Coffee Drinking Tied To Urinary Incontinence In Men

Men who consume about two cups of coffee a day, or the equivalent amount of caffeine, are significantly more likely to have urinary incontinence or a "leaky bladder" than men who drink less or none at all, according to new research from the US.
Senior author Alayne D. Markland, a professor at the University of Alabama at Birmingham, and colleagues, report their findings in a paper published online 2 January in The Journal of Urology.

In their background information they note while several studies have already established a link between caffeine intake and leaky bladder in women, the evidence for such a link in men is limited.

For their study, the researchers used national survey results from NHANES 2005-06 and 2007-08. This gave them data on over 5,000 American men aged 20 and over, with complete data available on nearly 4,000 of them.

The survey had collected information about food and drink intake which allowed the researchers to work out the men's caffeine consumption, water intake, and the total moisture content of their diet.

The survey data also included Incontinence Severity Index scores, for which a value of 3 and above is rated moderate to urinary incontinence (UI). Moderate to severe UI is more than a few drops of urine leakage in a month.

After adjusting for other potential influencers, the researchers found the men who consumed the most caffeine were more likely to have a leaky bladder than those who consumed the least or none at all.

Their analysis shows men who consumed 234 or more mg per day of caffeine were 72% more likely to have moderate to severe UI than men who consumed the least or none at all.

Men with a daily caffeine intake of 392 mg per day were more than twice as likely to have leaky bladder problems.

In contrast, men's total water intake was not linked to their risk for moderate to severe UI.

The researchers conclude:

"Caffeine consumption equivalent to approximately 2 cups of coffee per day (250mg) is significantly associated with moderate-severe UI in US men."

They call for further studies to look into this link.

Although the researchers did not establish whether coffee drinking causes men's leaky bladder problem, Markland told the press "It's something to consider ..."
People who are having problems with urinary incontinence should modify their caffeine intake and I think that's part of clinical practice," she says, in a statement reported by Reuter's Health

Robotic-Assisted Radical Bladder Surgery Potentially Benefits Bladder Cancer Patients

About 30 percent of the more than 70,000 bladder cancer cases expected in 2012 are muscle invasive. In such cases, radical cystectomy is the preferred treatment. In a pilot trial, a team of investigators assessed the efficacy of open radical cystectomy (ORC) vs. robotic-assisted laparoscopic radical cystectomy (RARC). While there were no significant differences in treatment outcomes, RARC resulted in decreased estimated blood loss and shorter hospital stay compared to ORC. The results are published in the February 2013 issue of The Journal of Urology.

"In the last decade minimally invasive approaches including robotic-assisted approaches have emerged as viable surgical options for many urological malignancies with the promise of decreased morbidity with shorter hospital stays, faster recovery, and less narcotic analgesic requirements," says lead investigator Dipen J. Parekh, MD, Professor and Chairman of the University of Miami Miller School of Medicine's Department of Urology and Director of robotic surgery; formerly at the University of Texas Health Science Center at San Antonio.

The goal of the clinical trial was to provide preliminary data from a single institution's randomized trial that evaluated the benefits of robotic-assisted vs. open surgery in patients with invasive bladder cancer. The trial, conducted between July 2009 and June 2011, involved 47 patients and was performed at the University of Texas Health Science Center at San Antonio. Primary eligibility was based on candidacy for an open or robotic approach at the discretion of the treating surgeon. Forty patients were randomized individually and equally to either an ORC or RARC group using a computer randomization program. Each of the two study groups was similar in distribution of age, gender, race, body mass index, previous surgeries, operative time, postoperative complications, and final pathological stage.

Investigators evaluated five surgery outcome factors: Estimated blood loss, operative time from incision to closure, transfusion requirements, time to return of bowel function, and length of stay.

The robotic group experienced significantly decreased blood loss, accompanied by a trend toward faster return of bowel function, fewer hospitalizations beyond five days, and fewer transfusions.

"The strength of our study is the prospective randomized nature that eliminates selection biases that may have been present in prior retrospective analyses," says Dr. Parekh. "We also believe that our study demonstrates that a prospective randomized trial comparing traditional open and robotic approaches in bladder cancer is possible."

This investigative team has joined with several institutions nationally to build on its study and has started an advanced randomized clinical trial among multiple institutions to further compare and assess open vs. robotic-assisted radical cystectomy among patients with invasive bladder cancer. It plans to collect intermediate and long-term survival data from these same patients as well as data on quality of life, daily living activities, handgrip strength, and mobility.