Effect of metabolic syndrome on treatment outcome of lower urinary tract symptoms in males due to benign prostatic hyperplasia

Y Roja Ramani,Preetish Panigrahy,Benu Panigrahy

doi:10.18231/j.pjms.2020.063

Abstract

Lower urinary tract symptoms in males are mostly due to benign prostatic hyperplasia and overactive bladder. Approximately three-fourths of them require medical management with drugs like a1blockers and 5-a reductase inhibitors. Metabolic syndrome[MeS] as a comorbidity has been documented with a number of cases of benign prostatic hyperplasia [BPH]. The present study finds MeS as a potential risk factor for BPH and compares the effectiveness of BPH medications among those with and /or without underlying MeS. Patients were evaluated basing on the parameters like biochemical findings and clinical symptoms using IPSS Score, Quality of Life Score, prostate volume using Ultrasound abdomen and pelvis. Our study revealed that, waist circumference, BMI, FBS, Total Cholesterol, HDL cholesterol, LDL cholesterol & HOMA-IR were the significantly associated with the clinical outcome in the MetS +ve patients having BPH. MetS significantly affects the response to medical treatment of BPH as revealed from the IPSS Score, prostate volume and quality of life index. It also emphasizes that MetS evaluation should be an integral part of the standard assessment of male patients with LUTS as well as a new domain in clinical and basic research. Keywords: Metabolic syndrome, Urinary tract, Benign prostatic hyperplasia.

Highlights

Most common causes of lower urinary tract symptoms [LUTS] in males are benign prostatic hyperplasia (BPH) and overactive bladder (OAB).In aging males along with the other geriatric health problems there is a gradual rise in the incidence of BPH from the 6th to 9th decades of life and reaches to 80% by 80 years of age
All the study participants were screened for metabolic syndrome initially and further divided into MeS +ve and MeS-ve groups
Anthropometric characteristics like body mass index (BMI) and waist circumference differed significantly among Metabolic Syndrome (MetS)+ and MetS- groups. [Table 2 ] both the groups differed significantly with respect to FBG (Fasting blood glucose) and HDL Cholesterol on evaluation of the biochemical variables. [Table 3] Risk factor analysis revealed that, waist circumference >102cm, BMI >25kg/m2, FBS >110mg/dl, Total Cholesterol >200mg/dl, HDL cholesterol 100mg/dl & HOMA-IR >2.77 were the associated in the MetS +ve patients.[Table 5 ]

Summary

Introduction

Most common causes of lower urinary tract symptoms [LUTS] in males are benign prostatic hyperplasia (BPH) and overactive bladder (OAB).In aging males along with the other geriatric health problems there is a gradual rise in the incidence of BPH from the 6th to 9th decades of life and reaches to 80% by 80 years of age. Threefourths of men with symptoms of LUTS aged more than 50 years require medical management for BPH. 7–9 The severity of lower urinary tract symptoms in patients with BPH and the likelihood of having diabetes are significantly associated. Approved drugs for management of moderate to severe LUTS associated with BPH include Alfuzosin, Doxazosin, Silodosin, Tamsulosin and Terazosin [α1blockers], Dutasteride, Finasteride [5-α reductase inhibitors], Oxybutynin, Darifenacin [Anticholinergics] Tadalafil, sildenafil [Phospodiesterase type 5 inhibitors] and mirabegron [selective β 3–adrenergic agonist]. The conventional medications used to treat LUTS secondary to BPH fall into two classes of agents: α1blockers and 5-α reductase inhibitors. These agents are used either alone or in combination (larger prostate volumes). LUTS due to BPH are caused by factors like dynamic (factor regulating tone of the prostatic smooth muscle and bladder neck), static (i.e, factor causing enlarged prostatic adenoma followed by mechanical obstruction), and compensatory (hypertrophy and irritability of the detrusor muscle). 20–23

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