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Evaluation of Urine Choline Levels in Women With and Without Overactive Bladder Syndrome

Sheyn, David, MD*‡; Hijaz, Adonis K., MD*‡; Hazlett, Fred E. Jr, MS; Dawodu, Konyinsola, BS; El-Nashar, Sherif, MD‡§; Mangel, Jeffrey M., MD‡∥; Petrikovets, Andrey, MD*‡; Mahajan, Sangeeta T., MD‡§

Female Pelvic Medicine & Reconstructive Surgery: September 12, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000639
Original Article: PDF Only

Objective The objective of this study was to determine whether levels of choline (Ch) differ in women with and without overactive bladder (OAB) symptoms.

Methods New patients were evaluated using the overactive bladder symptom score; Medical, Epidemiologic, and Social Aspects of Aging (MESA) urgency incontinence questionnaire; and Impact Questionnaire 7 and provided a urine sample. Patients were stratified into asymptomatic controls, scoring 0 on overactive bladder symptom score and the MESA questionnaire, and patients with OAB and urgency incontinence (OAB-wet). Patients with conditions predisposing to OAB or had a history of OAB treatment were excluded. Choline detection was accomplished using a commercially available kit. Wilcoxon rank sum test and Fisher exact test were used to express differences between groups. Spearman ρ correlation was used to determine the relationship between Ch and questionnaire scores. Logistic regression was used to identify significant variables associated with OAB.

Results Sixty-three women were included in the final analysis. Patients with OAB-wet were older (P = 0.001), more likely to be obese (P = 0.04), had greater apical descent (P = 0.02), were more likely to be postmenopausal (P = 0.01), and were more likely to have stress incontinence (P = 0.005). Choline was 34.8% lower in OAB compared with the controls (P = 0.014). Lower Ch levels were associated with higher MESA (Spearman ρ = −0.311, P = 0.03). After logistic regression, lower Ch (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.96–0.98), age (aOR, 1.12; 95% CI, 1.08–1.18), and body mass index (aOR, 1.09; 95% CI, 1.01–1.18) were significantly associated with OAB-wet.

Conclusions Choline levels are significantly decreased in women complaining of OAB with urgency incontinence, and lower levels are associated with higher MESA scores.

From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals Cleveland Medical Center;

Department of Nutrition, Case Western Reserve University;

School of Medicine, Case Western Reserve University;

§Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center; and

Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.

Correspondence: David Sheyn, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH 44106. E-mail:

The authors have declared they have no conflicts of interest.

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