Abstract
BackgroundBenign prostatic hyperplasia (BPH) is on the increase placing a substantial burden on health care systems. Recent studies have shown that men with high body mass index (BMI) and central obesity, as denoted by waist circumference (WC) have bigger prostate volumes (PV) with subsequent increase in lower urinary tract symptoms (LUTS) than men with normal BMI. The purpose of this research was to investigate the correlation between Obesity and PV in patients with BPH.MethodsThe study included 178 men aged between 50 and 75 years with BPH seen at Charlotte Maxeke Johannesburg academic hospital (CMJAH) Urology Outpatient Department between September 2018 and February 2019. Weight and height measurements were obtained to calculate BMI. Furthermore, WC was measured using a measuring tape, while a transrectal ultrasound (TRUS) was used to measure PV. Patient demographics, clinical characteristics such as hypertension, diabetes, smoking and prostate specific antigen (PSA) were also noted.ResultsPatients in the study had a mean age of 64.87 ± 6.526 years and the mean BMI was 27.31 ± 3.933 kg/m2. The mean PV of each BMI group were 52.92 ± 38.49, 61.00 ± 33.10 and 64.86 ± 37.46 cm3 for normal, overweight and obese groups, respectively, and the average PV score was 59.36 ± 36.507 cm3. The mean PSA score was 4.30 ± 3.126 with a range of 1.3–6.4, while the mean WC was 98.67 cm. There was no correlation between BMI and PV (p value = 0.195) as well as between PV and WC, hypertension, diabetes or smoking. The results revealed that the relationship between PV with PSA level as well as age was significant (p value = 0.001, p value = 0.009, respectively).ConclusionThe results showed no correlation between BMI and PV. Diabetes and hypertension as well had no positive correlation with PV. A follow-up study may be indicated to look at the correlation between obesity, LUTS and urinary flow rates to establish whether aggressive management of obesity would have significant impact on the management of BPH.
Highlights
Benign prostatic hyperplasia (BPH) is on the increase placing a substantial burden on health care systems
Patients in the study had a mean age of 64.87 ± 6.526 years and the mean body mass index (BMI) was 27.31 ± 3.933 kg/m2 with the average prostate volumes (PV) score of 59.36 ± 36.507 ml
The findings of this study suggest that the routine/ aggressive medical management of obesity would be of little to no benefit with regard to BPH/lower urinary tract symptoms (LUTS) as there was no correlation between PV and any of hypertension, diabetes, BMI, and waist circumference (WC)
Summary
Benign prostatic hyperplasia (BPH) is on the increase placing a substantial burden on health care systems. Obesity increases intra-abdominal pressure, which raises intravesical pressure, in turn worsening or causing BPH symptoms such as hesitancy, poor urine stream and nocturia [3]. Central obesity accentuates microvascular disease and inflammation, leading to ischemia and oxidative stress favourable to BPH [4]. Chronic inflammation causes the release of pro-growth cytokines and various other growth factors [5]. Another hypothesis is alteration of endocrine status, with raised estrogen to androgen ratio. Increased estrogen by adipose tissue causes suppression of gonadotropins, leading to reduction in testosterone levels, a mechanism favoured in the development of BPH [6]
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