Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms

Abstract

Study Type – Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? The metabolic syndrome, or Syndrome X, has traditionally been associated with an increased risk of cardiovascular disease and sexual dysfunction. Emerging data however now suggest that the metabolic syndrome may also have a heretofore unrecognized negative effect on voiding function as well. Weight loss through either behavioural modification or bariatric surgery has been shown to lead to improvement in stress and urge incontinence as well as LUTS. A potential relationship may be drawn between obesity and BPH. This study adds the knowledge that WC can represent a simple metric not only for elements of the metabolic syndrome but also for worsened voiding. These obese men may be at high risk of male pelvic dysfunction. OBJECTIVES To determine if central obesity as measured by waist circumference (WC) is a risk factor in metabolic dysfunction, which includes hypertension, dyslipidaemia and type 2 diabetes (DM2). To test the hypothesis that central obesity and WC are associated with and predictive of the severity of voiding dysfunction. METHODS Men aged ≥40 years with moderate or severe lower urinary tract symptoms (LUTS, International Prostate Symptom Score ≥ 8) with no previous treatment were included for study. Subjects were divided into three groups according to WC (<90, 90–99 and ≥100 cm). Baseline parameters including International Prostate Symptom Score, prostate volume, serum prostate‐specific antigen, presence of erectile dysfunction and ejaculatory dysfunction, and the prevalence of hypertension, coronary artery disease and DM2 were compared among the three WC categories. The association between WC and all parameters assessed was tested using multivariate logistic regression analysis. RESULTS In the 409 consecutive men analysed, WC was significantly and positively associated with prostate volume, serum prostate‐specific antigen and International Prostate Symptom Score. Higher WCs were also significantly associated with a greater prevalence of hypertension, coronary artery disease, DM2 and obesity as well as the presence of erectile dysfunction and ejaculatory dysfunction. CONCLUSIONS Increased WC is associated with worsened voiding. There was a significantly increased prevalence of components of the metabolic syndrome in patients with higher WC. Obese men, in particular those with other features of the metabolic syndrome, are at increased risk of male pelvic dysfunction and can be easily recognized by measurement of WC.

Metabolic syndrome and lower urinary tract symptoms: the role of inflammation

“…5,21 The inconsistency of the correlation between waist circumference and prostate volume, reported in our study, is in agreement with other previously reported experiences, 22 while a recent clinical trial on obesity and LUTS reported a significant and positive correlation between waist circumference and prostate volume. 23 It should be noted that the association between prostate volume and hypertension resulted very close to the level of MetS significance (HR ¼ 1.962, 95% confidence interval: 0.996-3.864, P ¼ 0.055, see Figure 3), suggesting that this component may be a potential contributor for the growth of prostate volume, as reported by other Authors. 5,21,23 A wealth of recent epidemiological and histopatological studies have clearly indicated that prostate chronic inflammation is not only a common finding in BPH, 24,25 but also has a primary role in triggering prostatic cells overgrowth.…”

“…23 It should be noted that the association between prostate volume and hypertension resulted very close to the level of MetS significance (HR ¼ 1.962, 95% confidence interval: 0.996-3.864, P ¼ 0.055, see Figure 3), suggesting that this component may be a potential contributor for the growth of prostate volume, as reported by other Authors. 5,21,23 A wealth of recent epidemiological and histopatological studies have clearly indicated that prostate chronic inflammation is not only a common finding in BPH, 24,25 but also has a primary role in triggering prostatic cells overgrowth. 26,27 Potential causes for inflammation and immune dysregulation in the prostate include exposure to dietary factors, and metabolic variations.…”

Early Effect of Bariatric Surgery on Urogenital Function in Morbidly Obese Men

“…With an increasing number of overweight or obese people globally, obesity has now been recognised as an epidemic affecting the health of populations mainly through obesity-related diseases such as Type 2 diabetes, cardiovascular diseases and stroke 1,3 . It is therefore not surprising that obesity has been identified as an independent risk factor for erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) [4][5][6][7][8] . Corona et al (2009) suggested that obesity is directly related to lower androgen levels in men who suffer from ED, and that obesity related comorbidities, particularly hypertension, are considered significant causes of arteriogenic obesity-related ED 9.…”

Endoscopic Management of a Large Calculus in a Transplant Kidney

“…Kristal et al [29] and Lee et al [30] observed positive correlation between BMI and LUTS while many other studies found no significant association between BMI and LUTS.…”