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Effect of caffeine on bladder function in patients with overactive bladder symptoms

Effect of caffeine on bladder function in patients with overactive bladder symptoms bladder (OAB) adults. Materials and Methods: Nine women and three men aged 21–40 years with OAB symptoms were included. Each subject drank 8 ml/kg of water with and without caffeine at two separate sessions. Cystometry and uroflowmetry were performed 30 minutes after each drink. The effects of caffeine on urodynamic parameters were compared. Results: After caffeine ingestion, the mean volume at bladder filling phase decreased at first desire to void and normal desire to void (P<0.05), compared to the mean volume after taking water (control) drink. The mean volume at strong desire to void, urgency and maximum cystometric capacity also tended to decrease. No change in the detrusor pressure at filling phase was found. At voiding phase, the maximal flow rate, average flow rate and voided volume were increased (P<0.05). The urine flow time and time to maximal flow rate were not changed. Conclusion: Caffeine at 4.5 mg/kg caused diuresis and decreased the threshold of sensation at filling phase, with an increase in flow rate and voided volume. So, caffeine can promote early urgency and frequency of urination. Individuals with lower urinary tract symptom should avoid or be cautious in consuming caffeine containing foodstuffs. Key Words: Caffeine, overactive bladder, uroflowmetry Address for correspondence: Dr. Supatra Lohsiriwat, Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok 10700, Thailand. E-mail: sislr@mahidol.ac.th Received: 18.06.2010, Accepted: 01.10.2010 [1] INTRODUCTION proven pathology. Quality of life is significantly impaired in [2] OAB patients, especially in women. Management includes Overactive bladder (OAB) is a common syndrome described excluding pathology and implementing behavioral changes by the International Continence Society (ICS) in 2002 as such as caffeine reduction, bladder and pelvic floor training, [3] “urgency, with or without urge incontinence, usually with as well as antimuscarinic drug therapy. As the etiology in frequency and nocturia,” in the absence of infection or other most cases is unknown, the treatment outcomes have until [3] recently been unsatisfactory. Treatment compliance, either Access this article online in pharmacologic or nonpharmacologic therapy, is often Quick Response Code: problematic. Caffeine is often blamed to exacerbate OAB Website: www.urologyannals.com symptoms, so patients are usually advised to avoid caffeine [3-5] consumption. For those OAB patients who are coffee lovers, avoiding coffee and coffee products can equally hurt DOI: their quality of life, and they may wonder if caffeine actually 10.4103/0974-7796.75862 has anything to do with their OAB symptoms at all. 14 Urology Annals | Jan - Apr 2011 | Vol 3 | Issue 1 Lohsiriwat, et al.: Caffeine and OAB This study aimed to evaluate the effect of caffeine at the dose Skovlunde, Danmark). It was set up and the method was of 4.5 mg/kg on bladder function in OAB adults. performed according to “Good Urodynamics practice” as [6] recommended by the International Continence Society. A MATERIALS AND METHODS 10-Fr double lumen catheter was inserted into the bladder. The bladder was filled with 0.9% sodium chloride at room T his study was reviewed and approved by the Siriraj temperature at a rate of 50 ml/minute in sitting position. Intra- Ethics Committee on Research Involving Human Subjects abdominal pressure was measured by inserting 8 Fr single lumen (No.114/2004). Twelve OAB patients (nine females and catheter into the rectum. Bladder sensations of first desire to three males) were studied at the Urodynamic Laboratory, void (FDV), normal desire to void (NDV), strong desire to Division of Urology, Department of Surgery, Faculty of void (SDV) and urgency were recorded toward the increase Medicine Siriraj Hospital, Mahidol University, Bangkok, infiltrate volume. Maximum cystometric capacity (MCC) Thailand. They fulfilled the inclusion criteria that they were was recorded when the patients felt that they could no longer OAB patients (urgency, with or without urge incontinence, delay micturition. The following pressure parameters were usually with frequency and nocturia), aged 18–40 years, recorded: abdominal pressure (P ), intravesical pressure (P ), abd ves regular caffeine consumers (more than three cups of coffee detrusor pressure (P = P –P ), compliance (δ V/δ P) and det ves abd per week or equivalent), and routine urinalysis revealed no [7] involuntary bladder contraction during filling the bladder. abnormalities (negative result for sugar, protein, bile and microscopic examination). Two series of urodynamic study were performed on each subject at two different occasions by random, with at least The exclusion criteria included diseases affecting urinary system 1 week interval. In one occasion, a control drink (8 ml/kg such as diabetes mellitus, hypertension, neurological diseases, body weight of boiled water) was taken. In another occasion, any urinary tract disorders such as benign prostatic hyperplasia a caffeine drink (caffeine 4.5 mg/kg of body weight in 8 ml/ (BPH), prostate or bladder cancer, urethral stricture, urinary kg body weight of boiled water) was taken. According to many tract stone, urinary retention, urinary tract infection (within articles, caffeine content of beverages in the market ranges from 2 weeks before study), history of urinary tract surgery and a modest 50 mg to an alarming 505 mg per can or bottle. So, females during menstrual period or pregnancy. we aimed to test for caffeine effect at the dose of 200–250 mg or about 4.5 mg/kg. Each subject completed a previously validated, self- administered questionnaire to assess medical history and All data were calculated in the computer using SPSS program urinary symptoms. The questionnaire consisted of 11 version 12.0. All basic parameters including dP were presented det questions covering frequency, nocturia, weak urinary stream, as mean and standard error of mean (SEM). Kolmogorov- urgency, incomplete emptying, intermittency, hesitancy and Smirnor test was used to test the data distribution. Wilcoxon’s straining modified from American Urological Association signed-rank test was used to test the difference in variables that (AUA) symptom index to suit Thai cultures and used in were not normal distribution. Two-sided P value of less than Division of Urology, Siriraj Hospital. 0.05 was considered statistically significant. Voiding diary and water intake were recorded. Subjects were asked RESULTS to self-record 48-hour voiding diary and water intake. From this record, the total 24-hour urinary output, number of voids, The effects of caffeine on bladder functions were studied in 12 voiding interval, diurnal distribution, timing and triggers for OAB subjects using cystometric and uroflowmetric techniques. incontinence, and functional bladder capacity were determined. The subjects’ characteristics are shown in Table 1. On arrival in our urodynamics unit, the patients were asked The temperature of the control and the caffeine drinks was to void in uroflowmetry machine (Dantec Urodyn 1000). about 24°C. The total amounts of water and caffeine consumed The parameters recorded were voided volume (V ), total by the subjects are shown in Table 1. comp voiding time (T100), time to maximum flowrate (TQ ), time max Table 1: Subject characteristics and the amount of water and of descending (T ), voiding time for 90% voided volume, desc caffeine consumed (mean±SEM) peak flow rate (Q ), mean flow rate (Q ), maximum rate of max ave Female:male 9:3 increase of flow rate (dQ/dT). Age (yr) 31.4±1.7 (range 21-40) Body weight (kg) 53.8±3.1 (range 43-75) Total dose of caffeine consumed (mg) 242.1±14.0 (range 193.5-337.5) Cystometry was performed with Dantec Manuet Multichannel Total volume of water consumed (ml) 433.3±23.5 (range 344-600) clinical urodynamics investigation System (Dantec Electrons, Urology Annals | Jan - Apr 2011 | Vol 3 | Issue 1 15 Lohsiriwat, et al.: Caffeine and OAB The baseline data on bladder functions were obtained from those after drinking water, though no statistical significance was reached. This finding indicates a tendency to an increase the voiding diary. The mean frequency of urine voiding was in bladder sensitivity after caffeine ingestion. 9.8±0.7 (range 6–16) times during the day and 3.0±0.6 (range 1–8) times during the night. Five subjects had incontinence The P at urgency and MCC were higher after caffeine intake, episodes and nine subjects had urgency symptom. det though not statistically significant. This indicates a tendency to stronger detrusor contractions at urgency and MCC after The results of the control and the caffeine drinks on bladder sensation are shown in Figure 1. After caffeine drink, volumes caffeine ingestion. No involuntary detrusor contractions were found. The P values are shown in Figure 2. of FDV and NDV decreased significantly compared to the det volumes at control day. The filling volume at FDV after The uroflowmetric parameters examined were V , T100, caffeine drink decreased in 10 subjects and increased in 2 comp TQ , Q and Q as presented in Figure 3. subjects, while the filling volume at NDV after caffeine drink max max ave decreased in 9 subjects and increased in 3 subjects. The volumes After caffeine consumption, the mean V increased comp of bladder filling at the SDV, urgency and MCC were all significantly compared to that after water ingestion. The mean decreased slightly without statistical significance (P>0.05). T100 tended to decrease after caffeine ingestion, though not significantly. T100 decreased in 10 subjects and increased After caffeine ingestion, the desire to void (FDV, NDV, and in 2 subjects. TQ after the caffeine ingestion was slightly SDV) came earlier at lower P compared to that found in max det decreased. Q and the Q increased significantly. max ave Volume (ml) DISCUSSION Water Caffeine This study, using cystometric and uroflowmetric techniques, demonstrated that drinking caffeine at the dose of 4.5 mg/kg Vcomp (ml) FD ND SD Urgency MCC Water Caffeine Sensations Figure 1: Sensation and volumes at bladder lling fi phases (mean±SE) Water in milliliters after water and caffeine ingestions (n=12) (FD=first Flow Rate (ml/sec) Cafferine desire to void, ND=normal desire to void, SD=strong desire to void, 25 MCC=maximal cystometric capacity); *P≤0.05 on comparing the volumes after water and caffeine ingestions Water Qm QM Detrusor Pressure ax 90 (mmHg) Caffeine Time (Sec) Q TQ FD ND SD Urgency MCC max Sensations Figure 2: Detrusor pressure at filling phase (mean±SE) in mmHg after Figure 3: Uroo fl wmetric parameters (mean±SE) after water and caffeine water and caffeine ingestions (FD=first desire to void, ND=normal ingestions (Q100=o fl w time, TQ =time to max o fl w rate, Q =maximal max max desire to void, SD=strong desire to void, MCC=maximal cystometric o fl w rate, QM 90=average o fl w rate, V =voided volume); *P≤0.05 on comp capacity) comparing the values after water and caffeine ingestions 16 Urology Annals | Jan - Apr 2011 | Vol 3 | Issue 1 Lohsiriwat, et al.: Caffeine and OAB affected urinary bladder function in patients with OAB This study demonstrated that caffeine decreased the bladder symptoms when compared to drinking plain water. The volumes at the FDV and NDV, thereby making the bladder more sensitive to bladder filling. This finding agrees with the cardiovascular parameters recorded in this present study also indicated that caffeine at 4.5 mg/kg caused an increase in the concept that coffee or caffeine aggravates the OAB symptoms [16-20] systolic blood pressure and the diastolic blood pressure. This and caffeine restriction can be beneficial. is most likely due to the action of caffeine in increasing cardiac CONCLUSIONS contractility, and the slight decrease in heart rate is most likely due to the baroreceptor reflex. This study showed that caffeine at a dose of 4.5 mg/kg caused diuresis and decreased threshold of sensation at filling phase, Caffeine (chemical name 3,7-dihydro-1,3,7-trimethyl-1H- with an increase in flow rate and voided volume. So, caffeine purine-2,6-dione) has four identifiable cellular actions [8] can promote early urgency and frequency of urination as well in vitro. Firstly, caffeine is able to significantly block adenosine as nocturia symptoms. Individuals with lower urinary tract effects on A and A receptors at the low concentrations 2A 1 symptom should avoid or be cautious in consuming caffeine achieved after a single cup of coffee. Secondly, caffeine containing foodstuffs. inhibits cyclic nucleotide breakdown via inhibition of phosphodiesterase, for which 20 times higher concentrations REFERENCES are required. Thirdly, caffeine blocks GABA receptors at 40 times higher concentrations. Fourthly, at 100 times higher 1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The concentrations, caffeine mobilizes intracellular calcium depots. standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology 2003;61:37-49. Based on these cellular actions, caffeine affects various organ 2. Tubaro A. Den fi ing overactive bladder: Epidemiology and burden of disease. functions in the human body, including the urinary system. In Urology 2004;64:2-6. the present study, the urine volume was increased in the caffeine 3. Freeman RM, Adekanmi OA. Overactive bladder. Best Pract Res Clin Obstet Gynaecol 2005;19:829-41. group, confirming the diuretic effect of caffeine. Nocturia was 4. Sussman DO. Overactive bladder: Treatment options in primary care [5] found to associate with caffeine consumption. medicine. J Am Osteopath Assoc 2007;107:379-86. 5. Liao YM, Dougherty MC, Biemer PP, Liao CT, Palmer MH, Boyington AR, The present study showed that Q and Q were significantly et al. Factors related to lower urinary tract symptoms among a sample of max ave increased in the caffeine group. Yi et al., in 2006, studied the effects employed women in Taipei. Neurourol Urodyn 2008;27:52-9. 6. Schäfer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, of caffeine in streptozotocin-induced diabetic rats and found that et al. Good urodynamic practices: Uroflowmetry, filling cystometry, and [9] caffeine improved the detrusor contractility. Creighton et al. pressure-flow studies. Neurourol Urodyn 2002;21:261-74. nd reported that after consuming 200 mg of caffeine, patients 7. Abram P. Urodynamics. 2 ed. London: Springer verlag London limited; 1997. p. 20-73. with detrusor instability showed an increase in detrusor pressure 8. Fredholm BB, Battig K, Holmen J, Nehlig A, Zvartau EE. Actions of caffeine on bladder filling, while normal women showed no change in in the brain with special reference to factors that contribute to its widespread [10] cystometric parameters. use. Pharmacol Rev 1999;51:83-133. 9. Yi CR, Wei Zo, Deng XL, Sun ZY, Li XR, Tian CG. Effects of coffee and Caffeine at a high concentration is a calcium releaser, releasing caffeine on bladder dysfunction in streptozotocin-induced diabetic rats. Acta [11] Pharmacol Sci 2006;27:1037-43. calcium from its intracellular store. This results in stronger 10. Creighton SM, Stanton SL. Caffeine: Does it affect your bladder? Br J Urol muscular contraction. Caffeine at a high concentration also 1990;66:613-4. improves reaction time, increases tense arousal, including 11. Yamamoto M, Unno T, Matsuyama H, Kohda M, Masuda N, Nishimura [12] anxiety, nervousness and jitteriness. This may result in an M. Two types of cation channel activated by stimulation of muscarinic receptors in guinea-pig urinary bladder smooth muscle. J Pharmacol Sci increase in perception of visceral sensation and interpretation. 2008;108:248-57 12. Nehlig A. Is caffeine a cognitive enhancer ? J Alzheimers Dis 2010;20: Since the pathophysiology of OAB is quite complex and still S85-94. [13] not so clear, the treatment is sometimes not satisfactory. It 13. Shafik A, El-Sibai O, Shafik AA, Ahmed I. The electrovesicogram in the overactive bladder: Role in determining pathogenesis and diagnostic is suggested that various stimulations release many substances, significance. 2004;32:290-3. including adenosine triphosphate, prostaglandins, nitric oxide, 14. Yoshida M, Masunaga K, Nagata T, Yono M, Homma Y. The forefront for and acetylcholine, from urothelium, which contributes to novel therapeutic agents based on the pathophysiology of lower urinary pathophysiology of the increased bladder sensation, OAB tract dysfunction: Pathophysiology and pharmacotherapy of overactive [14] bladder. J Pharmacol Sci 2004;112:128-34. symptoms, and detrusor overactivity. The bladder sensory 15. Lee SR, Kim HJ, Kim A, Kim JH. Overactive bladder is not only overactive profiles displayed a more sensitive bladder in OAB patients but also hypersensitive. Urology 2010;75:1053-9. compared with non-OAB subjects. OAB patients may have 16. Koziol JA, Clark DC, Gittes RF, Tan EM. The natural history of interstitial [15] bladders that are not only overactive but also hypersensitive. cystitis: A survey of 374 patients. J Urol 1993;149:465-9. Urology Annals | Jan - Apr 2011 | Vol 3 | Issue 1 17 Lohsiriwat, et al.: Caffeine and OAB 17. Weinberger MW, Goodman BM, Carnes M. Long-term efficacy of factors in older women. J Womens Health 2005;14:128-36. nonsurgical urinary incontinence treatment in elderly women. J Gerontol A 20. Hashim H, Al Mousa R. Management of fluid intake in patients with Biol Sci Med Sci 1999;54:M117-21. overactive bladder. Curr Urol Rep 2009;10:428-33. 18. Shorter B, Lesser M, Moldwin RM, Kushner L. Effect of comestibles on symptoms of interstitial cystitis. J Urol 2007;178:145-52. Source of Support: Nil, Conflict of Interest: None. 19. Bradley CS, Kennedy CM, Nygaard IE. Pelvic floor symptoms and lifestyle Author Help: Online submission of the manuscripts Articles can be submitted online from http://www.journalonweb.com. For online submission, the articles should be prepared in two files (first page file and article file). Images should be submitted separately. 1) First Page File: Prepare the title page, covering letter, acknowledgement etc. using a word processor program. All information related to your identity should be included here. Use text/rtf/doc/pdf files. Do not zip the files. 2) Article File: The main text of the article, beginning with the Abstract to References (including tables) should be in this file. Do not include any information (such as acknowledgement, your names in page headers etc.) in this file. Use text/rtf/doc/pdf files. Do not zip the files. Limit the file size to 1 MB. Do not incorporate images in the file. If file size is large, graphs can be submitted separately as images, without their being incorporated in the article file. This will reduce the size of the file. 3) Images: Submit good quality color images. Each image should be less than 4096 kb (4 MB) in size. The size of the image can be reduced by decreasing the actual height and width of the images (keep up to about 6 inches and up to about 1800 x 1200 pixels). JPEG is the most suitable file format. The image quality should be good enough to judge the scientific value of the image. For the purpose of printing, always retain a good quality, high resolution image. This high resolution image should be sent to the editorial office at the time of sending a revised article. 4) Legends: Legends for the figures/images should be included at the end of the article file. 18 Urology Annals | Jan - Apr 2011 | Vol 3 | Issue 1 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Urology Annals Pubmed Central

Effect of caffeine on bladder function in patients with overactive bladder symptoms

Urology Annals , Volume 3 (1) – Jul 1, 168

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0974-7796
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Abstract

bladder (OAB) adults. Materials and Methods: Nine women and three men aged 21–40 years with OAB symptoms were included. Each subject drank 8 ml/kg of water with and without caffeine at two separate sessions. Cystometry and uroflowmetry were performed 30 minutes after each drink. The effects of caffeine on urodynamic parameters were compared. Results: After caffeine ingestion, the mean volume at bladder filling phase decreased at first desire to void and normal desire to void (P<0.05), compared to the mean volume after taking water (control) drink. The mean volume at strong desire to void, urgency and maximum cystometric capacity also tended to decrease. No change in the detrusor pressure at filling phase was found. At voiding phase, the maximal flow rate, average flow rate and voided volume were increased (P<0.05). The urine flow time and time to maximal flow rate were not changed. Conclusion: Caffeine at 4.5 mg/kg caused diuresis and decreased the threshold of sensation at filling phase, with an increase in flow rate and voided volume. So, caffeine can promote early urgency and frequency of urination. Individuals with lower urinary tract symptom should avoid or be cautious in consuming caffeine containing foodstuffs. Key Words: Caffeine, overactive bladder, uroflowmetry Address for correspondence: Dr. Supatra Lohsiriwat, Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok 10700, Thailand. E-mail: sislr@mahidol.ac.th Received: 18.06.2010, Accepted: 01.10.2010 [1] INTRODUCTION proven pathology. Quality of life is significantly impaired in [2] OAB patients, especially in women. Management includes Overactive bladder (OAB) is a common syndrome described excluding pathology and implementing behavioral changes by the International Continence Society (ICS) in 2002 as such as caffeine reduction, bladder and pelvic floor training, [3] “urgency, with or without urge incontinence, usually with as well as antimuscarinic drug therapy. As the etiology in frequency and nocturia,” in the absence of infection or other most cases is unknown, the treatment outcomes have until [3] recently been unsatisfactory. Treatment compliance, either Access this article online in pharmacologic or nonpharmacologic therapy, is often Quick Response Code: problematic. Caffeine is often blamed to exacerbate OAB Website: www.urologyannals.com symptoms, so patients are usually advised to avoid caffeine [3-5] consumption. For those OAB patients who are coffee lovers, avoiding coffee and coffee products can equally hurt DOI: their quality of life, and they may wonder if caffeine actually 10.4103/0974-7796.75862 has anything to do with their OAB symptoms at all. 14 Urology Annals | Jan - Apr 2011 | Vol 3 | Issue 1 Lohsiriwat, et al.: Caffeine and OAB This study aimed to evaluate the effect of caffeine at the dose Skovlunde, Danmark). It was set up and the method was of 4.5 mg/kg on bladder function in OAB adults. performed according to “Good Urodynamics practice” as [6] recommended by the International Continence Society. A MATERIALS AND METHODS 10-Fr double lumen catheter was inserted into the bladder. The bladder was filled with 0.9% sodium chloride at room T his study was reviewed and approved by the Siriraj temperature at a rate of 50 ml/minute in sitting position. Intra- Ethics Committee on Research Involving Human Subjects abdominal pressure was measured by inserting 8 Fr single lumen (No.114/2004). Twelve OAB patients (nine females and catheter into the rectum. Bladder sensations of first desire to three males) were studied at the Urodynamic Laboratory, void (FDV), normal desire to void (NDV), strong desire to Division of Urology, Department of Surgery, Faculty of void (SDV) and urgency were recorded toward the increase Medicine Siriraj Hospital, Mahidol University, Bangkok, infiltrate volume. Maximum cystometric capacity (MCC) Thailand. They fulfilled the inclusion criteria that they were was recorded when the patients felt that they could no longer OAB patients (urgency, with or without urge incontinence, delay micturition. The following pressure parameters were usually with frequency and nocturia), aged 18–40 years, recorded: abdominal pressure (P ), intravesical pressure (P ), abd ves regular caffeine consumers (more than three cups of coffee detrusor pressure (P = P –P ), compliance (δ V/δ P) and det ves abd per week or equivalent), and routine urinalysis revealed no [7] involuntary bladder contraction during filling the bladder. abnormalities (negative result for sugar, protein, bile and microscopic examination). Two series of urodynamic study were performed on each subject at two different occasions by random, with at least The exclusion criteria included diseases affecting urinary system 1 week interval. In one occasion, a control drink (8 ml/kg such as diabetes mellitus, hypertension, neurological diseases, body weight of boiled water) was taken. In another occasion, any urinary tract disorders such as benign prostatic hyperplasia a caffeine drink (caffeine 4.5 mg/kg of body weight in 8 ml/ (BPH), prostate or bladder cancer, urethral stricture, urinary kg body weight of boiled water) was taken. According to many tract stone, urinary retention, urinary tract infection (within articles, caffeine content of beverages in the market ranges from 2 weeks before study), history of urinary tract surgery and a modest 50 mg to an alarming 505 mg per can or bottle. So, females during menstrual period or pregnancy. we aimed to test for caffeine effect at the dose of 200–250 mg or about 4.5 mg/kg. Each subject completed a previously validated, self- administered questionnaire to assess medical history and All data were calculated in the computer using SPSS program urinary symptoms. The questionnaire consisted of 11 version 12.0. All basic parameters including dP were presented det questions covering frequency, nocturia, weak urinary stream, as mean and standard error of mean (SEM). Kolmogorov- urgency, incomplete emptying, intermittency, hesitancy and Smirnor test was used to test the data distribution. Wilcoxon’s straining modified from American Urological Association signed-rank test was used to test the difference in variables that (AUA) symptom index to suit Thai cultures and used in were not normal distribution. Two-sided P value of less than Division of Urology, Siriraj Hospital. 0.05 was considered statistically significant. Voiding diary and water intake were recorded. Subjects were asked RESULTS to self-record 48-hour voiding diary and water intake. From this record, the total 24-hour urinary output, number of voids, The effects of caffeine on bladder functions were studied in 12 voiding interval, diurnal distribution, timing and triggers for OAB subjects using cystometric and uroflowmetric techniques. incontinence, and functional bladder capacity were determined. The subjects’ characteristics are shown in Table 1. On arrival in our urodynamics unit, the patients were asked The temperature of the control and the caffeine drinks was to void in uroflowmetry machine (Dantec Urodyn 1000). about 24°C. The total amounts of water and caffeine consumed The parameters recorded were voided volume (V ), total by the subjects are shown in Table 1. comp voiding time (T100), time to maximum flowrate (TQ ), time max Table 1: Subject characteristics and the amount of water and of descending (T ), voiding time for 90% voided volume, desc caffeine consumed (mean±SEM) peak flow rate (Q ), mean flow rate (Q ), maximum rate of max ave Female:male 9:3 increase of flow rate (dQ/dT). Age (yr) 31.4±1.7 (range 21-40) Body weight (kg) 53.8±3.1 (range 43-75) Total dose of caffeine consumed (mg) 242.1±14.0 (range 193.5-337.5) Cystometry was performed with Dantec Manuet Multichannel Total volume of water consumed (ml) 433.3±23.5 (range 344-600) clinical urodynamics investigation System (Dantec Electrons, Urology Annals | Jan - Apr 2011 | Vol 3 | Issue 1 15 Lohsiriwat, et al.: Caffeine and OAB The baseline data on bladder functions were obtained from those after drinking water, though no statistical significance was reached. This finding indicates a tendency to an increase the voiding diary. The mean frequency of urine voiding was in bladder sensitivity after caffeine ingestion. 9.8±0.7 (range 6–16) times during the day and 3.0±0.6 (range 1–8) times during the night. Five subjects had incontinence The P at urgency and MCC were higher after caffeine intake, episodes and nine subjects had urgency symptom. det though not statistically significant. This indicates a tendency to stronger detrusor contractions at urgency and MCC after The results of the control and the caffeine drinks on bladder sensation are shown in Figure 1. After caffeine drink, volumes caffeine ingestion. No involuntary detrusor contractions were found. The P values are shown in Figure 2. of FDV and NDV decreased significantly compared to the det volumes at control day. The filling volume at FDV after The uroflowmetric parameters examined were V , T100, caffeine drink decreased in 10 subjects and increased in 2 comp TQ , Q and Q as presented in Figure 3. subjects, while the filling volume at NDV after caffeine drink max max ave decreased in 9 subjects and increased in 3 subjects. The volumes After caffeine consumption, the mean V increased comp of bladder filling at the SDV, urgency and MCC were all significantly compared to that after water ingestion. The mean decreased slightly without statistical significance (P>0.05). T100 tended to decrease after caffeine ingestion, though not significantly. T100 decreased in 10 subjects and increased After caffeine ingestion, the desire to void (FDV, NDV, and in 2 subjects. TQ after the caffeine ingestion was slightly SDV) came earlier at lower P compared to that found in max det decreased. Q and the Q increased significantly. max ave Volume (ml) DISCUSSION Water Caffeine This study, using cystometric and uroflowmetric techniques, demonstrated that drinking caffeine at the dose of 4.5 mg/kg Vcomp (ml) FD ND SD Urgency MCC Water Caffeine Sensations Figure 1: Sensation and volumes at bladder lling fi phases (mean±SE) Water in milliliters after water and caffeine ingestions (n=12) (FD=first Flow Rate (ml/sec) Cafferine desire to void, ND=normal desire to void, SD=strong desire to void, 25 MCC=maximal cystometric capacity); *P≤0.05 on comparing the volumes after water and caffeine ingestions Water Qm QM Detrusor Pressure ax 90 (mmHg) Caffeine Time (Sec) Q TQ FD ND SD Urgency MCC max Sensations Figure 2: Detrusor pressure at filling phase (mean±SE) in mmHg after Figure 3: Uroo fl wmetric parameters (mean±SE) after water and caffeine water and caffeine ingestions (FD=first desire to void, ND=normal ingestions (Q100=o fl w time, TQ =time to max o fl w rate, Q =maximal max max desire to void, SD=strong desire to void, MCC=maximal cystometric o fl w rate, QM 90=average o fl w rate, V =voided volume); *P≤0.05 on comp capacity) comparing the values after water and caffeine ingestions 16 Urology Annals | Jan - Apr 2011 | Vol 3 | Issue 1 Lohsiriwat, et al.: Caffeine and OAB affected urinary bladder function in patients with OAB This study demonstrated that caffeine decreased the bladder symptoms when compared to drinking plain water. The volumes at the FDV and NDV, thereby making the bladder more sensitive to bladder filling. This finding agrees with the cardiovascular parameters recorded in this present study also indicated that caffeine at 4.5 mg/kg caused an increase in the concept that coffee or caffeine aggravates the OAB symptoms [16-20] systolic blood pressure and the diastolic blood pressure. This and caffeine restriction can be beneficial. is most likely due to the action of caffeine in increasing cardiac CONCLUSIONS contractility, and the slight decrease in heart rate is most likely due to the baroreceptor reflex. This study showed that caffeine at a dose of 4.5 mg/kg caused diuresis and decreased threshold of sensation at filling phase, Caffeine (chemical name 3,7-dihydro-1,3,7-trimethyl-1H- with an increase in flow rate and voided volume. So, caffeine purine-2,6-dione) has four identifiable cellular actions [8] can promote early urgency and frequency of urination as well in vitro. Firstly, caffeine is able to significantly block adenosine as nocturia symptoms. Individuals with lower urinary tract effects on A and A receptors at the low concentrations 2A 1 symptom should avoid or be cautious in consuming caffeine achieved after a single cup of coffee. Secondly, caffeine containing foodstuffs. inhibits cyclic nucleotide breakdown via inhibition of phosphodiesterase, for which 20 times higher concentrations REFERENCES are required. Thirdly, caffeine blocks GABA receptors at 40 times higher concentrations. Fourthly, at 100 times higher 1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The concentrations, caffeine mobilizes intracellular calcium depots. standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology 2003;61:37-49. Based on these cellular actions, caffeine affects various organ 2. Tubaro A. Den fi ing overactive bladder: Epidemiology and burden of disease. functions in the human body, including the urinary system. In Urology 2004;64:2-6. the present study, the urine volume was increased in the caffeine 3. Freeman RM, Adekanmi OA. Overactive bladder. Best Pract Res Clin Obstet Gynaecol 2005;19:829-41. group, confirming the diuretic effect of caffeine. Nocturia was 4. Sussman DO. Overactive bladder: Treatment options in primary care [5] found to associate with caffeine consumption. medicine. J Am Osteopath Assoc 2007;107:379-86. 5. Liao YM, Dougherty MC, Biemer PP, Liao CT, Palmer MH, Boyington AR, The present study showed that Q and Q were significantly et al. Factors related to lower urinary tract symptoms among a sample of max ave increased in the caffeine group. Yi et al., in 2006, studied the effects employed women in Taipei. Neurourol Urodyn 2008;27:52-9. 6. 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Published: Jul 1, 168

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