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Abstract

Background:

Lower urinary tract symptoms are common and can significantly impact quality of life, especially in men with co-morbidities and end-stage renal disease. The presence of lower urinary tract symptoms affect the quality of life of patients on hemodialysis.

Objectives:

The purpose of this study is assessing the presence and severity of lower urinary tract symptoms among male patients on hemodialysis. Factors that may exacerbate lower urinary tract symptoms were assessed and studied. The impact of lower urinary tract symptoms on quality of life was also identified.

Methods:

A prospective, multi-central, and cross-sectional study of male patients on hemodialysis was conducted. Demographics, clinical data, and core lower urinary tract symptoms score questionnaire were all collected. A correlation has been made between all variables.

Results:

One hundred forty-five patients were enrolled. Eighty-seven percent of hemodialysis patients had at least one storage symptom, and 85% had at least one voiding symptom. The prevalence of storage symptoms (frequency, nocturia, urgency, and urgency incontinence) was found to be 3%, 70%, 44%, and 12%, respectively. The voiding symptoms were mainly weak stream, straining, and incomplete emptying, which were found in 60%, 43%, and 36%, respectively. Fifteen percent of the cohort had a negatively significant impact on their quality of life. The absence of voiding symptoms was statistically linked to a better quality of life (p < 0.05). Hemodialysis patients who are over 60 years old, smokers, or obese were found to be significantly more likely to report storage symptoms (18%, 9%, and 79%, respectively; p < 0.05). Bladder pain was significantly correlated to the dialysis duration of more than 24 months (p < 0.05).

Conclusion:

Storage and voiding lower urinary tract symptoms are common among hemodialysis male patients with a minor impact on their quality of life. Age, smoking, and obesity are major risks of exaggerating such symptoms.

Keywords

CLSS ESRD lower urinary tract symptoms quality of life hemodialysis

Introduction

Lower urinary tract symptoms (LUTS) are common and hidden morbidity among a different cohort of patients and diseases according to several local and international studies.^1–6 LUTS are a broad category of symptoms that may directly affect the quality of life (QoL), especially in men with other co-morbidities.^7,8 Recently, subjective and objective evidence has been evolving to show that the lower urinary tract function is affected by the status of end-stage renal diseases.^9,10 Therefore, the presence of LUTS don’t not only affect the QoL of patients on hemodialysis (HD) but also may harbor a risk to the proposed renal transplant if not adequately addressed and treated.¹¹ Several factors play a role in developing LUTS among male patients on HD. For instance, age, duration of dialysis (DoD), and concomitant prostatic enlargement are potential risk factors for developing LUTS.^9,12 However, the evidence is still weak regarding the presence and severity of LUTS, risk factors, and the impact on QoL among HD patients.

LUTS, composed of both storage and voiding symptoms, can vary among different patient cohorts.^6,13 Storage symptoms such as nocturia, urgency, and urgency incontinence (UUI) can significantly affect the QoL of HD patients especially causing sleep disturbance.^14,15 However, given the complex co-morbidities of these patients, such storage symptoms might be overlooked by treating physicians.¹⁶ Furthermore, there is limited data on LUTS in HD patients. Therefore, we believe there’s a knowledge gap regarding LUTS and their impact on QoL in HD patients that this article aims to address. Poor QoL in HD patients may lead to negative impact and increase the morbidity and mortality of such vulnerable group.^17,18 Identifying this issue and its impact will guide treating physicians to screen for LUTS in HD patients early on, leading them to the appropriate investigations and treatments, ranging from simple bladder diaries to complex invasive urodynamic testing.¹⁹ Therefore, this study aims to analyze LUTS among HD patients across different institutions. This study enrolls patients on HD as a result of End-stage renal disease (ESRD) to analyze their storage and voiding symptoms and their impact on QoL. Factors such as, obesity, smoking, and diabetes are evidently linked to developing LUTS among different cohorts.^20,21 Thus, these variables are also analyzed to assess their impact on developing LUTS.

Methods

Study design and population

This multicentral, cross-sectional study enrolled male patients with HD. This study includes three main dialysis centers in Palestine. The data were prospectively collected and analyzed between October 2021 and January 2022. The study employed a convenient sampling method, inviting all HD patients from three dialysis centers who met the inclusion criteria to voluntarily participate in the study and fill out a questionnaire. Male patients over 18, with a dialysis duration of more than 12 months, were included. Patients with symptomatic urinary tract infection, an underlying functional or anatomical urological problem, or no urine output were excluded.

Data collection

A simple frequency-volume chart was used to assess the urine production among males with HD. Demographics and clinical data were collected. Age, body mass index (BMI), smoking, diabetes mellitus (DM), and dialysis duration in months were considered. The core lower urinary tract symptom score (CLSS) questionnaire was used.²² The Arabic version of the questionnaire was prepared and evaluated by a group of experts in the fields of urology and biostatisticians, the clarity of the questionnaire was pretested in a pilot study of 15 patients. This questionnaire measures LUTS severity and the impact on QoL. CLSS recognizes storage and voiding symptoms and the value of CLSS is linearly correlated to the severity of symptoms. There is a separate section about the impact of LUTS on QoL, which uses zero as delighted and six as terrible. The questionnaire has a total of 11 questions. The primary outcome was the detailed description of LUTS, which includes storage and voiding symptoms, risk factors for each category, and the impact on QoL.

Statistical analysis

The analysis was carried out using the IBM Statistical Package for Social Sciences (SPSS) program (version 21, developed by IBM Corporation). Descriptive analysis was employed to present participant characteristics, utilizing frequencies and percentages for categorical variables and mean ± standard deviation for continuous variables. Bivariate analysis was conducted using the Pearson chi-squared test to explore potential associations between demographic and clinical variables and storage and voiding symptoms. Additionally, this analysis aimed to uncover the relationship between LUTS and QoL among male HD patients. The significance level was set at p-values of less than 0.05.

Ethics approval and consent to participate

The study was conducted according to the ethical standards of the Human Experimentation Responsible Committee (institutional and national) and the Helsinki Declaration. Patients were invited to participate voluntarily, with a detailed explanation of the study’s purpose, objectives, and potential risks. To ensure confidentiality, no personal information was collected, and patients were identified by codes instead of names. Access to the collected data was restricted to the research team, exclusively for research purposes. Additionally, all patients provided verbal informed consent before participating in the study. The study protocol, including patient clinical data access and usage as well as conducting patient interviews and obtaining verbal informed consent, received approval from the Institutional Review Boards of An-Najah National University (Reference No: Med, Sep, 2021/8).

Results

Patients’ demographics and clinical data

One hundred forty-five patients were enrolled, with 74 (51%) being under the age of 60 years, 86 (61%) having a BMI of 25 or higher, 58 (41%) being smokers, 84 (58%) being diabetic, and 70 (48%) being on dialysis for more than 24 months. The median amount of urine output/24 h was 120 mL. Table 1 shows the demographics and clinical data.

Table 1.

Demographics and clinical data in male hemodialysis patients (N = 145).

Demographics	Frequency (%)	Median (range)
Age (years)
<60	74 (51)	59 (21–80)
⩾60	71 (49)	59 (21–80)
BMI
<18.5	4 (2.9)
18.5–24.9	50 (35.7)
25–29.9	44 (31.4)
⩾30	42 (30)
Smoking
Yes	58 (40.6)
No	85 (59.4)
DM
Yes	84 (58.3)
No	60 (41.7)
DoD (months)
⩽24	75 (51.7)	24 (0.5–156)
>24	70 (48.3)	24 (0.5–156)
Amount of urine (mL)		120 (5–500)

Storage symptoms

Frequency, urgency, and nocturia are common among the cohort, 5 (3%), 64 (44%), and 101 (70%), respectively. Stress urinary incontinence (SUI) and UUI are less prevalent in comparison to overactive bladder (OAB) symptoms as they appeared in 7 (5%) and 17 (12%), respectively. One hundred twenty-six (87%) had at least one storage symptom. Table 2 shows the frequency of both storage and voiding symptoms among HD patients.

Table 2.

Frequency of LUTS among male hemodialysis patients (N = 145).

LUTS	Frequency (%)	Median (range)
Storage symptoms score
Daytime frequency	5 (3.4)	2 (1–9)
Nocturia	101 (69.7)
Urgency	64 (44.1)
Urgency incontinence	17 (11.7)
Stress incontinence	7 (4.8)
At least one storage symptom	126 (86.9)
Voiding symptoms score
Weak stream	87 (60)	4 (1–15)
Straining	62 (42.8)
Incomplete emptying	52 (35.9)
Pain in the bladder	34 (23.4)
Pain in the urethra	53 (36.6)
At least one voiding symptom	123 (84.8)
Total score		6 (1–21)

Voiding symptoms

Weak stream, straining, and incomplete emptying were found in 87 (60%), 62 (43%), and 52 (36%), respectively. Eighty-five percent of the participants had at least one voiding symptom. Table 2 shows the frequency of both storage and voiding symptoms among HD patients.

Correlation between demographics and storage symptoms

Frequency significantly correlated to smoking and DoD of fewer than 24 months 9% and 7% (p < 0.05), respectively. Increasing BMI is strongly linked to nocturia as BMI of ⩾25 (77%), and ⩾30 (79%) had nocturia (p < 0.05). Age above 60 is significantly correlates to UUI (18%; p < 0.05). Table 3 displays the correlation between demographics, clinical data, and storage symptoms.

Table 3.

Correlation between demographics, clinical data, and storage symptoms among male hemodialysis patients (N = 145).

Storage symptoms	Age		BMI				Smoking		DM		DoD
Storage symptoms	<60	⩾60	<18.5	18.5–24.9	25–29.9	⩾30	No	Yes	No	Yes	⩽24	>24
Daytime frequency
No	71 (95.9%)	69 (97.2%)	4 (100%)	49 (98%)	41 (93.2%)	41 (97.6%)	85 (100%)	53 (91.4%)	58 (96.7%)	81 (96.4%)	70 (93.3%)	70 (100%)
Yes	3 (4.1%)	2 (2.8%)	0 (0%)	1 (2%)	3 (6.8%)	1 (2.4%)	0 (0%)	5 (8.6%)	2 (3.3%)	3 (3.6%)	5 (6.7%)	0 (0%)
p-Value^a	0.683		0.567				0.006		0.939		0.028
Nocturia
No	24 (32.4%)	20 (28.2%)	3 (75%)	20 (40%)	10 (22.7%)	9 (21.4%)	23 (27.1%)	20 (34.5%)	20 (33.3%)	23 (27.4%)	18 (24%)	26 (37.1%)
Yes	50 (67.6%)	51 (71.8%)	1 (25%)	30 (60%)	34 (77.3%)	33 (78.6%)	62 (72.9%)	38 (65.5%)	40 (66.7%)	61 (72.6%)	57 (76%)	44 (62.9%)
p-Value^a	0.577		0.032				0.342		0.442		0.085
Urgency
No	46 (62.2%)	35 (49.3%)	3 (75%)	27 (54%)	24 (54.5%)	23 (54.8%)	46 (54.1%)	34 (58.6%)	34 (56.7%)	46 (54.8%)	46 (61.3%)	35 (50%)
Yes	28 (37.8%)	36 (50.7%)	1 (25%)	23 (46%)	20 (45.5%)	19 (45.2%)	39 (45.9%)	24 (41.4%)	26 (43.3%)	38 (45.2%)	29 (38.7%)	35 (50%)
p-Value^a	0.119		0.880				0.594		0.821		0.170
Urgency incontinence
No	70 (94.6%)	58 (81.7%)	4 (100%)	40 (80%)	40 (90.9%)	40 (95.2%)	72 (84.7%)	54 (93.1%)	52 (86.7%)	75 (89.3%)	63 (84%)	65 (92.9%)
Yes	4 (5.4%)	13 (18.3%)	0 (0%)	10 (20%)	4 (9.1%)	2 (4.8%)	13 (15.3%)	4 (6.9%)	8 (13.3%)	9 (10.7%)	12 (16%)	5 (7.1%)
p-Value^a	0.016		0.101				0.128		0.631		0.098
Stress incontinence
No	72 (97.3%)	66 (93%)	4 (100%)	48 (96%)	42 (95.5%)	39 (92.9%)	78 (91.8%)	58 (100%)	57 (95%)	80 (95.2%)	71 (94.7%)	67 (95.7%)
Yes	2 (2.7%)	5 (7%)	0 (0%)	2 (4%)	2 (4.5%)	3 (7.1%)	7 (8.2%)	0 (0%)	3 (5%)	4 (4.8%)	4 (5.3%)	3 (4.3%)
p-Value^a	0.223		0.864				0.025		0.948		0.769

The significance value is 0.050. Bold figures indicate a significant p-value (<0.05).

DM: diabetes mellitus; DoD: duration of dialysis.

Statistical significance values calculated using Pearson’s chi-square test.

Correlation between demographics and voiding symptoms

Bladder pain significantly correlates to the dialysis duration of more than 24 months (p < 0.05). Nevertheless, none other voiding symptoms correlate significantly to demographics or clinical findings. Table 4 displays the correlation between demographics, clinical data, and voiding symptoms.

Table 4.

Correlation between demographics, clinical data and voiding symptoms among male hemodialysis patients (N = 145).

Voiding symptoms	Age		BMI				Smoking		DM			DoD
Voiding symptoms	<60	⩾60	<18.5	18.5–24.9	25–29.9	⩾30	No	Yes	No	Yes	⩽24	>24
Weak stream
No	33 (44.6%)	25 (35.2%)	2 (50%)	17 (34%)	17 (38.6%)	20 (47.6%)	34 (40%)	23 (39.7%)	23 (38.3%)	35 (41.7%)	35 (46.7%)	23 (32.9%)
Yes	41 (55.4%)	46 (64.8%)	2 (50%)	33 (66%)	27 (61.4%)	22 (52.4%)	51 (60%)	35 (60.3%)	37 (61.7%)	49 (58.3%)	40 (53.3%)	47 (67.1%)
p-Value^a	0.249		0.579				0.967		0.688		0.090
Straining
No	38 (51.4%)	45 (63.4%)	3 (75%)	32 (64%)	21 (47.7%)	24 (57.1%)	51 (60%)	31 (53.4%)	35 (58.3%)	48 (57.1%)	47 (62.7%)	36 (51.4%)
Yes	36 (48.6%)	26 (36.6%)	1 (25%)	18 (36%)	23 (52.3%)	18 (42.9%)	34 (40%)	27 (46.6%)	25 (41.7%)	36 (42.9%)	28 (37.3%)	34 (48.6%)
p-Value^a	0.143		0.380				0.437		0.887		0.172
Incomplete emptying
No	45 (60.8%)	48 (67.6%)	3 (75%)	32 (64%)	27 (61.4%)	27 (64.3%)	57 (67.1%)	35 (60.3%)	34 (56.7%)	59 (70.2%)	49 (65.3%)	44 (62.9%)
Yes	29 (39.2%)	23 (32.4%)	1 (25%)	18 (36%)	17 (38.6%)	15 (35.7%)	28 (32.9%)	23 (39.7%)	26 (43.3%)	25 (29.8%)	26 (34.7%)	26 (34.1%)
p-Value^a	0.394		0.954				0.411		0.093		0.756
Pain in the bladder
No	53 (71.6%)	58 (81.7%	3 (75%)	39 (78%)	35 (79.5%)	32 (76.2%)	65 (76.5%)	45 (77.6%)	45 (75%)	66 (78.6%)	63 (84%)	48 (68.6%)
Yes	21 (28.4%)	13 (18.3%)	1 (25%)	11 (22%)	9 (20.5%)	10 (23.8%)	20 (23.5%)	13 (22.4%)	15 (25%)	18 (21.4%)	12 (16%)	22 (31.4%)
p-Value^a	0.153		0.984				0.876		0.615		0.028
Pain in the urethra
No	44 (59.5%)	48 (67.6%)	2 (50%)	33 (66%)	30 (68.2%)	23 (54.8%)	58 (68.2%)	33 (56.9%)	36 (60%)	56 (66.7%)	50 (66.7%)	42 (60%)
Yes	30 (40.5%)	23 (32.4%)	2 (50%)	17 (34%)	14 (31.8%)	19 (45.2%)	27 (31.8%)	25 (43.1%)	24 (40%)	28 (33.3%)	25 (33.3%)	28 (40%)
p-Value^a	0.309		0.530				0.166		0.412		0.405

The significance value is 0.050. Bold figures indicate a significant p-value (<0.05).

DM, diabetes mellitus; DoD, duration of dialysis.

Statistical significance values calculated using Pearson’s chi-square test.

Impact of LUTS on QoL

One hundred twenty-four (86%) were satisfied with their storage and voiding symptoms. Twelve (8%), 8 (6%), and 1 (1%) “mostly dissatisfied,” “unhappy,” and Terrible feeling about their symptoms. Table 5 shows the impact of LUTS on QoL.

Table 5.

Impact of LUTS on quality of life among male hemodialysis patients (N = 145).

Quality of life	Frequency (%)
Delighted	4 (2.8)
Pleased	61 (42.1)
Mostly satisfied	40 (27.6)
Mixed, about equally satisfied and dissatisfied	19 (13.1)
Mostly dissatisfied	12 (8.3)
Unhappy	8 (5.5)
Terrible	1 (0.7)
Good (<4)	124 (85.5)
Poor (⩾4)	21 (14.5)

Correlation between LUTS and QoL

The absence of voiding symptoms was statistically linked to a better QoL (p < 0.05). No significant difference was found between storage symptoms and poor QoL (p > 0.05). Table 6 shows the impact of each symptom on QoL.

Table 6.

Correlation between LUTS and quality of life among male hemodialysis patients (N = 145).

LUTS	Frequency (%), quality of life		p-Value^a
LUTS	Good	Poor	p-Value^a
Absence of daytime frequency	120 (85.7)	20 (14.3)	0.721
Absence of nocturia	34 (77.3)	10 (22.7)	0.063
Absence of urgency	70 (86.4)	11 (13.6)	0.728
Absence of urgency incontinence	110 (85.9)	18 (14.1)	0.693
Absence of stress incontinence	118 (85.5)	20 (14.5)	0.988
Absence of weak stream	56 (96.6)	2 (3.4)	0.002
Absence of straining	77 (92.8)	6 (7.2)	0.004
Absence of incomplete emptying	86 (92.5)	7 (7.5)	0.001
Absence of pain in the bladder	99 (89.2)	12 (10.8)	0.023
Absence of pain in the urethra	86 (93.5)	6 (6.5)	0.000

The significance value is 0.050. Bold figures indicate a significant p-value (<0.05).

Statistical significance values calculated using Pearson’s chi-square test.

Discussion

Our results show that OAB is common among male patients with ESRD and being on regular HD. Underlying structural changes in bladder may be seen in ESRD.²³ Surprisingly, nocturia as a mono symptom was found in 70% of the cohort. The presence of nocturia rather than nocturnal polyurea in such a group of patients raises the question regarding the underlying pathophysiology and treatment.^24–26 Moreover, nocturia and sleep deprivation may negatively affect the mental health of such a vulnerable group of patients.^27–30 Thus, a bladder diary in HD has to be collected regularly as it is a simple tool that may early raise awareness about a potential lower urinary tract dysfunction (LUTD) and can differentiate between nocturia and nocturnal polyuria.³¹

Moreover, BMI is significantly associated with nocturia, according to our results. This is supported by the evidence that higher BMI and waist circumference are significantly associated with LUTS.^32,33 Thus, weight reduction strategies and regular exercise should be encouraged in this group of patients to help with LUTS.^34,35

UUI and SUI are not that common among male patients on HD. However, 87% of the cohort in our study complained of at least one storage symptom. Thus, a screening questionnaire about the storage LUTS is mandatory, especially since the treatment strategies for OAB are mostly lifestyle modification and medical treatment in the early phase, which are feasible and successful.^36–39 Furthermore, age, smoking, and high BMI are significantly related to different variable storage symptoms, according to our results. Thus, strategies such as lifestyle modification, smoking cessation, and regular physical activity may help to improve the overall storage symptoms.⁴⁰

Voiding symptoms are also a prominent feature in males on HD, higher than in the population-based study.⁴¹ Eighty-five percent of the cohort had at least one voiding symptom. Poor stream is the most prominent feature among this cohort of patients. It is not apparent whether it is related to the HD, poor urine output per stream, or even underlying bladder outlet obstruction.¹² However, such a problem has to be identified in order to reverse any underlying problem, such as benign prostatic enlargement or urethral stricture. Early identification may also help avoid unnecessary bladder damage secondary to high voiding pressure or consequent poor compliance, which harbor a risk to the potential transplanted kidney in the future.^42,43 Moreover, the poor flow may represent an underactive urinary bladder which has to be cleared by an objective test such as cytometry or video urodynamics.⁴⁴ Thus, we do believe that if the screening LUTS questionnaire raises the possibility of avoiding problem, a urinary flow test is a reasonable screening test prior to proceeding with further invasive tests.⁴⁵

Fifteen percent of the cohort had a negative impact on their QoL secondary to LUTS. Although it is a minority, it is significant as those patients are not willing to pursue with their life in such conditions. Several previous studies among different cohort of patients show a negative impact of LUTS on QoL.^2,46 Thus, actions should be taken to improve the HD QoL as it is already threatened by being connected to the dialysis machine most of the time.⁴⁷ Moreover, this study shows that the absence of voiding symptoms is positively correlated to a better QoL.

The study establishes that both voiding and storage LUTS are prevalent among HD patients, corroborating existing evidence.¹⁶ The findings reveal that LUTS significantly impair the QoL of these patients. It is well recognized that QoL in HD patients is influenced by various factors, including sleep disturbances, depression, and frailty.^48–50 The identification of LUTS as an additional factor exacerbating the difficulties faced by these patients represents a significant insight, highlighting the need for further attention in this area.

Addressing LUTS through various The International Continence Society (ICS) validated questionnaires can aid in their management.^19,22,51 Some patients might require more invasive diagnostics such as uroflowmetry and invasive urodynamics to ascertain the underlying issues prior to administering definitive treatments.^52,53 Looking ahead, future research could benefit from prospective and invasive studies that might include methodologies such as uroflowmetry or urodynamics. Such studies are poised to enhance our understanding of LUTDs in males undergoing HD, providing a foundation for improved diagnostic and treatment strategies.

Strength and limitation

This is the first study in Palestine to analyze LUTS among males on HD in three different centers in a prospective manner. Nevertheless, some limitations should be acknowledged. The absence of objective assessments such as urinary flow test and invasive urodynamics makes it difficult to draw major recommendations. LUTS is broad category of symptoms that required subjective and objective assessment to understand the pathophysiology and unmask major LUTD.¹⁹ Therefore, the addition of adjunctive tests such as uroflowmetry and invasive urodynamics is required in few occasions to properly evaluate LUTD according to the ICS.⁵⁴ Mainly, invasive urodynamics help to differentiate between underactive bladder and bladder outlet obstruction in case of poor flow, especially that the urine volume is decrease in HD.^55,56 Therefore, this article serves as an early call to conduct screenings for LUTS in HD patients, provide suitable noninvasive evaluations and treatments, and, in certain instances, recommend more invasive diagnostic procedures such as uroflowmetry and urodynamics. Moreover, future studies should aim to investigate more detailed information on relevant variables such as co-morbidities, medication usage, and socioeconomic status, thus enhancing the comprehensiveness of the research findings. Additionally, the use of a convenient sampling method without a formal sample size calculation is a limitation of this study.

Conclusion

LUTS represents a noticeable morbidity among HD patients that necessitates attention and treatment. Regular screening for LUTS among HD patients is advisable, with subsequent provision of suitable diagnostic measures and management strategies tailored to the severity of LUTS and its effects on QoL.

Supplemental Material

sj-docx-1-smo-10.1177_20503121241263302 – Supplemental material for Lower urinary tract symptoms among male patients on hemodialysis: Prospective and multi-central cross-sectional study

Supplemental material, sj-docx-1-smo-10.1177_20503121241263302 for Lower urinary tract symptoms among male patients on hemodialysis: Prospective and multi-central cross-sectional study by Faris Abushamma, Enas Zidan, Zainab E Douglass, Anas Jaber, Zaher Nazzal, Zakaria I Hamdan, Mahfouz Ktaifan and Hashim Hashim in SAGE Open Medicine

Footnotes

Acknowledgements

The abstract of this article was accepted as an oral presentation at the 20th Urological Association of Asia Congress 2023 which was held in United Arab Emirates from September 28, 2023 to October 1, 2023.

Author contributions

FA and ZN contributed to the conception of the idea, designed the study, and supervised the team in the data collection and analysis process in addition to participation in writing and finalization the article. EZ, ZED, and AJ conducted data collection, literature search, data analysis, and helped in writing the article. ZIH provided critical review and helped in the article final version. MK assisted in data analysis and article writing. HH contributed to the conception of the idea, reviewing and finalizing the article. All authors consented to the submission of the article to the journal after revising and approving the final version.

Availability of data and materials

The data from our surveillance are not available on the public domain due to privacy and ethical restrictions, but anyone interested in using the data for scientific purposes is free to request permission from the corresponding author.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethics approval

All aspects of the study protocol, including patient clinical data access and usage as well as conducting patient interviews, received approval from the Institutional Review Boards of An-Najah National University (Reference No. Med, Sep, 2021/8). The study was conducted according to the ethical standards of the Human Experimentation Responsible Committee (institutional and national) and the Helsinki Declaration.

Informed consent

Verbal Informed consent was obtained from all patients after detailed explanation of the study’s purpose and objectives, The IRB of An-Najah National University Approved verbal informed contest.

Trial registration

Not applicable.

ORCID iD

Faris Abushamma

Supplemental material

Supplemental material for this article is available online.

References

Abushamma

Nassar

Lower urinary tract symptoms among females with rheumatoid arthritis: a prospective cross-sectional study. Int J Gen Med 2021; 14: 8427–8435.

Ahmad

Saffarini

Samara

, et al. The impact of lower urinary tract symptoms on the quality of life during pregnancy: a cross-sectional study from Palestine. BMC Urol 2020; 20(1): 191.

Van Den Eeden

Ferrara

Shan

, et al. Impact of type 2 diabetes on lower urinary tract symptoms in men: a cohort study. BMC Urol 2013; 13: 12.

Elrashidy

, et al. Oxidative stress: a putative link between lower urinary tract symptoms and aging and major chronic diseases. Front Med 2022; 9: 812967.

Saffarini

Ahmad

Samara

, et al. Assessment of lower urinary tract symptoms during pregnancy: an observational cross-sectional study from Palestine. BMC Pregnancy Childbirth 2021; 21(1): 84.

Qasrawi

Tabouni

Almansour

, et al. An evaluation of lower urinary tract symptoms in diabetic patients: a cross-sectional study. BMC Urol 2022; 22(1): 178.

Papaefstathiou

Moysidis

Sarafis

, et al. The impact of diabetes mellitus on lower urinary tract symptoms (LUTS) in both male and female patients. Diabetes Metab Syndr 2019; 13(1): 454–457.

Liao

Chuang

YC.

Effect of lower urinary tract symptoms on the quality of life and sexual function of males in China, Taiwan, and South Korea: subgroup analysis of a cross-sectional, population-based study. Low Urin Tract Symptoms 2019; 11(2): O78–O84.

Zachoval

Borovicka

Marada

, et al. The effects of diuresis, duration of dialysis and age on lower urinary tract function in urologically healthy male patients on the waiting list for kidney transplant. Urol J 2018; 15(2): 49–54.

10.

Chen

Lee

Kuo

HC.

Reduction of cystometric bladder capacity and bladder compliance with time in patients with end-stage renal disease. J Formos Med Assoc 2012; 111(4): 209–213.

11.

Kashi

Wynne

Sadek

, et al. An evaluation of vesical urodynamics before renal transplantation and its effect on renal allograft function and survival. Transplantation 1994; 57(10): 1455–1457.

12.

Rule

Jacobson

Roberts

, et al. The association between benign prostatic hyperplasia and chronic kidney disease in community-dwelling men. Kidney Int 2005; 67(6): 2376–2382.

13.

Abushamma

Shbaita

, et al. The correlation between academic stress, overactive bladder syndrome (OAB) and quality of life among healthy university students: a cross-sectional study. Urologia 2024; 91(2): 426–434.

14.

Pawar

Gattani

Chaudhari

, et al. Impact of hemodialysis on sleep disorders in patients with end-stage renal disease in a Tertiary Care Academic Hospital. Cureus 2023; 15(8): e44416.

15.

Perl

Unruh

Chan

CT.

Sleep disorders in end-stage renal disease: “Markers of inadequate dialysis”?

Kidney Int 2006; 70(10): 1687–1693.

16.

Ando

Kamegawa

Shin

, et al. Lower urinary tract symptoms impair the quality of life in maintenance hemodialysis patients. Ren Replace Ther 2019; 5(1): 35.

17.

D’Onofrio

Simeoni

Rizza

, et al. Quality of life, clinical outcome, personality and coping in chronic hemodialysis patients. Ren Fail 2017; 39(1): 45–53.

18.

Ishtawi

Jomaa

Nizar

, et al. Vitamin D level, pain severity and quality of life among hemodialysis patients: a cross-sectional study. Sci Rep 2023; 13(1): 1182.

19.

Drake

MJ.

Fundamentals of terminology in lower urinary tract function. Neurourol Urodyn 2018; 37(Suppl 6): S13–S19.

20.

Gacci

Corona

Vignozzi

, et al. Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis. BJU Int 2015; 115(1): 24–31.

21.

Kawahara

Ito

Uemura

The impact of smoking on male lower urinary tract symptoms (LUTS). Sci Rep 2020; 10(1): 20212.

22.

Homma

Yoshida

Yamanishi

, et al. Core lower urinary tract symptom score (CLSS) questionnaire: a reliable tool in the overall assessment of lower urinary tract symptoms. Int J Urol 2008; 15(9): 816–820.

23.

Chen

Lee

Kuo

HC.

Changes in sensory proteins in the bladder urothelium of patients with chronic kidney disease and end-stage renal disease. Low Urin Tract Symptoms 2019; 11(2): O202–O208.

24.

Takezawa

Kuribayashi

Okada

, et al. Decreased renal function increases the nighttime urine volume rate by carryover of salt excretion to the nighttime. Sci Rep 2021; 11(1): 10587.

25.

Fukuda

Motokawa

Miyagi

, et al. Polynocturia in chronic kidney disease is related to natriuresis rather than to water diuresis. Nephrol Dial Transplant 2006; 21(8): 2172–2177.

26.

Hsu

, et al. Risks of nocturia in patients with chronic kidney disease—do the metabolic syndrome and its components matter? J Urol 2012; 188(6): 2269–2273.

27.

Ancoli-Israel

Bliwise

Nørgaard

JP.

The effect of nocturia on sleep. Sleep Med Rev 2011; 15(2): 91–97.

28.

Hafner

Andersson

FL.

Assessing the burden of nocturia in the workplace: the associations between nocturnal voiding, subjective well-being, work engagement and productivity. J Med Econ 2020; 23(9): 994–1003.

29.

Breyer

Shindel

Erickson

, et al. The association of depression, anxiety and nocturia: a systematic review. J Urol 2013; 190(3): 953–957.

30.

King-Wing Ma

Kam-Tao Li

. Depression in dialysis patients. Nephrology (Carlton) 2016; 21(8): 639–646.

31.

Weiss

Everaert

Management of nocturia and nocturnal polyuria. Urology 2019; 133S: 24–33.

32.

de Oliveira

Varella

Angelo

, et al. The relationship between the presence of lower urinary tract symptoms and waist circumference. Diabetes Metab Syndr Obes 2016; 9: 207–211.

33.

Penson

Munro

Signorello

, et al. Obesity, physical activity and lower urinary tract symptoms: results from the Southern Community Cohort Study. J Urol 2011; 186(6): 2316–2322.

34.

Mondul

Giovannucci

Platz

EA.

A prospective study of physical activity, sedentary behavior, and incidence and progression of lower urinary tract symptoms. J Gen Intern Med 2020; 35(8): 2281–2288.

35.

Silva

Grande

Peccin

MS.

Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev 2019; 4(4): CD012044.

36.

Yap

Brown

Cromwell

, et al. The impact of self-management of lower urinary tract symptoms on frequency-volume chart measures. BJU Int 2009; 104(8): 1104–1108.

37.

Brown

Yap

Cromwell

, et al. Self-management for men with lower urinary tract symptoms: randomised controlled trial. BMJ 2007; 334(7583): 25.

38.

Dmochowski

Abrams

Marschall-Kehrel

, et al. Efficacy and tolerability of tolterodine extended release in male and female patients with overactive bladder. Eur Urol 2007; 51(4): 1054–1064; discussion 64.

39.

Kaplan

Roehrborn

Rovner

, et al. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA 2006; 296(19): 2319–2328.

40.

Kawahara

Ito

Yao

, et al. Impact of smoking habit on overactive bladder symptoms and incontinence in women. Int J Urol 2020; 27(12): 1078–1086.

41.

Glasser

Carson

3rd Kang

, et al. Prevalence of storage and voiding symptoms among men aged 40 years and older in a US population-based study: results from the Male Attitudes Regarding Sexual Health study. Int J Clin Pract 2007; 61(8): 1294–1300.

42.

Lopez Pereira

Jaureguizar

Martinez Urrutia

, et al. Does treatment of bladder dysfunction prior to renal transplant improve outcome in patients with posterior urethral valves? Pediatr Transplant 2000; 4(2): 118–122.

43.

Ciszek

Urological evaluation prior to renal transplantation. Cent Eur J Urol 2015; 68(3): 383.

44.

Chang

Siu

Hsiao

, et al. Review of underactive bladder. J Formos Med Assoc 2018; 117(3): 178–184.

45.

Singla

Garg

Singla

, et al. Experience with uroflowmetry in evaluation of lower urinary tract symptoms in patients with benign prostatic hyperplasia. J Clin Diagn Res 2014; 8(4): NC01–NC03.

46.

Rosen

Giuliano

Carson

. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol 2005; 47(6): 824–837. doi: 10.1016/j.eururo.2004.12.013.

47.

Homaie Rad

Mostafavi

Delavari

, et al. Health-related quality of life in patients on hemodialysis and peritoneal dialysis: a meta-analysis of Iranian studies. Iran J Kidney Dis 2015; 9(5): 386–393.

48.

Wang

Tang

Chen

, et al. Poor sleep and reduced quality of life were associated with symptom distress in patients receiving maintenance hemodialysis. Health Qual Life Outcomes 2016; 14(1): 125.

49.

Alencar

SBV

de Lima

Dias

LDA

, et al. Depression and quality of life in older adults on hemodialysis. Braz J Psychiatry 2020; 42(2): 195–200.

50.

Garcia-Canton

Rodenas

Lopez-Aperador

, et al. Frailty in hemodialysis and prediction of poor short-term outcome: mortality, hospitalization and visits to hospital emergency services. Ren Fail 2019; 41(1): 567–575.

51.

Moreira

Jr. Neves

Neto

, et al. A population-based survey of lower urinary tract symptoms (LUTS) and symptom-specific bother: results from the Brazilian LUTS epidemiology study (BLUES). World J Urol 2013; 31(6): 1451–148.

52.

Abdul-Rahman

Al-Hayek

Belal

Urodynamic studies in the evaluation of the older man with lower urinary tract symptoms: when, which ones, and what to do with the results. Ther Adv Urol 2010; 2(5–6): 187–194.

53.

Jensen

KM.

Uroflowmetry in elderly men. World J Urol 1995; 13(1): 21–23.

54.

Drake

Doumouchtsis

Hashim

, et al. Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations. Neurourol Urodyn 2018; 37(Suppl 6): S50–S60.

55.

Mokoli

Sumaili

Lepira

, et al. Factors associated with residual urine volume preservation in patients undergoing hemodialysis for end-stage kidney disease in Kinshasa. BMC Nephrol 2018; 19(1): 68.

56.

Chapple

Osman

NI.

Underactive bladder versus bladder outlet obstruction: don’t get tricked!

Eur Urol Focus 2022; 8(2): 388–390.

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