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

Abstract

BACKGROUND: Epidemiological data indicate that lower urinary tract symptoms (LUTS)/BPH can be associated with metabolic syndrome (MetS). Chronic inflammation has been proposed as a candidate mechanism at the crossroad between these two clinical entities. Aim of study is to examine the correlation among pre-operatory LUTS/BPH severity, MetS features and inflammatory infiltrates in prostatectomy specimens. METHODS: A total of 271 consecutive men treated with simple prostatectomy were retrospectively selected for this study in two tertiary referral centers for LUTS/BPH. Prostate diameters and volume were measured by transrectal ultrasound, LUTS scored by International Prostate Symptom Score (IPSS) and obstruction by uroflowmetry. The International Diabetes Federation and American Heart Association and the National Heart, Lung and Blood Institute was used to define MetS. The inflammatory infiltrate was investigated combining anatomic location, grade and extent of flogosis into the overall inflammatory score (IS); the glandular disruption (GD) was used as a further marker. RESULTS: Eighty-six (31.7%) men were affected by MetS. Prostatic volume and anterior-posterior (AP) diameter were positively associated to the number of MetS components. Among MetS determinants, only dyslipidaemia (increased serum triglycerides and reduced serum high-density lipoprotein) was associated with an increased risk of having a prostatic volume 460 cm 3 (hazard ratio (HR) ¼ 3.268, Po0.001). A significant positive correlation between the presence of MetS and the IS was observed. MetS patients presented lower uroflowmetric parameters as compared with those without MetS (Maximum flow rate (Q max ): 8.6 vs 10.1, P ¼ 0.008 and average flow rate (Q ave ): 4.6 vs 5.3, P ¼ 0.033, respectively), and higher obstructive urinary symptoms score (P ¼ 0.064). A positive correlation among both IS-GD and IPSS Score was also observed (adjusted r ¼ 0.172, P ¼ 0.008 and adjusted r ¼ 0.128, P ¼ 0.050). CONCLUSIONS: MetS is associated with prostate volume, prostatic AP diameter and intraprostatic IS. The significantly positive association between MetS and prostatic AP diameter could support the observation that MetS patients presented lower uroflowmetric parameters. In conclusion, MetS can be regarded as a new determinant of prostate inflammation and BPH progression.

Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention?

“…Some previous studies confirmed that combination therapy with 5-phosphodiesterase inhibitors and ɑ-adrenergic blockers resulted in significant improvement of LUTS (7)(8)(9). Recently, a meta-analysis of the cross sectional data from twelve articles depicted that 5-phosphodiesterase inhibitors can significantly improve LUTS secondary to BPH in patients with or without erectile dysfunction (10) but there is no obvious data about the role of 5-phosphodiesterase inhibitors in AUR when administered as combination therapy with ɑ-blocker agents.…”

“…There are some previous reports regarding the safety and efficacy of sildenafil (25 or 50mg/day) in decreasing of IPSS as monotherapy or in combination with alpha blocker (7)(8)(9). A recent systematic review of the prospective and cross sectional studies on 3214 patients suggested that 5-phosphodiesterase inhibitors can significantly improve obstructive urinary symptoms secondary to BPH (10).…”

Association Between Metabolic Syndrome and Benign Prostate Hyperplasia

“…11. This study showed that reduced HDL-C and increased TG level were noted to be the main determinants of MetS related prostate enlargement 19 .…”

Prostate volume and growth during testosterone replacement therapy is related to visceral obesity in Klinefelter syndrome

“…Other authors (24,25,26), also in a population of young patients, have demonstrated that prostate volume was significantly associated with dyslipidemia (HDL and triglycerides). The authors have clearly indicated that prostate chronic inflammation has a primary role in triggering prostatic cells' overgrowth and that the exposure to dietary factors and metabolic variations represent potential causes for inflammation and immune dysregulation in the prostate (27).…”