Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
Male lower urinary tract symptoms (LUTS) are common, as they affect approximately 20% of men aged >45 yr and increase with age [1]. Aside from possible complications, LUTS has generally been considered a benign problem that mainly affects quality of life. In this month's issue of European Urology, however, Gacci and coworkers presented level 1a evidence of a correlation between LUTS severity and risk of major adverse cardiac events (MACE) through a well-performed systematic review and meta-analysis [2].
The historical view has been that male urinary problems are caused by age-related growth of the prostate gland, and LUTS has been seen as a symptom complex isolated from a man's general state of health. However, over recent decades, the view of male LUTS has become more balanced, and most experts now view the pelvic floor as a functional unit, meaning that LUTS has several possible causes [3]. One of the most predominant theories is the association and possible causative effect between metabolic factors and LUTS. Metabolic disturbances may cause LUTS through an insulin growth factor pathway, leading to increased prostate size and/or prostatic swelling from chronic inflammation [4]. In addition, an unhealthy lifestyle may cause pelvic atherosclerosis, which affects blood supply and leads to functional impairment of the bladder and urinary tract [5]. This will result in LUTS that is clinically indistinguishable from symptoms caused by benign prostatic enlargement. Because the same factors are known to cause cardiovascular disease, this provides the theoretical pathophysiologic background for the study hypothesis that LUTS and cardiovascular disease are associated conditions. In line with the theoretical considerations, the study found that the presence of moderate to severe LUTS significantly increased the risk of a reported history of MACE in cross-sectional studies, and LUTS was associated with an increased incidence of MACE in longitudinal trials [2]. The association was especially pronounced in younger men and men with diabetes.
The results may be considered controversial, as another recent meta-analysis by Bouwman et al showed no overall association between male LUTS and the development of cardiovascular disease in longitudinal trials [6]. The main difference between the meta-analyses seems to be that Gacci et al excluded a study on nocturia (n = 2447) [7] but included a newer study that assessed LUTS using the American Urological Association Symptom Index questionnaire (n = 2301) [8]. Both of these studies found associations between urinary problems and cardiovascular events in unadjusted analyses, whereas the effects were eliminated with multivariate statistical models. When examining the methods of the two meta-analyses, Bouwman et al chose to adjust for confounding factors such as obesity, hypertension, and diabetes in their primary analysis, whereas Gacci et al used the crude associations between LUTS and MACE. Considering that the theory is a shared metabolic pathophysiology between LUTS and cardiovascular disease, the adjustments made by Gacci et al seem more logical. There is no plausible reason why urinary problems in themselves would cause heart problems. This means that the conclusion that LUTS is not only associated with MACE but may also predict future cardiovascular events is credible and should be taken to heart by urologists.
Interestingly, the findings are quite similar to the known connection between cardiovascular disease and erectile dysfunction, and the implications for clinical practice are profound. LUTS may be an indicator of reduced general health and thus can be viewed as a signal to change one's lifestyle before more serious diseases arise. In essence, this enforces the view that we, as urologists, cannot see ourselves as physicians dealing exclusively with the urinary system and pelvic floor. Rather, we are faced with a responsibility to consider the global health of the aging man. This is especially important because tangible quality-of-life problems may be more likely to bring a man to see his doctor compared with theoretical future diseases. In this regard, a multidisciplinary approach with metabolic and cardiovascular workups is warranted in men presenting with LUTS. In practice, this will typically mean that men with an unknown cardiovascular risk profile should be referred to either a cardiologist or their general practitioner for further testing. For men at increased risk, the next step should be lifestyle changes involving diet and exercise. Generally, one should aim for weight loss through calorie restriction and increased physical activity consisting of aerobic and/or resistance training. This is undeniably a difficult goal to achieve, but it is nevertheless important because it has documented effects on MACE [9]. Whenever possible, patients should be offered support to achieve the desired lifestyle changes, and at a bare minimum, they should be informed of the possible benefits, thus empowering them to implement the needed lifestyle changes themselves.
There is limited data to suggest that modest weight loss in obese men may also be associated with clinically meaningful reductions in male LUTS [10]. Although more data are needed on the subject, it is feasible that weight loss could emerge as a first-line treatment for men with urinary problems in the future. As an added benefit for the aging man, lifestyle changes and weight loss may also improve both erectile function and testosterone levels [10]. Because these conditions are known to coexist with both LUTS and cardiovascular disease, the concept of urology as a gateway to improving the overall health of the aging male population is reinforced. With the demographic development of the Western world, the obligation to deliver high-quality health care to the aging population is only becoming more important. As physicians, we have a responsibility to consider the global health of our patients and not focus exclusively on a single symptom or disease. With their documentation of the connection between LUTS and MACE, Gacci and coworkers [2] have contributed important knowledge enabling urologists to further fulfill this responsibility.
