Review Article of Global Journal of Urology and Nephrology
Impact of components of metabolic syndrome on the prostatic volume and lower urinary tract symptoms in a sample of patient with benign prostatic hyperplasia in Iraq
Dr. Ali Zuhair Khudhur 1, Dr. Alaa Al-Deen Al-Dabbagh 2
1 Al-Yarmouk Teaching Hospital/Department of urology/Baghdad/Iraq
2 Assistant professor at Al-Mustansiriyah University/College of Medicine/Department of surgery / Baghdad / Iraq
To evaluate the association between the components of metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) focusing at their effects on prostatic volume and on the severity of LUTS .
Patients & Methods
From October 2016 to January 2018, eighty patients presented with LUTS due to the BPH. LUTS were assessed using the international prostatic symptoms score (IPSS) and MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III guidelines. Patients were randomly collected into two categories: A (48 patients) had MetS and B (32 patients) without MetS.
The mean age was 64.3 years, statistically significant variation was identified between the two categories regarding the moderate and severe IPSS, S.PSA, prostatic size and post voiding residue (PVR), the P value (<0.05).
The most frequent MetS components were: hypertension in 65/80 patients (81.25%), high fasting glucose in 49/80 patients (61, 25%), and waist circumference elevation in 55/80 patients (68.75%).
The association between MetS components, the prostatic volume and severity of LUTS had shown that all MetS components except HDL-cholesterol were significantly correlated with higher prostatic volume (P < 0.05). Also a positive statistically significant association was discovered between each component of MetS and higher IPSS, excepting HDL-cholesterol (P = 0.93) and triglyceride (P = 0.58).
The results of the present study confirmed that there is a significant relation between the components of metabolic syndrome, the increase in prostatic volume and the severity of LUTS/BPH.
Keywords: LUTS, BPH, MetS, prostatic volume
How to cite this article:
Ali Zuhair Khudhur, Alaa Al-Deen Al-Dabbagh. Impact of components of metabolic syndrome on the prostatic volume and lower urinary tract symptoms in a sample of patient with benign prostatic hyperplasia in Iraq. Global Journal of Urology and Nephrology, 2019, 2:17. DOI: 10.28933/gjun-2019-09-1406
1. Roehrborn CG, Siami P, Barkin J, Damião R, Becher E, Miñana B, et al. The influence of baseline parameters on changes in international prostate symptom score with dutasteride, tamsulosin, and combination therapy among men with symptomatic benign prostatic hyperplasia and an enlarged prostate: 2-year data from the CombAT study. European urology. 2009 Feb 28; 55(2):461-471.
2. Unnikrishnan R, Almassi N and Fareed K. Benign prostatic hyperplasia: evaluation and medical management in primary care. Cleveland Clinic Journal of Medicine 2017; 84(1): 53-64.
3. Fitzpatrick JM. The natural history of benign prostatic hyperplasia. BJU Int. 2006; 97(suppl 2): 3-6
4. Emberton M, Cornel EB, Bassi PF, et al. Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. Int J Clin Pract. 2008; 62: 1067-86
5. Ito H, Yokoyama O. Metabolic syndrome and lower urinary tract symptoms. World Journal Clinical Urology. 2014; 3(3):330–335.
6. Yeh HC, Liu CC, Lee YC, Wu WJ, Li WM, Li CC, Hour TC, Huang CN, Chang CF, Huang SP. Associations of the lower urinary tract symptoms with the lifestyle, prostate volume, and metabolic syndrome in the elderly males. The Aging Male. 2012 Sep 1; 15(3):166-172.
7. Aktas BK, Gokkaya CS, Bulut S, Dinek M, Ozden C, Memis A. Impact of metabolic syndrome on erectile dysfunction and lower urinary tract symptoms in benign prostatic hyperplasia patients. The Aging Male. 2011 Mar 1; 14(1):48-52.
8. Demir O, Akgul K, Akar Z, Cakmak O, Ozdemir I, Bolukbasi A, Can E, Gumus BH. Association between severity of lower urinary tract symptoms, erectile dysfunction and metabolic syndrome. The Aging Male. 2009 Jan 1; 12(1):29-34.
9. Dahle SE, Chokkalingam AP, Gao YT, Deng J, Stanczyk FZ, Hsing AW. Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. J Urol 2002; 168: 599–604.
10. Gassi M, Vignozzi L, Sebastianelli A, et al. Metabolic syndrome and lower urinary tract symptoms: the role of in flammation. Prostate Cancer Prostatic Dis. 2013; 16: 101-6
11. Fusco F, D’Anzeo G, Sessa A, et al. BPH/LUTS and ED: common pharmacological pathways for a common treatment. The journal of sexual medicine .2013; 10:2382–2393.
12. Ozden C, Ozdal OL, Urgancioglu G, Koyuncu H, Gokkaya S, Memis A, Seitz C, Witjes WP. The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia. European urology. 2007 Jan 1;51(1):199-206.
13. Hammarsten J, Hِgstedt B, Holthuis N, Mellstrom D. Components of the metabolic syndrome-risk factors for the development of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 1998; 1: 157–62.
14. Favilla V, Cimino S, Salamone C, Fragalà E, Madonia M, Condorelli R, et al. Risk factors of sexual dysfunction after transurethral resection of the prostate (TURP): A12 months follow-up. Journal of endocrinological investigation. 2013 Dec 1; 36(11):1094-1098.
15. Crawford ED, Wilson SS, McConnell JD, Slawin KM, Lieber MC, Smith JA, Meehan AG, Bautista OM, Noble WR, Kusek JW, Nyberg LM. Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. The Journal of urology. 2006 Apr 1; 175(4):1422-7.
16. Expert Panel on Detection E. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Jama. 2001 May 16; 285(19):2486.
17. Cruz F, Desgrandchamps F. New concepts and pathophysiology of lower urinary tract symptoms in men. European Urology Supplements. 2010 Jul 31; 9(4):472-476.
18. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287: 356-9
19. Parsons JK, Sarma AV, Mc Vary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol 2009; 182; 527-31
20. Issa MM and Regan TS. Medical therapy for benign prostate hyperplasia present and future impact. The American journal of managed care .2007; 13: 4-9.
21. Hammarsten J, Högstedt B. Hyperinsulinemia as a risk factor for developing benign prostatic hyperplasia. European urology. 2001; 39:151-158.
22. Parsons JK, Carter HB, Partin AW, et al. Metabolic factors associated with benign prostatic hyperplasia. The Journal of Clinical Endocrinology & Metabolism. 2006; 91:2562-2568.
23. Hammarsten J, Damber JE, Karlsson M, et al. Insulin and free oestradiol are independent risk factors for benign prostatic hyperplasia. Prostate cancer and prostatic diseases. 2009; 12:160-165.
24. Dahle SE, Chokkalingam AP, Gao YT, Deng J, Stanczyk FZ, Hsing AW. Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. The Journal of urology. 2002; 168:599-604.
25. Gupta A, Gupta S, Pavuk M, Roehrborn CG. Anthropometric and metabolic factors and risk of benign prostatic hyperplasia: a prospective cohort study of air force veterans. Urology 2006; 68: 1198–1205
26. De Nunzio C, Cindolo L, Gacci M, Pellegrini F, Carini M, Lombardo R, et al. Metabolic syndrome and lower urinary tract symptoms in patients with benign prostatic enlargement: a possible link to storage symptoms. Urology. 2014 Nov 30;84(5):1181-1187.
27. Hammarsten J, Peeker R. Urological aspects of the metabolic syndrome. Nature Reviews Urology. 2011 Sep 1; 8(9):483-494.
28. Kirby MG, Wagg A, Cardozo L, Chapple C, Castro‐Diaz D, De Ridder D et al. Overactive bladder: Is there a link to the metabolic syndrome in men? Neurourology and urodynamics. 2010 Nov 1;29(8):1360-1364.
29. Pan JG, Liu M, Zhou X. Relationship between lower urinary tract symptoms and metabolic syndrome in a Chinese male population. Journal of endocrinological investigation. 2014 Apr 1;37(4):339-344.
30. Yang TK, Hsieh JT, Chen SC, Chang HC, Yang HJ, Huang KH. Metabolic syndrome associated with reduced lower urinary tract symptoms in middle-aged men receiving health checkup. Urology. 2012 Nov 30; 80(5):1093-1097.
31. Cellek S, Rodrigo J, Lobos E, Fernández P, Serrano J, Moncada S. Selective nitrergic neurodegeneration in diabetes mellitus- a nitric oxide-dependent phenomenon. British journal of pharmacology. 1999; 128:1804-1812.
32. Spranger MD, Kaur J, Sala-Mercado JA, Machado TM, Krishnan AC, Alvarez A, O’Leary DS. Attenuated muscle metaboreflex-induced pressor response during postexercise muscle ischemia in renovascular hypertension. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 2015 Apr 1;308(7): 650-658.
33. Gao Y, Wang MJ, Zhang HY, et al. Are metabolic syndrome and its components associated with lower urinary tract symptoms? Results from a Chinese male population survey. Urology. 2012; 79:194- 201.
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