Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III)

Abstract

OBJECTIVE:To examine the association of components of the metabolic syndrome with lower urinary tract symptoms (LUTS), which often result from prostate enlargement and heightened tone of prostate and bladder smooth muscle. DESIGN: Third National Health and Examination Survey (NHANES III), from which LUTS cases and controls were selected. SUBJECTS: A total of 2372 men aged 60 þ y who participated in NHANES III. LUTS cases were men with at least three of these four symptoms: nocturia, incomplete bladder emptying, weak stream, and hesitancy, and who never had noncancer prostate surgery. Controls were men without any of the symptoms and who never had noncancer prostate surgery. MEASUREMENTS: As part of NHANES III, an oral glucose tolerance test was carried out, glycosylated hemoglobin, HDL and LDL cholesterol, and triglycerides were measured, and history of diabetes mellitus and hypertension were assessed. Logistic regression was used to calculate odds ratios (ORs) after applying sampling weights. RESULTS: History of diabetes (OR 1.67; 95% confidence interval (CI) 0.72-3.86) and hypertension (OR 1.76; 95% CI 1.20-2.59) appeared to be positively associated with LUTS. The odds of LUTS increased with increasing glycosylated hemoglobin (Ptrend ¼ 0.005). No statistically significant associations between fasting or 2-h glucose or fasting insulin and LUTS were observed. However, men classified as having three or more components of the metabolic syndrome had an increased odds of LUTS (OR ¼ 1.80; 95% CI 1.11-2.94). CONCLUSION: These findings support the role for metabolic perturbations in the etiology of LUTS.

Effects of a low-energy diet on sexual function and lower urinary tract symptoms in obese men

“…Nevertheless, the improvements in both groups were proportionally similar (B30%). Abdominal obesity is associated with B1.5-fold increase in LUTS; 9,10 accordingly, the decrease in the IPSS score was strongly correlated with loss of weight and abdominal adiposity. As the improvements in LUTS and erectile function were also significantly associated with each other, it is likely that LUTS, such as ED and hypoandrogenism, is a feature of abdominal obesity and the metabolic syndrome, due to defective pelvic blood flow from atherosclerosis, endothelial dysfunction and autonomic system overactivity.…”

“…The International Prostate Symptom Scale (IPSS) is a series of questions used to assess the severity of irritative (frequency, urgency, nocturia) and obstructive LUTSs (incomplete emptying, intermittency, weak stream, straining), attributable to bladder outlet obstruction caused by prostatic enlargement. 19 Symptoms are classified as mild (score 0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) or severe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

“…8 Moreover, men with ED are more likely to be depressed and to have lower quality of life. 4 Metabolic syndrome 9 and abdominal obesity 10 are also associated with a higher prevalence of frequency and urgency of urination, incomplete bladder emptying and other irritative and obstructive lower urinary tract symptoms (LUTSs). In addition, there are strong associations between ED and LUTS, which are independent of age, weight, cardiovascular risk factors and androgen levels.…”

Metabolic syndrome and common urological conditions: looking beyond the obvious

“…6 A history of diabetes or hypertension is particularly associated with LUTS, with odds ratios of 1.67 and 1.76, respectively. In diabetic men, the risk of LUTS increases with increasing glycosylated haemoglobin (HbA1c).…”

Editorial Comment on: Daily Treatment with Sildenafil Reverses Endothelial Dysfunction and Oxidative Stress in an Animal Model of Insulin Resistance

“…We know that there is an epidemiologic association between ED and subsequent cardiovascular disease [4] and it is well recognised that a relationship exists between endothelial dysfunction and cardiovascular disease. Given the recently identified association between the metabolic syndrome and LUTS [5], this paper suggests a rationale for hypothesising that if PDE5 inhibitors are used in a chronic dosing regime, either for ED or LUTS, there may be additional cardiovascular benefits.…”