{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:36:06Z","timestamp":1789025766302,"version":"build-2803163510"},"reference-count":27,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Background: Khat (Catha edulis) chewing is highly prevalent in Yemen, but its potential urological effects are poorly characterized. The pharmacological action of its alkaloids on alpha-adrenergic receptors suggests a plausible link to voiding dysfunction. This study explored the association between khat chewing patterns, concurrent stimulant use, and lower urinary tract symptom (LUTS) severity.Methods: In this cross-sectional study, 112 medical and paramedical university students from seven Yemeni governorates completed a structured digital questionnaire being recruited via convenience sampling. LUTS severity was assessed using the International Prostate Symptom Score (IPSS). Exposure variables included khat chewing (status, duration, daily hours), coffee, soda, and tobacco use. Participants were categorized into poly-substance use clusters. Multivariable linear and logistic regression models identified predictors of LUTS, adjusting for confounders including age and sex.Results: Among participants (mean age 24.3\u00b15.7 years), 86 (76.8%) were current khat chewers. A significant dose-response relationship was observed. Each additional hour of daily chewing was associated with a 1.85-point increase in IPSS score (95% CI: 1.32-2.38; p&lt;0.001). The concurrent use of khat, coffee, and soda was associated with the highest mean symptom score (21.4) and a significantly elevated adjusted odds ratio for severe LUTS (IPSS \u226520) of 17.15 (95% CI: 6.28-47.10; p&lt;0.001) compared to non-users. Daily coffee consumption and tobacco smoking were also independent predictors of higher IPSS scores.Conclusions: Among this sample of Yemeni university students, khat chewing demonstrated a strong, dose-dependent association with more severe LUTS. This association was markedly amplified by the co-use of caffeine-containing beverages. While the cross-sectional design precludes causal inference, these findings highlight a potential public health concern and underscore the need for longitudinal studies and clinical awareness of urological symptoms in khat-chewing populations.<\/jats:p>","DOI":"10.4081\/aiua.2026.14744","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T13:20:45Z","timestamp":1772630445000},"source":"Crossref","is-referenced-by-count":1,"title":["Khat chewing, poly-substance use, and lower urinary tract symptoms: a cross-sectional analysis among Yemeni medical university students"],"prefix":"10.4081","volume":"98","author":[{"given":"Mohammed","family":"Noman","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology, and Andrology, Faculty of Medicine and Health Sciences, Sana'a University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7188-2715","authenticated-orcid":false,"given":"Faisal","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Urology, School of Medicine, Ibb University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh","family":"Al-Wageeh","sequence":"additional","affiliation":[{"name":"Department of General Surgery, School of Medicine, Ibb University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qasem","family":"Alyhari","sequence":"additional","affiliation":[{"name":"Department of General Surgery, School of Medicine, Ibb University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"Ghabisha","sequence":"additional","affiliation":[{"name":"Department of General Surgery, School of Medicine, Ibb University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Ateik","sequence":"additional","affiliation":[{"name":"Department of General Surgery, School of Medicine, 21 September University, Sana'a"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Alnadhari","sequence":"additional","affiliation":[{"name":"Al Wakra Hospital, Hamad Medical Corporation, Al Wakra; Department of Surgery, College of Medicine, Qatar University, Doha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulghani","family":"Al-Hagri","sequence":"additional","affiliation":[{"name":"Student Research Committee, Faculty of Medicine, Sana'a University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasr","family":"Alhajeeli","sequence":"additional","affiliation":[{"name":"Vice Chancellor of the School of Medicine, Ibb University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen","family":"Karama","sequence":"additional","affiliation":[{"name":"Urology Department, School of Medicine, Aden University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"217283","doi-asserted-by":"crossref","unstructured":"1. 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Toennes SW, Harder S, Schramm M, et al. Pharmacokinetics of cathinone, cathine and norephedrine after the chewing of khat leaves. Br J Clin Pharmacol. 2003; 56:125-30.","DOI":"10.1046\/j.1365-2125.2003.01834.x"},{"key":"217295","doi-asserted-by":"crossref","unstructured":"13. Brenneisen R, Fisch HU, Koelbing U, et al. Amphetamine-like effects in humans of the khat alkaloid cathinone. Br J Clin Pharmacol. 1990; 30:825-8.","DOI":"10.1111\/j.1365-2125.1990.tb05447.x"},{"key":"217296","doi-asserted-by":"crossref","unstructured":"14. Patel NB. Mechanism of action of cathinone: the active ingredient of khat (Catha edulis). East Afr Med J. 2000; 77:329-32.","DOI":"10.4314\/eamj.v77i6.46651"},{"key":"217297","doi-asserted-by":"crossref","unstructured":"15. Michel MC, Vrydag W. Alpha1-, alpha2- and beta-adrenoceptors in the urinary bladder, urethra and prostate. Br J Pharmacol 2006;147:S88-119.","DOI":"10.1038\/sj.bjp.0706619"},{"key":"217298","doi-asserted-by":"crossref","unstructured":"16. Noman M, Al-Nawd E, Ahmed F. Effects of Khat (Catha edulis) chewing on seminal fluid parameters: findings from a fertility clinic cohort and cessation trial. Arch Ital Urol Androl 2025;97:13931.","DOI":"10.4081\/aiua.2025.13931"},{"key":"217299","unstructured":"17. Wabe NT. Chemistry, pharmacology, and toxicology of khat (catha edulis forsk): a review. Addict Health. 2011; 3:137-49."},{"key":"217300","doi-asserted-by":"crossref","unstructured":"18. Koo KC, Lee DH, Kim JH, et al. Prevalence and management of lower urinary tract symptoms in methamphetamine abusers: an under-recognized clinical identity. J Urol. 2014; 191:722-6.","DOI":"10.1016\/j.juro.2013.08.020"},{"key":"217301","unstructured":"19. Zelger JL, Schorno HX, Carlini EA. Behavioural effects of cathinone, an amine obtained from Catha edulis Forsk.: comparisons with amphetamine, norpseudoephedrine, apomorphine and nomifensine. Bull Narc. 1980; 32:67-81."},{"key":"217302","doi-asserted-by":"crossref","unstructured":"20. Kassa A, Loha E, Esaiyas A. Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia. Afr Health Sci. 2017;17:175-85.","DOI":"10.4314\/ahs.v17i1.22"},{"key":"217303","doi-asserted-by":"crossref","unstructured":"21. Lohsiriwat S, Hirunsai M, Chaiyaprasithi B. Effect of caffeine on bladder function in patients with overactive bladder symptoms. Urol Ann. 2011; 3:14-8.","DOI":"10.4103\/0974-7796.75862"},{"key":"217304","doi-asserted-by":"crossref","unstructured":"22. Odenwald M, Neuner F, Schauer M, et al. Khat use as risk factor for psychotic disorders: a cross-sectional and case-control study in Somalia. BMC Med. 2005; 3:5.","DOI":"10.1186\/1741-7015-3-5"},{"key":"217305","doi-asserted-by":"crossref","unstructured":"23. Mahfouz MS, Alsanosy RM, Gaffar AM. The role of family background on adolescent khat chewing behavior in Jazan Region. 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