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Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Abstract

PURPOSE

The relationship of lower urinary tract symptoms (LUTS) to objective measures of benign prostatic hyperplasia (BPH), such as prostatic size and urodynamic parameters, has proved difficult to evaluate. Studies in animal models of BPH suggest that autonomic nervous system (ANS) activity is an important determinant of prostatic growth. We investigated the relationship of ANS activity to LUTS as well as to objective measures of BPH in men with BPH.

MATERIALS AND METHODS

This study was done in 3,047 men with LUTS secondary to BPH during screening for enrolment at 1 center in a large, multicenter, double-blind, placebo controlled trial designed to assess the long-term effects of medical therapy on BPH progression. A total of 38 men with an American Urological Association (AUA) symptom score of 8 or greater and a maximum urinary flow rate of 4 to less than 15 ml per second had ANS activity assessed based on heart rate, blood pressure, the response to circulatory stress via tilt table, and plasma and urinary catecholamine. These ANS related variables were compared with subjective measures of LUTS (AUA symptom score, quality of life score and BPH impact index), overall health measures (RAND 36-Item Health Survey) and objective clinical measures of BPH (prostate size, post-void residual volume and maximum urinary flow rate). Pearson correlation coefficients were calculated for each ANS variable vs each LUTS and BPH variable. These correlations were further assessed using stepwise multiple regression analysis to determine which BPH and LUTS variables were independently related to the ANS variable. Relationships that were identified as significant then underwent final multiple regression analysis together with control variables to exclude known extraneous and confounding influences on ANS activity.

RESULTS

After adjusting for extrinsic influences on ANS activity AUA symptom score (p <0.01), BPH impact index score (p <0.001) and quality of life score (p <0.05) were independently associated with the change in systolic and diastolic blood pressure 1 and 5 minutes after tilt. Additionally, prostate transition zone volume (p <0.001) and the RAND 36-Item Health Survey mental subscale score (p <0.001) were independently associated with the plasma norepinephrine response to tilt.

CONCLUSIONS

ANS hyperactivity is significantly associated with the most commonly used measures of LUTS, namely AUA symptom score and BPH impact index score. Also, the magnitude of the serum norepinephrine increase after tilt predicts prostate size. These relationships persist after controlling for extrinsic influences on ANS activity. The current findings may have important implications concerning the pathophysiological mechanisms underlying or influencing LUTS as well as its optimal treatment in men with BPH.

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  • Authors+Show Affiliations

    ,

    Department of Urology, Feinberg School of Medicine, Northwestern University Chicago, Illinois 60611, USA. k-mcvary@northwestern.edu

    , ,

    Source

    The Journal of urology 174:4 Pt 1 2005 Oct pg 1327-433

    MeSH

    Aged
    Autonomic Nervous System
    Catecholamines
    Humans
    Male
    Middle Aged
    Multicenter Studies as Topic
    Multivariate Analysis
    Prostatic Hyperplasia
    Quality of Life
    Sympathetic Nervous System
    Tilt-Table Test
    Urination Disorders
    Urodynamics

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    16145413

    Citation

    McVary, Kevin T., et al. "Autonomic Nervous System Overactivity in Men With Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia." The Journal of Urology, vol. 174, no. 4 Pt 1, 2005, pp. 1327-433.
    McVary KT, Rademaker A, Lloyd GL, et al. Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2005;174(4 Pt 1):1327-433.
    McVary, K. T., Rademaker, A., Lloyd, G. L., & Gann, P. (2005). Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. The Journal of Urology, 174(4 Pt 1), pp. 1327-433.
    McVary KT, et al. Autonomic Nervous System Overactivity in Men With Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol. 2005;174(4 Pt 1):1327-433. PubMed PMID: 16145413.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. AU - McVary,Kevin T, AU - Rademaker,Alfred, AU - Lloyd,Granville L, AU - Gann,Peter, PY - 2005/9/8/pubmed PY - 2005/10/20/medline PY - 2005/9/8/entrez SP - 1327 EP - 433 JF - The Journal of urology JO - J. Urol. VL - 174 IS - 4 Pt 1 N2 - PURPOSE: The relationship of lower urinary tract symptoms (LUTS) to objective measures of benign prostatic hyperplasia (BPH), such as prostatic size and urodynamic parameters, has proved difficult to evaluate. Studies in animal models of BPH suggest that autonomic nervous system (ANS) activity is an important determinant of prostatic growth. We investigated the relationship of ANS activity to LUTS as well as to objective measures of BPH in men with BPH. MATERIALS AND METHODS: This study was done in 3,047 men with LUTS secondary to BPH during screening for enrolment at 1 center in a large, multicenter, double-blind, placebo controlled trial designed to assess the long-term effects of medical therapy on BPH progression. A total of 38 men with an American Urological Association (AUA) symptom score of 8 or greater and a maximum urinary flow rate of 4 to less than 15 ml per second had ANS activity assessed based on heart rate, blood pressure, the response to circulatory stress via tilt table, and plasma and urinary catecholamine. These ANS related variables were compared with subjective measures of LUTS (AUA symptom score, quality of life score and BPH impact index), overall health measures (RAND 36-Item Health Survey) and objective clinical measures of BPH (prostate size, post-void residual volume and maximum urinary flow rate). Pearson correlation coefficients were calculated for each ANS variable vs each LUTS and BPH variable. These correlations were further assessed using stepwise multiple regression analysis to determine which BPH and LUTS variables were independently related to the ANS variable. Relationships that were identified as significant then underwent final multiple regression analysis together with control variables to exclude known extraneous and confounding influences on ANS activity. RESULTS: After adjusting for extrinsic influences on ANS activity AUA symptom score (p <0.01), BPH impact index score (p <0.001) and quality of life score (p <0.05) were independently associated with the change in systolic and diastolic blood pressure 1 and 5 minutes after tilt. Additionally, prostate transition zone volume (p <0.001) and the RAND 36-Item Health Survey mental subscale score (p <0.001) were independently associated with the plasma norepinephrine response to tilt. CONCLUSIONS: ANS hyperactivity is significantly associated with the most commonly used measures of LUTS, namely AUA symptom score and BPH impact index score. Also, the magnitude of the serum norepinephrine increase after tilt predicts prostate size. These relationships persist after controlling for extrinsic influences on ANS activity. The current findings may have important implications concerning the pathophysiological mechanisms underlying or influencing LUTS as well as its optimal treatment in men with BPH. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/16145413/Autonomic_nervous_system_overactivity_in_men_with_lower_urinary_tract_symptoms_secondary_to_benign_prostatic_hyperplasia_ L2 - https://www.jurology.com/doi/full/10.1097/01.ju.0000173072.73702.64?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -