Hakkı Uzun

Metabolic Syndrome in Female Patients With Overactive Bladder

OBJECTIVE To investigate the relevance of metabolic syndrome in the etiopathogenesis of overactive bladder in female patients. It has been shown that obesity has been associated with overactive bladder (OAB), and the metabolic syndrome and insulin resistance have been related to the annual growth rates of prostate and lower urinary tract symptoms. METHODS Female patients applying to our policlinics with OAB symptoms or other urologic complaints were enrolled in the study. The International Diabetes Federation criteria were used for the definition of the metabolic syndrome. The chi-square, Student t, and Mann-Whitney U tests and logistic regression analyses were used to compare differences in the variables. RESULTS The metabolic syndrome was diagnosed in 201 (64%) of 313 patients with OAB and 73 (35%) of 208 patients without OAB. The difference was statistically significant (P=.002). A larger waist circumference, greater body mass index, low high-density lipoprotein level, and incidence of hypertension were significantly greater statistically in the OAB group than in the controls. CONCLUSION The metabolic syndrome correlates highly with OAB in female patients. The metabolic syndrome can be an etiologic pathway for the onset of symptoms.

Relationship between non-alcoholic fatty liver disease and benign prostatic hyperplasia/lower urinary tract symptoms: new insights from an Italian cross-sectional study

regarding the relationship between metabolic derangement and LUTS for both men and women. However, it is well known that NAFLD is strongly associated with hepatic and adipose tissue insulin resistance, as well as reduced whole body insulin sensitivity and is considered the hepatic manifestation of metabolic syndrome. Insulin resistance and metabolic syndrome are the common risk factors for both BPH and NAFLD; therefore, we agree to the authors that similar common etiopathogenetic factors may have similar trophic effects on hepatic tissue and prostate.

Association of Insulin Resistance with Overactive Bladder in Female Patients

Purpose Metabolic syndrome and obesity have been advocated to be risk factors for the development of overactive bladder (OAB). Additionally, insulin resistance is the underlying mechanism of metabolic syndrome. We aimed to investigate the association of insulin resistance with overactive bladder in female patients. Methods We prospectively conducted the study in our urology department. Female patients aged between 30 and 76 years old applied to our policlinics with or without OAB symptoms were enrolled. One hundred and twenty-two patients with OAB and 62 age-matched controls without OAB were included into the study. Fasting serum insulin, glucose, high-density lipoprotein (HDL-c), and triglycerides levels were measured. Insulin resistance value was obtained via the homeostasis model assessment of insulin resistance (HOMA-IR) calculator. The chi-square and Mann-Whitney U tests were used to compare differences in variables. Results Serum insulin level was found higher in female patients with OAB (11.5±6.2 µU/mL) relative to controls (6.4±2.1 µU/mL), statistically significant (P=0.036). In addition, HOMA-IR was significantly found higher in the OAB group, 2.86 (0.76 to 17.04) in comparison to controls, 1.32 (0.67 to 224), P=0.018. High-density lipoprotein cholesterol levels (HDL-c) were significantly found lower in females with OAB. Conclusions Insulin resistance can be associated to overactive bladder and may play significant role in pathogenesis.

Increased pulse-wave velocity and carotid intima–media thickness in patients with lower urinary tract symptoms

Abstract Objective.Vascular risk factors frequently coexist with lower urinary tract symptoms (LUTS) in both men and women, suggesting that atherosclerosis and endothelial dysfunction may play a major role in the development of LUTS. Arterial stiffness owing to decreased arterial compliance is one of the major signs of vascular ageing, and carotid intima–media thickness (CIMT) can be used in establishing the extent and severity of vascular impairment. This study investigated the association of arterial stiffness and vascular atherosclerotic involvement with LUTS in men and overactive bladder (OAB) in women. Material and methods.This study was prospective and cross-sectional, consisting of 66 patients with LUTS (38 men with LUTS, 28 women with OAB) and 62 controls without LUTS or OAB. Carotid–femoral pulse-wave velocity (CF-PWV) was measured as an index of arterial stiffness. CIMT was measured with B-mode ultrasonography to assess vascular impairment. Results.Patients with LUTS had significantly higher CF-PWV (9.8 ± 2.6 vs 7.0 ± 1.4 m/s, p < 0.001) and CIMT (0.89 ± 0.16 and 0.56 ± 0.31 mm, p < 0.001) compared with controls. Age and glucose were also different between LUTS and control groups (p < 0.001 and p = 0.003, respectively). In the multivariate analyses, both CIMT ( = 0.429, p < 0.001) and PWV ( = 0.451, p < 0.001) were related to LUTS. Conclusions.Vascular impairment was found to be associated with LUTS in both men and women. Atherosclerosis-related vascular risk factors are also known to be related to LUTS and both disorders may have pathogenic interactions.

Autonomic nervous system dysfunction in lifelong premature ejaculation: analysis of heart rate variability.

OBJECTIVE To identify autonomic nervous dysfunction in patients with lifelong premature ejaculation. METHODS The study participants were 25 men with lifelong premature ejaculation and 25 healthy controls. The parameters of 24-hour heart rate variability that are influenced by the autonomic nervous system were compared between the men with lifelong premature ejaculation and the healthy controls. RESULTS The laboratory results of all patients were within normal limits, and no significant differences were found between the patients and the controls in age, body weight, and body mass index. A low-frequency signal that is influenced by the sympathetic system was increased in the patients (P = .026). Furthermore, a high-frequency signal that is influenced by the parasympathetic system was decreased in the patients (P = .011). Finally, the low frequency-to-high frequency ratio, an indicator of the balance between the two components of the autonomic nervous system, was increased in the patients (P = .002). CONCLUSION To our knowledge, no study has investigated the influence of the autonomic nervous system on 24-hour heart rate variability in premature ejaculation. In the present study, sympathetic activity was increased in men with lifelong premature ejaculation; this overactivity might lead to lifelong premature ejaculation. Additional studies are required to reveal the possible alteration of the autonomic nervous system in premature ejaculation.

Non-alcoholic fatty liver disease is associated with benign prostate hyperplasia in men and with overactive bladder in women.

Abstract Objective. Metabolic syndrome plays a significant role in the development of benign prostate hyperplasia (BPH) and overactive bladder (OAB). Non-alcoholic fatty liver disease (NAFLD) is accepted as the hepatic component of metabolic syndrome. This study investigated the association of NAFLD with BPH and OAB. Material and methods. In total, 702 men with BPH and 529 women with and without OAB were recruited into the study in a cross-sectional risk factor analysis. All male and female patients were separated into two groups, with or without NAFLD. An overnight fasting blood profile was obtained and whole abdominal ultrasound was performed by a blinded radiologist in each patient to measure hepatic steatosis. Results. NAFLD was diagnosed in 387 (55.8%) of 702 men with BPH. Statistically significantly higher prostate volumes were found in men with NAFLD in comparison to without (p = 0.018). The female population included 207 women with NAFLD and 322 women without. OAB was found in 75.8% and 52.4% of women with and without NAFLD (p = 0.022). Conclusions. NAFLD is associated with BPH in men and with OAB in women. These findings confirm the hypothesis that BPH is an aspect of the metabolic syndrome and support the hypothesis that OAB is an aspect of the metabolic syndrome.

Increased Bladder Wall Thickness in Diabetic and Nondiabetic Women With Overactive Bladder

Purpose Bladder wall thickness has been reported to be associated with overactive bladder (OAB) in women. Diabetic women have an increased risk for OAB syndrome and may have an increased risk for bladder wall thickness. Methods A total of 235 female patients aged 40 to 75 years were categorized into four groups. The first group consisted of women free of urgency or urge urinary incontinence. The second group included nondiabetic women with idiopathic OAB. The third group consisted of women with diabetes and clinical OAB, and women with diabetes but without OAB constituted the fourth group. Bladder wall thickness at the anterior wall was measured by ultrasound by the suprapubic approach with bladder filling over 250 mL. Results The diabetic (third group) and nondiabetic (second group) women with OAB had significantly greater bladder wall thickness at the anterior bladder wall than did the controls. However, the difference was not significant between the diabetic (third group) and the nondiabetic (second group) women with OAB. Women with diabetes but without OAB (fourth group) had greater bladder wall thickness than did the controls but this difference was not significant. Additionally, the difference in bladder wall thickness between diabetic women with (third group) and without (fourth group) OAB was not significant. Conclusions This is the first study to show that bladder wall thickness is increased in diabetic women with and without OAB. Additionally, nondiabetic women with OAB had increased bladder wall thickness. Further studies may provide additional information for diabetic and nondiabetic women with OAB, in whom the etiopathogenesis of the disease may be similar.

Granular cell tumor of the urinary bladder

Granular cell tumors (GCTs) are extremely rare neoplasms of the bladder. In the literature, there are only a few reported cases. We present a GCT case with clinical, radiological, histomorphological, immünohistochemical findings and its differential diagnosis.

The Effect of Different Metabolic Syndrome: Definitions on the Relationship Between Metabolic Syndrome and LUTS in Men With Benign Prostatic Enlargement

Because various criteria are used to define metabolic syndrome (MetS), this study examines the most relevant definition for patients with benign prostatic enlargement (BPE). Most studies regarding the link between MetS and BPE/lower urinary tract symptoms (LUTS) have used the National Cholesterol Education Program Adult Treatment Panel III criteria for diagnosis, while a few have used criteria from the International Diabetes Federation and/or American Heart Association. Patients with LUTS due to BPE are classified as having MetS or not by the aforementioned three definitions. Prostate volume, International Prostate Symptom Score, storage and voiding subscores, maximum urinary flow rate, and the postvoid urine of patients with and without MetS were compared separately in the three different groups. Surgical and medical treatment prevalence was also compared between three groups. No matter which definition was used, the International Prostate Symptom Score, the storage and voiding symptom scores, prostate volume, prostate-specific antigen, and postvoid urine were significantly higher in the patients with MetS. The maximum urinary flow rate was similar between patients with and without MetS, according to all three different definitions. There was no significant difference in the aforementioned parameter between patients with MetS diagnosed with the three different definitions. Irrespective of which definition was used, the surgical treatment rate was not significantly different in patients diagnosed with than without MetS, or between the patients with MetS diagnosed with the three different definitions. The authors suggest that it does not matter which of the aforementioned three definitions is used during the evaluation of MetS in men with BPE/LUTS.

Inflammatory pseudotumor of the epididymis: a case report and review of the literature

Inflammatory pseudotumors (IPTs) are rare benign tumor-like lesions in the epididymis. They result from myofibrohistiocytic proliferation of the parenchymal organs of the body, such as the lungs and genitourinary system. A 48-year-old male patient presented with a palpable left scrotal mass and developed painless swelling within two months. Scrotal ultrasound revealed a 3 cm solid mass and spermatocele sac in the epididymis. Local excision was performed. Histopathologic and immunohistochemical examination revealed an inflammatory pseudotumor. Only ten cases have been reported in the literature to date. We present our case of pseudotumor of the epididymis as the eleventh case reported in the literature with a brief review.