Abstract
ObjectiveChronic inflammation is considered as one of the contributing mechanisms of lower urinary tract symptoms (LUTS). Serum C-reactive protein (CRP) level is the widely used biomarker of inflammatory status. This study investigated the association between serum CRP level in men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) before and after medical treatment.MethodsA total of 853 men with BPH and LUTS were enrolled. All patients completed the International Prostate Symptoms Score (IPSS) questionnaire and urological examinations. The parameters of uroflowmetry (maximum flow rate, Qmax; voided volume, VV), post-void residual (PVR), total prostate volume (TPV) and transition zone index (TZI), serum prostate specific antigen (PSA), and serum CRP levels were obtained. All patients were treated with alpha-blocker or antimuscarinic agent based on the IPSS voiding to storage subscore ratio (IPSS-V/S). Correlation analyses were performed between serum CRP levels with age, IPSS, TPV, TZI, Qmax, PVR, VV, PSA and between baseline and post treatment.ResultsThe mean age was 66.9±11.6 years old and the mean serum CRP levels were 0.31±0.43 mg/dL. Univariate analyses revealed serum CRP levels were significantly associated with age (p<0.001), PSA levels (p = 0.005) and VV (p = 0.017), but not significantly associated with TPV (p = 0.854) or PVR (p = 0.068). CRP levels were positively associated with urgency (p<0.001) and nocturia (p<0.001) subscore of IPSS, total IPSS (p = 0.008) and storage IPSS (p<0.001) and negatively associated with IPSS- V/S ratio (p = 0.014). Multivariate analyses revealed that serum CRP levels were significantly associated with age (p = 0.004) and storage IPSS subscore p<0.001). Patients with IPSS-V/S<1 and treated with tolterodine for 3 months had significant decrease of CRP levels after treatment.ConclusionSerum CRP levels are associated with storage LUTS and sensory bladder disorders, suggesting chronic inflammation might play a role in the patients with storage predominant LUTS.
Highlights
International Continence Society (ICS) defined lower urinary tract symptoms (LUTS) as three categories including storage, voiding, and post-micturition symptoms [1]
When we correlated serum C-reactive protein (CRP) levels with each item subscore of International Prostate Symptoms Score (IPSS), a significant association was only noted in urgency (r2 = 0.133, p,0.001) and nocturia (r2 = 0.122, p,0.001), but not in the subscore of incomplete emptying (r2 = 0.015, p = 0.665), frequency (r2 = 20.003, p = 0937), intermittency (r2 = 20.003, p = 0.937), weal stream (r2 = 0.036, p = 0.297), straining to void (r2 = 0.025, p = 0.463) or quality of life index (r2 = 0.014, p = 0.678)
The multivariate model was based on all significant variables in the univariate analysis and showed that only IPSS-S (p,0.001) and age (p = 0.004) were the independent predictors associated with an elevated serum CRP level. (Table 1)
Summary
International Continence Society (ICS) defined lower urinary tract symptoms (LUTS) as three categories including storage, voiding, and post-micturition symptoms [1]. In a cohort study consisting of 19,165 individuals in five countries by using the ICS definition in 2002, 62.5% of men 40 years or older reported at least one LUTS. Storage symptoms (51%) were more common than voiding symptoms (26%), and the incidence of all LUTS increased with age [2]. Benign prostatic hyperplasia (BPH) was considered the dominant cause of LUTS in the population aged greater than 60 years. Subclinical inflammation has been reported to involve in the pathophysiology of erectile dysfunction [3,4]. High-sensitivity C-reactive protein (hs-CRP) level is helpful in predicting the risk of cardiovascular disease and diabetes in asymptomatic people [6] as well as in men with erectile dysfunction [7]
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