Michelle M. Kim

In Their Own Words: An Analysis of the Experiences of Medical Interns Participating in a Prospective Cohort Study of Depression.

Purpose To compare the subjective experiences of interns with and without symptoms of depression using a mixed-methods approach. Method In 2007–2008, interns from six institutions were screened for depression before and during internship using an online survey that included the Patient Health Questionnaire (PHQ-9). At the end of internship, participants were asked what made the year difficult, easy, and memorable, and how they had changed. Computerized lexical and qualitative thematic analyses were performed to analyze their free-text responses. Results Sixty-three percent (244/388) of invited interns participated in the original cohort study. Of those, 42% (103/244) answered the open-ended questions for this analysis. Thirty-five percent (36/103) screened positive for clinically significant depression (i.e., PHQ-9 score ≥ 10) during their intern year. Respondents with symptoms of depression were more likely to report problems with cynicism, exhaustion, and stress, while those without them were more likely to mention positive patient care and educational experiences. Respondents with symptoms of depression preferentially described experiences that “broke” their confidence, sense of well-being, and belief in the medical profession, while those who did not described profoundly positive, life-changing experiences regarding interactions with patients and supportive colleagues, through which they grew personally and professionally. Conclusions Depression during internship affects not only objective outcomes like medical errors but also how interns value the profession and themselves, with potentially profound consequences for their future career decisions. Residency programs should implement reactive interventions targeting depression and proactive interventions promoting resilience and well-being to address the issues that lead to depression.

Differential Response to Medical Therapy for Male Lower Urinary Tract Symptoms

Medical therapy has assumed a critical role in the treatment of male lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction. Targeting both bladder and prostate, these medications provide an effective means to manage LUTS for millions of men. However, significant proportion of men do not respond adequately to medical therapy and go on to surgical treatment of bladder outlet obstruction. In order to provide patients with appropriate therapy, prevent unnecessary exposure to drug side effects, and reduce medical costs, it is important to identify those men in whom medication will not be effective. In this review, we focus on the risk factors that predict failure of the common medical therapies for male LUTS. In addition, we describe recently discovered molecular targets that show promise for treatment of LUTS recalcitrant to conventional therapies.

The Association of Serum Testosterone Levels and Urinary Incontinence in Women

Purpose: Pelvic floor integrity is an important predictor of stress urinary incontinence. Androgen receptors have been found in the pelvic floor musculature and fascia, and testosterone administration has been shown to increase levator ani hypertrophy and improve stress incontinence in a rodent model. We examined the relationship between serum total testosterone levels and self‐reported urinary incontinence in women. Materials and Methods: We included women older than 20 years in the 2012 NHANES (National Health and Nutrition Examination Survey) cycle who underwent serum total testosterone measurement and answered self‐reported urinary incontinence questions. A weighted, multivariate logistic regression model was used to determine the association between incontinence and serum testosterone levels after adjusting for age, body mass index, diabetes, race, parity, menopause and time of venipuncture. Results: A total of 2,321 women were included in analysis, of whom 37.5% had stress incontinence, 29.8% had urge incontinence and 16.4% had mixed incontinence. Women in the lowest quartile of serum testosterone were more likely to complain of stress and mixed incontinence (OR 1.45, 95% CI 1.03–2.12 and OR 1.68, 95% CI 1.23–2.22, respectively). No association was noted between serum testosterone levels and urge incontinence. Conclusions: Low serum testosterone is associated with an increased likelihood of stress and mixed incontinence in women. Given the role of pelvic musculature in maintaining urethral support and the anabolic effect of androgens on skeletal muscle, a physiological mechanism for this relationship can be proposed and further evaluated in prospective and translational studies.

Herbal Supplements for Prostate Enlargement: Current State of the Evidence

OBJECTIVE To provide a comprehensive review of the current state of herbal supplement market for lower urinary tract symptoms (LUTS) and correlate the ingredients of each product with available scientific evidence. MATERIALS AND METHODS Twenty-seven products from Amazon.com that were advertised as herbal supplements for LUTS and had listed their active ingredients were selected. Active ingredients were reviewed on Google Scholar. Product price, warranty, and consumer review information were also collected. RESULTS A total of 58 unique active ingredients were identified. The mean number of ingredients was 8.26 (standard deviation 5.25). Whereas 17 (63%) products had an ingredient with a systematic review to support their use, 20 (74%) had an ingredient with conflicting evidence based on systematic reviews. Out of the supplements that contained ingredients supported by literature, all (100%) products simultaneously had other ingredients with no, conflicting, or refuting evidence. There was no (0%) product that contained only scientifically proven ingredients. There is no scientific study to evaluate these supplements as a whole. CONCLUSION Despite the widespread use of herbal supplements for LUTS, there is scant scientific evidence to support their safety and efficacy. Lack of adequate regulation and government support for research and development are some of the factors that disincentivize researchers to study safety and efficacy of these products. We encourage physicians to warn their patients on the lack of adequate evidence to support the safety and efficacy of many of these supplements.

Voiding Dysfunction in Multiple Sclerosis

Voiding dysfunction is a common and debilitating consequence of multiple sclerosis (MS). The prevalence and severity of voiding dysfunction increases with the increasing severity of MS, but even the mildest forms of the disease are associated with urinary symptoms in 30% of patients. Every component of the central nervous system is involved in regulating voiding; as a result, MS can lead to a wide variety of urinary symptoms and urologic complications. The effect of MS on voiding can be classified according to the resulting function of the bladder and the urethral sphincter during storage and emptying of urine. Therapy is targeted to the specific bladder and sphincter abnormalities that occur. The primary goals of therapy are prevention of injury to the upper urinary tract (kidneys), reduction in urinary tract infections, and maintenance of urinary continence. These goals can be achieved by interventions ranging from behavioral modification to major reconstructive surgery.

Is There an Optimal Sperm DNA Test

Sperm DNA assays have become more commonplace in the evaluation of male infertility. They provide additional information to the standard semen analysis, potentially identifying male factor issues leading to infertility and predicting outcomes for assisted reproduction techniques. This chapter provides an overview of the more commonly used assays, reviews correlations and comparisons among the assays, and contends whether there may be an ideal assay for determination of sperm DNA integrity.

PD50-07 LOW SERUM TESTOSTERONE IS ASSOCIATED WITH INCREASED STRESS AND MIXED INCONTINENCE IN WOMEN

with the variables ages over 52 years (p 1⁄4 0.041), menopause (p 1⁄4 0.029) were the most susceptible to IUE permanence. ICIQ-SF variation average in group B was 9,625 points and in group C was 6,5 points. Presence of uterine prolapse implicated in increasing up to 4,75 points in average on post-operation ICIQ-SF (p1⁄40,03). VAS satisfaction average was higher in group B (8,84 1,12) than in group C(5,5 3,27). IGP-I showed better results in group B when compared to group C (p1⁄40,065). CONCLUSIONS: Weight loss through bariatric surgery completely improves SUI and its repercussions on quality of life in the vast majority of patients. Increased age and abdominal circumference raises the chance of SUI in obese women, and the age over 52 years and menopause are strongly related to the persistence of SUI after weight loss.

MP25-20 ASSOCIATION BETWEEN GENITOURINARY DISEASES AND DEPRESSIVE SYMPTOMS IN THE 2005-2012 NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

INTRODUCTION AND OBJECTIVES: Genitourinary diseases may increase the risk of depression. However, the magnitudes of these associations are unclear. To clarify the available evidence, we analyzed self-reported urologicand depressive-symptom questionnaire data from the 2005-2012 National Health and Nutrition Examination Survey (NHANES). METHODS: We analyzed the responses of 2005-2012 NHANES participants who completed surveys on kidney failure, urolithiasis, and lower urinary tract symptoms (e.g., frequency, leakage, and nocturia) and depression (assessed using the nine-item Patient Health Questionnaire, or PHQ-9). Urologic-symptom variables were examined in sample-weighted linear regression models for associations with depressive symptoms. Models were adjusted for potential confounders including age, sex, body-mass index, alcohol intake, tobacco use, income-to-poverty ratio, physical activity, and the presence of medical comorbidities. Statistical significance was defined as a twotailed P < 0.05. RESULTS: Survey data from 5,009 men and 5,278 women with a median age of 49 years (range: 20 to 85) were analyzed. On multivariate analysis, self-report of urine leakage at rest, during physical activity, before reaching the toilet, at night, or at any time was significantly associated with increased depressive symptoms (quantitative results are shown in the Figure). Self-report of weak or failing kidneys was similarly associated with increased depressive symptoms. Urolithiasis was not significantly associated with depressive symptoms. CONCLUSIONS: In this analysis, potentially clinically important independent associations between genitourinary and depressive symptoms were identified. Further studies are needed to determine the importance of these results with regard to screening for or treating depression in the urology clinic.

Urinary Lignans Are Associated With Decreased Incontinence in Postmenopausal Women.

OBJECTIVE To examine the association between urinary phytoestrogens and self-reported urinary incontinence in postmenopausal women in the United States using a large, cross-sectional, population-based cohort survey. METHODS Data were analyzed for 1789 postmenopausal women aged 50 years or older who participated in one of the 2001-2010 cycles of National Health and Nutrition Examination Survey and underwent measurement of 4 isoflavone (soy derived) and 2 lignan (flax derived) phytoestrogens in their urine. Incontinence was defined as self-reported stress, urge, other, or mixed incontinence. Urine phytoestrogen concentrations were examined in weighted, multivariate logistic regression models for association with each of the lower urinary tract symptoms. All models were adjusted for age, body mass index, diabetes, race, smoking, and parity. RESULTS Increasing urine concentrations of the lignan phytoestrogen enterodiol was associated with decreased likelihood of urge (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.85-0.99), mixed (OR, 0.90; 95% CI, 0.82-0.98), and other (OR, 0.90; 95% CI, 0.81-0.99) incontinence, whereas increasing urine concentrations of the lignan phytoestrogen enterolactone was associated with decreased likelihood of urge (OR, 0.92; 95% CI, 0.86-0.99) and mixed (OR, 0.91; 95% CI, 0.84-0.99) incontinence. No association was observed between any isoflavone phytoestrogens and types of incontinence. CONCLUSION This study demonstrates that lignan phytoestrogens may have a protective effect against incontinence in postmenopausal women. Prospective clinical and laboratory studies are warranted to investigate the mechanism of this relationship.