title: Prevalence and management of lower urinary tract symptoms in methamphetamine abusers: an under-recognized clinical identity.
abstract: OBJECTIVE
  We investigate the prevalence of lower urinary tract symptoms in a cohort of methamphetamine abusers, and assess the therapeutic efficacy of α-blockers and anticholinergics.
  
  
  METHODS
  From May 2011 to March 2013, 78 male methamphetamine abusers diagnosed with methamphetamine addiction were identified at the National Forensic Hospital, Korea. The I-PSS (International Prostate Symptom Score) with consultation was used to investigate the prevalence of lower urinary tract symptoms, defined as total I-PSS 8 or greater and quality of life index score of 2 or greater. These values for methamphetamine abusers were compared to those of 71 age matched controls. α-Blockers and anticholinergics were administered to methamphetamine abusers with lower urinary tract symptoms according to predominant voiding and storage symptoms based on voiding-to-storage subscore ratios. For methamphetamine abusers with no response, defined as a reduction of 4 or less in total I-PSS, an alternative drug or combination was administered. Efficacy was assessed based on a 4-week interval.
  
  
  RESULTS
  The median periods of methamphetamine abuse and abstinence were 18.1 years and 5.7 months, respectively. Methamphetamine abusers showed a higher prevalence of lower urinary tract symptoms compared to controls (77% vs 15%, p <0.001), with higher I-PSS and quality of life index score (13.3 vs 5.6 and 2.9 vs 0.9, respectively; p <0.001). Anticholinergics showed the greatest effect on I-PSS reduction with overall response rates for α-blockers, anticholinergics and combinations of 13%, 61% and 14%, respectively. Seven (12%) methamphetamine abusers did not respond to any therapy.
  
  
  CONCLUSIONS
  Lower urinary tract symptoms were highly prevalent among methamphetamine abusers. Our results imply that pathological dopaminergic mechanisms have a role in methamphetamine associated lower urinary tract symptoms. Moreover, first line anticholinergics and prompt combination with α-blockers conferred the most therapeutic benefit to nonresponders.
authors: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Drug and Substance Abuse Treatment and Rehabilitation Center, National Forensic Hospital, Banpo-meun, Gongju, Republic of Korea.
authors: Kyo Chul
authors: KC
authors: Koo
authors: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Dong Hoon
authors: DH
authors: Lee
authors: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Jang Hwan
authors: JH
authors: Kim
authors: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Koon Ho
authors: KH
authors: Rha
authors: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Byung Ha
authors: BH
authors: Chung
authors: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: sjhong346@yuhs.ac.
authors: Sung Joon
authors: SJ
authors: Hong
authors: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: mahsy@yuhs.ac.
authors: Sang Yol
authors: SY
authors: Mah
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D016022:Case-Control Studies; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008694:Methamphetamine / Q000633:toxicity*; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D056910:Republic of Korea / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000317:Adrenergic alpha-Antagonists; D018680:Cholinergic Antagonists; D008694:Methamphetamine
keywords: lower urinary tract symptoms; methamphetamine; prevalence; treatment outcome