Association Between The Metabolic Syndrome And Benign Prostatic Hyperplasia

【Background】Benign Prostatic Hyperplasia(BPH)is one of the most common diseases of the urological system,often causing urinary disturbances in middle-aged and elderly people,and its incidence increases with age.BPH mainly causes Lower Urinary Tract Symptoms(LUTS),including urinary storage symptoms such as frequency,urgency,and increased nocturia,and urinary symptoms such as hesitation,intermittent urination,difficulty urinating,and even urinary retention,which seriously affects the quality of life of patients.【Objective】Metabolic syndrome(Met S)is a complex group of clinical syndromes,including obesity,abnormal glucose metabolism,hypertension,abnormal lipid metabolism and other abnormal metabolic factors,with insulin resistance as its core.In recent years,the incidence of generation of TSE syndrome has been increasing.Therefore,in this study,303 patients with BPH were collected to retrospectively analyze the effect of Met S and its components on BPH.In this study,the correlation between lower urinary tract symptoms,prostate volume,annual prostate growth rate,maximum urinary flow rate,PSA and metabolic syndrome and its components in patients with BPH was investigated by correlating the metabolic indexes(body mass index,lipid profile,fasting glucose,blood pressure)The purpose of this study was to investigate the effect of metabolic syndrome on lower urinary tract symptoms and prostate enlargement in patients with BPH,and to provide a reference for the treatment of BPH patients in clinical practice.To analyze the effect of metabolic syndrome and its components on prostatic hyperplasia,especially its lower urinary tract symptoms.【Methods】We selected patients aged 50 years or older who had undergone transurethral resection of prostate(TURP)and further confirmed by histopathological examination for BPH who attended the Department of Urology of the Second Hospital of Guangzhou Medical University during June 2017-June 2021.Relevant clinical data were collected from patients,including age(years),height(cm),weight(kg),body mass index(BMI,kg/m2),smoking status,fasting blood glucose(FBG,mmol/L),fasting triglyceride concentration(TG,mmol/L),fasting total cholesterol(TC,mmol/L),fasting low-density lipoprotein cholesterol(LDL-C mmol/L),fasting high-density lipoprotein cholesterol(HDL-C,mmol/L),systolic blood pressure(SP,mm Hg),diastolic blood pressure(DP,mm Hg),residual urine volume,prostate volume(PV,m L),average annual prostate growth rate(m L/y),maximum urinary flow rate(Qmax,m L/s)and International Prostate Symptom Score(IPSS score).Then the patients in the BPH group were subdivided into Met S and non-Met S groups according to the Met S diagnostic criteria,and the relationship between Met S and BPH,especially its lower urinary tract symptoms,was analyzed using a retrospective study.The patients were also grouped according to their BMI,HDL-C,blood pressure,fasting glucose level,and the number of Mets components,respectively,to analyze the relationship between each Met S component and the number of components and BPH,especially its lower urinary tract symptoms.Finally,patients with BPH were divided into a moderate LUTS group(IPSS 8-19points)and a severe LUTS group(IPSS 20-35 points)according to the total IPSS score to further investigate the relationship between the metabolic syndrome and its components and lower urinary tract symptoms.【Results】1.Compared with BPH patients without Met S,those with combined Met S had greater total prostate volume(76.04±26.81 ml vs 56.97±20.52 ml),IPSS score(23.92±7.45 vs18.02±5.85),annual prostate growth rate(1.85±0.99 m L/year vs 1.37±0.88 m L/year)was greater and the maximum urinary flow rate was lower(5.32±1.60 m L/s vs 7.72±1.95 m L/s)(p<0.001).2.Prostate volume,maximum urinary flow rate,IPSS score,and annual prostate growth rate were significantly different between the normal weight group and the obese group(P<0.05).The prostate volume(65.53±24.84 m L vs.57.26±21.15 m L),IPSS score(20.56±7.08 vs.18.17±6.06),and prostate growth rate in the obese group were significantly larger than those in the normal group.annual growth rate(1.60±0.97 m L/year vs1.37±0.88 m L/year)was significantly greater than that of the normal group,and the maximum urinary flow rate was less than that of the normal group(6.74±2.12 m L/s vs7.62±2.23 m L/s).PSA was not significantly different between the two groups(P>0.05).3.Compared with patients in the normal HDL-C level group,the prostate volume(68.12±24.04 m L vs.57.87±22.03 m L),annual prostate growth rate(1.68±0.97 m L/year vs.1.39±0.89 m L/year),and IPSS score(21.75±6.84 vs.18.21 ±6.23)were significantly greater(P<0.05);maximum urinary flow rate(6.23±1.77 m L/s vs 7.64±2.09 m L/s)was lower(P<0.05);no significant difference was seen in serum PSA between the two groups(P>0.05)4.Patients in the abnormal fasting glucose group had higher prostate volume(70.64±26.73 m L vs 58.24±21.51 m L),IPSS score(23.14±6.76 vs 18.23±6.19),and annual prostate growth rate(1.75±1.06 m L/year vs 1.40±0.88 m L/year)than the normal fasting glucose group.The maximum urinary flow rate(1.75±1.06 m L/s vs 1.40±0.88 m L/s)was lower than that of the fasting glucose normal group(P<0.001);no significant difference was seen in serum PSA between the two groups(P>0.05).5.Compared with BPH patients in the normotensive group,total prostate volume(70.64±26.73 m L vs 57.22±20.93 m L)and IPSS score(20.77±6.97 vs 17.93±6.00)were significantly higher in the hypertensive group(P<0.05);maximum urinary flow rate(6.59±2.03 m L/s vs 7.77±2.02 m L/s)were significantly lower(P<0.001);no significant differences were seen in serum PSA and annual prostate growth rate between the two groups(P>0.05).6.According to the number of Met S groups divided into 4 groups(0,1,2,3 groups or more),two-by-two comparison of the relevant prostate observation indexes of the 4 groups of patients revealed that prostate volume,maximum urinary flow rate,IPSS score,and annual prostate growth rate were significantly different between the 4 groups(P < 0.05);the more the number of Met S groups,the greater the prostate volume,IPSS score,annual prostate growth rate,and The higher the number of Met S groups,the greater the prostate volume,IPSS score,and annual prostate growth rate,and the lower the maximum urinary flow rate;no significant differences were found between the groups in serum PSA(P > 0.05).7.Prostate volume was positively correlated with BMI(r=0.60),fasting glucose(r=0.674),and systolic blood pressure(r=0.1530),and negatively correlated with HDL-C(r=-11.886)(all P less than 0.05);IPSS score was positively correlated with BMI(r=1.37),fasting glucose(r=0.556),systolic blood pressure(r=0.73),HDL-C(r=-4.219)were negatively correlated(all P less than 0.05);maximum urinary flow rate was negatively correlated with BMI(r=-0.057),fasting glucose(r=-0.032),systolic blood pressure(r=-0.223),and HDL-C(r=1.947)(all P less than 0.05).Annual prostate growth rate was positively correlated with BMI(r=0.013),fasting glucose(r=0.03),systolic blood pressure(r=0.013),and HDL-C(r=-0.502)(all P less than 0.05).There was no significant correlation between PSA and BMI,fasting glucose,systolic blood pressure,and HDL-C(P>0.05).8.FBG,BMI,systolic blood pressure,diastolic blood pressure,and were significantly higher in the severe LUTS group than in the moderate LUTS group,and HDL-C was significantly lower in the severe LUTS group than in the moderate LUTS.the prevalence of Met S was higher in patients with severe LUTS(25.4%)than in those with moderate LUTS(12.7%).9.Fasting glucose(OR 1.741,95% CI 1.004 to 3.016,P<0.05),hypertension(OR 2.357,95% CI 1.132 to 4.908,P<0.05),and lipids(OR 2.536,95% CI 1.433 to 4.488,P<0.05)were significant predictors of severe LUTS.In contrast,no correlation was found between hypertension and LUTS severity in terms of risk of development.【Conclusions】1.BPH patients with obesity,low HDL-C,high FBG,and high blood pressure had larger prostate volume,higher IPSS scores,lower maximum urinary flow rate,and greater annual prostate growth rate.2.Prostate volume,IPSS score,and annual prostate growth rate were positively correlated with BMI,fasting glucose,and systolic blood pressure,and negatively correlated with HDL-C;maximum urinary flow rate was positively correlated with BMI,fasting glucose,and systolic blood pressure,and negatively correlated with HDL-C.3.The higher the number of metabolic syndrome groups,the larger the prostate volume,the higher the IPSS score,the lower the maximum urinary flow rate,and the greater the annual prostate growth rate.4.Hyperglycemia,hypertension,and hyperlipidemia were significant predictors of severe LUTS.