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Project: Prevention of lower urinary tract symptoms (LUTS) in elderly males; the effects of an increased urine output on symptoms and bladder functioning |  Print View  |
| |  | | Titel | Preventie van lagere urineweg syndromen bij oudere mannen; het effect van een verhoogde urinelozing op de symptomen en het functioneren van de blaas | | Abstract | Problems with the storage and voiding of urine (Lower Urinary Tract Symptoms (LUTS)) are a major burden for the ageing male population. It has been estimated that approximately 30% of men aged 50 and over have mild or severe micturition problems. LUTS are very bothering, and a major indication for surgery. The aspects of quality of life, which have been reported to be affected the most, are sleep, worry about the disease, mobility, leisure, daily activities and sexual activities. Despite many years of research, the pathophysiology of LUTS remains unexplained. Obstruction of the urethra, by Benign Prostatic Hyperplasia (BPH) - a benign enlargement of the prostate - is frequently considered to be the major cause of LUTS. However, the BPH-hypothesis is increasingly being doubted since several studies have shown that there is only a weak correlation between prostate enlargement, urethral obstruction and LUTS. It appears that both BPH and obstruction are common phenomena in elderly men. Instead, it is assumed that the bladder plays a key role in the pathophysiology of LUTS. This hypothesis is supported by the almost equal prevalence of obstruction in both symptomatic and asymptomatic elderly men: a strong bladder may thus be able to build up enough pressure to overcome the obstruction and, on the other hand, a weak bladder can cause micturition problems without a present obstruction. Improvement of bladder function would therefore be a promising objective of prevention. In support of this, several animal studies have clearly shown that bladder function can be improved. Just like skeletal muscle, the bladder seems to adapt to the demands placed upon it. A diuretics-induced 3-fold increase in urine output in rabbits caused within two weeks a 100% increase in contractility, a 50% increase in bladder weight and an increase of both the capacity and the compliance of the bladder. The authors suggest that the increase in bladder mass and contractility is the result of an increase in functional smooth muscle capable of increased tension generation per cross-sectional area. This is in contrast to the contractile defects that accompany bladder hyperthrophy secondary to partial outlet obstruction. Ohnishi et al. found that diuresis-induced bladder hyperthrophy protected the rat bladder from these contractile dysfunctions. We wonder whether the same mechanism of adaptation can be achieved in humans and wether this has a positive effect on LUTS. In a human population, diuresis can be induced by surplus intake of water and thus the use diuretics will be unnecessary. To our knowledge, no scientific papers have described any relationship between water intake and LUTS so far. Drinking water would be a very practical and cheap advice to prevent complaints and expensive treatments. We therefore propose a trial in which we will study the effects of additional water intake on LUTS in elderly males. Lower Urinary Tract Symptoms (LUTS) are a very common but difficult problem to manage in general practice. Prevention of LUTS is impossible, since the pathophysiology is still unclear. Bladder functioning is considered to be a key factor in the development of LUTS, independently of a present urethral obstruction. Improvement of bladder functioning could therefore be a promising objective in the prevention of LUTS in elderly men. Several animal studies have shown that, as a result of a 3-fold increase in urine output, the bladder contractility and the bladder weight increased significantly. In addition, diuresis-induced hyperthorphy protected the rat bladder from the contractile defects that usually follow partial outflow obstruction. Apparently the bladder is able to adapt to demands placed upon it just like skeletal muscle. We want to investigate if the same mechanism of adaptation can be achieved in a human population. We will screen elderly men (55-75 years) in general practices on symptom score (8-19) according to the International Prostate Symptoms Score (IPSS). Men who are diagnosed as LUTS patients or men who receive medical treatment will be excluded. The urine output will be increased by drinking 2 litres of additional water per day. A control group will receive placebo intervention in the form of a syruplike substance. We will analyse the effects of an increased urine output on symptoms, urinary flow, bladder pressure and bladder weight | | |
# posted by roodbont @ 1:44 PM
