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European UrologyVolume 60, issue 6, pages e49-e58, December 2011
Reply from Authors re: Christopher J. Keto, Elizabeth M. Masko, Stephen J. Freedland. Physical Activity, Obesity, and Lower Urinary Tract Symptoms. Eur Urol 2011;60:1181–3
Published online 7 September 2011, page 1183
Refers to article:
Physical Activity, Obesity, and Lower Urinary Tract Symptoms
December 2011 (Vol. 60, Issue 6, pages 1181 - 1183)
Refers to article:
Obesity Increases and Physical Activity Decreases Lower Urinary Tract Symptom Risk in Older Men: The Osteoporotic Fractures in Men Study
Accepted 12 July 2011
December 2011 (Vol. 60, Issue 6, pages 1173 - 1180)
We appreciate the balanced comments of Keto and colleagues . The complex physiologic mechanisms by which obesity increases and physical activity decreases the risks of lower urinary tract symptoms (LUTS) remain to be elucidated. Nevertheless, accumulating evidence linking modifiable risk factors with LUTS and benign prostatic hyperplasia (BPH)  and  demonstrates that lifestyle alterations may substantially alter the natural history of these conditions. We hope that our data—the first prospective analysis of obesity and physical activity with incident urinary symptoms in older men living in the community—will encourage translational studies of lifestyle interventions for LUTS and BPH.
Clinical trials are needed to determine whether behavioral modifications may prevent or delay LUTS onset in asymptomatic men, attenuate LUTS severity in symptomatic men, and obviate the need for medical or surgical treatment. Obese individuals represent a higher-risk population that may particularly benefit from lifestyle interventions . At least one study has demonstrated the feasibility and efficacy of targeting adiposity to treat urinary symptoms: In a randomized trial, weight loss led to reductions in urinary incontinence in obese women . Still, although weight loss is one potential intervention, the appeal of physical activity is that it is simple and beneficial to overall health and appears to be strongly protective against LUTS and BPH .
We look forward to further scientific endeavor in this field. Given their ubiquity among older men, their associated treatment costs, and their considerable morbidity, LUTS and BPH will undoubtedly impose ever-greater burdens on the public health of our aging population.
Conflicts of interest
The authors have nothing to disclose.
-  C.J. Keto, E.M. Masko, S.J. Freedland. Physical activity, obesity, and lower urinary tract symptoms. Eur Urol. 2011;60:1181-1183 Abstract, Full-text, PDF, Crossref.
-  J.K. Parsons. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol. 2007;178:395-401 Crossref.
-  J.K. Parsons, J. Bergstrom, E. Barrett-Connor. Lipids, lipoproteins and the risk of benign prostatic hyperplasia in community-dwelling men. BJU Int. 2008;101:313-318 Crossref.
-  J.K. Parsons, A.V. Sarma, K. McVary, J.T. Wei. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2009;182(Suppl):S27-S31 Crossref.
-  L.L. Subak, R. Wing, D.S. West, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481-490 Crossref.
-  J.K. Parsons, C. Kashefi. Physical activity, benign prostatic hyperplasia, and lower urinary tract symptoms. Eur Urol. 2008;53:1228-1235 Abstract, Full-text, PDF, Crossref.
a Division of Urology, University of California San Diego, San Diego, CA, USA
b Urologic Cancer Unit, Moores UCSD Cancer Center, La Jolla, CA, USA
c Department of Surgery, San Diego Veterans Affairs Medical Center, La Jolla, CA, USA
d Division of Biostatistics, Moores UCSD Cancer Center, La Jolla, CA, USA
e Department of Family and Preventive Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
f Department of Medicine, University of California San Francisco, San Francisco, CA, USA
g Department of Medicine, Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
h Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
© 2011 European Association of Urology, Published by Elsevier B.V.
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