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Int Neurourol J > Volume 22(3); 2018 > Article
Kim: Deepening Knowledge Through Basic and Clinical Research
People of every age experience lower urinary tract symptoms (LUTS) are closely related with quality of life. The causes of LUTS are diverse, and methods to treat LUTS depending on their specific cause have therefore been developed. Moreover, treatment methods have evolved through the development of new therapies, as well as by increasing treatment quality and decreasing the frequency of adverse events associated with treatment through preclinical and clinical studies. This issue of the International Neurourology Journal (INJ) contains articles that investigate LUTS from various points of view, with the goal of in-depth perspectives on points to be considered by investigators in the field of neurourology.
Demographic factors such as sex, education, and lifestyle influence the prevalence of LUTS. An analysis of the characteristics of LUTS in elderly residents of rural areas in Korea reported that the majority of men and women experienced at least 1 LUTS, the most common of which was nocturia [1]. Urinary incontinence (UI) was the second most common LUTS in men and women, however, most common form of UI in women was stress UI, whereas urge UI was the most common type of UI in men. As reported by Park et al. [1] in this study, the increasing prevalence of overactive bladder (OAB) and UI in women after menopause is a well-known fact. Decreased estrogen is a risk factor for diminished function of the pelvic floor muscles and LUTS. However, few studies have investigated how low serum estrogen influences the pelvic floor muscles. The results by Carrasco-Ruiz et al. [2] offer some clues. They observed the presence of estrogen receptor alpha and beta in the pubococcygeus and iliococcygeus muscles. In addition, the expression of glucose transporter type 4 (Glut4) was analyzed to evaluate metabolic changes in the pubococcygeus and iliococcygeus muscles depending on the level of serum estrogen. Glucose uptake in adult skeletal muscle is mediated by Glut4, and estrogen controls Glut4-mediated glucose uptake [3,4]. Carrasco-Ruiz et al. [2] showed that Glut4 was expressed in the pubococcygeus and iliococcygeus muscles; however, high estradiol levels increased Glut4 expression and glycogen content only in the pubococcygeus muscle. These findings provide insights of pelvic floor muscle changes in menopausal women.
In this issue of INJ, 2 articles show that LUTS can play a key role in diagnosing or discriminating among diseases and that LUTS are common in patients with chronic diseases. LUTS are commonly seen in neurologic diseases, and they can be an initial symptom of specific neurologic diseases. Moreover, the similarities of LUTS among various neurologic diseases can cause confusion. Nonetheless, LUTS can play a key role for the differential diagnosis of neurologic diseases that show similar symptoms, such as neuromyelitis optica (NMO) and multiple sclerosis (MS). Declemy et al. [5] investigated differences in the LUTS experienced by patients between NMO and MS. NMO patients frequently experienced OAB and urinary retention, whereas low bladder compliance, serious urinary tract infections, and urinary retention were commonly observed in MS patients. As the survival rate of cancer patients is increasing, concerns about the functional changes caused by cancer treatment have emerged. Many reports have investigated voiding dysfunction associated with surgical treatment in cancer patients; however, studies of chemotherapy-associated voiding dysfunction are lacking. Cho et al. [6] analyzed the associations between the severity of chemotherapy-induced peripheral neuropathy (CIPN) and LUTS. Their results demonstrated that LUTS are important symptoms in patients with CIPN.
In addition, the current issue of INJ contains clinical studies to offer useful information about specific treatment modalities, such as an analysis of risk factors for stress UI after holmium laser enucleation of the prostate [7], follow-up results of a new therapeutic device for anterior vaginal wall prolapse [8], and factors associated with successful sacral neuromodulation [9].


Conflict of Interest
No potential conflict of interest relevant to this article was reported.


1. Park J, Kim ES, Lee YJ, Lee HS, Seo JT. Sex differences in lower urinary tract symptoms in older Korean adults living in rural areas: prevalence, quality of life, and associated factors. Int Neurourol J 2018;22:212-9. crossref
2. Carrasco-Ruiz MD, Hernández-Aragón LG, Chávez-Ríos JR, Rodríguez-Antolín J, Pacheco P, Martínez-Gómez M, et al. High estradiol differentially affects glucose transporter type 4 in the pelvic floor muscles of rats. Int Neurourol J 2018;22:161-8. crossref
3. Barros RP, Gustafsson JÅ. Estrogen receptors and the metabolic network. Cell Metab 2011;14:289-99. PMID: 21907136
crossref pmid
4. Gupte AA, Pownall HJ, Hamilton DJ. Estrogen: an emerging regulator of insulin action and mitochondrial function. J Diabetes Res 2015;2015:916585. PMID: 25883987
crossref pmid pmc pdf
5. Declemy A, Chesnel C, Charlanes A, Le Breton F, Ismael SS, Amarenco G. Specificity of lower urinary tract symptoms in neuromyelitis optica in comparison with multiple sclerosis patients. Int Neurourol J 2018;22:185-91. crossref
6. Cho OH, Yoo YS, Kim JC, Park RH, Hwang KH. Factors influencing lower urinary tract symptoms in advanced cancer patients with chemotherapy-induced peripheral neuropathy. Int Neurourol J 2018;22:192-9. crossref
7. Cho KJ, Koh JS, Choi JB, Kim JC. Factors associated with early recovery of stress urinary incontinence following holmium laser enucleation of the prostate in patients with benign prostatic enlargement. Int Neurourol J 2018;22:200-5. crossref
8. Palma PC, Monteiro MV, Ledesma MA, Altuna S, Sardi JJL, Riccetto CL. Treatment of anterior vaginal wall prolapse using transvaginal anterior mesh with apical fixation: a prospective multicenter study with up to 2 years of follow-up. Int Neurourol J 2018;22:177-84. crossref
9. Stensland KD, Sluis B, Vance J, Schober JP, MacLachlan LS, Mourtzinos AP. Predictors of nerve stimulator success in patients with overactive bladder. Int Neurourol J 2018;22:206-11. crossref
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Official Journal of Korean Continence Society & ESSIC (International Society for the Study of BPS) & Korean Society of Urological Research & The Korean Children’s Continence and Enuresis Society & The Korean Association of Urogenital Tract Infection and Inflammation & Korean Society of Geriatric Urological Care
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