Ariana L Smith1, Liisa Hantsoo2,3,4, Anna P Malykhina5, Daniel W File6, Rita Valentino7, Alan J Wein8, Mary D Sammel9, C Neill Epperson2,10,3,4. 1. Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, 800 Walnut Street, 19th Floor, Philadelphia, PA, 19107, USA. Ariana.smith@uphs.upenn.edu. 2. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19107, USA. 3. Penn Center for the Study of Sex and Gender in Behavioral Health, Philadelphia, PA, 19107, USA. 4. Penn Center for Women's Behavioral Wellness, Philadelphia, PA, 19107, USA. 5. Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, 80045, USA. 6. Department of Mathematics & Computer Science, Muhlenberg College, Allentown, PA, 18104, USA. 7. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA. 8. Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, 800 Walnut Street, 19th Floor, Philadelphia, PA, 19107, USA. 9. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19107, USA. 10. Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19107, USA.
Abstract
INTRODUCTION AND HYPOTHESIS: The aim of this study was to measure physiologic and psychologic stress reactivity in women with overactive bladder (OAB). There is growing evidence in preclinical models that central nervous system dysregulation, particularly in response to psychological stress, may contribute to lower urinary tract symptoms in women with OAB. METHODS: Postmenopausal women with OAB and healthy controls underwent Structured Clinical Interview for DSM-IV Axis I disorders (SCID) to identify those without identifiable psychiatric disease. Eligible participants underwent physiologic measures including basal (cortisol-awakening response; CAR) and stress-activated salivary cortisol levels, heart rate (HR), urinary metanephrines and neurotrophins, as well as validated symptom assessment for stress, anxiety, depression, and bladder dysfunction at baseline and during, and following an acute laboratory stressor, the Trier Social Stress Test (TSST). RESULTS: Baseline measures of cortisol reactivity measured by CAR showed blunted response among women with OAB (p = 0.015), while cortisol response to the TSST was greater in the OAB group (p = 0.019). Among OAB patients, bladder urgency as measured by visual analog scale (VAS) increased from pre- to post-TSST (p = 0.04). There was a main effect of TSST on HR (p < 0.001), but no group interaction. CONCLUSIONS: Preliminary findings suggest that women with OAB have greater physiologic and psychologic stress reactivity than healthy controls. Importantly for women with OAB, acute stress appears to exacerbate bladder urgency. Evaluation of the markers of stress response may suggest targets for potential diagnostic and therapeutic interventions.
INTRODUCTION AND HYPOTHESIS: The aim of this study was to measure physiologic and psychologic stress reactivity in women with overactive bladder (OAB). There is growing evidence in preclinical models that central nervous system dysregulation, particularly in response to psychological stress, may contribute to lower urinary tract symptoms in women with OAB. METHODS: Postmenopausal women with OAB and healthy controls underwent Structured Clinical Interview for DSM-IV Axis I disorders (SCID) to identify those without identifiable psychiatric disease. Eligible participants underwent physiologic measures including basal (cortisol-awakening response; CAR) and stress-activated salivary cortisol levels, heart rate (HR), urinary metanephrines and neurotrophins, as well as validated symptom assessment for stress, anxiety, depression, and bladder dysfunction at baseline and during, and following an acute laboratory stressor, the Trier Social Stress Test (TSST). RESULTS: Baseline measures of cortisol reactivity measured by CAR showed blunted response among women with OAB (p = 0.015), while cortisol response to the TSST was greater in the OAB group (p = 0.019). Among OABpatients, bladder urgency as measured by visual analog scale (VAS) increased from pre- to post-TSST (p = 0.04). There was a main effect of TSST on HR (p < 0.001), but no group interaction. CONCLUSIONS: Preliminary findings suggest that women with OAB have greater physiologic and psychologic stress reactivity than healthy controls. Importantly for women with OAB, acute stress appears to exacerbate bladder urgency. Evaluation of the markers of stress response may suggest targets for potential diagnostic and therapeutic interventions.
Authors: Paul Abrams; Linda Cardozo; Magnus Fall; Derek Griffiths; Peter Rosier; Ulf Ulmsten; Philip van Kerrebroeck; Arne Victor; Alan Wein Journal: Neurourol Urodyn Date: 2002 Impact factor: 2.696
Authors: Jong Kyu Kwon; Jae Heon Kim; Hoon Choi; In Ho Chang; Bo Ra Park; Soon-Sun Kwon; Eun Sil Lee; Gyu Yeon Choi; Jeong Jae Lee; Im Soon Lee Journal: Maturitas Date: 2014-07-28 Impact factor: 4.342
Authors: Bernard T Haylen; Dirk de Ridder; Robert M Freeman; Steven E Swift; Bary Berghmans; Joseph Lee; Ash Monga; Eckhard Petri; Diaa E Rizk; Peter K Sand; Gabriel N Schaer Journal: Int Urogynecol J Date: 2009-11-25 Impact factor: 2.894
Authors: W F Stewart; J B Van Rooyen; G W Cundiff; P Abrams; A R Herzog; R Corey; T L Hunt; A J Wein Journal: World J Urol Date: 2002-11-15 Impact factor: 4.226
Authors: Sonya S Brady; Linda Brubaker; Cynthia S Fok; Sheila Gahagan; Cora E Lewis; Jessica Lewis; Jerry L Lowder; Jesse Nodora; Ann Stapleton; Mary H Palmer Journal: Health Promot Pract Date: 2020-01-07
Authors: Shambe Mutungi; Jacqueline Parrish; Robert Maunder; May Alarab; Colleen D McDermott; Nucelio Lemos; Danny Lovatsis Journal: Int Urogynecol J Date: 2019-07-13 Impact factor: 2.894