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Excess risk of bladder cancer has also been observed among rubber workers; painters; truck, bus, and taxi drivers; aluminum workers; and leather workers (Engel et al. 2002). It has been estimated that these occupational exposures are responsible for 18% of bladder cancer cases. As little as 2 years¡Ç exposure may be sufficient to increase the risk, but the time between exposure and subsequent cancer may be as long as 45 years (Goroll et al. 2000).

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This article demonstrates how the lack of adequate and accessible bathroom facilities in New York likely accounts for most of the genitourinary pathology that taxi drivers have.

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Musculoskeletal pain, diabetes, hypertension, vision problems, stress, obesity, and constipation were pervasive throughout the group. Additionally, urinary tract issues such as kidney problems, bladder dysfunction, and prostatism were noted. 

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One of the participants attributed his onset of kidney problems to intentional infrequent urination, and said this was mostly ¡Èbecause you don't have facilities at most places where you can stand and urinate.¡É Two other drivers with diabetes-induced polyuria also attributed their severe problem with this issue. Specifically, they noted that ¡Èvoiding with less than usual frequency can result in the development of urinary tract infections, renal failure, and the attendant difficulties.

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In 1985, Kinn studied 10 patients who were known to chronically suppress their impulses to void, leading to high capacity bladders (greater than 1000 mL for the study subjects).¡¡Using data from previous literature, she theorized that the ¡Èneurologic lazy detrusor is due to deterioration of neuromuscular transmission after mechanical overdistension¡Ä [and] as the muscle fibers become progressively overstretched, they gradually sustain permanent loss of contractility, [where after] fibrosis later develops in the muscular tissue and the end result is a decompensated bladder with failure to initiate and sustain a micturition contraction.¡É3 This can be similar in concept to non-neurogenic neurogenic bladder described by Hinman.4

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Bendtsen and colleagues,5 who termed this infrequent voiders syndrome, studied nurses who were known to exhibit an ¡Èhabitual suppression of the desire to void over a [long] period of time¡Ä resulting [in the] overdistension of the bladder muscle [which] damages bladder sensation and increases the bladder capacity.¡É They theorized that a hectic work schedule, coupled with poor access to adequate toilet facilities, was the root cause of infrequent voiding. Interestingly, the nurses in this study had a 16% prevalence of self-reported cystitis (no documented urine studies confirmed this), as compared with a 6% prevalence for average childbearing women.5

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A significant characteristic of the infrequent voiders syndrome is the intentional restriction of fluid intake in order to reduce need to urinate throughout the day. This pattern has been linked to urinary stone formation. Embon and colleagues9 studied 708 patients with diagnosed urolithiasis through the use of questionnaires and 24-hour urine collections. Low urine volume, described in the paper as chronic dehydration (19%), was the second most prevalent finding after idiopathic hypercalciuria. Interestingly, 40 of the 98 patients who were classified as chronically dehydrated noted poor water intake as at least one of the reasons for this.9

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In a prospective study of over 45,000 men with no history of kidney stones, Curhan and colleagues10 found that those who had greater than 2500 mL of fluid intake per day had a statistically reduced risk of developing urolithiasis over 4 years of follow-up, as compared with control subjects who had less than 1275 mL of fluid intake per day (multivariate adjusted relative risk [RR] = 0.71; 95% CI, 0.52–0.97; adjustment factored in age, profession, thiazide use, alcohol intake, and dietary intake of calcium, animal protein, and potassium).10 The sequelae of those with infrequent voiders syndrome appears to consist of development of urinary tract infections, renal failure, urolithiasis, and bladder dysfunction caused by detrusor weakness.

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