Introduction African descent populations in the United States have high rates of type 2 diabetes and are incorrectly represented as a single group. Current glycated hemoglobin A 1c (HbA 1c ) cutoffs (5.7% to <6.5% for prediabetes; ≥6.5% for type 2 diabetes) may perform suboptimally in evaluating glycemic status among African descent groups. We conducted a scoping review of US-based evidence documenting HbA 1c performance to assess glycemic status among African American, Afro-Caribbean, and African people. Methods A PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search (January 2020) yielded 3,238 articles published from January 2000 through January 2020. After review of titles, abstracts, and full texts, 12 met our criteria. HbA 1c results were compared with other ethnic groups or validated against the oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), or previous diagnosis. We classified study results by the risk of false positives and risk of false negatives in assessing glycemic status. Results In 5 studies of African American people, the HbA 1c test increased risk of false positives compared with White populations, regardless of glycemic status. Three studies of African Americans found that HbA 1c of 5.7% to less than 6.5% or HbA 1c of 6.5% or higher generally increased risk of overdiagnosis compared with OGTT or previous diagnosis. In one study of Afro-Caribbean people, HbA 1c of 6.5% or higher detected fewer type 2 diabetes cases because of a greater risk of false negatives. Compared with OGTT, HbA 1c tests in 4 studies of Africans found that HbA 1c of 5.7% to less than 6.5% or HbA 1c of 6.5% or higher leads to underdiagnosis. Conclusion HbA 1c criteria inadequately characterizes glycemic status among heterogeneous African descent populations. Research is needed to determine optimal HbA 1c cutoffs or other test strategies that account for risk profiles unique to African American, Afro-Caribbean, and African people living in the United States.

No abstract

Purpose: To conduct a systematic review of preclinical and clinical peer-reviewed evidence linking alterations in oxidative stress biomarkers or outcome measures that were also prevalent in specific age-related lower urinary tract (LUT) disorders.Methods: PubMed, Scopus, CINAHL, and Embase were searched for peer-reviewed studies published between January 2000 and March 2021. Animal and human studies that reported on the impact of oxidative stress in age-related LUT disorders through structural or functional changes in the LUT and changes in biomarkers were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed.Results: Of 882 articles identified, 21 studies (13 animal; 8 human) met inclusion criteria. Across LUT disorders, common structural changes were increased bladder and prostate weights, ischemic damage, nerve damage and detrusor muscle hypertrophy; common functional changes included decreased bladder contraction, increased bladder sensation and excitability, decreased perfusion, and increased inflammation. The disorders were associated with increased levels of biomarkers of oxidative stress that provided evidence of either molecular damage, protective mechanisms against oxidative stress, neural changes, or inflammation. In all cases, the effect on biomarkers and enzymes was greater in aged groups compared to younger groups.Conclusions: Increased oxidative stress, often associated with mitochondrial dysfunction, plays a significant role in the pathogenesis of age-related LUT disorders and may explain their increasing prevalence. This systematic review identifies potential markers of disease progression and treatment opportunities; further research is warranted to evaluate these markers and the mechanisms by which these changes may lead to age-related LUT disorders.

Purpose: The pathophysiology of nocturia and nocturnal polyuria (NP), conditions that become more prevalent with aging, may in part be explained by changes in hormones involved in water homeostasis. The purpose of this study was to analyze the impact of aging on urinary natriuretic peptides in nocturia and NP.Methods: Patients aged ≥18 years completed 24-hour bladder diaries for assessment of nocturia and NP. They were divided into subgroups of ≥65 years old and <65 years old. Urine samples were collected and analyzed for natriuretic peptide (NT-proANP, NT-proBNP, and NT-proCNP) levels. Peptide levels were compared between patients with and without nocturia/NP and within age subgroups; correlation to the NP index (NPi) was determined.Results: Compared to patients without nocturia (N=15), patients with nocturia (N=36) had higher median levels of urinary NT-proANP (15.8 pmol/mmol Cr vs. 10.9 pmol/mmol Cr, P=0.016) and NT-proBNP (6.3 pmol/mmol Cr vs. 4.5 pmol/mmol Cr, P=0.021), but showed no differences in NT-proCNP (2.4 pmol/mmol Cr vs. 2.5 pmol/mmol Cr, P=0.967). Patients ≥65 years old with nocturia had higher NT-proANP (29.8 pmol/mmol Cr vs. 11.0 pmol/mmol Cr, P<0.001) and NT-proBNP (9.6 pmol/mmol Cr vs. 5.0 pmol/mmol Cr, P<0.001) than patients <65 years old. Additionally, patients with NP (N=30) showed higher urinary NT-proANP (19.6 pmol/mmol Cr vs. 10.5 pmol/mmol Cr, P<0.001) and NT-proBNP (6.7 pmol/mmol Cr vs. 4.7 pmol/mmol Cr, P=0.020) compared to patients without NP (N=21). NP patients ≥65 years had higher NT-proANP (29.8 pmol/mmol Cr vs. 12.5 pmol/mmol Cr, P<0.001) and NT-proBNP (9.6 pmol/mmol Cr vs. 4.4 pmol/mmol Cr, P=0.004) than patients <65 years old. NPi positively correlated with urinary NT-proANP (R_S=0.417, P=0.002) and NT-proBNP (R_S=0.303, P=0.031), but not with NT-proCNP (R_S=-0.094, P=0.510).Conclusions: Since urinary NT-proANP and NT-proBNP were greater in aged patients with nocturia and NP, natriuretic peptides may contribute to the pathophysiology of these conditions and further research should aim to explore them as targets for management.

BackgroundWith COVID-19 leading to several isolation measures for preventative care, health care utilization, especially within urology, decreased substantially. The impact of COVID-19 on the population's interests in urologic conditions remains to be established. By using the platform of Google Trends, which allows search behaviors and interest in healthcare topics to be quantified over time, we investigated the impact of COVID-19 on online search behaviors relating to common urologic conditions in the US. MethodsThe platform of Google Trends was utilized to analyze online interest in twelve common urologic conditions in the US from October 1, 2018 to August 1, 2021 (divided into "pre-COVID" and "COVID" periods at March 1, 2020). Search volume index (SVI), a measure of relative search volume on Google, data sets for the US, top queried and populated states, rising queries, and top queries were retrieved and analyzed for all conditions. Pre-COVID and COVID median SVIs were compared using the Mann Whitney U test, and correlations were analyzed using Spearman's rank-order correlation test. ResultsFor all twelve urologic conditions, rising and top queries were often related to symptoms, treatments, and COVID-19. COVID showed higher SVIs for erectile dysfunction (p=0.04) and lower SVIs for bladder cancer (p<0.01), hematuria (p<0.01), kidney cancer (p<0.01), kidney stones (p=0.03), and prostate cancer (p<0.01). Correlations to COVID-19 searches were seen for bladder cancer (R S =-0.36, p<0.01), erectile dysfunction (R S =0.20, p=0.04), hematuria (R S =-0.31, p<0.01), overactive bladder (R S =-0.23, p=0.04), and prostate cancer (R S =-0.33, p<0.01). No correlations were found for benign prostatic hyperplasia, interstitial cystitis, low testosterone, urinary incontinence, and urinary tract infections. ConclusionsOnline interest in many urologic conditions, especially cancers, decreased during COVID. Given the internet's increasing role in healthcare, a reduced interest could translate to delayed diagnosis and treatment of these conditions. Only erectile dysfunction showed increasing interest, potentially due to research or misinformation linking it to COVID-19.

No abstract

The LURN SI-10 correlates strongly with the AUA-SI, a validated and widely used questionnaire for BPH in men. Additionally, the LURN SI-10 can help identify PVD, bladder pain/ discomfort, and UUI in men with BPH, symptoms that are not identified by the AUA-SI. Further prospective study of the LURN SI-10 in men with BPH, including before and after medical and surgical treatment, is warranted.

INTRODUCTION AND OBJECTIVE: Bladder outlet obstruction (BOO) is a common problem among elderly men. It is known that persistent BOO can affect bladder function. We aimed to evaluate the long-term impact of persistent BOO on bladder function using urodynamic profiles.METHODS: We analyzed the prospectively collected urodynamic database of Seoul National University Hospital about 19000 cases over 20 years. We included male patients aged 40 years or older with non-neurogenic LUTS/BPH who have repeated urodynamic studies 2 or more times and had persisted BOO in both studies. BOO defined as BOO index (PdetQmax e 2Qmax) >40. First and repeat UDS profiles were compared, including post-void residual, bladder sensation, bladder compliance, bladder capacity, involuntary detrusor contraction, bladder contractility index (PdetQmaxþ5Qmax), and voiding efficiency (post-void residual/(voided volumeþpost-void residual)). The student's t-test and Chi-square test were used as appropriate.RESULTS: A total of 37 patients were included in our analysis. The mean age at repeat UDS was 69. The mean time interval between the two studies was 61 months. UDS profiles tended to deteriorate over time. Mean bladder compliance decreased from (64.53ml/cmH2O) to (41.92ml/cmH2O) (p<0.01). The mean volume to induce normal desire to void decreased from (247.78ml) to (185.23ml) (p[0.01). Mean bladder capacity decreased from (359.84ml) to (283.75ml) (p[0.01). The mean bladder contractility index decreased from (108.36) to (99.08), though not reaching statistical significance (p[0.13). Rate of involuntary detrusor contraction increased from (24.32%) to (69.44%) (p<0.01).CONCLUSIONS: Our results show that persistent BOO induced functional-urodynamic deteriorations in the bladder function, such as reduced capacity, decreased compliance, and induced detrusor overactivity. In patients with LUTS/BPH with confirmed BOO, more active treatment should be considered.