Correction: Percentage fractions of urinary di(2-ethylhexyl) phthalate metabolites: Association with obesity and insulin resistance in Korean girls.

[This corrects the article DOI: 10.1371/journal.pone.0208081.].

Percentage fractions of urinary di(2-ethylhexyl) phthalate metabolites: Association with obesity and insulin resistance in Korean girls.

OBJECTIVE: We assessed the associations of percentage fractions of urinary di(2-ethylhexyl) phthalate (DEHP) metabolites with obesity and insulin resistance in Korean girls. METHODS: In total, 137 girls, aged 6 to 13 years (65 overweight cases and 72 controls), were recruited. Anthropometric indices and the homeostatic model assessment of insulin resistance (HOMA-IR) index were determined. Four major urinary DEHP metabolites were analyzed in spot urine samples by gas chromatography-tandem mass spectrometry, including mono(2-ethylhexyl) phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono(2-ethyl-5-carboxypentyl) phthalate. RESULTS: There were no significant differences in the urinary concentrations of the DEHP metabolites between the overweight and control groups. The percentage fraction of MEHHP (MEHHP%) among all DEHP metabolites was significantly higher in the overweight prepubertal girls than in the controls (P = 0.035). MEHHP% was positively associated with the body mass index percentile, waist circumference, body fat percentage, and HOMA-IR index in the prepubertal girls. After adjusting for covariates, the prepubertal girls in a higher MEHHP% quartile were found to have a higher odds ratio for central obesity than those in a lower quartile (odds ratios: 5.05 for quartile 3; 7.30 for quartile 4). The relative rate of MEHHP oxidation to MEOHP was negatively associated with the body mass index percentile and waist circumference in the prepubertal girls. However, no such association was observed in the pubertal girls. CONCLUSIONS: MEHHP% was positively associated with obesity and insulin resistance in prepubertal girls. Further studies are necessary to elucidate the causal links between altered phthalate metabolism and increased susceptibility to insulin resistance in children.

Clinical significance of anatomical urethral length on stress urinary incontinence women.

OBJECTIVE: To evaluate the association between the length of the female urethra and urodynamic study (UDS) parameters in patients presenting with stress urinary incontinence (SUI). PATIENTS AND METHODS: We retrospectively enrolled 391 women who underwent a transobturator adjustable tape sling implantation for the management of SUI between April 2009 and March 2016. All patients underwent a physical examination and UDS. Filling cystometry data that were evaluated included the Valsalva leak point pressure, and the cough leak point pressure. The maximal urethral closure pressure, the functional urethral length (FUL), and the length of the continence zone (LCZ) were measured using the urethral profile obtained from the UDS. The anatomical urethral length (AUL) was measured intraoperatively using a Foley catheter. We calculated the LCZ/FUL ratio to determine the anatomical continence length for this study. RESULTS: We noted that 299 patients completed the study. The mean AUL was 26.25±3.59 mm. The mean FUL and LCZ were 41.37±15.05 mm and 24.15±13.90 mm, respectively. The mean LCZ/FUL was 0.57±0.19. Using the Pearson correlation coefficient, we observed that the AUL showed a correlation with the FUL (0.168, P=0.034), the LCZ (0.212, P=0.007), the LCZ/FUL ratio (0.190, P=0.016), the Valsalva leak point pressure (0.223, P=0.005), the cough leak point pressure (0.215, P=0.006), and the maximal urethral closure pressure (0.178, P=0.043). CONCLUSION: Our results show that the AUL in women is associated with UDS parameters relating to SUI.

Clinical significance of diabetes mellitus on detrusor functionality on stress urinary incontinent women without bladder outlet obstruction.

INTRODUCTION AND HYPOTHESIS: Our aim was to evaluate the effect of diabetes mellitus (DM) on detrusor contractility (DC) in women without bladder outlet obstruction (BOO) by using urodynamic study (UDS). METHODS: We reviewed the clinical records of 863 consecutive women without BOO, each of whom was diagnosed with stress urinary incontinence (SUI) by UDS. Uroflowmetry measurements included maximal flow rate (Qmax), time to Qmax, voided volume, and postvoid residual urine volume (PVR). Data from filling cystometry included the first strong desire to void and the Valsalva leak-point pressure (VLPP). For voiding cystometry data, detrusor pressure at Qmax (Pdet@Qmax) and bladder contractility index (BCI) were analyzed. In the DM group, the level of glycosylated hemoglobin (HbA1c) and DM duration were measured. RESULTS: After the application of exclusion criteria, complete UDS data of 708 patients were available. The cohort was divided into two groups according to DM status. The DM group comprised 92 (12.9 %) patients, the non-DM group 616 (87.0 %). Mean maximal flow rate and Pdet@Qmax and bladder contractility index were lower in the DM group, in whom mean DM duration was 9.24 ± 7.63 years and mean HbA1c level 7.27 ± 1.43 %. DM duration was significantly correlated with Qmax (-0.309, p = 0.003), Pdet@Qmax (-0.369, p < 0.001), and BCI (-0.409, p < 0.001). Moreover, the HbA1c level was significantly correlated with Qmax (-0.256, p = 0.016), Pdet@Qmax (-0.231, p = 0.026), and BCI (-0.308, p = 0.002). CONCLUSIONS: Our UDS data revealed that DM is associated with impaired DC in women without BOO. Moreover, longer DM duration and poor glycemic control were associated with impaired DC.

Effect of aging on urodynamic parameters in women with stress urinary incontinence.

PURPOSE: Stress urinary incontinence (SUI) is one of the most common lower urinary tract symptoms in women. We analyzed age-associated changes in urodynamic parameters in women with SUI. MATERIALS AND METHODS: We analyzed the urodynamic study (UDS) results of patients with urodynamically proven SUI between March 2008 and July 2014. In uroflowmetry, maximal flow rate (Qmax), time to Qmax, voided volume, and postvoid residual urine volume (PVR) and filling cystometry data including first, strong desire to void and Valsalva leak point pressure (VLPP) were measured. Also, Qmax and detrusor pressure at Qmax (Pdet@Qmax) of voiding cystometry data were analyzed. RESULTS: The subjects included 776 patients. Among the patients, 151 were withdrawn because of incomplete UDS data or because they met the exclusion criteria. A total of 625 patients enrolled in our study. The mean age of the population was 57.3 years. The mean Qmax, voided volume, voiding time, and PVR were 26.2 mL/s, 292.1 mL, 25.7 s, and 31.7 mL, respectively. Qmax (p=0.001) in uroflowmetry, PVR (p=0.042), first desire to void (p=0.042), Pdet@Qmax (p=0.016), and the bladder contractility index (p=0.046) were significantly different between the age groups. Qmax and Pdet@Qmax were decreased and PVR was increased significantly with age after 60 years. CONCLUSIONS: Older women with SUI also have worsened voiding function with age as the results of urodynamic parameters. Specifically, detrusor contractility decreased with age after 60 years.

Biomonitoring of urinary di(2-ethylhexyl) phthalate metabolites of mother and child pairs in South Korea.

Di(2-ethylhexyl) phthalate (DEHP) is one of the common phthalate plasticizers used primarily in soft polyvinyl chloride, which is a plastic polymer that makes up the total weight of goods from 1% up to 40% in many consumer products. The aims of this study were to examine the urinary DEHP metabolites in South Korean children and to investigate the correlation between mother and child DEHP urine excretion. Three kinds of urinary DEHP metabolites: mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (5-OH-MEHP) and mono(2-ethyl-5-oxohexyl) phthalate (5-oxo-MEHP), were analyzed. The total of 954 samples (nChildren=392, nMothers=265, nAadults=297), including 258 mother and child pairs, were analyzed using isotope dilution gas chromatography-mass spectrometry. Many studies present higher concentration of DEHP metabolites detected from adults in reproductive age than adults in other ages. Therefore, adults who are age-matched to mothers were evaluated to serve as a standard of comparison against mothers. All statistical analysis was made by adjusting detected volume concentrations (µg/L) with respect to creatinine concentrations (mg/dL) since urinary DEHP metabolites were studied using human reference. The difference in median levels of sum of urinary DEHP metabolites was only significant when children were analyzed in relation to region (p-value≤0.005). Among the three DEHP metabolites, only MEHP of children was significantly correlated to that of paired mothers (p-value≤0.01). The present paper defines the relative metabolic rate (RMR) of DEHP metabolism for the first time in study on phthalates. Children had faster RMR than mothers and adults, specifically in the first step of DEHP metabolism (RMR1: MEHP hydroxylation to 5-OH-MEHP), and RMR1 of children between 1 and 24 months was the fastest. The above results may be used to study and assess human health risk from DEHP exposures, especially among mothers and children in Korea.