Urgency incontinence travels with vascular disease and erectile dysfunction

Design

Secondary analysis of prospective observational cohorts

Population

2,118 adults (1,241 urgency incontinence, 609 urgency only, 268 controls)

Primary outcome

Vascular comorbidity and erectile dysfunction

Effect

Vascular comorbidity OR 3.2 (95% CI 1.7 to 6.2); erectile dysfunction 64% vs 29% of controls

A secondary analysis of the US LURN cohorts compared 1,241 people with urgency urinary incontinence, 609 with urgency without incontinence, and 268 controls.

Both urgency groups had about three times the odds of vascular comorbidity, such as angina, heart failure, myocardial infarction, stroke or peripheral vascular disease, after adjusting for age, sex and other comorbidity (OR 3.2, 95% CI 1.7 to 6.2). Among 762 men, erectile dysfunction affected 64% with urgency incontinence, 41% with urgency alone and 29% of controls. Cardiometabolic protein differences between groups disappeared after adjustment. Vascular comorbidity did not predict improvement at 12 months.

This is cross-sectional and based on self-reported vascular disease, so it cannot show that vascular disease causes urgency. It does fit a picture of bladder ischaemia contributing in some patients.

For clinicians, a man with urgency incontinence and erectile dysfunction is a reasonable prompt to review cardiovascular risk.

• Ask about erectile function in men presenting with urgency incontinence
• Consider checking blood pressure, lipids and glucose in patients with urgency incontinence and erectile dysfunction
• Vascular comorbidity did not predict a poorer response to treatment
• Remember anticholinergic burden when treating older patients with vascular disease

Why it matters

It links a common bladder symptom with cardiovascular risk that may be going unchecked.

Don't overread it

The design shows association; it does not show that treating vascular risk improves bladder symptoms.

The statistics, in plain English

An odds ratio of 3.2 with a confidence interval of 1.7 to 6.2 is a strong association, but the control group was small (268), and vascular disease was self-reported.

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