The Association of Urinary Nerve Growth Factor Levels With Bladder Outlet Obstruction in Women

Abstract

Objectives Nerve growth factor (NGF) has been proposed as a urinary biomarker and previously shown to be elevated in male patients with bladder outlet obstruction (BOO) and other lower urinary tract symptoms. No published studies have examined NGF as a potential urinary biomarker in women with BOO. The aims of this prospective study were to evaluate NGF levels in urine from women with anatomic BOO resulting from pelvic organ prolapse (POP) and/or previous incontinence surgery and to measure the effect associated with surgical or conservative management. Methods From January to September 2012, all female patients referred for evaluation and management of BOO from POP or previous incontinence surgery were screened for enrollment. Inclusion criteria included elevated postvoid residual, valsalva voiding on urodynamics, or urinary peak flow (Qmax) of 12 mL/s or less. A control group of 10 asymptomatic age-matched female volunteers was also recruited. In all subjects, urinary NGF and creatinine (Cr) levels were measured and normalized to the urinary Cr concentrations (NGF/Cr). Urinary NGF levels were measured at 1 month and 3 months after either surgical correction or initiation of clean intermittent catheterization. Results A total of 10 female patients with anatomic BOO (mean [SD] age of 66.2 [3.88] years) and 10 female control subjects (mean [SD] age of 62 [7] years) were recruited. Nine patients had POP. Six patients had undergone a previous anti-incontinence procedure. Five patients had both POP and undergone a previous anti-incontinence procedure. The urinary NGF/Cr levels in the study patients with BOO (mean [SE] 20.8 [4.31] pg/mg) were significantly higher (P = 0.0001) than the levels in the age-matched control group (5.6 [0.65] pg/mg). After treatment, the urinary NGF/Cr level significantly decreased to 6.50 (0.57) pg/mg (P = 0.01) Conclusions In this study, female patients with anatomic BOO resulting from POP and/or previous incontinence surgery had significantly higher urinary NGF/Cr levels when compared with age-matched controls. After treatment, the urinary NGF/Cr levels significantly decreased.

The profile of urinary biomarkers in overactive bladder

“…In view of the fact that urinary biomarkers are increased in a wide spectrum of LUTS, the magnitude of variation of biomarkers' concentrations relative to a baseline or a cut-off value may be analyzed to provide insight about the underlying pathogenetic mechanisms of disease. As in the case of OAB, a similar degree of increase of NGF values was demonstrated in other pathologies such as BOO (3.71 fold increase relative to baseline values) 46 and urinary tract infections (UTI) (2.72 fold increase). 47 Interestingly, NGF saw significantly higher values in interstitial cystitis (IC) (34.5 fold increase).…”

The surgical effect on overactive bladder symptoms in women with pelvic organ prolapse

“…They showed that these levels were significantly higher when compared with age-matched controls. After surgical correction, the urinary NGF/Cr levels significantly decreased 1 month after intervention 30 . In this study with a larger patient population, we observed that the urinary NGF increased at the 1- and 3-month postoperative follow-ups and decreased to a level similar to baseline at 6-month after surgery.…”

Diminished long‐term recovery of peak flow rate (PFR) after robotic prostatectomy in men with baseline PFR <10 mL/s and incidental association with high‐risk prostate cancer

“…At first glance PFR ≤7 mL/s would seem unlikely to be associated with high‐risk prostate cancer. However recent studies suggest an association between significantly greater increases in NGF and BOO or BOO and OAB compared with controls. These finding are especially important in the light of recent evidence linking nerve growth and NGF with prostate cancer in both mice and human studies .…”

“…The aim of the present study was primarily to evaluate whether there were significant improvements in PFR from baseline after RARP in men at risk of BOO, similar to those in men without BOO, and whether the improvements persist over long‐term follow up . Finally, because several reports have found an association between BOO and nerve growth factor (NGF), we explored whether this relationship resulted in a more aggressive prostate cancer.…”