Nocturia is significantly associated with depressive symptoms in Caucasian-European men seeking medical help for sexual dysfunction without known psychiatric disorders
Boeri, L1; Capogrosso, P2; Ventimiglia, E2; Pederzoli, F2; Cazzaniga, W2; Frego, N2; Chierigo, F2; Pozzi, E2; Dehò, F2; Montanari, E1; Gaboardi, F2; Mirone, V3; Montorsi, F2; Salonia, A2
1: UOC Urologia Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; 2: Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; 3: Department of Urology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Objectives: We aimed to investigate the association between nocturia and mood impairment in a homogeneous cohort of Caucasian-European men seeking medical help for solitary erectile dysfunction (ED) as a primary reason for office evaluation, without any known psychiatric disorders.
Materials and Methods: Data from 426 patients with ED were analysed. Patients completed the Beck’s inventory for Depression (BDI), the International Index of Erectile Function (IIEF) and the International Prostatic Symptoms Score (IPSS). Depressive symptoms (DS) were considered for BDI≥11, with clinical depression (CD) defined as a BDI score ≥16. Nocturia was defined as ≥2 nocturnal voiding episodes. The number of nocturia episodes was assessed using IPSS question 7. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Testosterone deficiency (TD) was defined as tT <3.5 ng/mL. Descriptive statistics and logistic regression models tested the association between nocturia and DS and/or CD.
Results: Overall, mean (SD) age was 47.6 (14.1) yrs and mean tT value was 4.9 (2.9) ng/mL; TD was observed in 90 (21.2%) patients. Mean BDI was 7.23 (7.2); BDI scores suggestive for DS and CD were observed in 107 (25.1%) and 51 (12.0%) patients, respectively. Of all, 66 (15.6%), 59 (13.9%), 69 (16.1%) and 133 (31.2%) men had mild, mild-to-moderate, moderate and severe ED, respectively. Nocturia was reported in 150 (35.2%) men. Patients with nocturia showed higher rate of obesity (p=0.02), BDI scores suggestive for either DS (31.3% vs. 21.7%; p=0.029) or CD (18.7% vs. 8.3%; p=0.002) compared to patients without nocturia. No differences in terms of age, CCI, IIEF-EF and TD prevalence were observed between the two groups. At multivariable analysis, BMI (p=0.015), CCI (p=0.015), low IIEF-EF score (p=0.03) and nocturia (p=0.024) achieved independent predictor status for DS, after accounting for age and testosterone values. Conversely, only age (p=0.04), low IIEF-EF score (p=0.04) and nocturia (p=0.016) achieved independent predictor status for CD.
Conclusions: These findings showed that both DS and CD are highly prevalent in men with concomitant nocturia and sexual dysfunction. Nocturia emerged as an independent predictor for DS and CD in this cohort of patients not known for psychiatric disorders. Clinicians should consider administering a brief self-administered scale to investigate depressive symptoms mostly in patients with concomitant nocturia and ED.
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