BERKELEY, CA (UroToday.com) - Recently, metabolic syndrome (MetS) has been considered to have an important role in lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) etiologies. Pathophysiological conditions of MetS involve enhanced sympathetic nervous activity and possibly an elevated risk for atherosclerotic diseases. Further, MetS might aggravate systemic vascular factors and disturb blood flow of the lower urinary tract, thus leading to the onset of LUTS and lower urinary tract dysfunction (LUTD). Recent studies imply an important role of bladder ischemia and change of bladder blood flow (BBF) in the development and severity of LUTS and LUTD, and these reports show the possibility that atherosclerosis plays a pathophysiological role in the development of LUTS/BPH. We hypothesized that abdominal aortic calcification and visceral fat area (VFA) might influence LUTS and lower urinary tract function, possibly through bladder ischemia and change of BBF. In this study, we investigated the impact of abdominal aortic calcification and VFA on LUTS and clinical parameters in patients with BPH.
We retrospectively collected data of 250 male patients (72.4 ± 9.6 years old) diagnosed with LUTS/BPH. Each participant was examined with routine examination including measurement of various data;
- voided volume (VV), maximum urinary flow rate (Qmax) on free uroflowmetry
- postvoid residual urine volume and prostate volume using transabdominal ultrasound,
- IPSS and Overactive Bladder Symptom Score (OABSS),
- aortic calcification index (ACI) and VFA were measured by abdominal CT.
In result, ACI significantly correlated with VV (P=0.0392) and tended to correlate with Qmax, while ACI did not correlate with subjective symptoms. These results suggested that abdominal aortic calcification might have an influence on bladder capacity. VFA significantly correlated with nocturia score of IPSS (P=0.0177) and frequency score of OABSS (P=0.0166), and tended to correlate with urgency score of IPSS and Qmax.
In conclusion, ACI correlated with only objective parameter, while VFA correlated with only storage symptoms. Although abdominal aortic calcification and visceral fat obesity seem to affect the overactivity of the sympathetic nervous system and therefore have an influence on LUTS/BPH, interrelationship among arteriosclerosis, visceral fat obesity, and LUTS/BPH remains to be further elucidated. Despite these limitations, the present study suggests that ACI and VFA might affect subjective and objective parameters in patients with LUTS/BPH.
Written by:
Seiji Matsumoto, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Asahikawa Medical University
Dept. of Renal and Urological Surgery
2-1-1-1 Midorigaoka-Higashi
Asahikawa, Hokkaido 078-8510, Japan