BERKELEY, CA (UroToday.com) - In this, our small sample-size clinical study, we found a relationship between overactive bladder (OAB) and increased serum insulin levels and HOMA-IR values in female patients.
Overactive bladder, a prevalent and disturbing disease with a profound impact on quality of life, is defined as urinary urgency accompanied by frequency and nocturia, with or without urge urinary incontinence, in the absence of urinary tract infection or other obvious pathology. The pathogenesis has not been clarified, however, neurogenic or myogenic hypotheses have been argued. These models claim that disorders of nerves of the bladder or detrusor could be the underlying mechanisms. However, these presumed models fall far from explaining the major part of the entire mechanism.
Recently, we had put forth a strong relationship with metabolic syndrome (MetS) and OAB in females. In that study, MetS was found in 64% of female patients with overactive bladder, in comparison to 35% of females without. However, role of insulin resistance was not known in the development of overactive bladder in females. Our previous, and other published studies, have revealed associations between OAB and MetS components, including obesity, hypertension, dyslipidemia, and glucose intolerance. Insulin resistance is the underlying mechanism and a link between these metabolic disturbances.
Obesity is no longer characterized as a chronic and systemic inflammatory disease where adipose tissue produces inflammatory mediators. In addition, insulin resistance is related to endothelial dysfunction, chronic ischemia, oxidative stress, and sympathetic overactivity where all these pathogenetic reactions have been separately shown to be associated with overactive bladder. We proposed a new model for the development of idiopathic overactive bladder in our study. We advocated that development of overactive bladder in women is based on insulin resistance, obesity-related chronic inflammation, and other metabolic syndrome-related pathogenetic interactions. Nevertheless, the major limitation of the study is the nature of the cross-sectional and small size of the patient cohort.
Studies from Far Eastern countries such as South Korea and Japan have revealed weak or absent relations of lower urinary tract symptoms with MetS or insulin resistance. However, we believe the criteria of MetS and serum insulin values should likely differ among societies and many further studies are needed.
MetS- insulin resistance complex has been shown to be associated with many prevalent diseases, including diabetes, coronary artery disease, Alzheimer’s disease, and cancer. Additionally, it was reported that people with nocturia have higher mortality rates and these MetS-related diseases could be the underlying causes. Futhermore, women with OAB may also have higher mortality rates due to association with MetS-insulin resistance-related state and chronic inflammation. Therefore, OAB can be a predictor of general health status such as cardiovascular diseases, diabetes, or Alzheimer’s disease.
- Uzun H, Zorba OU. Metabolic syndrome in female patients with overactive bladder. Urology. 2012;79:72–75.
Hakkı Uzun, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology
Recep Tayyip Erdoğan University School of Medicine