Connections between lower urinary tract symptoms related to benign prostatic enlargement and metabolic syndrome with its components: a systematic review and meta-analysis

Abstract

A significant amount of epidemiological evidences have underlined an emerging link between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement a (BPE). We aimed to assess the connections between LUTS and MetS with its components. Meta-analysis were conducted to determine the mean differences (MD) and confidence intervals of IPSS total score, IPSS-voiding, IPSS-storage and prostate volume (PV) in patients with or without MetS. Ln(odds-ratio) were calculated to estimate the risk of having moderate-to-severe LUTS (IPSS ≥ 8). Nineteen studies were identified as eligible for this systematic review, with a total of 18,476 participants, including 5554 (30.06%) with and 12,922 (69.94%) without MetS. Pooled analysis did not demonstrate significant MD of IPSS, IPSS-voiding and IPSS-storage in men with or without MetS but PV was significantly different (MD = 2.18; p = 0.03). Presence of MetS was not significantly associated with moderate-to-severe LUTS (odds ratio = 1.13; p = 0.53) and only altered serum triglycerides and diabetes were associated with this risk. The association between MetS and LUTS/BPE remain unclear and further observational studies in a population with metabolic disorders should be conducted in order to address it's potential role in determining LUTS/BPE.

Impact of Testosterone Deficiency and Testosterone Therapy on Lower Urinary Tract Symptoms in Men with Metabolic Syndrome

“…We should point out that some studies [21] suggested that the presence of Met S was not significantly associated with moderate to severe LUTS (OR=1.13, p=0.53) and only altered serum triglycerides, an important component of Met S, and diabetes were associated with this risk. Yet, a positive association was noted between number of Met S components and LUTS/bladder outlet obstruction in this study [21]. It is possible that endocrine abnormalities attributed to central obesity and hypertriglyceridemia may play an important role in development or progression of the pathophysiology of lower urinary tract dysfunction [3839].…”

“…A number of studies have suggested that an inverse association exist between serum T levels and LUTS; however, the underlying biochemical and physiological mechanisms by which reduced T levels affect LUTS have yet to be fully delineated [70717273]. A significantly larger prostate volume was reported in men afflicted with Met S [1921747576], however it is unclear if this increase in prostate volume indeed exerts a clinical significance [32]. Met S which was associated with decreased improvement of postoperative symptoms and LUTS after prostate surgery, suggesting interplay of multiple metabolic risk factors contributing to this complex disorder [77].…”

“…Furthermore, increased WC in men with Met S was positively correlated with prostate volume, which may contribute to severity of LUTS [8081]. In contrast, a recent meta-analysis found that Met S components, such as alteration in WC and serum HDL levels were not associated with increased odds of having moderate to severe LUTS [21]. This meta-analysis suggested that serum triglycerides and diabetes may be more significantly associated with increased risk of LUTS and severity.…”

“…Central obesity and WC, components of Met S, have been associated with increased risk for BPH and LUTS [1415161718192021222324252627282930]. However, central obesity may adversely impact LUTS independent of the prostate growth, as demonstrated by changes in severity of LUTS in men after prostatectomy [31323334].…”

“…After adjusting for age, men younger than 60 years with Met S were more likely to report intermittency, incomplete emptying, and nocturia [38]. We should point out that some studies [21] suggested that the presence of Met S was not significantly associated with moderate to severe LUTS (OR=1.13, p=0.53) and only altered serum triglycerides, an important component of Met S, and diabetes were associated with this risk. Yet, a positive association was noted between number of Met S components and LUTS/bladder outlet obstruction in this study [21].…”