Aşırı Aktif Mesaneli Erkek Bireylerdeki Otonomik Sinir Sistemi Fonksiyon Bozukluğu

Year 2023, , 367 - 371, 31.08.2023

Betül Banu Karasu , Ahmedi Uğur Oruç

https://doi.org/10.54005/geneltip.1265765

Abstract

Amaç: Aşırı aktif mesane, oldukça sık görülen ve hayat kalitesini azaltan ürolojik bir hastalıktır. Bu klinik durumun altında yatan ana patofizyolojiyi açıklayan birçok hipotez öne sürülmüştür, ancak altta yatan mekanizma tam olarak açıklığa kavuşamamıştır. Ayrıca ilgili çalışmaların sayısı oldukça sınırlı, sadece bayan hastaları kapsamakta ve çelişen sonuçlar içermektedir. Biz burada, öne sürülen hipotezlerden biri olan otonomik sinir sistemi fonksiyon bozukluğunu aşırı aktif mesanesi olan erkek hastalarda araştırmayı amaçladık.
Yöntem: Bu çalışmaya, 41 aşırı aktif mesanesi olan erkek hasta ile 43 sağlıklı erkek birey alınmıştır. Katılımcıların elektrokardiyografik sinyalleri işeme öncesi ve işeme sonrası dönemde kaydedilmiş ve otonomik sinir sistemi fonksiyon bozukluğunu gösterebilen kalp hızı değişkenliği parametrelerine dönüştürülmüştür.
Bulgular: Kontrol grubuna kıyasla, aşırı aktif mesaneli erkek hastalarda; NN intervallerinin standart sapması, ardışık normal NN intervalleri arasındaki farkların karekökü, düşük frekans bandı, düşük frekans/yüksek frekans oranı anlamlı olarak daha düşük, yüksek frekans bandı ise anlamlı olarak daha yüksek bulundu (p<0.05)
Sonuç: Aşırı aktif mesaneli erkek hastalarda kalp hızı değişkenliği azalmakta ve bayan hastalardaki sempatik hakimiyeti raporlayan önceki bazı çalışmaların aksine, hem işeme öncesi hem de işeme sonrası dönemde parasempatik hakimiyet gözlenmektedir.

Keywords

aşırı aktif mesane, , elektrokardiyografi, erkek, kalp hızı, otonomik sinir sistemi

Alteration of Autonomic Nervous System Function in Male Patients with Overactive Bladder Syndrome

Abstract

Background/Aims: Overactive bladder is a frequently encountered urological disease that has debilitating effects on quality of life. Some hypotheses have been brought forward in order to explain the main pathophysiology underlying this clinical phenomenon, however the exact mechanism remains unclear and the relevant reports are limited in number, confined to female patients and have conflicting results. Therefore, we aimed to examine one of these hypotheses -autonomic nervous system dysfunction- in male patients with overactive bladder.
Methods: We enrolled 41 male patients with overactive bladder and 43 healthy males in this study. Their electrocardiographic signals are recorded in the prevoiding and postvoiding periods and then converted to heart rate variability parameters which may reveal autonomic nervous system dysfunction.
Results: Standard deviation of normal-to-normal interval, square root of the mean squared differences of successive normal-to-normal intervals, low frequency signal and low frequency/high frequency ratio were found to be significantly lower while high frequency signal was significantly higher in the patient group compared to healthy controls (p<0.05).
Conclusions: Heart rate variability was attenuated in male patients with overactive bladder and parasympathetic predominance was observed during both prevoiding and postvoiding periods, contrary to some of the previous reports revealing sympathetic predominance in female patients.

Keywords

autonomic nervous system, electrocardiography, heart rate, male, overactive urinary bladder

References

• Nambiar AK, Arlandis S, Bø K, Cobussen-Boekhorst H, Costantini E, de Heide M, et al. European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. Eur Urol 2022 Jul;82(1):49-59.
• Nitti VW, Patel A, Karram M. Diagnosis and management of overactive bladder: A review. J Obstet Gynaecol Res 2021 May;47(5):1654-1665.
• Santander J, Plata M, Zuluaga L, Azuero J, Daza F, Trujillo CG, et al. What is the real burden of the overactive bladder? Results from a national prevalence study Neurourol Urodyn 2022 Apr;41(4):926-934.
• Brading AF. A myogenic basis for the overactive bladder. Urology 1997 Dec;50(6A Suppl):57-67; discussion 68-73.
• Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, et al. A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment. Eur Urol 2019 Jun;75(6):988-1000.
• Chapple C. Chapter 2: Pathophysiology of neurogenic detrusor overactivity and the symptom complex of "overactive bladder". Neurourol Urodyn 2014 Jul;33 Suppl 3:S6-13.
• Hsiao SM, Su TC, Chen CH, Chang TC, Lin HH. Autonomic dysfunction and arterial stiffness in female overactive bladder patients and antimuscarinics related effects. Maturitas 2014 Sep;79(1):65-9.
• Liao WC, Jaw FS. A noninvasive evaluation of autonomic nervous system dysfunction in women with an overactive bladder. Int J Gynaecol Obstet 2010 Jul;110(1):12-7.
• Hsiao SM, Tu FC, Su TC, Wu PC, Lin HH. Impact of mirabegron versus solifenacin on autonomic function and arterial stiffness in female overactive bladder syndrome: a randomized controlled trial. Sci Rep 2022 Aug 20;12(1):14219.
• Shapiro KK, Brucker BM. Treatment of overactive bladder in men: Is it really different? Neurourol Urodyn 2022 Nov;41(8):1975-1982.
• Cygankiewicz I, Zareba W. Heart rate variability. Handb Clin Neurol 2013;117:379-93.
• Tiwari R, Kumar R, Malik S, Raj T, Kumar P. Analysis of Heart Rate Variability and Implication of Different Factors on Heart Rate Variability. Curr Cardiol Rev 2021;17(5):e160721189770.
• Xhyheri B, Manfrini O, Mazzolini M, Pizzi C, Bugiardini R. Heart rate variability today. Prog Cardiovasc Dis 2012 Nov-Dec;55(3):321-31.
• Coyne K, Revicki D, Hunt T, Corey R, Stewart W, Bentkover J, et al. Psychometric validation of an overactive bladder symptom and health-related quality of life questionnaire: the OAB-q. Qual Life Res 2002 Sep;11(6):563-74.
• Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Int Urogynecol J 2010 Jan;21(1):5-26.
• Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health 2017 Sep 28;5:258.
• Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation 1996 Mar 1;93(5):1043-65.
• Kobayashi H, Ishibashi K, Noguchi H. Heart rate variability; an index for monitoring and analyzing human autonomic activities. Appl Human Sci 1999 Mar;18(2):53-9.
• de Groat WC, Yoshimura N. Anatomy and physiology of the lower urinary tract. Handb Clin Neurol 2015;130:61-108.
• Ochodnicky P, Uvelius B, Andersson KE, Michel MC. Autonomic nervous control of the urinary bladder. Acta Physiol (Oxf) 2013 Jan;207(1):16-33.
• Michel MC, Barendrecht MM. Physiological and pathological regulation of the autonomic control of urinary bladder contractility. Pharmacol Ther 2008 Mar;117(3):297-312.
• Kim JC, Joo KJ, Kim JT, Choi JB, Cho DS, Won YY. Alteration of autonomic function in female urinary incontinence. Int Neurourol J 2010 Dec;14(4):232-7.
• Choi JB, Kim YB, Kim BT, Kim YS. Analysis of heart rate variability in female patients with overactive bladder. Urology 2005 Jun;65(6):1109-12; discussion 1113.
• Im HW, Kim MD, Kim JC, Choi JB. Autonomous nervous system activity in women with detrusor overactivity. Korean J Urol 2010 Mar;51(3):183-6.
• Hsiao SM, Su TC, Chen CH, Chang TC, Lin HH. Autonomic dysfunction and arterial stiffness in female overactive bladder patients and antimuscarinics related effects. Maturitas 2014 Sep;79(1):65-9.
• Hubeaux K, Deffieux X, Ismael SS, Raibaut P, Amarenco G. Autonomic nervous system activity during bladder filling assessed by heart rate variability analysis in women with idiopathic overactive bladder syndrome or stress urinary incontinence. J Urol 2007 Dec;178(6):2483-7.
• Ben-Dror I, Weissman A, Leurer MK, Eldor-Itskovitz J, Lowenstein L. Alterations of heart rate variability in women with overactive bladder syndrome. Int Urogynecol J 2012 Aug;23(8):1081-6.