Tag Archive | "lower urinary tract symptoms"

Weight Loss Increases Libido in Obese Men with Type 2 Diabetes

A small Australian clinical study showed that sexual function improved significantly and quickly in obese men with type 2 diabetes after weight loss with reduced-calorie diets.  For 31 men who lost five percent to ten percent of their body weight in eight weeks, erectile function, sexual desire, and urinary symptoms all improved significantly.  According to an article published in the Journal of Sexual Medicine, metabolic parameters, including blood glucose, insulin sensitivity, and lipid profile, also responded favorably to either a low-calorie, meal-replacement diet or a high protein-low carbohydrate diet.

The improvements were maintained during a year of follow-up.  Joan Khoo, MRCP, of Changi General Hospital in Singapore, and Australian co-authors wrote, “Further improvements during weight maintenance, using a high-protein low-fat diet, suggest that both nutrient quality and caloric restriction contribute to these benefits.”  Although the favorable effect of weight loss on sexual function is not new, this study may be the first to demonstrate an impact on sexual desire.

Another important finding was weight loss’ apparently favorable effect on systemic inflammation.  Obesity and type 2 diabetes increase the risk of erectile dysfunction and lower urinary tract symptoms (LUTS), which are associated with each other and with systemic inflammation and endothelial dysfunction.

Rapid weight loss through dieting can improve erectile dysfunction and LUTS. Previous studies also have shown improved endothelial function and reduced inflammation after weight loss, especially for people who lose at least 10 percent of body weight.  Not much data had been collected regarding the influence of macronutrient composition on associations between weight loss, endothelial function, systemic inflammation, sexual function, and LUTS in obese men.

All 31 men involved in the study had type 2 diabetes, a body mass index greater than 30, and a waist circumference of at least 102cm.  They were randomized to two dietary plans.  The first plan was a liquid meal-replacement consumed twice daily and one small, nutritionally balanced meal, providing a total energy of about 900 kcal/day (low-calorie diet).  The second plan was a low-fat, low-carbohydrate diet designed to reduce energy intake by about 600 kcal/day.

The first assessment occurred after eight weeks, and follow-up continued for an additional 44 weeks.  The participants who opted to stay in the study for long-term follow-up consumed the high-protein diet during the follow-up.

Men in the low-calorie diet group had about ten percent reduction in mean body weight and waist circumference at eight weeks, as compared with about five percent among men assigned to the high-protein diet.  Weight loss at eight weeks averaged 9.5kg with the low-calorie diet and 5.4 kg with the high-protein diet, both of which were statistically significant.

In general, inflammatory markers decreased significantly in the high-protein group but not the low-calorie group, but the men assigned to the high-protein diet had higher baseline levels of the markers.  About half of the men remained in the study for the entire 52 weeks. Of those who did, improvements were either maintained or increased.

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No Relationship Found Between Weight Changes and LUTS

Even though obesity has been related to lower urinary tract symptoms (LUTS) in aging men, new findings from researchers at the Mayo Clinic College of Medicine in Rochester, Minnesota suggest that modest weight loss may not prevent the onset or progression of LUTS among these men.  Also, no relationship was found between weight gain and the development or progression of LUTS.

The research team analyzed data from 1,674 white men participating in the Olmstead County Study (OCS) of Urinary Symptoms and Health Status among Men, funded by Merck Research Laboratories, and 168 black men participating in the Flint Men’s Health Study.  Researchers separated the participants into three categories based on differences between their baseline weight and weight during four year of follow-up: no weight loss, less than 5% of baseline weight loss, and more than 5% of baseline weight loss.

Jennifer L. St. Sauver, Ph.D., the lead author of the study, reported at the American Urological Association annual meeting that participants in both studies and in all weight categories experienced no statistically significant change in LUTS.  Her research team found that in the OCS cohort, weight loss was not related to receipt of treatment for benign prostatic hyperplasia.  Dr. St. Sauver concludes that although weight loss can help prevent a number of diseases such as diabetes, modest weight loss may not prevent development of LUTS.  A report of the study will be published in Urology. Data collection for this study was additionally funded by grants from the National Institutes of Health.

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Generic Urologic Drugs Less Effective

Two small observational studies suggest that switching from branded to generic urologic drugs led to deterioration of efficacy and more side effects.

In one study, investigators studied 257 men with lower urinary tract symptoms (LUTS) that was treated for at least 6 months with branded medication – alpha-blocker in 169 men and 5 alpha-reductase inhibitor (5ARI) in 88 men. The patients were switched from a branded drug to generic substitute as required by the patient’s insurance company or by the patient’s primary care physician.  After the switch the men were followed for a year.

The mean baseline symptom score (IPSS) for patients on alpha-blocker was 8.9, after the switch to generic drug it increased to 12.9 at six months and 13.2 at 12 months.

For 5ARI, the mean IPSS was 11.3 which increased to 14.7 at six months and 16.2 at 12 months after the switch.

The mean PSA value increased from 1.1 to 1.7 ng/mL in the 12 months after switching from Avodart (dutasteride) to generic finasteride and from 1.2 to 1.5 ng/mL in men switched from Proscar to generic finasteride.

A third of patients in the Avodart group had more than a 0.75 ng/mL rise in PSA after the switch, as did 14% of the Proscar group.

Dr. Steven Kaplan, M.D. of Weill Cornell Medical College in New York said “The PSA changes after the switch to generic finasteride could have been sufficient to trigger unnecessary biopsies.”

Side effects which include dizziness, nasal congestion, and ejaculatory dysfunction also increased by 2% to almost 5% after the switch from branded to generic alpha-blocker.  Because of adverse effects, 26 men were switched back to the branded alpha-blocker.

In the second study, 87 women and 69 men with overactive bladder were switched from a branded anticholinergic drug to generic oxybutynin.  After the switch, the women had 29.4% increase in the rate of urge incontinence and similar increases in frequency and nocturia.  Men had increased rates of urge incontinence, nocturia and frequency. Postvoid residual increased by 15 mL in women and by 18.9 mL in men after the switch.

Following conversion from branded to generic drugs, the frequency of dry mouth and constipation increased in women by 36.4% and 23.01%, respectively, and by 39.5% in men.

“These findings should not consider generic drugs as bad or that it should go away.  People should understand what generic drugs are and make their decisions accordingly.” said Dr. Kaplan.

Generics drugs have been gaining popularity. Prescriptions of generic drugs increased by 12% a year from 2004 to 2008 whereas prescriptions for branded drugs decreased by 6% a year.  In 2008, generic drugs accounted for 2.4 billion prescriptions compared to 1.4 billion branded drugs.

Manufacturers of generic drugs only need to demonstrate the bioequivalence of their drugs vis a vis the branded version.  In the U.S. the definition of bioequivalence encompasses the range from 80% to 125% of the active compound.

That definition means that generics within a specific drug class can vary substantially in the bioavailability of the active compound and that generic versions of individual drugs within the class may exhibit just as much variability.

“The bottom line is that bioequivalence does not mean therapeutic equivalence,” said Dr. Kaplan.

Note that these studies were published as abstracts and presented orally at a conference.  These data and conclusions should be considered to be preliminary.

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Sleep Problems Associated with Incontinence

According to the results of a new study, sleep problems are associated with urologic conditions such as incontinence, lower urinary tract symptoms (LUTS) and nocturia – the need to get up during the night to urinate.

For five years, researchers at New England Research Institutes, Inc. in Watertown Massachusetts followed 1,610 men and 2,535 women assessing sleep disturbances and the development of urologic symptoms.

The investigators found that short sleep duration among men and restless sleep in both men and women was strongly associated with the incidence of lower urinary tract symptoms – 8% among men and 13% among women. Incidences of urinary incontinence and nocturia were associated with restless sleep among women but not in men.

The study is scheduled to be presented to the media during a special press conference at the American Urological Association’s (AUA) annual meeting in Washington, D.C. along with another study that examined the relationship between obstructive sleep apnea (OSA) and erectile dysfunction.

In the association’s news release, Dr. Kevin T McVary, AUA spokesman said “We know that proper amounts of sleep and quality of sleep can impact a wide range of health conditions, these data may help us better assess how helping patients modify their sleep patterns may help improve their health and overall quality of life.”

The data and conclusions of these studies should be viewed as preliminary until published in a peer-reviewed journal because these studies were presented during a medical meeting.

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Research Study for Treatment of Lower Urinary Tract Symptoms (LUTS) Due To Benign Prostatic Hyperplasia (BPH)

Are you a man age 50 or older?

Do you have to urinate frequently during the day and at night?

Do you have trouble urinating?

Are these and other urinary problems interfering with your life and your relationships?

If you answered “yes” to the above questions, you may be a candidate for the L.I.F.T. Study.

The L.I.F.T. Study is an FDA approved research study to evaluate the UroLift system to support a premarketing application to FDA.  Its purpose is to determine the safety and effectiveness of the UroLift system for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).  The study is being conducted at urology practices throughout the U.S., in Canada and in Australia.

BPH is a non cancerous condition that causes the prostate to enlarge as men age.  When the enlarged prostate presses on the urethra, it can cause bothersome urinary symptoms. The UroLift System is a minimally invasive approach to treating BPH that lifts/holds the enlarged prostate tissue out of the way so it no longer blocks the urethra.  There is no cutting, heating or removal of prostate tissue. The goal of UroLift system treatment is to relieve symptoms so you can get back to your life and resume your daily activities.

The UroLift system is an investigational device as such is limited by Federal Law to investigational use only.

To find out more about L.I.F.T. Study and UroLift system treatment and study locations, go to www.neotract.com.

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Susceptibility to Urinary Incontinence Linked to Genetic Factors

University of Gothenburg in collaboration with the Swedish Twin Registry at Karolinska Institutet in Stockholm, Sweden studied just over 25,000 Swedish twins aged 20 to 46. Information about urinary incontinence, overactive bladder and other lower urinary tract symptoms were analysed using a statistical method which measures how much of the difference between people is due to genetic variation. By comparing the prevalence of these symptoms in identical twins, who have identical genes, and non-identical twins, who share half of their genetic material, the researchers were able to draw conclusions about the relative significance of genetic and environmental factors.

Gynecologist Anna Lena Wennberg, one of the researchers behind the study said “incontinence is caused by a combination of factors and we already knew that there are hereditary factors, but now we’ve been able to show for the first time how important the genetic component is for various types of urinary tract disorder”.

In urinary incontinence, half of the variation (51%) can be explained by genetic factors. This means that around 50% of people’s susceptibility to urinary incontinence can be explained by their genes.

In nocturia – the need to get up in the night to urinate, 34% of the variation has a genetic explanation.

Wennberg does not believe that there is a single incontinence gene, rather that a number of different genes play a role. These genes combine with various environmental factors or cause disorders which, in turn, increase the risk of urinary incontinence.

“Urinary incontinence is a multifactorial condition, and while we now know that much of the variation between people is down to their genes, treatment will continue to focus on environmental factors which are easier to influence, such as smoking and excess weight.”

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