Do we need to know more about the effects of hormones on lower urinary tract dysfunction? ICI-RS 2014

Abstract

This review article reflects the presentations and subsequent discussions during a think tank at the 5th International Consultation on Incontinence Research Society’s annual meeting, held in Bristol, UK (September 22–24, 2014). It reviews the current state of knowledge on the role of hormones in lower urinary tract dysfunction (LUTD) and overactive bladder (OAB) and in particular: highlights some specific basic research findings from discussion participants; reviews future research topics; and discusses potential new therapeutic opportunities for LUTD and OAB. The role of the large conductance voltage- and Ca2+-activated K+ (BK) channels, as novel therapeutic targets for OAB was discussed, in particular as recent studies on human detrusor smooth muscle suggest that estradiol exerts a direct non-genomic activation of the BK channels. Recent developments on the roles of sex hormones on diuresis, as well as the roles of melatonin and vitamin D on LUTD were also discussed. It was concluded that further basic science and translational studies are needed to better understand hormonal regulatory mechanisms of the lower urinary tract and the implications for novel treatment options for LUTD and OAB.

International Continence Society consensus on the diagnosis and treatment of nocturia

“…In the 2002 standardization document, low estrogen and menopause are recognized as a cause of nocturia, and androgen deprivation is also associated with LUTS and nocturia. There is no evidence‐based medicine to demonstrate that hormonal substitution in postmenopausal women is an effective treatment of nocturia (ICI‐RS 2017) . The 2015 NICE guidelines (https://www.nice.org.uk/guidance/ng23) state that there is a good evidence that hormonal substitution is helpful for vasomotor symptoms (hot flushes) and for vaginal atrophy and its consequences, but do not mention nocturia.…”

“…The sex hormones are also involved in regulation of diuresis. 26 Deficiency in sex hormones (estrogen, testosterone) is diagnosed based on history taking and physical examination and can be confirmed with blood analysis. Some validated questionnaires are available for diagnosing menopause.…”

Nongenomic modulation of the large conductance voltage- and Ca2+ -activated K+ channels by estrogen: A novel regulatory mechanism in human detrusor smooth muscle

“…, ; Hanna‐Mitchell et al. ). Large epidemiological studies investigating the use of systemic hormone replacement therapy in the prevention of cardiovascular disease and osteoporosis revealed that these therapies may increase the risk for development of urinary incontinence (Grady et al.…”

“…As BK channels are fundamental regulators of DSM function under normal and OAB conditions, when the channel expression is altered, pharmacological modulation of their activity could potentially be an effective approach to treat forms of lower urinary tract dysfunction, such as OAB (Petkov , ; Hanna‐Mitchell et al. ).…”

“…Current research has suggested a potential role for estrogen replacement therapies in the treatment of bladder disorders including overactive bladder (OAB) and urinary incontinence (Smith and Wein 2010;Robinson et al 2013Robinson et al , 2014. Some studies have reported positive results for estrogen therapies in mitigating symptoms of OAB in postmenopausal women, while other studies reported the contrary (Robinson et al 2013(Robinson et al , 2014Hanna-Mitchell et al 2016). Large epidemiological studies investigating the use of systemic hormone replacement therapy in the prevention of cardiovascular disease and osteoporosis revealed that these therapies may increase the risk for development of urinary incontinence (Grady et al 2001;Grodstein et al 2004;Hendrix et al 2005).…”