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Re: The Relationship between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review
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VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
1 open label. All were included in the article by Bakali and Tincello. They felt “cannabinoids relevantly decreased incontinence episodes in all 3 studies.” The pooled data showed the mean difference in incontinence episodes per 24 hours to be -0.35 but all baselines were relatively low. They conclude “. the evidence base is poor and more high quality, well designed and adequately powered and sampled studies are urgently needed to reach definitive conclusions.” The committee on pharmacological treatment of urinary incontinence of the International Consultation on Incontinence (2016) listed cannabinoids under “other promising targets” and quoted the article by Hedlund and Gratzke thus: “. the endocannabinoids system can be considered as a potential drug target . with a more favorable advance event profile than antimuscarinic agents.” With the current focus on the possible legalization of marijuana for various medical uses it will be interesting to see whether future clinical trials, which most assuredly will be done, will prove to be positive and, as well, whether true double-blinding will be possible. Alan J. Wein, MD, PhD (hon)
Re: The Relationship between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review M. Kathrins, K. Doersch, T. Nimeh, A. Canto, C. Niederberger and A. Seftel Division of Urology, Brigham and Women’s Hospital, Boston, Massachusetts, Department of Surgery, Texas A&M Health Science Center College of Medicine, Temple, Texas, Department of Urology, University of Illinois at Chicago, Chicago, Illinois, and Division of Urology, Cooper Medical School of Rowan University, Camden, New Jersey Urology 2016; 88: 22e32. doi: 10.1016/j.urology.2015.11.006
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26616095 Editorial Comment: This is a subject that comes up periodically for discussion. These authors did a literature review from 1994 to 2015 on trials of hypogonadal men with benign prostatic hyperplasia or lower urinary tract symptoms (LUTS) treated with testosterone replacement therapy (TRT). Their conclusion is that the “literature did not uncover evidence to support the claim that TRT worsens LUTS or increases prostate volume when used in [hypogonadal] men. Recommendations to avoid TRT in men with baseline severe range LUTS are not based on high quality evidence.” The authors admit that many studies excluded men with baseline severe range International Prostate Symptom Score and other criteria based on qualitative assessment of benign prostatic enlargement. The subset of hypogonadal men with the metabolic syndrome generally showed consistent improvement in International Prostate Symptom Score after testosterone replacement therapy. The authors conclude, “Prospective trials specifically examining men with severe range lower urinary tract symptoms and their outcomes while receiving testosterone replacement therapy are necessary to further evaluate current guidelines recommendations.” Alan J. Wein, MD, PhD (hon)
Suggested Reading American Urological Association: AUA Position Statement on Testosterone Therapy. Available at http://www.auanet.org/guidelines/testosterone-therapy. Accessed December 21, 2016. Pearl JA, Berhanu D, Franc¸ois N et al: Testosterone supplementation does not worsen lower urinary tract symptoms. J Urol 2013; 190: 1828.
Re: Impact of Childhood and Recent Traumatic Events on the Clinical Presentation of Overactive Bladder H. H. Lai, C. D. Morgan, J. Vetter and G. L. Andriole Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri Neurourol Urodyn 2016; 35: 1017e1023. doi: 10.1002/nau.22872
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26332868 Editorial Comment: The relationship between the symptomatology of overactive bladder (OAB) and bladder pain syndrome/interstitial cystitis and prior childhood trauma has long been a subject of Dochead: Urological Survey
LIT 5.5.0 DTD JURO15024_proof 6 October 2017 11:52 am EO:
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VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
1 open label. All were included in the article by Bakali and Tincello. They felt “cannabinoids relevantly decreased incontinence episodes in all 3 studies.” The pooled data showed the mean difference in incontinence episodes per 24 hours to be -0.35 but all baselines were relatively low. They conclude “. the evidence base is poor and more high quality, well designed and adequately powered and sampled studies are urgently needed to reach definitive conclusions.” The committee on pharmacological treatment of urinary incontinence of the International Consultation on Incontinence (2016) listed cannabinoids under “other promising targets” and quoted the article by Hedlund and Gratzke thus: “. the endocannabinoids system can be considered as a potential drug target . with a more favorable advance event profile than antimuscarinic agents.” With the current focus on the possible legalization of marijuana for various medical uses it will be interesting to see whether future clinical trials, which most assuredly will be done, will prove to be positive and, as well, whether true double-blinding will be possible. Alan J. Wein, MD, PhD (hon)
Re: The Relationship between Testosterone-Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review M. Kathrins, K. Doersch, T. Nimeh, A. Canto, C. Niederberger and A. Seftel Division of Urology, Brigham and Women’s Hospital, Boston, Massachusetts, Department of Surgery, Texas A&M Health Science Center College of Medicine, Temple, Texas, Department of Urology, University of Illinois at Chicago, Chicago, Illinois, and Division of Urology, Cooper Medical School of Rowan University, Camden, New Jersey Urology 2016; 88: 22e32. doi: 10.1016/j.urology.2015.11.006
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26616095 Editorial Comment: This is a subject that comes up periodically for discussion. These authors did a literature review from 1994 to 2015 on trials of hypogonadal men with benign prostatic hyperplasia or lower urinary tract symptoms (LUTS) treated with testosterone replacement therapy (TRT). Their conclusion is that the “literature did not uncover evidence to support the claim that TRT worsens LUTS or increases prostate volume when used in [hypogonadal] men. Recommendations to avoid TRT in men with baseline severe range LUTS are not based on high quality evidence.” The authors admit that many studies excluded men with baseline severe range International Prostate Symptom Score and other criteria based on qualitative assessment of benign prostatic enlargement. The subset of hypogonadal men with the metabolic syndrome generally showed consistent improvement in International Prostate Symptom Score after testosterone replacement therapy. The authors conclude, “Prospective trials specifically examining men with severe range lower urinary tract symptoms and their outcomes while receiving testosterone replacement therapy are necessary to further evaluate current guidelines recommendations.” Alan J. Wein, MD, PhD (hon)
Suggested Reading American Urological Association: AUA Position Statement on Testosterone Therapy. Available at http://www.auanet.org/guidelines/testosterone-therapy. Accessed December 21, 2016. Pearl JA, Berhanu D, Franc¸ois N et al: Testosterone supplementation does not worsen lower urinary tract symptoms. J Urol 2013; 190: 1828.
Re: Impact of Childhood and Recent Traumatic Events on the Clinical Presentation of Overactive Bladder H. H. Lai, C. D. Morgan, J. Vetter and G. L. Andriole Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri Neurourol Urodyn 2016; 35: 1017e1023. doi: 10.1002/nau.22872
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26332868 Editorial Comment: The relationship between the symptomatology of overactive bladder (OAB) and bladder pain syndrome/interstitial cystitis and prior childhood trauma has long been a subject of Dochead: Urological Survey
LIT 5.5.0 DTD JURO15024_proof 6 October 2017 11:52 am EO:
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