Affective Temperament Profiles of Overactive Bladder Patients

Dear Editor,

We have read the article “Affective Temperament Profiles of Overactive Bladder Patients” presented by Saribacak et al. with great interest (1). This study assesses the potential relationship between the overactive bladder (OB) disease profile of individuals with temperament. The authors reported that there might be a relationship between OB syndrome, which presents as serotonergic dysfunction, and anxious temperament.

Overactive bladder, which is still one of the most controversial issues in urology, is defined as a complex of symptoms, including frequent urination without local pathological or metabolic causes, urgent sense of urination (accompanied or not accompanied by incontinence), and nocturia, by the International Continence Society (ICS) (2). As noted in this study, OB is a common disease; although the adult prevalence of OB reported to be 16.5%, it is known that the prevalence is about 20%–40% in the elderly (3). Twenty-nine is a small value for the number of participants in the study for a disease that affects approximately one-third of the population; therefore, this is the subject of our criticism.

Overactive bladder is a symptomatic condition, with the main symptom being a sense of urgency. Today, the terms OB and overactive detrusor (OD) are used interchangeably in the wrong way. OD is defined as the occurrence of involuntary detrusor contractions during the filling of the bladder by ICS (2,4). To diagnose OB, all the local, systemic, and metabolic pathologies that may cause OD must be ruled out. The first stage of diagnosis is careful history taking, physical examination, and urinalysis (4). In some patients, urine culture, residual urine determination, voiding diary, and symptom survey may be useful in the exclusion of other diseases and treatment planning (4). In noncomplicated cases, urinary ultrasound, urodynamic testing, and cystoscopy should not be performed in the first phase (4). Cases of abnormal uroflowmetry, significant residual urine volume, or neurogenic bladder can be considered as an indication for urodynamic testing. In this study, all participants were subjected to urodynamic testing. However, as mentioned in the guidelines, urodynamic testing in all patients is not necessary to diagnose OB (4).

On the other hand, although the etiology of OB is still controversial, decrease in the inhibition of detrusor muscle is commonly considered to be the underlying mechanism (4). Serotonin, which stimulates the 5-HT2A receptors in the detrusor, directly affects the bladder smooth muscle or indirectly causes contraction via the autonomic innervation of the bladder (5). Seratonin is a neurotransmitter that is important in the central and peripheral regulation of micturition. Serotonergic antidepressants are very effective in the treatment of urge urinary incontinence (5). As it noted in this study, serotonin metabolism disorders, which are considered to be an etiological factor in depression and anxiety disorders, are thought to predispose to the occurrence of OB (5,6). OB is a disease causing stress and anxiety in the patient; whether the anxiety and/or temperament lead to OB or vice versa remains controversial. We have used the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) as valid questionnaires to achieve a definitive diagnosis (7,8). These questionnaires, which are also valid in the Turkish society, have not been administered to all participants. We believe that this is a significant limitation (8). Although the main purpose of this study is to reveal the temperament profiles of OB patients, evaluation and comparison of symptoms of anxiety and depression in patients and healthy volunteers, will add strength to the research.

This study contributes to our knowledge about OB, the etiology of which is nearly unknown. However, we need more studies involving more participants and a better methodology to achieve more robust results for a better understanding of OB disease.