Alteration of autonomic function in female urinary incontinence.
OBJECTIVE
Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) have different mechanisms of action. We believe that alteration of autonomic nervous system (ANS) activity may contribute to UUI because the lower urinary tract is regulated through the sympathetic and parasympathetic nervous systems. Heart rate variability (HRV) allows measurement of autonomic nervous function, therefore we measured and compared HRV parameters in women with urinary incontinence.


METHODS
From March 2008 to March 2010, we evaluated all patients who visited 2 university hospitals for treatment of urinary incontinence. Theywere performed 3-day voiding diary, urodynamic study, physical examination and routine laboratory examination. We excluded subjects who had diabetes, cardiovascular problems, or other condition that affect ANS. Patients with mixed urinary incontinence (MUI) were also excluded. Finally 47 women with SUI (group 1) and 29 women with UUI (group 2) were enrolled according to their symptoms and voiding diary. We compared their HRV parameters. And excluding 11 patients who had detrusor underactivity, we divided them again into group A, 53 women without detrusor overactivity (DO) and group B, 12 women with DO. We compared HRV parameters between DO and non-DO group.


RESULTS
Older women had a higher incidence of UUI and DO. In HRV parameters, only the ratio of low frequency (LF) and high frequency (HF) was significantly higher in group 2 than group 1 (3.5±3.6 vs. 1.6±1.1, P<0.05). Also group A had higher mean LF/HF ratio than group B (4.3±3.8 vs. 1.9±1.9, P<0.05).


CONCLUSIONS
Increased LF/HF values indicate relative sympathetic hyperactivity over parasympathetic activity. Changes in ANS activity could indicate the presence of UUI and potentially DO.
Department of Urology, The Catholic University of Korea School of Medicine, Seoul, Korea.
Joon Chul
JC
Kim
Kwan-Joong
KJ
Joo
Jin Tae
JT
Kim
Jong Bo
JB
Choi
Dae Sung
DS
Cho
Yong-Yeun
YY
Won
Cardiology. 1999;91(2):109-13
10449882
JAMA. 1998 Sep 16;280(11):951-3
9749464
Am J Gastroenterol. 2001 Feb;96(2):460-6
11232691
Eur Heart J. 1996 Mar;17(3):354-81
8737210
Scand J Urol Nephrol. 2001 Oct;35(5):350-6
11771860
Circulation. 1992 Jan;85(1):164-71
1728446
BJU Int. 2004 Mar;93(4):478-83
15008713
Crit Rev Biomed Eng. 1993;21(3):245-311
8243093
Am J Obstet Gynecol. 2004 Mar;190(3):602-8
15041987
Korean J Urol. 2010 Mar;51(3):183-6
20414394
Acta Obstet Gynecol Scand Suppl. 1990;153:7-31
2093278
Am J Physiol. 1981 Oct;241(4):H620-9
7315987
Neurourol Urodyn. 2007 Oct;26(6 Suppl):934-47
17696154
Ergonomics. 1973 Jan;16(1):85-97
4702067
Am J Cardiol. 1987 Feb 1;59(4):256-62
3812275
Rev Urol. 2003;5 Suppl 8:S3-S10
16985987
Tohoku J Exp Med. 2004 Sep;204(1):63-9
15329464
Eur Urol. 2002 Jul;42(1):29-33
12121726
J Urol. 2004 Jul;172(1):27-33
15201731
Psychophysiology. 1997 Nov;34(6):623-48
9401419
J Urol. 2000 Feb;163(2):646-51
10647702
J Urol. 2007 Dec;178(6):2483-7
17937953
Prog Urol. 2003 Sep;13(4):656-9
14650298
Eur Heart J. 1989 Dec;10(12):1060-74
2606116
Rev Urol. 2002;4 Suppl 4:S7-S18
16986023
Prog Urol. 2001 Jun;11(3):492-7
11512463
Urology. 2003 Jan;61(1):37-49
12559262
Am J Obstet Gynecol. 1994 Jun;170(6):1713-20; discussion 1720-3
8203431
Urology. 2005 Jun;65(6):1109-12; discussion 1113
15923026
Am J Manag Care. 2001 Mar;7(2 Suppl):S62-75
11261409
J Urol. 2006 Jul;176(1):367-73
16753445
BJU Int. 2005 Feb;95(3):335-40
15679789
Int J Urol. 1997 Mar;4(2):111-25
9179682
Urology. 1997 Dec;50(6A Suppl):36-52; discussion 53-6
9426749