Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases

Abstract

Aging and major chronic diseases are risk factors for lower urinary tract symptoms (LUTS). On the other hand, oxidative stress (OS) is one of the fundamental mechanisms of aging and the development of chronic diseases. Therefore, OS might be a candidate mechanism linking these two clinical entities. This article aims to summarize the studies on the prevalence of LUTS, the role of OS in aging and chronic diseases, and the potential mechanisms supporting the putative link. A comprehensive literature search was performed to identify recent reports investigating LUTS and OS in major chronic diseases. In addition, studies on the impact of OS on the lower urinary tract, including bladder, urethra, and prostate, were collected and summarized. Many studies showed LUTS are prevalent in aging and major chronic diseases, including obesity, metabolic syndrome, diabetes, cardiovascular disease, hypertension, obstructive sleep apnea, autoimmune diseases, Alzheimer’s disease, and Parkinson’s disease. At the same time, OS is a key component in the pathogenesis of those chronic diseases and conditions. Recent studies also provided evidence that exacerbated OS can cause functional and/or structural changes in the bladder, urethra, and prostate, leading to LUTS. The reviewed data support the concept that OS is involved in multiple risk factors-associated LUTS, although further studies are needed to confirm the causative relationship. The specific ROS/RNS and corresponding reactions/pathways involved in chronic diseases and associated LUTS should be identified in the future and could serve as therapeutic targets.

Age‐specific effect of transurethral holmium laser enucleation of the prostate on overactive bladder in men with benign prostatic hyperplasia: An investigation using an overactive bladder symptom score

“…OAB is a complex, multifactorial symptom syndrome, 22 and OAB associated with metabolic syndrome has gained a lot of attention recently 23 . It arises from increased vesical afferent and efferent activity, oxidative stress‐related abnormalities, dysregulation of nutrient‐sensing pathways, and gut as well as bladder dysbiosis 22‐25 . Moreover, metabolic syndrome may further deteriorate bladder hypoperfusion secondary to BPH 23 .…”

“…23 It arises from increased vesical afferent and efferent activity, oxidative stressrelated abnormalities, dysregulation of nutrient-sensing pathways, and gut as well as bladder dysbiosis. [22][23][24][25] Moreover, metabolic syndrome may further deteriorate bladder hypoperfusion secondary to BPH. 23 Therefore, it is conceivable that metabolic syndrome might affect the persistence of OAB as well as de novo OAB.…”

Novel Key Ingredients in Urinary Tract Health—The Role of D-mannose, Chondroitin Sulphate, Hyaluronic Acid, and N-acetylcysteine in Urinary Tract Infections (Uroial PLUS®)

“…Considering that UTIs are characterized by increased oxidative stress in the urinary tract, which can contribute to tissue damage and exacerbate the inflammatory response, NAC could act as a potent antioxidant by replenishing intracellular glutathione levels and scavenging reactive oxygen species. The reduction of oxidative stress could therefore alleviate the damage caused by UTIs and support the healing process [ 68 , 69 , 70 ]. Lastly, the urinary tract’s mucosal lining acts as a physical barrier against bacterial colonization.…”

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“…[ 6 ] Aging is one main reason accounting for LUTS because of the structural and functional changes in lower urinary tracts of the elderly. [ 7 ] What is more, LUTS caused by some chronic diseases including obesity, metabolic syndrome, diabetes, obstructive sleep apnea, etc., is quite prevalent in children and young adults, [ 8 ] and some people with congenital neurological diseases or bladder dysfunction may even suffer from this issue in their lifetime. [ 7 ] Because of the troublesome symptoms like urinary incontinence, urinary frequency, urgency, nocturia, bladder pain, and so on, the quality of life of the LUTS patients will be greatly influenced.…”