J Korean Med Sci.  2014 Aug;29(8):1145-1151. 10.3346/jkms.2014.29.8.1145.

The Influence of Depression, Anxiety and Somatization on the Clinical Symptoms and Treatment Response in Patients with Symptoms of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

• Yang YJ
• Koh JS
• Ko HJ
• Cho KJ
• Kim JC
• Lee SJ
• Pae CU

• KMID: 2129612
• DOI: http://doi.org/10.3346/jkms.2014.29.8.1145

Abstract

This is the first study to investigate the influence of depression, anxiety and somatization on the treatment response for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the Korean versions of the International Prostate Symptom Score (IPSS), the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the PHQ-15. The primary endpoint was a responder rate defined by the total score of IPSS (< or = 7) at the end of treatment. The LUTS/BPH severity was significantly higher in patients with depression (whole symptoms P = 0.024; storage sub-symptom P = 0.021) or somatization (P = 0.024) than in those without, while the quality of life (QOL) was significantly higher in patients with anxiety (P = 0.038) than in those without. Anxious patients showed significantly higher proportion of non-response (odds ratio [OR], 3.294, P = 0.022) than those without, while somatic patients had a trend toward having more non-responders (OR, 2.552, P = 0.067). Our exploratory results suggest that depression, anxiety and somatization may have some influences on the clinical manifestation of LUTS/BPH. Further, anxious patients had a lower response to treatment in patients with LUTS/BPH. Despite of limitations, the present study demonstrates that clinicians may need careful evaluation of psychiatric symptoms for proper management of patients with LUTS/BPH.

Keyword

Lower Urinary Tract Symptoms; Benign Prostatic Hyperplasia; Depression; Anxiety; Somatization; Response

MeSH Terms

Anxiety/epidemiology/*psychology
Causality
Comorbidity
Depression/epidemiology/*psychology
Humans
Lower Urinary Tract Symptoms/epidemiology/prevention & control/*psychology
Male
Middle Aged
Outcome Assessment (Health Care)/methods
Prostatic Hyperplasia/epidemiology/*psychology/*therapy
Psychometrics/methods
Republic of Korea/epidemiology
Risk Factors
Severity of Illness Index
Somatoform Disorders/epidemiology/*psychology
Treatment Outcome

Reference

1. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol. 2004; 46:547–554.

2. Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J. International Consultation on New Developments in Prostate Cancer and Prostate Diseases. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2013; 189:S93–S101.

3. Speakman MJ. Lower urinary tract symptoms suggestive of benign prostatic obstruction: what is the available evidence for rational management? Eur Urol. 2001; 39:6–12.

4. De la Rosette J. Definitions: LUTS, BPH, BPE, BOO, BPO. In : Bachmann A, de la Rosette J, editors. OUL benign prostatic hyperplasia and lower urinary tract symptoms in men. London: Oxford University Press;2012.

5. Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, Aiyer LP. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009; 103:4–11.

6. Fourcade RO, Lacoin F, Rouprêt M, Slama A, Le Fur C, Michel E, Sitbon A, Cotté FE. Outcomes and general health-related quality of life among patients medically treated in general daily practice for lower urinary tract symptoms due to benign prostatic hyperplasia. World J Urol. 2012; 30:419–426.

7. Maserejian NN, Chen S, Chiu GR, Araujo AB, Kupelian V, Hall SA, McKinlay JB. Treatment status and progression or regression of lower urinary tract symptoms in a general adult population sample. J Urol. 2014; 191:107–113.

8. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N'dow J, Nordling J, de la Rosette JJ. European Association of Urology. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013; 64:118–140.

9. Roehrborn CG. BPH progression: concept and key learning from MTOPS, ALTESS, COMBAT, and ALF-ONE. BJU Int. 2008; 101:17–21.

10. Parsons JK. Benign prostatic hyperplasia and male lower urinary tract symptoms: epidemiology and risk factors. Curr Bladder Dysfunct Rep. 2010; 5:212–218.

11. Taylor BC, Wilt TJ, Fink HA, Lambert LC, Marshall LM, Hoffman AR, Beer TM, Bauer DC, Zmuda JM, Orwoll ES, et al. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study. Urology. 2006; 68:804–809.

12. Kupelian V, Wei JT, O'Leary MP, Kusek JW, Litman HJ, Link CL, McKinlay JB. BACH Survery Investigators. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Arch Intern Med. 2006; 166:2381–2387.

13. Robertson C, Link CL, Onel E, Mazzetta C, Keech M, Hobbs R, Fourcade R, Kiemeney L, Lee C, Boyle P, et al. The impact of lower urinary tract symptoms and comorbidities on quality of life: the BACH and UREPIK Studies. BJU Int. 2007; 99:347–354.

14. Rom M, Schatzl G, Swietek N, Rücklinger E, Kratzik C. Lower urinary tract symptoms and depression. BJU Int. 2012; 110:E918–E921.

15. Wong SY, Hong A, Leung J, Kwok T, Leung PC, Woo J. Lower urinary tract symptoms and depressive symptoms in elderly men. J Affect Disord. 2006; 96:83–88.

16. Glover L, Gannon K, McLoughlin J, Emberton M. Men's experiences of having lower urinary tract symptoms: factors relating to bother. BJU Int. 2004; 94:563–567.

17. Litman HJ, Steers WD, Wei JT, Kupelian V, Link CL, McKinlay JB. Boston Area Community Health Survey Investigators. Relationship of lifestyle and clinical factors to lower urinary tract symptoms: results from Boston Area Community Health survey. Urology. 2007; 70:916–921.

18. Seyfried LS, Wallner LP, Sarma AV. Psychosocial predictors of lower urinary tract symptom bother in black men: the Flint Men's Health Study. J Urol. 2009; 182:1072–1077.

19. Choi HR, Chung WS, Shim BS, Kwon SW, Hong SJ, Chung BH, Sung DH, Lee MS, Song JM. Translation validity and reliability of I-PSS Korean version. Korean J Urol. 1996; 37:659–665.

20. Han C, Jo SA, Kwak JH, Pae CU, Steffens D, Jo I, Park MH. Validation of the Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan Geriatric Study. Compr Psychiatry. 2008; 49:218–223.

21. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16:606–613.

22. Han C, Pae CU, Patkar AA, Masand PS, Kim KW, Joe SH, Jung IK. Psychometric properties of the Patient Health Questionnaire-15 (PHQ-15) for measuring the somatic symptoms of psychiatric outpatients. Psychosomatics. 2009; 50:580–585.

23. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002; 64:258–266.

24. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166:1092–1097.

25. Chapple CR, Montorsi F, Tammela TL, Wirth M, Koldewijn E, Fernández Fernández E. European Silodosin Study Group. Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe. Eur Urol. 2011; 59:342–352.

26. Barkin J. Benign prostatic hyperplasia and lower urinary tract symptoms: evidence and approaches for best case management. Can J Urol. 2011; 18:14–19.

27. Thor KB, Morgan C, Nadelhaft I, Houston M, De Groat WC. Organization of afferent and efferent pathways in the pudendal nerve of the female cat. J Comp Neurol. 1989; 288:263–279.

28. Thor KB, Katofiasc MA. Effects of duloxetine, a combined serotonin and norepinephrine reuptake inhibitor, on central neural control of lower urinary tract function in the chloralose-anesthetized female cat. J Pharmacol Exp Ther. 1995; 274:1014–1024.

29. Lee KS, Na YG, Dean-McKinney T, Klausner AP, Tuttle JB, Steers WD. Alterations in voiding frequency and cystometry in the clomipramine induced model of endogenous depression and reversal with fluoxetine. J Urol. 2003; 170:2067–2071.

30. Cornelissen LL, Brooks DP, Wibberley A. Female, but not male, serotonin reuptake transporter (5-HTT) knockout mice exhibit bladder instability. Auton Neurosci. 2005; 122:107–110.

31. Springer JP, Kropp BP, Thor KB. Facilitatory and inhibitory effects of selective norepinephrine reupta'ke inhibitors on hypogastric nerve-evoked urethral contractions in the cat: a prominent role of urethral beta-adrenergic receptors. J Urol. 1994; 152:515–519.

32. Danuser H, Bemis K, Thor KB. Pharmacological analysis of the noradrenergic control of central sympathetic and somatic reflexes controlling the lower urinary tract in the anesthetized cat. J Pharmacol Exp Ther. 1995; 274:820–825.

33. Danuser H, Thor KB. Inhibition of central sympathetic and somatic outflow to the lower urinary tract of the cat by the alpha 1 adrenergic receptor antagonist prazosin. J Urol. 1995; 153:1308–1312.

34. Marks DM, Shah MJ, Patkar AA, Masand PS, Park GY, Pae CU. Serotonin-norepinephrine reuptake inhibitors for pain control: premise and promise. Curr Neuropharmacol. 2009; 7:331–336.

35. Cortes E, Sahai A, Pontari M, Kelleher C. The psychology of LUTS: ICI-RS 2011. Neurourol Urodyn. 2012; 31:340–343.

36. Anderson RU, Orenberg EK, Chan CA, Morey A, Flores V. Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2008; 179:956–960.

37. Lai HH, North CS, Andriole GL, Sayuk GS, Hong BA. Polysymptomatic, polysyndromic presentation of patients with urological chronic pelvic pain syndrome. J Urol. 2012; 187:2106–2112.

38. Walters MD, Taylor S, Schoenfeld LS. Psychosexual study of women with detrusor instability. Obstet Gynecol. 1990; 75:22–26.

39. Streiner DL, Norman GR. Correction for multiple testing: is there a resolution? Chest. 2011; 140:16–18.

40. Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990; 1:43–46.