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- Brandin, Lisa, 1974, et al.
(author)
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Effects of estrogen plus progesterone on hemodynamic and vascular reactivity in hypertensive postmenopausal women.
- 2010
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In: Blood pressure. - : Informa UK Limited. - 1651-1999 .- 0803-7051. ; 19:3, s. 156-63
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Journal article (peer-reviewed)abstract
- AIMS: To investigate the medium-term effects of estrogen plus progesterone therapy (EPT) on vascular reactivity, endothelial function and hemodynamic responses in 20 hypertensive postmenopausal women. METHODS: This randomized, double-blind, cross-over, placebo-controlled study investigates the effect of 6 months of EPT (conjugated equine estrogen plus medroxyprogesterone). Blood pressure (office and ambulatory), heart rate and heart rate variability (HRV) were measured at baseline and following EPT/placebo treatment. In eight women, we used a wire-myograph to assess endothelial function and contractile response of subcutaneous arteries to transmural nerve stimulation (TNS) and exogenous noradrenaline. RESULTS: EPT decreased vascular reactivity to cumulative TNS compared with baseline (p<0.01) and placebo (p<0.05). Moreover, EPT diminished sensitivity to exogenous noradrenaline (p<0.05). Although EPT reinforced response to acetylcholine, we observed no difference in maximal relaxation induced by substance P or acetylcholine. EPT did not affect ambulatory blood pressure, heart rate or HRV. CONCLUSIONS: Oral combined medium-term EPT reduces adrenergic reactivity in subcutaneous arteries from treated hypertensive postmenopausal women. EPT might act postjunctionally at the adrenergic vascular receptor level. In the present study, EPT neither reduces sympathetic activity nor increases vagal tone, and thus does not support an effect on the central hemodynamic system.
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- de Boer, T A, et al.
(author)
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Pelvic organ prolapse and overactive bladder.
- 2010
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In: Neurourology and urodynamics. - : Wiley. - 1520-6777 .- 0733-2467. ; 29:1, s. 30-9
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Research review (peer-reviewed)abstract
- AIMS: In this review we try to shed light on the following questions: *How frequently are symptoms of overactive bladder (OAB) and is detrusor overactivity (DO) present in patients with pelvic organ prolapse (POP) and is there a difference from women without POP? *Does the presence of OAB symptoms depend on the prolapsed compartment and/or stage of the prolapse? *What is the possible pathophysiology of OAB in POP? *Do OAB symptoms and DO change after conservative or surgical treatment of POP? METHODS: We searched on Medline and Embase for relevant studies. We only included studies in which actual data about OAB symptoms were available. All data for prolapse surgery were without the results of concomitant stress urinary incontinence (SUI) surgery. RESULTS: Community- and hospital-based studies showed that the prevalence of OAB symptoms was greater in patients with POP than without POP. No evidence was found for a relationship between the compartment or stage of the prolapse and the presence of OAB symptoms. All treatments for POP (surgery, pessaries) resulted in an improvement in OAB symptoms. It is unclear what predicts whether OAB symptoms disappear or not. When there is concomitant DO and POP, following POP surgery DO disappear in a proportion of the patients. Bladder outlet obstruction is likely to be the most important mechanism by which POP induces OAB symptoms and DO signs. However, several other mechanisms might also play a role. CONCLUSIONS: There are strong indications that there is a causal relationship between OAB and POP.
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- Irwin, Debra E, et al.
(author)
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Dynamic progression of overactive bladder and urinary incontinence symptoms: a systematic review.
- 2010
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In: European urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 58:4, s. 532-43
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Journal article (peer-reviewed)abstract
- CONTEXT: Overactive bladder (OAB) and urinary incontinence (UI) are worldwide public health problems. Longitudinal epidemiologic studies that assess the natural history of OAB and UI are valuable in making accurate prognoses, determining causes and consequences, and predicting resource utilization. OBJECTIVE: Our aim was to assess whether the severity of OAB and UI symptoms progress dynamically over time, with the secondary aim of assessing factors that may be associated with symptom progression and regression. EVIDENCE ACQUISITION: A systematic review of English articles published between January 1, 1990, and September 20, 2009, was conducted using PubMed and Embase. Search terms included longitudinal, natural history, overactive bladder, incontinence, progression, remission, and regression. Eligibility was assessed by Dr. Irwin with editorial assistance. Studies were required to be longitudinal and population based; meeting abstracts and conference proceedings were excluded. Results were assessed qualitatively. EVIDENCE SYNTHESIS: Overall, the 7 longitudinal studies of OAB and 14 longitudinal studies of UI reviewed reported an increase in the incidence and remission/regression of both OAB and UI symptoms over time that varied across studies (eg, OAB incidence, 3.7-8.8%; UI incidence, 0.8-19%). The studies provide evidence for a dynamic progression of OAB and UI symptoms (eg, among women with OAB without urge urinary incontinence [UUI], 28% reported OAB with UUI 16 yr later) and also show that although symptom severity progresses dynamically, for many individuals symptoms also persist over long time periods. CONCLUSIONS: The results support the hypothesis that OAB and UI symptom severity progress dynamically and are also sustained over time. However, the variations in symptom definitions and methods used across studies prevent statistical determinations of overall incidence rates. The recognition of OAB and UI as progressive conditions allows for a shift from the current treatment paradigm of symptom control alone to one of symptom management.
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- Kirby, Michael G, et al.
(author)
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Overactive bladder: Is there a link to the metabolic syndrome in men?
- 2010
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In: Neurourology and urodynamics. - : Wiley. - 1520-6777 .- 0733-2467. ; 29:8, s. 1360-4
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Journal article (peer-reviewed)abstract
- It is becoming increasingly clear that a variety of metabolic, cardiovascular, and endocrine factors contribute to male pelvic health. In particular, a growing body of evidence suggests a relationship between lower urinary tract symptoms, benign prostatic hyperplasia, overactive bladder, erectile dysfunction, and the metabolic syndrome. This article explores these relationships, focusing on the role of the autonomic nervous system and hyperinsulinemia, together with their implications for urological practice.
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- Lindh, Ingela, 1954, et al.
(author)
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A longitudinal study of contraception and pregnancies in the same women followed for a quarter of a century.
- 2010
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In: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 25:6, s. 1415-22
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Journal article (peer-reviewed)abstract
- BACKGROUND: There is a need to improve our understanding of contraceptive use over the long term. The aims of this study were to describe contraceptive use and pregnancies in the same women followed prospectively from 19 to 44 years of age. METHODS: In 1981, a postal questionnaire about contraception, pregnancies and reproductive health was sent to a random sample (n = 656) of 19-year-old women resident in Gothenburg, Sweden. The responders were contacted again every fifth year. RESULTS: At 19 years of age, 74% of the women had already used contraception and this increased to 98% at 44 years. Combined oral contraception was the commonest method currently used up to 29 years of age (48/51/22% at 19/24/29 years of age, respectively) and thereafter an intrauterine device (IUD: 34/39/38% at 34/39/44 years of age, respectively). Condom use alone during the 25-year study period was: 14/12/24/21/21/15% and non-use of contraception was: 35/24/26/20/21/26%. The mean number of pregnancies/children increased from 0.2/0.1 at 19 years of age to 3.1/2.1 at 44 years. Women who had been pregnant and women who had not been pregnant
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| 7. |
- Malmsten, Ulf G H, et al.
(author)
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Urinary incontinence, overactive bladder, and other lower urinary tract symptoms: a longitudinal population-based survey in men aged 45-103 years.
- 2010
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In: European urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 58:1, s. 149-56
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Journal article (peer-reviewed)abstract
- BACKGROUND: Lower urinary tract symptoms (LUTS) such as urinary incontinence (UI) and overactive bladder (OAB) are highly prevalent conditions, but there are few studies describing progression and remission of LUTS in men, especially over the long term. OBJECTIVE: To describe the prevalence of UI, OAB, and LUTS using current International Continence Society definitions in the same men studied longitudinally over time. DESIGN: Prospective, population-based, longitudinal study. SETTING AND PARTICIPANTS: In 1992, 10 458 men aged 45-99 yr, resident in the city of Gothenburg, were selected at random from the Population Register. MEASUREMENTS: The men received a postal questionnaire about the presence of LUTS, as well as questions on social, medical, health-related quality of life (HRQoL), and demographic data. Responders in 1992 were reassessed 11 yr later in 2003 using a similar questionnaire. RESULTS AND LIMITATIONS: In 2003, 4072 of the 7763 men who responded in 1992 were still available in the Population Register and 3257 men (80%) aged 56-103 yr, responded. Prevalence of UI and OAB had increased (p<0.01) in the same men assessed in 1992 (4.5% and 15.6%, respectively) and 2003 (10.5% and 44.4%, respectively). The prevalence of nocturia, urgency, slow stream, hesitancy, incomplete emptying, postmicturition dribble, and the number of daytime micturitions had also increased (p<0.01). Only a minority reported regression of symptoms. Men with UI or OAB reported a poorer (p<0.001) HRQoL compared with men without UI or OAB. CONCLUSIONS: There was a marked increase in the prevalence of UI, OAB, and other LUTS in the same men assessed longitudinally over this 11-yr period. UI and OAB had a negative influence on HRQoL, and men who developed UI or OAB had a greater deterioration in HRQoL than men who had no change in their UI/OAB status over time.
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- Manhem, Karin, 1954, et al.
(author)
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Influence of chronic hormone replacement therapy on left ventricular mass and serum-ACE activity.
- 2010
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In: Blood pressure. - : Informa UK Limited. - 1651-1999 .- 0803-7051. ; 19:5, s. 295-300
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Journal article (peer-reviewed)abstract
- AIMS: The aim of this investigation was to study the effects of hormone replacement therapy (HRT) on left ventricular mass (LVM) and serum-angiotensin-converting enzyme (ACE) activity (S-ACE) in well controlled hypertensive postmenopausal women. METHODS: In this prospective, randomized, crossover, double-blind trial we studied 20 well controlled hypertensive postmenopausal women who received 6 months of HRT and 6 months of placebo on top of antihypertensive treatment. Two-dimensional M-mode, office blood pressure, 24-h ambulatory blood pressure (ABPM), S-estradiol and S-ACE activity were investigated at baseline, after 6 and 12 months. RESULTS: LVM was significantly influenced by HRT (analysis of variance, ANOVA, p<0.01). However, the order in randomization of HRT and placebo had an impact on the analysis of LVM reduction (baseline - HRT - placebo: ns; baseline - placebo - HRT: p<0.01 ANOVA). Only the women lacking blockade of the renin-angiotensin-aldosterone system (RAAS) as antihypertensive treatment (n=10) experienced a reduction in LVM and a tendency of decreased S-ACE activity in response to HRT compared with baseline (p< 0.05 and p= 0.06 respectively). CONCLUSIONS: Six months of HRT resulted in significant reduction of LVM without any change in ABPM. HRT may reduce LVM through interaction with the RAAS, since hypertensive women without RAAS blockade exhibited an effect of HRT on LVM and S-ACE activity, which was not seen in women on RAAS blockade.
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