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Obesity related to lower urinary tract symptoms

Central and general obesity are modifiable metabolic factors associated with lower urinary tract symptoms, including urinary incontinence in both men and women and overactive bladder syndrome in women, suggesting that weight loss interventions could provide effective therapy for these patients, according to a study published in Urology.

“The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) sought to address ... knowledge gaps by recruiting a large cohort of male and female patients who were seeking care for their [lower urinary tract symptoms],” H. Henry Lai, MD, of the division of urologic surgery in the department of surgery at Washington University School of Medicine in St. Louis, and colleagues wrote. “We assessed multiple metabolic factors and their relationships to [overactive bladder syndrome], [urinary incontinence], and other [lower urinary tract symptoms]. We expect[ed] to gain insights into the relevant and modifiable metabolic factor(s) associated with these [lower urinary tract symptoms] that may inform future primary and secondary management and prevention strategies.”

Researchers observed 920 adult patients who had lower urinary tract symptoms and who went to a LURN clinical center for treatment between June 2015 and January 2017 (456 men; mean age, 59.1 years; 81.5% white). The lower urinary tract symptoms tool was used to assess these symptoms, which included the presence of overactive bladder syndrome, urinary incontinence, stress urinary incontinence, urgency urinary incontinence, urgency, frequency and nocturia.

Researchers then considered metabolic factors including central obesity (defined by waist circumference), general obesity (BMI 30 kg/m²), overweight (BMI 25 kg/m²), hypertension, dyslipidemia and diabetes. Associations between urinary symptoms and metabolic factors were examined with multivariable logistic regression.

The researchers found that 60.4% of the patients had central obesity per the Adult Treatment Panel III definition, 70.2% had central obesity per the International Diabetes Federation definition, 43.4% had general obesity, 76.5% had overweight, 65.2% had hypertension, 31.5% had dyslipidemia and 17.1% had diabetes.

Researchers also found that that central obesity (for each 10 cm larger waist) was associated with greater odds of urinary incontinence and urgency urinary incontinence in both men (OR = 1.16; P = .008) and women (OR = 1.24; P = .001) and stress urinary incontinence (OR = 1.27; P .008) and overactive bladder syndrome (OR = 1.248; P = .003) in women. Central obesity was also associated with frequency and nocturia.

Furthermore, general obesity (for each 5-unit increase in BMI) was associated with urinary incontinence, urgency urinary incontinence, urgency and frequency in both men and women, as well as with stress urinary incontinence and overactive bladder syndrome in women.

“Our data showed that obesity is a key modifiable metabolic factor associated with [urinary incontinence], [stress urinary incontinence], [urgency urinary incontinence], and [overactive bladder syndrome],” The researchers wrote. “This finding may have important implications for primary and secondary preventive strategies to reduce the prevalence and burden of [overactive bladder syndrome] and [urinary incontinence]. Weight loss interventions targeting physical activity and healthy diet might be considered as an adjuvant therapy in [overactive bladder syndrome] and [urinary incontinence] patients who are obese. A 2015 Cochrane systematic review concluded that the therapeutic effect of weight loss on [urinary incontinence] is building and should be a research priority.” – by Melissa J. Webb

Disclosures: The authors report no relevant financial disclosures.