BENIGN PROSTATIC HYPERPLASIA
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and, as part of our role, advise patients in a more holistic and overarching fashion, to include nutrition and exercise. If we do not, those in other specialties will! Steven A. Kaplan, MD
Suggested Reading Francavilla S, Properzi G, Bellini C et al: Endothelin-1 in diabetic and nondiabetic men with erectile dysfunction. J Urol 1997; 158: 1770.
Re: Is Type-2 Diabetes Mellitus Associated with Overactive Bladder Symptoms in Men with Lower Urinary Tract Symptoms? W. J. Bang, J. Y. Lee, K. C. Koo, Y. S. Hah, D. H. Lee and K. S. Cho Departments of Urology, Hallym University College of Medicine, Chuncheon and Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine and Severance Check-up, Yonsei University Health System, Seoul, Korea Urology 2014; 84: 670e674.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.031 available at http://jurology.com/ Editorial Comment: Classic urological teaching suggests that diabetes mellitus (DM) can have significant effects on bladder function. The term “diabetic cystopathy,” which reflects the triad of impaired detrusor contractility, increased bladder capacity and impaired bladder sensation, was coined partly to reflect these deleterious changes through time. More recent data suggest that overactive bladder may be an initial manifestation of diabetic related changes. In this analysis a cohort of men with DM was compared to a group of nondiabetic controls who were matched for age and prostate volume. Total and storage International Prostate Symptom Scores were higher in the diabetic group. Overactive bladder scores were also higher in the diabetic group, although this finding was primarily driven by differences in nocturia and not due to urgency or urge incontinence. As the authors note, subjective symptom scores rather than objective parameters such as urodynamics drove the data. There are numerous reasons why DM can affect voiding function in men, including hyperglycemia mediated sympathetic nervous system activation and neuronal apoptosis, insulin-like growth factor mediated enlargement of the prostate and generalized inflammation mediated prostate growth. The bottom line is that DM can affect bladder function, and it appears that there is a wide range and spectrum of effects based on severity, longevity and concomitant prostate growth. Urodynamic findings can be somewhat heterogeneous but one should be mindful that even in this cohort many men have significant bladder outlet obstruction secondary to prostate enlargement. Finally, overactive bladder symptoms may be mediated more by daytime frequency and nocturia rather than urge and urge incontinence. Steven A. Kaplan, MD
Suggested Reading Daneshgari F, Liu G and Imrey PB: Time dependent changes in diabetic cystopathy in rats include compensated and decompensated bladder function. J Urol 2006; 176: 380.
Re: 5a-Reductase Type 1 Modulates Insulin Sensitivity in Men R. Upreti, K. A. Hughes, D. E. Livingstone, C. D. Gray, F. C. Minns, D. P. Macfarlane, I. Marshall, L. H. Stewart, B. R. Walker and R. Andrew University/British Heart Foundation Centre for Cardiovascular Science and Clinical Research Imaging Centre, University of Edinburgh, Queen’s Medical Research Institute, and Radiology and Urology Departments, National Health Service, Lothian University Hospitals Division, Western General Hospital, Edinburgh, United Kingdom J Clin Endocrinol Metab 2014; 99: E1397eE1406.
736
and, as part of our role, advise patients in a more holistic and overarching fashion, to include nutrition and exercise. If we do not, those in other specialties will! Steven A. Kaplan, MD
Suggested Reading Francavilla S, Properzi G, Bellini C et al: Endothelin-1 in diabetic and nondiabetic men with erectile dysfunction. J Urol 1997; 158: 1770.
Re: Is Type-2 Diabetes Mellitus Associated with Overactive Bladder Symptoms in Men with Lower Urinary Tract Symptoms? W. J. Bang, J. Y. Lee, K. C. Koo, Y. S. Hah, D. H. Lee and K. S. Cho Departments of Urology, Hallym University College of Medicine, Chuncheon and Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine and Severance Check-up, Yonsei University Health System, Seoul, Korea Urology 2014; 84: 670e674.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.06.031 available at http://jurology.com/ Editorial Comment: Classic urological teaching suggests that diabetes mellitus (DM) can have significant effects on bladder function. The term “diabetic cystopathy,” which reflects the triad of impaired detrusor contractility, increased bladder capacity and impaired bladder sensation, was coined partly to reflect these deleterious changes through time. More recent data suggest that overactive bladder may be an initial manifestation of diabetic related changes. In this analysis a cohort of men with DM was compared to a group of nondiabetic controls who were matched for age and prostate volume. Total and storage International Prostate Symptom Scores were higher in the diabetic group. Overactive bladder scores were also higher in the diabetic group, although this finding was primarily driven by differences in nocturia and not due to urgency or urge incontinence. As the authors note, subjective symptom scores rather than objective parameters such as urodynamics drove the data. There are numerous reasons why DM can affect voiding function in men, including hyperglycemia mediated sympathetic nervous system activation and neuronal apoptosis, insulin-like growth factor mediated enlargement of the prostate and generalized inflammation mediated prostate growth. The bottom line is that DM can affect bladder function, and it appears that there is a wide range and spectrum of effects based on severity, longevity and concomitant prostate growth. Urodynamic findings can be somewhat heterogeneous but one should be mindful that even in this cohort many men have significant bladder outlet obstruction secondary to prostate enlargement. Finally, overactive bladder symptoms may be mediated more by daytime frequency and nocturia rather than urge and urge incontinence. Steven A. Kaplan, MD
Suggested Reading Daneshgari F, Liu G and Imrey PB: Time dependent changes in diabetic cystopathy in rats include compensated and decompensated bladder function. J Urol 2006; 176: 380.
Re: 5a-Reductase Type 1 Modulates Insulin Sensitivity in Men R. Upreti, K. A. Hughes, D. E. Livingstone, C. D. Gray, F. C. Minns, D. P. Macfarlane, I. Marshall, L. H. Stewart, B. R. Walker and R. Andrew University/British Heart Foundation Centre for Cardiovascular Science and Clinical Research Imaging Centre, University of Edinburgh, Queen’s Medical Research Institute, and Radiology and Urology Departments, National Health Service, Lothian University Hospitals Division, Western General Hospital, Edinburgh, United Kingdom J Clin Endocrinol Metab 2014; 99: E1397eE1406.
