Periprostatic fat thickness measured on MRI correlates with lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia progression

Abstract

This study investigated the correlation between periprostatic fat thickness (PPFT) measured on magnetic resonance imaging and lower urinary tract symptoms, erectile function, and benign prostatic hyperplasia (BPH) progression. A total of 286 treatment-naive men diagnosed with BPH in our department between March 2017 and February 2019 were included. Patients were divided into two groups according to the median value of PPFT: high (PPFT >4.35 mm) PPFT group and low (PPFT <4.35 mm) PPFT group. After the initial evaluation, all patients received a combination drug treatment of tamsulosin and finasteride for 12 months. Of the 286 enrolled patients, 244 completed the drug treatment course. Patients with high PPFT had larger prostate volume (PV; P = 0.013), higher International Prostate Symptom Score (IPSS; P = 0.008), and lower five-item version of the International Index of Erectile Function (IIEF-5) score ( P = 0.002) than those with low PPFT. Both high and low PPFT groups showed significant improvements in PV, maximum flow rate, IPSS, and quality of life score and a decrease of IIEF-5 score after the combination drug treatment. The decrease of IIEF-5 score was more obvious in the high PPFT group than that in the low PPFT group. In addition, more patients in the high PPFT group underwent prostate surgery than those in the low PPFT group. Moreover, Pearson's correlation coefficient analysis indicated that PPFT was positively correlated with age, PV, and IPSS and negatively correlated with IIEF-5 score; however, body mass index was only negatively correlated with IIEF-5 score.

How obesity affects the benefits of holmium laser enucleation of the prostate for the treatment of male lower urinary tract symptoms

“…5,17 Due to increased retropubic and periprostatic fat, obesity already presents a risk factor for perioperative complications in OP and many studies deal with endoscopic alternatives to open surgery in obese patients. 18,19 Furthermore, increased abdominal fat can lead to severely altered anatomic conditions in the lower urinary tract and obese patients are already at increased risk of multiple comorbidities, posing a challenging decision even when offering minimally-invasive techniques functionally equivalent to open surgery. 19,20 In our study population, HoLEP offered high functional efficacy combined with low perioperative morbidity, regardless of BMI, thus corroborating the favourable risk profile of HoLEP when compared with OP or TURP.…”

“…18,19 Furthermore, increased abdominal fat can lead to severely altered anatomic conditions in the lower urinary tract and obese patients are already at increased risk of multiple comorbidities, posing a challenging decision even when offering minimally-invasive techniques functionally equivalent to open surgery. 19,20 In our study population, HoLEP offered high functional efficacy combined with low perioperative morbidity, regardless of BMI, thus corroborating the favourable risk profile of HoLEP when compared with OP or TURP. 5,8 Various studies have demonstrated that obesity in general prolongs operative time and, with that, increases perioperative morbidity and mortality in an already higher risk patient cohort.…”

“…18,19 Furthermore, increased abdominal fat can lead to severely altered anatomic conditions in the lower urinary tract and obese patients are already at increased risk of multiple comorbidities, posing a challenging decision even when offering minimally-invasive techniques functionally equivalent to open surgery. 19,20…”

Periprostatic Adipose Tissue: A New Perspective for Diagnosing and Treating Prostate Cancer

“…Therefore, they play a different role than other adipose tissues and their study alone has some significance. PPAT affects various prostate-related diseases, such as prostatitis, benign prostatic hyperplasia (BPH), secondary lower urinary tract symptoms, erectile dysfunction, urethral dysfunction, and PCa 23 , 24 , 25 . PPAT is an active secretory organ that can affect the PCa lipid microenvironment and inflammatory state, thus promoting PCa progression by secreting lipids, adipokines, and hormones in a paracrine or endocrine manner.…”