Metabolic syndrome and smoking are associated with an increased risk of nocturia in male patients with benign prostatic enlargement

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To evaluate the relationship between cigarette smoking, metabolic syndrome (MetS) and nocturia in patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE).


From 2009 onward, a consecutive series of patients with LUTS/BPE were enrolled. Symptoms were assessed using the International Prostate Symptom Score (IPSS). Age, body mass index (BMI), smoker status, prostate volume (PV), prostate-specific antigen (PSA) levels, fasting glucose levels, triglyceride levels, and high-density lipoprotein levels were recorded. MetS was defined according to Adult Treatment Panel III criteria. Moderate/severe nocturia was defined as nocturnal micturition episodes ≥2.


Overall 492 patients were enrolled with median age and BMI of 68 years (IQR 61/74) and 26.5 kg/m2 (IQR: 24/29), respectively. Moderate/severe nocturia was reported in 212 (43.1%) patients. MetS was diagnosed in 147 (29.9%) patients and out of them 89 (60.5%) complained moderate/severe nocturia (p = 0.001). Overall 187 (38%) patients were current smokers and out of them 99 (52%) presented moderate/severe nocturia(p = 0.034). Patients with moderate/severe nocturia were older (p = 0.001) and with larger prostate volume (p = 0.003). On multivariate analysis, age (OR: 1.067 per year, 95% CI: 1.036–1.098; p = 0.001), PV (OR: 1.011 per ml, 95% CI: 1.003–1.019; p = 0.006), MetS (OR: 2.509, 95% CI: 1.571–4.007; p = 0.001) and smoking (OR: 1.690, 95% CI: 1.061–2.693; p = 0.027) were associated with nocturia severity.


MetS and smoking doubled the risk of moderate/severe nocturia in patients with LUTS and BPE. Assessing smoking and metabolic status in LUTS/ BPE patients is suggested.

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Author information


  1. Department of Urology, Sant’Andrea Hospital, “La Sapienza” University of Rome, 00189, Rome, Italy

    • Cosimo De Nunzio
    • , Aldo Brassetti
    • , Flavia Proietti
    • , Marianna Deroma
    •  & Francesco Esperto
  2. Department of Urology, Ospedale Sant’Andrea, “La Sapienza” University of Rome, 00189, Rome, Italy

    • Andrea Tubaro


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Conflict of interests

The authors declare that they have no competing interest.

Corresponding authors

Correspondence to Cosimo De Nunzio or Andrea Tubaro.