043 available at http://jurology.com/ Editorial Comment: Urinary incontinence (UI) and behavioral issues associated with dementia are often cited among the most common factors necessitating nursing home placement for older adults. This study examined UI prevalence in 321 elderly nursing home residents (mean age 81.5 years) in a large Brazilian city. Overall UI prevalence was 58.88%. Multiple variables were associated with an increased rate of UI, including white race, physical inactivity, stroke, mobility impairment and cognitive decline. Although urgency UI tends to be the most common form in community dwelling older adults, functional incontinence due to mobility or cognitive impairment was most common in this cohort. It is noteworthy that only 8% of these incontinent nursing home residents were treated with structured toileting programs and the only type offered was prompted voiding, despite an abundance of research demonstrating the efficacy of various types of programs in nursing homes. Unfortunately most not-for-profit nursing homes in Brazil lack physicians or physician oversight, which might influence these results. In addition, higher UI rates were seen in white subjects, which was likely a reflection of increased debility. This finding was likely due to disparities in nursing home placement by race and ethnicity in this community. Thus, race was a proxy marker for socioeconomic status
BENIGN PROSTATIC HYPERPLASIA
734
because more affluent individuals tended not to be admitted to nursing homes until they were quite debilitated and suffered more severe UI. It will be interesting to see if this sociocultural trend occurs in other countries. Tomas L. Griebling, MD, MPH
Re: Urinary Incontinence and Prevalence of High Depressive Symptoms in Older Black versus White Women M. K. Townsend, V. A. Minassian, O. I. Ikereke, N. M. Resnick and F. Grodstein Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts Int Urogynecol J 2014; 25: 823e829.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.044 available at http://jurology.com/ Editorial Comment: Multiple studies have identified an association between urinary incontinence (UI) and depression, particularly in older adults. Causation can be difficult to determine and the etiology may be bidirectional. Those with incontinence are at risk for decreased activity and social isolation, and negative body image, which can lead to depression. Those with baseline depression also tend to have lower circulating levels of serotonin, which can predispose to urinary incontinence. Treatment of either condition may lead to improvements in the other. This series examined racial and ethnic difference in these conditions in women enrolled in the Nurses’ Health Study, a large epidemiological study of multiple health parameters. A cross-sectional sample of 934 black and 71,161 white women (mean age 70 years) was analyzed. UI in black women was statistically associated with higher rates of depression, which increased with more frequent weekly episodes of urinary leakage. Those with mixed UI also tended to have higher rates of depression compared to those with stress or urgency UI. These results suggest that sociocultural factors may have an important role in this process beyond changes in genitourinary pathophysiology, and additional research on this topic is warranted. Suggested Reading
Tomas L. Griebling, MD, MPH
Ragins AI, Shan J, Thom DH et al: Effects of urinary incontinence, comorbidity and race on quality of life outcomes in women. J Urol 2008; 179: 651. Diokno AC, Brown MB, Brock BM et al: Clinical and cystometric characteristics of continent and incontinent noninstitutionalized elderly. J Urol 1988; 140: 567.
Benign Prostatic Hyperplasia
Re: Relationship between Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms and Total Serum Testosterone Level in Healthy Middle-Aged Eugonadal Men J. H. Lee, Y. Kim, Y. W. Park and D. G. Lee Department of Urology, National Police Hospital, Seoul, Korea J Sex Med 2014; 11: 1309e1315.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.029 available at http://jurology.com/ Editorial Comment: The role of testosterone in aging men has undergone an almost 180-degree turn during the last decade. What was once thought to be the scourge of prostate disease and verboten as a supplement is now one of the most commonly prescribed and used products in the United States. In fact, the “fountain of youth” is a major recruitment tool being used by the