A New Journal Called LUTS: Lower Urinary Tract Symptoms

Lower Urinary Tract Symptoms

9a. RIU0473_12-14.qxd 12/14/09 5:40 PM Page 219 REVIEWING THE LITERATURE News and Views From the Literature A New Journal Called LUTS: Lower Urinary Tract Symptoms The LUTS Editorial office may be reached c/o Wiley Japan, Frontier Koishikawa Building, 4F, 1-28-1 Koishikawa, Bunkyo-ku, Tokyo 112-0002, Japan; E-mail: luts@wiley.com; Tel: 81 3 3830 1267; Fax: 81 3 5689 7278. Relationship Between Blood Pressure and Nocturia in Hypertensive Patients Reviewed by Joseph Mashni, MD, Michael B. Chancellor, MD Sugaya K, Nakada S, Simoji T, et al. William Beaumont Hospital, Royal Oak, MI LUTS. 2009;1:16-19. [Rev Urol. 2009;11(4):219-220 doi: 10.3909/riu0473] The frequency of nocturia is one of the most troublesome urologic symptoms, and the incidence increases with age. Blood pressure and plasma catecholamines have also been shown to be elevated in the elderly population in those with and without nocturia. The authors investigated the relationship between the pattern of hypertension and nocturia. The study included 77 patients who were being treated for hypertension at Chibana Clinic (Okinawa, Japan). Patients recorded the number of times they urinated during the day and at night, and also measured their blood pressure at home immediately after rising in the morning and just before going to sleep at night. The morningevening (ME) average blood pressure was calculated as the average of the systolic blood pressures measured at home in the early morning and at night and was used to classify the subjects according to their pattern of hypertension. The patients were divided into a sustained hypertension group (ME average  135 mm Hg and clinic systolic blood pressure  140 mm Hg), a masked hypertension group (ME average  135 mm Hg and clinic systolic blood pressure  140 mm Hg), a white coat hypertension group (ME average © 2009 MedReviews®, LLC e would like to introduce a new international journal called LUTS: Lower Urinary Tract Symptoms and highlight 2 papers in the first issue of this exciting new publication. LUTS contains timely peer-reviewed studies in the field of neurourology, urodynamics, and urogynecology. The journal contains both basic and clinical research on lower urinary tract dysfunctions such as overactive bladder, detrusor underactivity, benign prostatic hyperplasia, bladder outlet obstruction, urinary incontinence, pelvic organ prolapse, painful bladder syndrome/interstitial cystitis, and other relevant conditions. Published manuscripts include original articles, case reports on new findings, surgical techniques, ultrasound diagnoses, videourodynamics, and letters to the editor. Contributions are selected by a group of international experts, some of whom sit on the journal’s editorial board. LUTS is an official journal of the Japanese Neurogenic Bladder Society, the Korean Continence Society, and the Taiwanese Continence Society. W VOL. 11 NO. 4 2009 REVIEWS IN UROLOGY 219 9a. RIU0473_12-14.qxd 12/14/09 5:40 PM Page 220 A New Journal Called LUTS: Lower Urinary Tract Symptoms continued  135 mm Hg and clinic systolic blood pressure  140 mm Hg), and a normotension group (ME average  135 mm Hg and clinic systolic blood pressure  140 mm Hg by treatment). The patients were also divided into a morning surge group (systolic blood pressure in the morning increased by  15 mm Hg compared with that at night) and a non–morning surge group, as well as into a morning hypertension group (ME average  135 mm Hg and a morning surge of blood pressure) and a non–morning hypertension group. The relationship between blood pressure and the pattern of urination was then investigated. The number of daytime urinations was significantly lower in the sustained hypertension group when compared with the normotension and white coat hypertension groups. When the subjects were divided into morning blood pressure surge and non–morning surge groups, or into morning hypertension and non–morning hypertension groups, the number of nighttime urinations was significantly higher in the morning surge group and the morning hypertension group as compared with the non–morning surge group and non–morning hypertension group, respectively. The authors concluded that sustained hypertension decreases the number of daytime urinations, and that an elevation of blood pressure in the early morning increases the number of nighttime urinations. Furthermore, blood pressure control in hypertensive patients could be important in managing voiding symptoms such as nocturia. Relationship Between Autonomic Nervous System Activity and Lower Urinary Tract Symptoms: An Analysis of Heart Rate Variability in Men With Lower Urinary Tract Symptoms Kim IH, Choi JB, Kim SJ, et al. LUTS. 2009;1:25-28. Lower urinary tract symptoms (LUTS) are common, but their etiology and mechanism remain unclear. The authors propose that changes in autonomic nervous system activity may be contributory because the lower urinary tract is regulated through the sympathetic and parasympathetic nervous systems. Heart rate variability, a validated tool used in cardiology, can be used to assess sympathetic and parasympathetic activity. The authors believe that autonomic nervous dysfunction may be one of the causative factors of LUTS because the lower urinary tract is controlled through the sympathetic and parasympathetic nervous systems. A total of 35 men with LUTS (mean age, 50.5  14.9 years) and 110 asymptomatic male volunteers who had 220 VOL. 11 NO. 4 2009 REVIEWS IN UROLOGY requested a health checkup (mean age, 49.5  5.19 years) were enrolled in the study. Patient selection was based on subjective symptoms using the International Prostate Symptom Score (IPSS) and a 3-day voiding diary. Patients had a daytime urinary frequency greater than 8 occasions or nocturia greater than 2 occasions in their voiding diary. Patients with neurologic disease, diabetes, hypertension, coronary heart disease, heart failure, cardiac arrhythmia, or any disease that affects autonomic nervous system activity were excluded. None of the control subjects had voiding complaints. The authors confirmed that each subject’s bladder contained at least 100 mL of urine before testing. After 30 minutes of rest, each patient and control subject underwent electrocardiographic signal recording (SA-3000P; Medicore, Seoul, Korea) for 5 minutes while in a seated position. With the subjects breathing normally, authors calculated the mean heart rate, standard deviation of the N-N interval (SDNN), and the square root of the mean squared differences of successive N-N intervals (RMSSD). The resting sympathetic and parasympathetic heartbeat rate modulation was also determined, using frequency domain analysis, including total power (TP), very low frequency (VLF), low frequency (LF), high frequency (HF), and LF:HF ratio. The IPSS of patients with LUTS was 21.0  6.7, and that of asymptomatic control subjects was 6.0  1.8 (P  .000). There were no significant differences in age between patients and control subjects. Regarding time domain analysis, the mean SDNN and RMSSD of the patients with LUTS were not significantly lower than those of the asymptomatic control subjects (P  .05). With regard to frequency domain analysis, the mean values of TP, LF, and VLF and the LF:HF ratio were not significantly different between the groups. The mean value of HF in men with LUTS was lower than in the control subjects (P  .015). Efferent vagal activity is a major contributor to the HF component, as is seen in clinical and experimental observations of autonomic maneuvers such as electrical vagal stimulation, muscarinic receptor blockade, and vagotomy. The decreased HF values suggest a decreased ability to control the parasympathetic systems. The authors demonstrated that men with LUTS exhibited decreased values of HF in heart rate variability. They conclude that these patients may have autonomic nervous system imbalances, particularly decreased parasympathetic activity. However, in vivo study is required to confirm the causal relationship between the autonomic nervous system and LUTS. The data presented here may help to further characterize LUTS.