65–67 In an epidemiological study, Rohrmann et al. reported that men with metabolic syndrome had an increased risk of nocturia, incomplete bladder emptying, weak stream

and hesitancy.68 Yu et al. indicated that hyperlipidemia is associated with OAB in Taiwanese women.69 Furthermore, obesity alone or combing with diabetes can precipitate Selleck HSP inhibitor lower urinary tract dysfunction, such as OAB and stress urinary incontinence in women.70 The impact of diabetes on the lower urinary tract is multifactorial, including osmolarity diuresis effect, metabolic perturbation, and neuropathy. Diabetes may cause dysfunctions of smooth muscle, urothelium and neuronal components of the bladder.71,72 In a survey of 1359 consecutive DM subjects, 22.5% reported having OAB with 11.7% reporting OAB dry and 10.8% with OAB wet.73 The male gender (24.8%) was more commonly associated with OAB than female gender (20.1%) in DM population with a mean age of 60 years.73 Diabetic men had a larger prostate than the non-diabetic group.74 Men aged 60 years or above had a high prevalence of benign prostatic hyperplasia, which often caused BOO and contributed to the presence OAB. The impact of diabetes on bladder function was observed in a model of streptozocin-induced diabetic rats. In the early stage of diabetic bladder dysfunction, remodeling of the bladder wall occurs.75,76The

diuresis and metabolic effects of diabetes result in detrusor hypertrophy and mechanical property changes, which Beta adrenergic receptor kinase cause a decrease in bladder voiding efficiency. The early stage of diabetic vesical neuropathy also contributes to the development of detrusor

overactivity. Increased expression this website of M2 and M3 receptors in uroepithelium and bladder muscle layer were observed in 2-week-old streptozocin-induced diabetic rats.77,78 However, in patients with classic diabetic cystopathy, decreased bladder sensation and urodynamic detrusor underactivity are seen and may explain why some patients with diabetic bladder dysfunction can have reduced urgency. In an animal model of metabolic syndrome induced by fructose feeding, Tong et al. reported that upregulation of M2,3-muscarinic receptors in the bladder were associated with DO.79 The metabolic perturbations induced by long-term fructose feeding also contributed to DO and OAB symptoms, including proinflammation, increased oxidative stress, mitochondria dysfunction, an increase of apoptosis in the detrusor muscle, and detrusor hypertrophy.80,81 In a spontaneously hypertensive and hyperlipidemic rat model, Nobe et al. also indicated decreased Rho kinase and protein kinase activities, which weaken detrusor contractility.82 It has been shown that heritable hyperlipidemia can cause reduced bladder capacity, DO and nerve degeneration in a chronic hyperlipidemic rabbit model.83 This observation may explain the increase of OAB symptoms in patients with hyperlipidemia.70 Azadoi et al.