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Table of Contents
EDITORIAL
Year : 2020  |  Volume : 31  |  Issue : 3  |  Page : 89-90

Functional urology – Renew our understanding of overactive bladder and lower urinary tract symptoms


Department of Urology, Kaohsiung Chang Gung Memorial Hospital; Department of Urology, College of Medicine, Chang Gung University; Center for Shock Wave Medicine and Tissue Engineering; Department of Urology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

Date of Submission12-May-2020
Date of Acceptance12-May-2020
Date of Web Publication26-Jun-2020

Correspondence Address:
Yao-Chi Chuang
No. 123, Ta-pei Road, Niaosong District, Kaohsiung City
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/UROS.UROS_56_20

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How to cite this article:
Chuang YC. Functional urology – Renew our understanding of overactive bladder and lower urinary tract symptoms. Urol Sci 2020;31:89-90

How to cite this URL:
Chuang YC. Functional urology – Renew our understanding of overactive bladder and lower urinary tract symptoms. Urol Sci [serial online] 2020 [cited 2020 Jul 12];31:89-90. Available from: http://www.e-urol-sci.com/text.asp?2020/31/3/89/287979



Overactive bladder (OAB) is a diagnosis dependent on clinical symptoms of urgency, with or without urgency incontinence, often with frequency and nocturia. OAB could be due to bladder centric, which could respond to medical treatment, like antimuscarinic drugs and β3-adrenoceptor agonists, intravesical botulinum toxin injection, and phosphodiesterase-5 inhibitors (PDE5I).[1] However, some systemic actors induced OAB symptoms might not be bladder centric and are always poor respond to current OAB medical treatment. New drugs with new mechanisms of action cold provide an additional chance to improve the therapeutic effects on OAB.

Pseudoephedrine and antihistamines, commonly used nasal decongestants, both of which work in different ways, might effect on voiding function. Lee et al. prospectively enrolled 200 consecutive male patients who visited the otolaryngology department for rhinitis.[2] These patients were then randomized to the pseudoephedrine or antihistamine groups. They found that the IPSST increased significantly in patients ≥50 years old treated with pseudoephedrine, which was not observed in the antihistamine group. The IPSSV was significantly higher in patients <50 years old treated with antihistamine. The PVR did not significantly change after treatment with both drugs. They suggested that in elderly men with rhinitis, antihistamines may be more suitable, while pseudoephedrine would be preferable in younger men. Since the mean age of both groups was at the early forty, no cases of AUR were reported. The impact of pseudoephedrine and antihistamines on voiding function might be down evaluated. We guess that pseudoephedrine and antihistamines might induce more urinary retention or voiding dysfunction in the real elderly group.

Chen et al. aimed to find predictors in urinalysis to detect underlying causes in patients with acute urinary tract infection symptoms, which included various lower urinary tract symptoms (LUTS).[3] They recruited 192 patients who presented with acute urinary tract infection symptoms from a single institute. They found that higher urine red blood cell (RBC) and lower urine white blood cell (WBC) medians were predictors of urolithiasis. In the receiver operator characteristic analysis, WBC median lower than 7.75 per high-power field (HPF) was a significant predicting factor for the positive finding of urolithiasis on a computed tomography (CT) scan. In daily practice, patients with acute onset of flank pain with or without LUTS, and higher urine RBC might be highly associated with urolithiasis. We applauded the novel finding that WBC median lower than 7.75 per HPF was a significant predicting factor for the positive finding of urolithiasis on a CT scan. A larger scale, multi centers study is warranted to reconfirm the findings.

The presence of LUTS has a negative impact on male erectile function. Phosphodiesterase 5 inhibitors (PDE5is) have been proved to improve both ED and LUTS. Alphablockers monotherapy, regarding as the first line treatment for male LUTS, is not always effective. Therefore, combination therapy of alpha-blockers and PDE5i could be more effective for male patients with LUTS. Chen et al. performed A Systematic Review and Meta-Analysis to assess the difference between the combination therapy and alpha-blockers monotherapy.[4] A total of 13 randomized controlled studies with 1173 patients were included for meta-analysis. They concluded that a combination of alpha-blockers and PDE5is provided a greater improvement in total IPSS, IPSS voiding subscore, IPSS storage subscore, Qmax, and EF than alpha-blockerr monotherapy. Undoubtedly, PDE5i could provide synergistic effects with alpha-blocker monotherapy for male LUTS improvement.



 
  References Top

1.
Lin CT, Chiang BJ, Liao CH. Perspectives of Medical Treatment for Overactive Bladder. Urol Sci 2020;31:91-8.  Back to cited text no. 1
  [Full text]  
2.
Lee CC, Tam YY, Chang YH, Hsieh ML, Shao IH. The impact of pseudoephedrine and antihistamine on lower urinary tract symptoms in male patients with rhinitis: A prospective randomized study. Urol Sci 2020;31:108-13.  Back to cited text no. 2
  [Full text]  
3.
Juan YS. Editorial comment: A lower urine white blood cell median can be a predictor of undiscovered urolithiasis in patients with acute urinary tract symptoms. Urol Sci 2020;31:122.  Back to cited text no. 3
  [Full text]  
4.
Chen PC, Wang CC, Tu YK. Combination alpha blocker and phosphodiesterase 5 inhibitor versus alpha-blocker monotherapy for lower urinary tract symptoms associated with benign prostate hyperplasia: A systematic review and meta-analysis. Urol Sci 2020;31:99-107.  Back to cited text no. 4
  [Full text]  




 

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