Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia; School of Medicine, University of Adelaide, Adelaide, South Australia.
School of Medicine, University of Adelaide, Adelaide, South Australia.
J Urol. 2014 Jan;191(1):130-7. doi: 10.1016/j.juro.2013.06.018. Epub 2013 Jun 11.
We determined the metabolic, lifestyle and physical factors associated with progression or improvement of storage and voiding lower urinary tract symptoms in a population based cohort of men.
After the exclusion of men with prostate or bladder cancer and/or surgery from the study, progression and improvement of storage and voiding lower urinary tract symptoms was assessed using the AUA-SI (American Urological Association symptom index) in 780 men, age 35 to 80 years at baseline, who attended 5-year followup clinics.
Storage and voiding lower urinary tract symptoms progressed in 39.8% (308) and 32.3% (250) of men, and improved in 33.1% (256) and 23.4% (181), respectively. In final adjusted regression models greater bother and physical activity at baseline predicted improvement in storage and voiding lower urinary tract symptoms, while greater income, high-density lipoprotein cholesterol and lower triglycerides predicted improvement of storage lower urinary tract symptoms only. Being widowed, higher plasma estradiol and depression at baseline predicted the progression of storage and voiding lower urinary tract symptoms, while greater abdominal fat mass and obstructive sleep apnea risk predicted the progression of storage lower urinary tract symptoms only. Older age, lower high-density lipoprotein cholesterol, testosterone, income, previous benign prostatic hyperplasia and erectile dysfunction at baseline predicted the progression of voiding lower urinary tract symptoms only. The initiation or continued use of α-blockers or anticholinergics (storage lower urinary tract symptoms), and 5α-reductase inhibitors (voiding lower urinary tract symptoms), were associated with symptom improvement.
Lower urinary tract symptoms may progress or remit. Even accounting for medication use, progression may be associated with modifiable disease, or metabolic or behavioral factors, which are also risk factors for type 2 diabetes and cardiovascular disease. These factors should be looked for and managed.
我们在一个基于人群的男性队列中，确定了与储存和排空下尿路症状进展或改善相关的代谢、生活方式和身体因素。
排除研究中的前列腺癌或膀胱癌和/或手术男性后，使用 AUA-SI（美国泌尿协会症状指数）评估 780 名年龄在 35 至 80 岁的男性在基线时的储存和排空下尿路症状的进展和改善情况，这些男性参加了 5 年随访诊所。
储存和排空下尿路症状分别在 39.8%（308）和 32.3%（250）的男性中进展，在 33.1%（256）和 23.4%（181）的男性中改善。在最终的调整回归模型中，基线时更大的困扰和体力活动预测了储存和排空下尿路症状的改善，而更高的收入、高密度脂蛋白胆固醇和较低的甘油三酯仅预测了储存下尿路症状的改善。基线时丧偶、较高的血浆雌二醇和抑郁预测了储存和排空下尿路症状的进展，而较大的腹部脂肪量和阻塞性睡眠呼吸暂停风险仅预测了储存下尿路症状的进展。年龄较大、较低的高密度脂蛋白胆固醇、睾酮、收入、既往良性前列腺增生和勃起功能障碍预测了仅排尿下尿路症状的进展。α-阻滞剂或抗胆碱能药物（储存下尿路症状）和 5α-还原酶抑制剂（排尿下尿路症状）的起始或持续使用与症状改善相关。
下尿路症状可能会进展或缓解。即使考虑到药物使用，进展也可能与可改变的疾病或代谢或行为因素相关，这些因素也是 2 型糖尿病和心血管疾病的危险因素。这些因素应该被寻找和管理。
