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Urgency Urinary Incontinence Is Associated with Vascular Comorbidity and Erectile Dysfunction: A LURN Cohort Analysis
Glenn T Werneburg1,2, Nathan P Goodrich3, Victor P Andreev3
1Department of Urology, University of Michigan, Ann Arbor, MI 48108.
Purpose:
To evaluate whether OAB subtypes urgency urinary incontinence (UUI) and urgency without incontinence (URG) are associated with vascular comorbidity, erectile dysfunction (ED), and cardiometabolic proteomic profiles.
Subjects:
and Methods: A secondary analysis of LURN I and II cohorts (controls, URG, UUI) was performed. Vascular comorbidity comprised self-reported angina, congestive heart failure, myocardial infarction, stroke, or peripheral vascular disease. Multivariable regression adjusted for age, sex, and non-vascular comorbidity burden. Serum samples underwent cardiometabolic proteomic profiling. Vascular and non-vascular predictors of 12-month improvement (PGI-I) were evaluated in LURN II (n=581).
Results:
Among 2,118 participants (268 controls; 1,241 UUI; 609 URG), urgency syndromes had higher odds of vascular comorbidity than controls (OR 3.2, 95% CI 1.7-6.2; p<0.001), similar for UUI and URG. Among 762 men, ED was more prevalent in urgency cases than controls (53% vs. 29%) and highest in UUI (64% vs. 41% in URG). IIEF reduction versus controls was larger in UUI than URG (-5.59, p<0.001 vs. -2.00, p=0.08). Proteomic profiling identified 22 cardiometabolic proteins more abundant in UUI than URG (FDR-adjusted p <0.05), including those involving lipid metabolism (ANGPTL3, APOM) and inflammation (CCL18). None remained significant after FDR correction following adjusting for age, sex, and non-vascular comorbidity burden. Vascular comorbidity was not associated with 12-month improvement; surgery/invasive therapy was.
Conclusions:
Urgency syndromes, particularly UUI, are associated with increased vascular comorbidity and erectile dysfunction relative to controls. Cardiometabolic proteomic differences between phenotypes were attenuated after adjusting for demographic and comorbidity factors. These findings support biologic heterogeneity across urinary urgency syndromes and a vascular/cardiometabolic contribution to urgency pathobiology.
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