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Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome

Key Points

  • Multiple studies have investigated associations of BPH and/or lower urinary tract symptoms (LUTS) with metabolic syndrome as a whole and its components, for example visceral obesity, glucose intolerance, dyslipidaemia and hypertension

  • Although evidence for associations is conflicting for some components, metabolic syndrome as a whole is an important determinant in both the development and the progression of BPH-related LUTS (BPH–LUTS)

  • Metabolic-syndrome-related pathological changes, such as sex steroid alterations and low-grade inflammation, have been related to BPH–LUTS development and progression

  • Elevated oestrogen and oxidized LDL cholesterol levels increase inflammatory signalling of prostatic cells, stimulating chronic inflammation and proliferation, which contribute to BPH–LUTS development; androgens blunt this effect

  • Several intervention studies have demonstrated that testosterone replacement therapy can improve LUTS, but a therapeutic role of statin use for already established LUTS is still under debate

  • Promoting a healthy lifestyle, even in the asymptomatic phase, could alter a man's propensity to develop BPH–LUTS

Abstract

Epidemiological studies have shown that age is the principal unmodifiable risk factor of lower urinary tract symptoms (LUTS). Until the past decade, the process of lower urinary tract ageing was, therefore, considered unmodifiable — as ageing per se. However, the traditional dogma that BPH-related LUTS (BPH–LUTS) is an immutable consequence of old age is no longer acceptable. Results from multiple preclinical and clinical studies indicate that several modifiable, age-related metabolic aberrations (metabolic syndrome, obesity, dyslipidaemia, diabetes) are important determinants in both the development and the progression of BPH–LUTS. Metabolic syndrome and its related comorbidities, such as sex steroid alterations and low-grade inflammation, have been related to BPH–LUTS development and progression. With the correct treatment and recommended lifestyle changes, many individuals with metabolic syndrome might be able to prevent or delay the onset of metabolic-syndrome-related complications; however, whether promoting healthier lifestyles can really alter a man's propensity to develop BPH–LUTS remains to be clarified.

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Figure 1: Prevalence of metabolic syndrome by age and gender26.
Figure 2: Molecular effects of metabolic syndrome on prostate inflammatory signalling.
Figure 3: 'Two-hit' hypothesis for the pathogenesis of BPH–LUTS.

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L.V. and M.G. researched data for the article. L.V. and M.M. provided a substantial contribution to discussion of the content, wrote the article and reviewed/edited the manuscript before submission.

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Vignozzi, L., Gacci, M. & Maggi, M. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nat Rev Urol 13, 108–119 (2016). https://doi.org/10.1038/nrurol.2015.301

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