Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial

LUTS/BPH increases the risk of depressive symptoms among elderly adults: A 5-year longitudinal evidence from CHARLS

OBJECTIVE

The prevalence of Lower Urinary Tract Symptoms suggestive of Benign Prostatic Hyperplasia (LUTS/BPH) is notably high and potentially elevates the likelihood of depressive symptoms. This study was designed to employ both cross-sectional and longitudinal methodologies to explore the correlation between LUTS/BPH and depressive symptoms among middle-aged and elderly men in China.

METHODS

This investigation utilized data from the China Health and Retirement Longitudinal Study (CHARLS), with the initial dataset from 2015 serving as the baseline and subsequent data from 2018 and 2020 facilitating longitudinal analysis. The study encompassed a baseline cohort of 5156 men aged 45 years and above, and an expansive longitudinal analytical sample of 23,530 participants spanning from 2015 to 2020. The assessment of depressive symptoms was conducted using the 10-item Center for Epidemiological Studies Depressive Symptoms Scale (CESD-10). To investigate the factors associated with LUTS/BPH, the relationship between LUTS/BPH and depressive symptoms, and to evaluate the incidence rate of depressive symptoms onset based on LUTS/BPH status, multivariate logistic analyses and logistic regression models were employed.

RESULTS

Our results reveal a markedly higher incidence of depressive symptoms among individuals with LUTS/BPH, at 30.16 %, compared to 22.94 % in those without LUTS/BPH. This pattern was consistent in both mild and moderate depressive symptoms categories. However, the prevalence of severe depressive symptoms did not exhibit a significant disparity between the two groups. Longitudinal analysis spanning from 2015 through 2018 and 2020 further corroborated these observations. Individuals with LUTS/BPH showed a substantially higher incidence of depressive symptoms across all severity levels compared to those without LUTS/BPH. Specifically, the presence of LUTS/BPH was linked to a 53 % heightened risk of mild depressive symptoms, a 45 % increase in moderate depressive symptoms, and an alarming 229 % surge in severe depressive symptoms risk between 2015 and 2018. Additionally, from 2015 to 2020, there was a 30 % increased risk for mild depressive symptoms, a 41 % rise for moderate depressive symptoms, and a 106 % escalation in the risk of severe depressive symptoms among those with LUTS/BPH.

CONCLUSION

In middle-aged and older Chinese adults, LUTS/BPH were correlated with an elevated risk of depressive symptoms.

The correlation between obesity and prostate volume in patients with benign prostatic hyperplasia: A prospective cohort study

OBJECTIVE/BACKGROUND

Benign prostatic hyperplasia (BPH) is increasing substantial burden on health care systems. Men with high body mass index (BMI) 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.

METHOD

The study included 560 patients (50-80 years) with BPH. Weight and height measured to calculate BMI. TRUS was used to measure PV. Patient demographics such as IPSS score and prostate specific antigen (PSA) were also noted.

RESULTS

Patients in the study had a mean age of 65.3 ± 9.45 years and the mean BMI was 23.97 ± 4.89 kg/m2. The mean PV of each BMI group were 37.45 ± 0.81, 57.89 ± 1.52 and 77.94 ± 2.17 (ml) for normal, overweight and obese groups, respectively, and the average PV score was 57.76 ± 1.50 ml. The mean PSA score was 3.26 ± 0.94 (ng/dl) with a range of 0.6-10.4. There was significant correlation between BMI and PV (p = 0.001) as well as between BMI with PSA and IPSS (p = 0.02, 0.001, respectively).

CONCLUSION

The results showing strong correlation between BMI and PV also BMI with PSA and IPSS. Therefore reducing weight may lead to a lower prostate volume in the elderly stage, making LUTS less noticeable and improving quality of life.

Prevalence and trends in overactive bladder among men in the United States, 2005-2020

The purpose of present study was to examine the current prevalence and recent trends of overactive bladder (OAB) among US adult men and examine the correlations between OAB and several potential risk factors. The study used the nationally representative data between 2005 and 2020 from the National Health and Nutrition Examination Survey in the US. A total of 18,386 participants aged ≥ 20 years were included in the study. We divided the data into three groups: 2005-2008, 2009-2014 and 2015-2020 to investigate the trends in OAB prevalence. The weighted prevalence and corresponding 95% confidence intervals (CI) of OAB were calculated. The differences (95% CI) in prevalence between the surveys were calculated and multivariate-adjusted weighted logistic regression analysis was performed to determine the correlates of OAB. Among all US adult men, the overall prevalence of OAB increased slightly from 11.3% in 2005-2008 to 11.7% in 2009-2014 and significantly increased to 14.5% in 2015-2020 (difference, 3.2% [95% CI (1.9-4.4%)]; P < 0.05). Increases in OAB prevalence especially concentrated on those who were 40-59 years, non-Hispanic White, non-Hispanic Black and those who were overweight and obese. Older age, non-Hispanic Black, lower educational level and family poverty ratio, diabetes, depression, sleep disorder, other chronic comorbidities, less intense recreational activity, poorer health condition and unsafe food were independent risk factors of OAB. The contemporary prevalence of OAB was high, affecting 14.5% US men and the estimated overall prevalence significantly increased from 2005 to 2020. Therefore, future research should be focused to prevent and remedy this growing socioeconomic and individually troublesome malady.

Link between circadian rhythm and benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS)

BACKGROUND

Benign prostatic hyperplasia (BPH) is the most common urologic disease in aging males, affecting 50% of men over 50 and up to 80% of men over 80 years old. Its negative impact on health-related quality of life implores further investigation into its risk factors and strategies for effective management. Although the exact molecular mechanisms underlying pathophysiological onset of BPH are poorly defined, the current hypothesized contributors to BPH and lower urinary tract symptoms (LUTS) include aging, inflammation, metabolic syndrome, and hormonal changes. These processes are indirectly influenced by circadian rhythm disruption. In this article, we review the recent evidence on the potential association of light changes/circadian rhythm disruption and the onset of BPH and impact on treatment.

METHODS

A narrative literature review was conducted using PubMed and Google Scholar to identify supporting evidence. The articles referenced ranged from 1975 to 2023.

RESULTS

A clear relationship between BPH/LUTS and circadian rhythm disruption is yet to be established. However, common mediators influence both diseases, including proinflammatory states, metabolic syndrome, and hormonal regulation that can be asserted to circadian disruption. Some studies have identified a possible relationship between general LUTS and sleep disturbance, but little research has been done on the medical management of these diseases and how circadian rhythm disruption further affects treatment outcomes.

CONCLUSIONS

There is evidence to implicate a relationship between BPH/LUTS and circadian rhythm disruptions. However, there is scarce literature on potential specific link in medical management of the disease and treatment outcomes with circadian rhythm disruption. Further study is warranted to provide BPH patients with insights into circadian rhythm directed appropriate interventions.

Is Race Associated with the Surgical Treatment for Benign Prostatic Hyperplasia? An Analysis of 30,000 Medicare Lives

BACKGROUNDS

With an increased prevalence and burden of benign prostatic hyperplasia (BPH), effective and equitable treatment is a priority. Limited data exist evaluating treatment disparities for patients with BPH by race. This study examined the association between race and BPH surgical treatment rates among Medicare beneficiaries.

METHODS

Medicare claims data were used to identify men newly diagnosed with BPH from January 1, 2010 through December 31, 2018. Patients were followed until their first BPH surgery, a diagnosis of prostate/bladder cancer, termination of Medicare enrollment, death, or end of study. Cox proportional hazards regression compared the likelihood of BPH surgery between men of different races (White vs. Black, Indigenous, and People of Color (BIPOC)), controlling for patients' geographical region, Charlson comorbidity score, and baseline comorbidities.

RESULTS

The study included 31,699 patients (13.7% BIPOC). BIPOC men had significantly lower BPH surgery rates (9.5% BIPOC vs. 13.4% White; p=0.02). BIPOC race was associated with a 19% lower likelihood of receiving BPH surgery than White race (HR, 0.81; 95% CI 0.70, 0.94). Transurethral resection of the prostate was the most common surgery for both groups (49.4% Whites vs. 56.8% BIPOC; p=0.052). A higher proportion of BIPOC men underwent procedures in inpatient settings compared to White men (18.2% vs. 9.8%; p<0.001).

CONCLUSIONS

Among a cohort of Medicare beneficiaries with BPH, there were notable treatment disparities by race. BIPOC men had lower rates of surgery than White men and were more likely to undergo procedures in the inpatient setting. Improving patient access to outpatient BPH surgical procedures may help address treatment disparities.

Association between body mass index, metabolic syndrome and common urologic conditions: a cross-sectional study using a large multi-institutional database from the United States

INTRODUCTION

The study aims to determine whether body mass index (BMI), metabolic syndrome (MS) or its individual components (primary hypertension, type 2 diabetes mellitus and dyslipidemias) are risk factors for common urological diseases.

MATERIALS AND METHODS

Cross-sectional study with data collected on February 28, 2022 from the TriNetX Research Network. Patients were divided in cohorts according to their BMI, presence of MS (BMI > 30 kg/m2, type 2 diabetes mellitus, primary hypertension and disorders of lipoprotein metabolism) and its individual components and its association with common urological conditions was determined. For each analysis, odds ratio (OR) with 95% confidence intervals were calculated. Statistical significance was assessed at p < .05.

RESULTS

BMI > 30 kg/m2 was associated with increased risk of lithiasis, kidney cancer, overactive bladder, male hypogonadism, benign prostatic hyperplasia, and erectile dysfunction (p < .05). On the contrary, BMI was inversely associated with ureteral, bladder and prostate cancer (p < .05). In all urological diseases, MS was the strongest risk factor, with prostate cancer (OR = 2.53) showing the weakest and male hypogonadism the strongest (OR = 13.00) associations.

CONCLUSIONS

MS and its individual components were significant risk factors for common urological conditions. Hence holistic approaches with lifestyle modification might prevent common urological disease.Key messagesOverall, metabolic syndrome is the strongest risk factor for all the analysed urological diseases.Abnormally high body mass index can be a risk or protective factor depending on the threshold and urological disease that are being evaluated.Metabolic syndrome and increased BMI should be considered important factors associated to the prevalence of common urological diseases.

The causal relationship between sarcopenic obesity factors and benign prostate hyperplasia

Background

Both benign prostatic hyperplasia (BPH) and sarcopenic obesity (SO) are common conditions among older adult/adults males. The prevalent lifestyle associated with SO is a significant risk factor for the development of BPH. Therefore, we investigated the causal relationship between SO factors and BPH.

Method

The instrumental variables for SO factors were selected using the inverse variance-weighted method, which served as the primary approach for Mendelian randomization analysis to assess the causal effect based on summary data derived from genome-wide association studies of BPH.

Result

The increase in BMR (OR = 1.248; 95% CI = (1.087, 1.432); P = 0.002) and ALM (OR = 1.126; 95% CI = (1.032, 1.228); P = 0.008) was found to be associated with an elevated risk of BPH. However, no genetic causality between fat-free mass distribution, muscle mass distribution, and BPH was observed.

Conclusion

Our findings indicate that a genetic causal association between BMR, ALM and BPH. BMR and ALM are risk factors for BPH. The decrease in BMR and ALM signified the onset and progression of SO, thus SO is a protective factor for BPH.

Lipoxygenase-12 Levels and Biochemical Parameters in Iraqi Patients With Type 2 Diabetes With and Without Benign Prostatic Hyperplasia

Background Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia caused by a defect in the secretion or action or both of insulin. It has a complex pathogenesis. Benign prostatic hyperplasia (BPH) refers to an increase in the size of the prostate; it is one of the most common health problems in men that manifests with age. Lipoxygenase-12 (Lipox-12) is one of the enzymes in the Lipox 12/15 family, which plays a major role in catalyzing a variety of polyunsaturated fatty acids (PUFAs) that are capable of producing different metabolites. Lipox-12 has a significant effect on arachidonic acid metabolism, with PUFA, a pro- and anti-inflammatory mediator, as one of the enzyme isoforms. It also plays a major role in modulating inflammation at multiple checkpoints as diabetes progresses. The present study aims to measure Lipox-12 levels in patients with DM type 2 (DM2) and patients with DM2 + BPH. Methodology This study was conducted in Musayyib General Hospital, south of Baghdad, where a clinical examination was performed on 50 samples from controls (healthy subjects), 50 patients with DM2, and 50 patients with DM2 + BPH after taking each patient's history. The examinations performed included fasting blood sugar (FBS), hemoglobin A1c (HbA1c), prostate-specific antigen (PSA), triglycerides (TG), cholesterol (Chol), and Lipox-12. Results The results showed that both the DM2 and DM2 + BPH groups had higher FBS, HbA1c, TG, and Chol levels than healthy subjects; in contrast, Lipox-12 levels were the lowest in the DM2 group (sensitivity = 79% and specificity = 81%) but higher in the DM2 + BPH group (sensitivity = 80%; specificity = 82%) compared to the control group. Conclusions Lipox-12 had a high sensitivity and specificity in the DM2 and DM2 + BPH groups compared to the control group, and in both cases, it was used to monitor and diagnose DM2 and BPH.

Does Significant Weight Loss After Bariatric Surgery Affect Sexual Function and Urinary Symptoms? An Iranian Study

INTRODUCTION

For sexual dysfunction and lower urinary tract symptoms (LUTS), obesity is identified as an independent risk factor. The current study aimed to evaluate the effect of significant rapid weight loss by bariatric surgery on LUTS and sexual function among men and women with class III obesity.

METHOD

A group of patients who were planned to undergo bariatric surgery was enrolled in the study. Male patients were given the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaires. In the female group, they filled in the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) questionnaires. Patients were followed up 1 year after their bariatric surgery.

RESULTS

All questionnaires were completed by eighty-one patients. (mean age ± SD: 39.4 ± 9.2 years; mean body mass index (BMI) ± SD: 47.15 ± 5.4 kg/m2). The total score of the IPSS questionnaire decreased from 5.83 ± 3.01 preoperatively to 2.37 ± 1.66 postoperatively. The weight loss caused significant improvement in the storage phase of LUTS domains, but there were no considerable changes in the voiding phase. In the IIEF questionnaire, domains of sexual desire, overall satisfaction, and orgasmic function improved significantly. There was not a significant change in any FSFI domains after bariatric surgery. Mean ICIQ-SF decreased, but it was not substantial.

CONCLUSION

Bariatric surgery can significantly improve the storage phase in men, but not the voiding phase. Sexual desire, orgasmic function, and overall satisfaction were significantly improved in men. No significant improvement in sexual function and UI in women was observed.

The Molecular Basis and Clinical Consequences of Chronic Inflammation in Prostatic Diseases: Prostatitis, Benign Prostatic Hyperplasia, and Prostate Cancer

Chronic inflammation is now recognized as one of the major risk factors and molecular hallmarks of chronic prostatitis, benign prostatic hyperplasia (BPH), and prostate tumorigenesis. However, the molecular mechanisms by which chronic inflammation signaling contributes to the pathogenesis of these prostate diseases are poorly understood. Previous efforts to therapeutically target the upstream (e.g., TLRs and IL1-Rs) and downstream (e.g., NF-κB subunits and cytokines) inflammatory signaling molecules in people with these conditions have been clinically ambiguous and unsatisfactory, hence fostering the recent paradigm shift towards unraveling and understanding the functional roles and clinical significance of the novel and relatively underexplored inflammatory molecules and pathways that could become potential therapeutic targets in managing prostatic diseases. In this review article, we exclusively discuss the causal and molecular drivers of prostatitis, BPH, and prostate tumorigenesis, as well as the potential impacts of microbiome dysbiosis and chronic inflammation in promoting prostate pathologies. We specifically focus on the importance of some of the underexplored druggable inflammatory molecules, by discussing how their aberrant signaling could promote prostate cancer (PCa) stemness, neuroendocrine differentiation, castration resistance, metabolic reprogramming, and immunosuppression. The potential contribution of the IL1R-TLR-IRAK-NF-κBs signaling molecules and NLR/inflammasomes in prostate pathologies, as well as the prospective benefits of selectively targeting the midstream molecules in the various inflammatory cascades, are also discussed. Though this review concentrates more on PCa, we envision that the information could be applied to other prostate diseases. In conclusion, we have underlined the molecular mechanisms and signaling pathways that may need to be targeted and/or further investigated to better understand the association between chronic inflammation and prostate diseases.

Characteristics of recurrent acute urinary retention in BPH patients in the United States: Retrospective analysis of US-based insurance claims database

PURPOSE

The objective of this study is to analyze characteristics of recurrent acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH), utilizing a population based data set. Also, we sought to report on how AUR was treated, specifically regarding the need and length of catheterization and types of procedures utilized for mitigation.

MATERIALS & METHODS

A retrospective observational cohort study was performed using Optum's deidentified Clinformatics® Data Mart Database. We compared two groups, BPH patients with AUR (n = 180,737) and BPH patients without AUR (n = 1,139,760) from January 1, 2003 to December 31, 2017. Also, we analyzed the factors affecting the development of multiple episodes of AUR through age-adjusted multivariate analysis.

RESULTS

In contrast to the 47.7% of patients who had a single AUR episode, 33.5% of AUR patients developed 3 or more subsequent episodes of retention. For age matched patients, the risks of additional episodes of retention increase significantly with older age, Caucasian race, diabetes, neurologic conditions, or low income. Overall, the rate of BPH surgery in AUR patients over the study period decreased and the most common procedure was transurethral resection of the prostate.

CONCLUSIONS

Risk factors for multiple episodes of AUR included age (60 and older), Caucasian race, lower income socioeconomic status, diabetes, and neurological disorders. Patients with a high probability of developing recurrent episodes of AUR are recommended to receive preemptive BPH medication before such AUR occurrences. Also, more expeditious surgical treatment should be considered rather than temporary catheterization when AUR occurs.

Relationship between severity of obstructive sleep apnea and benign prostatic hyperplasia

PURPOSE

The cause of benign prostatic hyperplasia (BPH) is controversial, local hypoxia and inflammation being the main two possibilities proposed. The aim of this study was to evaluate the relationship between obstructive sleep apnea (OSA) and BPH.

METHODS

The study cohort comprised men from January 2016 to December 2020 in our Sleep Center. These patients were classified into four groups (no, mild, moderate, severe OSA) by apnea-hypopnea indexes (AHI). Logistic regression was used to identify independent risk factors for BPH, after which participants were stratified into younger (age ≤ 40 years) and older groups (age > 40 years) for further analysis.

RESULTS

The study cohort comprised 467 patients including 135 younger subjects and 332 older subjects. The prevalence of BPH in the above listed AHI categories was 37.5%, 55.0%, 62.9%, and 52.3%, respectively (p = 0.075). Logistic regression analysis of all patients identified age as a risk factor for BPH (p < 0.001). Stratified analysis according to AHI category found a prevalence of BPH of 0.0%, 13.0%, 33.3%, and 43.9%, respectively, in younger group (p = 0.006), and 52.2%, 71.9%, 71.1%, and 56.3%, respectively, in older group (p = 0.038). Logistic regression analysis found age and AHI were independent risk factors for BPH in younger group (both p < 0.05), whereas only age was identified as a risk factor for BPH in older group (p < 0.001).

CONCLUSIONS

Age is an independent risk factor for BPH in men with OSA. AHI is also an independent risk factor for BPH in younger men, suggesting that OSA may affect development of BPH in younger men.

Lipidic extract of whole tomato reduces hyperplasia, oxidative stress and inflammation on testosterone-induced BPH in obese rats

PURPOSE

Tomato is an important source of lycopene, a carotenoid that has been emerging as a natural preventive agent for prostate disease. Moreover, tomato contains other components with a wide range of physiological properties, but their potential beneficial effects on prostatic hyperplasia (PH) during obesity have not been completely established. In this study, we compared the effect of a lipidic extract of tomato saladette (STE) with Serenoa repens (SR) on obese rats with PH.

METHODS

Forty-eight Wistar rats were divided in Control (C) and Obese (Ob) treated without (n = 12) and with (n = 36) testosterone enanthate (TE), once a week for 8 weeks to induce PH. After 4 weeks, SR and STE were administered. Biochemical parameters, oxidative stress markers and inflammatory cytokines production were determined.

RESULTS

TE increased prostate weight and caused prostatic hyperplasia in C group, and these effects were exacerbated by obesity. SR and STE reverted the increase in prostate weight and hyperplasia caused by TE in C and Ob groups. Obesity increased LDL, TGs, NOx and MAD, but decreased HDLc, GSx, SOD and CAT. SR reverted the effects of obesity, but these were significantly reduced and HDLc increased with STE. Obesity and TE increased TNFα, IL-1β and IL-6 levels, but these were partially reverted by STE compared with SR.

CONCLUSIONS

Excess of fat tissue increases the alterations by PH. STE diminishes these alterations compared with SR, suggesting its beneficial effect to improve prostate function. Whole tomato lipid extract could serve as sole therapy or as an adjunct to pharmacological treatment for PH.

Trends and Racial Disparities in the Prevalence of Urinary Incontinence Among Men in the USA, 2001-2020

BACKGROUND

Male urinary incontinence (UI) affects quality of life and leads to a significant burden to the health care system. However, the contemporary prevalence and recent trends in UI and its subtypes among US men remain unknown.

OBJECTIVE

We evaluated 20-yr trends in the prevalence of UI and its subtype in US men aged ≥20 yr.

DESIGN, SETTING, AND PARTICIPANTS

A serial, cross-sectional analysis of the US nationally representative data from the National Health and Nutrition Examination Survey among men from 2001 to 2020.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Prevalence of any, stress, urgency and overflow UI were derived. The frequency of UI was assessed in four categories: less than one time per month, a few times per month, a few times per week, and every day and/or night. All analyses were conducted using sample weights, stratification, and clustering of the complex sampling design. Sociodemographic and lifestyle correlates of UI over time were identified using multivariable logistic regressions.

RESULTS AND LIMITATIONS

Data on 22994 US men (mean age, 46.6 yr [standard error, 0.20]; weighted population, 848642150) were analyzed. The prevalence of any UI increased from 2001-2002 (11.5% [95% confidence interval {CI}, 10.0-13.0]) to 2017-2020 (19.3% [95% CI, 17.2-21.3]), driven by urgency (from 9.0% [95% CI, 7.5-10.4]) to 15.2% [95% CI, 13.4-16.9]) and overflow UI (from 3.3% [95% CI, 2.7-4.0] to 5.5% [95% CI, 4.5-6.4]; all p for trend < 0.01). UI affects 38.5% US men ≥60 yr of age, with increasing trends in urgency and overflow UI and a decreasing trend in stress UI (all p for trend < 0.05). Racial/ethnic disparities were noted, with patterns differed by UI subtype. Compared with non-Hispanic White, non-Hispanic Black men were more likely to report urgency UI (odds ratio [OR], 1.94 [95% CI, 1.71-2.20]). Hispanic men were more likely to report urgency UI (OR, 1.33 [95% CI, 1.14-1.56]), but less likely to report stress (OR, 0.74 [95% CI, 0.56-0.98]) and overflow (OR, 0.75 [95% CI, 0.58-0.98]) UI. Men with higher body mass index and current smokers were more likely to report any, stress, and urgency UI than their counterparts. A higher prevalence of any UI was found in men with low family poverty ratios and chronic diseases, and those who were physically inactive.

CONCLUSIONS

From 2001 to 2020, the overall prevalence of UI increased among US men, particularly for urgency and overflow UI.

PATIENT SUMMARY

In this report, we looked at the prevalence of urinary incontinence among US men in a nationally representative sample. We found that urinary incontinence increased in the past 20 yr driving by the urgency and overflow urinary incontinence.

Racial Disparities in Diagnosis and Management of Benign Prostatic Hyperplasia: A Review

PURPOSE OF REVIEW

We sought to perform a contemporary literature review highlighting the racial disparities which exists in the evaluation and management of benign prostatic hyperplasia (BPH).

RECENT FINDINGS

Current literature suggests that racial disparities exist in the diagnosis of BPH and treatment lower urinary tract symptoms (LUTS). This is seen in the presentation and diagnosis of the disease as well as a difference in preventative care with discordant incidences of medical and surgical management among racial groups. The racial disparities that exist in the diagnosis and management of BPH and LUTS require further investigation to better identify the underlying causes. This will ultimately allow for continued improvement in care delivery and a more personalized approach in patient management.

Phosphodiesterase 5 inhibitor suppresses prostate weight increase in type 2 diabetic rats

AIMS

Hyperinsulinemia is an important causative factor of prostate enlargement in type 2 diabetes (T2D), however, clinically prostate weight increases during hypoinsulinemic condition. To investigate the pathogenesis of prostate enlargement and effects of phosphodiesterase 5 inhibitor (PDE5i), male Otsuka Long-Evans Tokushima Fatty (OLETF) and Long-Evans Tokushima Otsuka (LETO) rats were used as T2D and control, respectively.

MATERIALS AND METHODS

OLETF and LETO rats were treated with oral tadalafil (100 μg/kg/day) or vehicle for 12 wks from at the age of 36 wks.

KEY FINDINGS

Prostate weight of OLETF rats was significantly higher than that of LETO at 36 wks, and increased at 48 wks. In OLETF rats, prostate blood flow was significantly lower at 48 wks versus 36 wks. Twelve-week-tadalafil treatment increased prostate blood flow and suppressed prostate weight increase in both strains. This change was inversely correlated with changes in prostate expressions of hypoxia-inducible factor-1 alpha (HIF-1α) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Increases with age were observed in mRNA and/or protein levels of cytokines interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha (TNF-α) and cell growth factors insulin-like growth factor-1 (IGF-1), basic fibroblast growth factor (bFGF), and transforming growth factor-beta (TGF-β); especially IL-6, TNF-α, IGF-1, bFGF and TGF-β increased with T2D. Tadalafil suppressed these cytokines and growth factors.

SIGNIFICANCE

These data suggest chronic ischemia caused by T2D leads to oxidative stress, resulting in prostate enlargement through upregulation of several cytokines and growth factors. Treatment with PDE5i improves prostate ischemia and might prevent enlargement via suppression of cytokines and growth factors in T2D.

Evaluation of pedometer use in men with lower urinary tract symptoms: a randomized clinical trial

PURPOSE

To assess the effect of a pedometer use in men aged between 50 and 59 years presenting lower urinary tract symptoms (LUTS).

METHODS

A single-center, not blind clinical trial with two parallel groups and equal randomization was performed with 38 men aged 50-59 years with LUTS. All patients received guidance and encouragement to physical activity practice. Only the intervention group received a Pedometer with a goal of 10,000 steps/day. After a period of 12 weeks, the groups were compared through the following variables: number of steps/day, IPSS score, flexibility, anthropometric values and Maximum Oxygen Consumption (VO2max).

RESULTS

The number of steps per day in the intervention group was 9753 ± 1549 compared to 6212 ± 1152 in the control group (p = 0.004). Pedometer use efficacy was a 50% risk reduction of not achieve the goal of 10,000 steps per day. Regarding IPSS score, the intervention group achieved lower scores (6.95 ± 2.85 vs. 10.16 ± 3.23, p = 0.007). Pedometer use efficacy was a 94% risk reduction of not achieve more than 30% reduction in IPSS score. In VO2max, the intervention group performed better than the control group (34.84 ± 3.25 vs. 32.58 ± 6.89; p = 0.011). There was no difference in flexibility and anthropometric values between the groups.

CONCLUSIONS

The use of pedometer in LUTS patients provided an increase in the number of steps/day, a decrease in LUTS score and an improvement in VO2max measure.

CLINICAL TRIAL REGISTRATION

Trial url: www.ensaiosclinicos.gov.br/rg/RBR-4vynk5/ . Register Number: RBR-4vynk5 .

Longitudinal Changes in Adiposity and Lower Urinary Tract Symptoms Among Older Men

BACKGROUND

Adiposity increases risk for male lower urinary tract symptoms (LUTS), although longitudinal studies have produced conflicting results. No prior studies have evaluated longitudinal associations of changes in adiposity with concurrent LUTS severity among older men.

METHODS

We used repeated adiposity measurements from dual-energy x-ray absorptiometry (DXA), body mass index (BMI), and American Urological Association Symptom Index (AUASI) measured at four study visits over a 9-year period among 5949 men enrolled in the Osteoporotic Fractures in Men (MrOS) study. Linear mixed effect models adjusted for age, health-related behaviors, and comorbidities were created to evaluate the association between baseline and change in visceral adipose tissue (VAT) area, total fat mass, and BMI with change in LUTS severity measured by the AUASI.

RESULTS

A non-linear association was observed between baseline VAT area and change in AUASI: men in baseline VAT tertile (T) 2 had a lower annual increase in AUASI score compared to men in T1 and T3 (T2 versus T1: β=-0.07; 95% CI -0.12, -0.03; P= 0.008; T3 versus T1: NS) but differences were small. No significant associations were observed between change in VAT area and change in AUASI score. Neither baseline tertiles nor change in total fat mass or BMI were associated with change in AUASI score.

CONCLUSIONS

Changes in VAT area, total fat mass, and BMI were not associated with change in LUTS severity in this cohort. Thus, despite other health benefits, interventions targeting adiposity alone are unlikely to be effective for preventing or treating LUTS among older men.

The Impact of Race, Ethnicity and Insurance Status on Surgery Rates for Benign Prostatic Hyperplasia

OBJECTIVE

To determine whether patient race/ethnicity are associated with differences in likelihood of undergoing surgical treatment for LUTS/BPH.

METHODS

Queried hospital network database between 1/2011 and 10/2018. Men over age 40 on medical therapy for LUTS (selective alpha blockade and/or 5-alpha-reductase inhibitor), with 2+ provider visits, and without bladder/prostate malignancy were included. Ethnicity/race determined by self-identification. Insurance status classified as public (Medicare/Medicaid/Tricare), private, self-pay, or other. Multivariable backwards step-wise logistic regression was performed to compare odds of undergoing a surgical procedure by race/ethnicity, controlling for patient age, insurance status, comorbidities, and type of medical therapy.

RESULTS

30,466 patients included, with White (n=24,443, 80.2%), Hispanic (n=2,715, 8.9%), Black (n=1,245, 4.1%), and other race/ethnicity (2,073, 6.8%) identified within the study population. After adjusting for age, insurance status, major comorbidities, and type of medical therapy, Black patients were less likely to undergo surgery than White patients (OR 0.57, 95% CI 0.37 - 0.88, P = .011), as were patients of other race/ethnicity (OR 0.67, 95% CI 0.49 - 0.92, P = .013).

CONCLUSIONS

Adjusting for age, insurance status, major comorbidities and type of LUTS medication, men categorized as Black were significantly less likely to undergo surgical treatment for LUTS/BPH than White patients. It is unknown whether this difference results from differences in counseling, access, or other bias in therapy. Efforts to understand and respond to this disparity are necessary. Limitations include lack of IPSS data, additional comorbidity data, limited geographic area, and retrospective nature.

Correlation between body mass index and prostate volume in benign prostatic hyperplasia patients undergoing holmium enucleation of the prostate surgery

Background

Benign prostatic obstruction (BPO) due to benign prostatic hyperplasia (BPH) is a leading cause of morbidity in men over the age of 40. This study examined whether there was an association between body mass index (BMI) and pre-operative prostate volume and whether expression of two genes, alpha-2-macroglobulin (A2M) and transforming growth factor beta 3 (TGFB3), was correlated with BMI, pre-operative prostate volume, and age at surgery.

Methods

Medical records of patients who underwent holmium enucleation of the prostate surgery for treatment of BPO were retrospectively reviewed. Surgical specimens were obtained from formalin-fixed paraffin-embedded blocks, and expression of the targeted genes was quantified using a real time PCR approach. Linear regression analysis was performed to assess association between BMI and prostate volume adjusting for demographic characteristics and co-morbidity. Spearman’s correlation was used to examine whether gene expression was correlated with BMI, prostate volume, and age at surgery.

Results

A total of 278 patients were identified, including 62.9% European Americans (n = 175) and 27.7% Hispanic Americans (n = 77). BMI was significantly correlated with prostate volume (Spearman’s rho = 0.123, P = 0.045). In linear regression analysis, BMI was positively associated with prostate volume (β = 0.01, P = 0.004), while hyperlipidemia was negatively associated with prostate volume (β = −0.08, P = 0.02). A trend for a positive association was also observed for diabetes (β = 0.07, P = 0.099). In the race/ethnicity stratified analysis, age at surgery showed a trend for significantly positive association with prostate volume in European Americans (β = 0.005, P = 0.08), but not in Hispanic Americans. Expression of the A2M gene in the stroma was negatively correlated with age at surgery (P = 0.006). A2M expression in the gland was positively correlated with prostate volume among older men (Age ≥ 70, P = 0.01) and overweight men (BMI 25–30, P = 0.04). TGFB3 expression in the gland was positively correlated with BMI (P = 0.007) among older men.

Conclusions

This study demonstrated the positive correlation between BMI and prostate volume. Expression of TGFB3 and A2M was correlated with BMI, prostate volume, and age at surgery.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12894-020-00753-9.

Genome-wide association study identifies a role for the progesterone receptor in benign prostatic hyperplasia risk

BACKGROUND

Benign prostatic hyperplasia (BPH) is common noncancerous prostate enlargement, which is usually associated with lower urinary tract symptoms (LUTS) and can lead to complex urinary, bladder, or kidney diseases. The majority of elderly men will be affected by BPH as age increases.

METHODS

Here, we conducted a genome-wide association study (GWAS) of BPH using 1942 cases and 4730 controls from the Electronic Medical Records and Genomics network (eMERGE) as discovery cohort. We then used 5109 cases and 161,911 controls from UK Biobank as validation cohort.

RESULTS

This GWAS discovered 35 genome-wide significant variants (P < 5 × 10-8), located at 22 different loci in discovery cohort. We validated four significant variants located at four different loci in validation cohort: rs8027714 at 15q11.2, rs8136152 at 22q13.2, rs10192133 at 2q24.2, and rs1237696 at 11q22.1. rs1237696 is an intronic variant on chromosome 11 in the progesterone receptor (PGR) gene (P = 4.21 ×10-8, OR [95% CI] = 1.36 [1.22-1.52]). PGR is a known drug target for BPH as the PGR agonist gestonorone caproate has been used to treat BPH in multiple countries.

CONCLUSIONS

Our results suggest that genetic variants identified from BPH GWAS can identify pharmacologic targets for BPH treatment.

Body size throughout the life-course and incident benign prostatic hyperplasia-related outcomes and nocturia

BACKGROUND

Existing evidence suggests that there is an association between body size and prevalent Benign Prostatic Hyperplasia (BPH)-related outcomes and nocturia. However, there is limited evidence on the association between body size throughout the life-course and incident BPH-related outcomes.

METHODS

Our study population consisted of men without histories of prostate cancer, BPH-related outcomes, or nocturia in the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (n = 4710). Associations for body size in early- (age 20), mid- (age 50) and late-life (age ≥ 55, mean age 60.7 years) and weight change with incident BPH-related outcomes (including self-reported nocturia and physician diagnosis of BPH, digital rectal examination-estimated prostate volume ≥ 30 cc, and prostate-specific antigen [PSA] concentration > 1.4 ng/mL) were examined using Poisson regression with robust variance estimation.

RESULTS

Men who were obese in late-life were 25% more likely to report nocturia (Relative Risk (RR): 1.25, 95% Confidence Interval (CI): 1.11-1.40; p-trend_{for continuous BMI} < 0.0001) and men who were either overweight or obese in late-life were more likely to report a prostate volume ≥ 30 cc (RR_overweight: 1.13, 95% CI 1.07-1.21; RR_obese: 1.10, 95% CI 1.02-1.19; p-trend_{for continuous BMI} = 0.017) as compared to normal weight men. Obesity at ages 20 and 50 was similarly associated with both nocturia and prostate volume ≥ 30 cc. Considering trajectories of body size, men who were normal weight at age 20 and became overweight or obese by later-life had increased risks of nocturia (RR_{normal to overweight}: 1.09, 95% CI 0.98-1.22; RR_{normal to obese}: 1.28, 95% CI 1.10-1.47) and a prostate volume ≥ 30 cc (RR_{normal to overweight}: 1.12, 95% CI 1.05-1.20). Too few men were obese early in life to examine the independent effect of early-life body size. Later-life body size modified the association between physical activity and nocturia.

CONCLUSIONS

We found that later-life body size, independent of early-life body size, was associated with adverse BPH outcomes, suggesting that interventions to reduce body size even late in life can potentially reduce the burden of BPH-related outcomes and nocturia.

Analysis of the relationship between asthma and benign prostatic hyperplasia: A STROBE-compliant study

The purpose of this study was to evaluate the association between asthma and benign prostatic hyperplasia (BPH) in an adult Korean population and to evaluate this association based on the treatment status of asthmatics.We utilized the Korean genome and epidemiology study health examinee 2004 to 2016 database. A total of 47,186 participants (825 asthmatics and 46,361 controls) were selected and their BPH histories were analyzed. We categorized the participants according to their asthma treatment status: "well controlled"; "being treated"; and "not being treated". The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for BPH were analyzed using multiple logistic regression. Subgroup analyses were performed according to age (60 years).The results showed that the prevalence of BPH was higher among asthma patients (17.1%) than among controls (8.7%, P < .001). Asthma patients had a higher risk of having BPH (OR = 1.64, 95% CI = 1.37-2.01, P < .001) than controls, after adjustment for age, income, body mass index (BMI), smoking, alcohol consumption, frequency of physical activity, and the past medical diseases. The ORs for BPH were 1.35 (95% CI = 1.04-1.76) in those aged >60 years and 2.24 (95% CI = 1.70-2.96) in those aged ≤60 years. The ORs for BPH were 1.82 (95% CI = 1.16-2.87, P = .009) in the "well-controlled" group, 1.05 (95% CI = 0.74-1.49, P = .794) in the "being treated" group, and 2.24 (95% CI = 1.69-2.97, P < .001) in the "not being treated" group.We found that there is a correlation between asthma and BPH in the adult Korean population. There is a stronger association between asthma and BPH in younger adults and in those who are not receiving treatment for asthma.

Racial Differences in Urinary Incontinence Prevalence, Overactive Bladder and Associated Bother among Men: The Multi-Ethnic Study of Atherosclerosis

PURPOSE

We examined the association of race/ethnicity with urinary incontinence subtypes and overactive bladder, and associated bother in older men.

MATERIALS AND METHODS

This cross-sectional analysis used data from the Multi-Ethnic Study of Atherosclerosis, an observational cohort of 4 racial/ethnic groups. At the sixth followup examination (age 60 to 98 years, 2015 to 2016) urinary symptoms were ascertained with the International Consultation on Incontinence Questionnaire. Prevalence ratios of urinary incontinence subtypes and overactive bladder without incontinence by race/ethnicity were calculated while adjusting for demographics, comorbidities and medications. Degree of bother was based on scale of 0 (none) to 10 (most) with bother presence defined as a score of 3 or greater.

RESULTS

Among 1,536 men 94% completed the questionnaire. Among completers, race/ethnicity was 40.7% nonHispanic White, 14.3% Chinese, 23.0% nonHispanic Black and 22.1% Hispanic. Urinary incontinence was reported by 11.1% and urgency urinary incontinence accounted for 78.0% of all urinary incontinence. The highest prevalence of urgency urinary incontinence was noted among nonHispanic Black men (13.0%) followed by Hispanic (11.3%), nonHispanic White (6.8%) and Chinese (2.9%) men. NonHispanic Black men showed a higher prevalence of any urinary incontinence (PR 1.62, 95% CI 1.06-2.47) and urgency urinary incontinence (1.63, 95% CI 1.01-2.61) compared to nonHispanic White men after adjustments for covariates. No significant association was noted with other urinary incontinence subtypes by race/ethnicity after adjustment for covariates. More than 70% of urinary incontinence was associated with bother for all racial/ethnic groups.

CONCLUSIONS

Urinary incontinence prevalence differs by race/ethnicity but most urinary incontinence is associated with bother regardless of race/ethnicity.

Endocrinology of the Aging Prostate: Current Concepts

Benign prostate hyperplasia (BPH), one of the most common diseases in older men, adversely affects quality-of-life due to the presence of low urinary tract symptoms (LUTS). Numerous data support the presence of an association between BPH-related LUTS (BPH-LUTS) and metabolic syndrome (MetS). Whether hormonal changes occurring in MetS play a role in the pathogenesis of BPH-LUTS is a debated issue. Therefore, this article aimed to systematically review the impact of hormonal changes that occur during aging on the prostate, including the role of sex hormones, insulin-like growth factor 1, thyroid hormones, and insulin. The possible explanatory mechanisms of the association between BPH-LUTS and MetS are also discussed. In particular, the presence of a male polycystic ovarian syndrome (PCOS)-equivalent may represent a possible hypothesis to support this link. Male PCOS-equivalent has been defined as an endocrine syndrome with a metabolic background, which predisposes to the development of type II diabetes mellitus, cardiovascular diseases, prostate cancer, BPH and prostatitis in old age. Its early identification would help prevent the onset of these long-term complications.

The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis

OBJECTIVE

We performed this meta-analysis to assess the association between metabolic syndrome (MetS) and benign prostatic hyperplasia (BPH).

METHOD

We conducted extensive searches on the PubMed, Science and Cochrane Library to identify all articles. Outcomes including annual prostate growth rate, prostate volume (PV), International Prostate Symptom Score (IPSS), IPSS sub-scores (voiding and storage), prostate- specific antigen (PSA), maximum urine flow rate (Qmax), post-void residual urine volume (PVR) and quality of life (QoL) were assessed.

RESULTS

21 studies with 15,317 patients were included. Patients with MetS had higher annual prostate growth rate [weighted mean difference (WMD) = 0.79; p < .001], larger PV (WMD = 2.62; p < .001), lower Qmax (WMD = -0.48; p = .001) and more PVR (WMD = 8.28; p < .001). However, no significant differences were found between two groups in IPSS (WMD = 0.20; p = .37), IPSS-voiding (WMD = -0.05; p = .78), IPSS-storage (WMD = -0.22; p = .26), PSA (WMD = 0.04; p = .43), and QoL (WMD = -0.01; p = .70).

CONCLUSIONS

The study suggested that MetS may be one of the risk factors for the clinical progress of BPH. However, further study is warranted to support these results.

Aerobic exercise ameliorates benign prostatic hyperplasia in obese mice through downregulating the AR/androgen/PI3K/AKT signaling pathway

OBJECTIVE

Emerging evidence has suggested that physical activities can reduce the risk of benign prostatic hyperplasia (BPH). Here, we evaluated the effect of aerobic exercise in a model of BPH using obese mice.

METHODS

Obese C57BL/6J mice in the control group, obesity group (OB), and obesity group plus exercise (OB + E) with eight weeks training were inspected for morphological alterations via hematoxylin-eosin (H&E) staining, lipid and sex hormone metabolites via enzyme-linked immunosorbent assays (ELISAs), relative protein expression via Western blotting, and prostate cancer-up-regulated long noncoding RNA (PlncRNA) and androgen receptor (AR) mRNA levels via quantitative real-time PCR (qRT-PCR).

RESULTS

Aerobic exercise training slowed fat-mass gain in OB mice. Prostate volume (PV) and area of lumen was significantly decreased in OB mice and was slightly increased following aerobic exercise. Epithelial volume density in the OB group was higher than that in the control group. Furthermore, aerobic exercise lowered serum low-density lipoprotein (LDL), triglyceride, and free fatty acid (FFA) levels, whereas it raised high-density lipoprotein (HDL) levels in OB + E mice. Additionally, the hormonal ratio of estradiol/testosterone (E2/T) approached that of the control group following aerobic exercise in OB + E mice. Mechanistically, aerobic exercise downregulated the PlncRNA-AR/androgen signaling pathway via the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) axis in the prostates of OB + E mice.

CONCLUSION

These data demonstrate that aerobic exercise may alleviate BPH in obese mice through regulation of the AR/androgen/PI3K/AKT signaling pathway.

Body Mass Index and Risk of Prostate Volume, International Prostate Symptom Score, Maximum Urinary Flow Rate, and Post-Void Residual in Benign Prostatic Hyperplasia Patients

The objective of this study was to evaluate association between body mass index (BMI) and prostate volume (PV), international prostate symptom scores (IPSS), maximum urinary flow rate (Q_max), and post-void residual (PVR) of Chinese benign prostatic hyperplasia (BPH) patients. All newly diagnosed BPH patients between September 2016 and August 2018 were selected and 788 patients were included. According to BMI, the patients were categorized into four groups, while according to PV, IPSS, Q_max, and PVR, they were categorized into two groups based on clinical significant cutoffs. Univariable and multivariable logistic regressions and a restricted cubic spline (RCS) were applied to explore the relationship of BMI with categorical PV, IPSS, Q_max, and PVR. Compared with normal BMI, obesity presented significant association with increased risk of larger PV (>80 ml) in both unadjusted and adjusted models (unadjusted odds ratio [OR] = 1.772, 95% CI [1.201, 2.614], p = .004; adjusted OR = 1.912, 95% CI [1.212, 3.017], p = .005); however, underweight or overweight did not present a significant connection with such risk. No significant effect was identified for BMI on IPSS, Q_max, or PVR in either unadjusted or adjusted model. Nonlinear test including BMI using RCS and adjusting for confounders showed no significance (p > .05); however, a significant linear relationship was ascertained between BMI and the risk of larger PV (p < .001). In conclusion, there was a significant linear association between BMI and the risk of larger PV in BPH patients. Hence, this suggests urologists should consider both BMI and PV when providing surgical treatment for BPH patients.

Serum omentin-1 level in patients with benign prostatic hyperplasia

Backgroud

To evaluate the relationship between omentin-1 and benign prostatic hyperplasia (BPH). BPH is the most common urological disease in elderly men worldwide. Lower serum omentin-1 levels were reported to be negatively associated with the incidence of inflammation, diabetes, obesity and metabolic syndrome, which all play a role in the development of BPH. To the best of our knowledge, the relationship between omentin-1 and BPH has not been investigated previously.

Methods

A total of 70 males participated in this study, including forty patients diagnosed with BPH and thirty healthy males. The anthropometric measurements and the biochemical parameters were measured in this study. We evaluated serum omentin-1 levels and the correlation with those data. We also test the gene expression of IL-8, IL-18 in BPH group using the TURP tissues.

Results

The serum omentin-1 levels were lower in the BPH patients than in the control group (27.95 ± 4.18 versus 32.03 ± 5.46, p < 0.001). The general characteristics and biochemical parameters were investigated, and a negative correlation was found between serum omentin-1 levels and BMI in the BPH group (r = − 0.391, p = 0.013) as well as the whole group (r = − 0.457, p < 0.001). Multiple-factor binary regression analysis revealed that serum omentin-1was a protective factor of BPH development. Furthermore, lower serum omentin-1 levels were associated with higher mRNA expression of IL-8 or IL-18 in the BPH group.

Conclusion

Omentin-1 may suppress the development of BPH and Lower serum omentin-1 levels in BPH patients might associated with higher prostate volume and higher IL-8 and IL-18 expression levels in their prostatic cells.

Optimal high-density lipoprotein cholesterol level for decreasing benign prostatic hyperplasia in men not taking statin medication: A historical cohort study

BACKGROUND

We evaluated the optimal high-density lipoprotein cholesterol level for benign prostatic hyperplasia (BPH) prevention in men not taking statin medication using a large historical cohort.

METHODS

We initially selected 130 454 men who underwent health checkups in 2009 from the National Health Information Database of the National Health Insurance Service. After excluding 36 854 men with BPH in 2009, and 45 061 men for statin use, 48 539 men were ultimately included in the analysis. A Kaplan-Meier analysis and multivariable Cox regression analysis was performed to assess the optimal high-density lipoprotein cholesterol level for preventing BPH.

RESULTS

High-density lipoprotein cholesterol levels were less than 40 mg/dL in 7431 (15.3%) men, 40 to 49 in 15 861 (32.7%), 50 to 59 in 15 328 (27.5%), and greater than or equal to 60 in 11 919 (24.6%). The overall cumulative incidence of BPH was 4.4%, 8.7%, 13.0%, and 17.8% at the 1-, 2-, 3-, and 4-year follow-up periods, respectively. In multivariable analysis, high-density lipoprotein greater than or equal to 60 mg/dL were significantly associated with a decreased incidence of BPH, as were age, residence, income, body mass index, diabetes, hypertension, triglyceride, and increased annual clinic visits, especially in men in their 40s.

CONCLUSION

Elevated serum high-density lipoprotein cholesterol levels were negatively associated with BPH incidence. In addition, maintaining high-density lipoprotein greater than or equal to 60 mg/dL was associated with a decreased BPH incidence compared with high-density lipoprotein less than 40 mg/dL, especially in men in their 40s.

Age, height, BMI and FBG predict prostate volume in ageing benign prostatic hyperplasia: Evidence from 5285 patients

AIMS

Several studies have reported a potential association between prostate volume (PV) and prostate disease. Here, we classified the risk factors for PV among benign prostatic hyperplasia (BPH) patients.

METHODS

In all, 4293 BPH patients with available clinical information were enrolled. Body mass index (BMI) was obtained as weight divided by height squared. PV was calculated as length × width × height (cm) × π/6. Mann-Whitney U tests were used to determine the differences between PV subgroups. Univariate and multiple linear regression tests were performed to uncover the connection between clinical features and PV. The differences in the age, BMI, height and fasting blood glucose (FBG) of the subgroups were evaluated by Kruskal-Wallis tests and adjusted with Bonferroni post hoc correction. A nomogram was created to directly illustrate the mutual interaction of amalgamator parameters.

RESULTS

PV did not influence the incidence of kidney stones (P = .815), whereas prostate calculi were positively associated with an enlarged prostate (>30 mL) (P < .001). Age (adjusted R = 0.363, P < .001), height (adjusted R = 0.088, P < .001), BMI (adjusted R = 0.039, P = .013) and FBG (adjusted R = -0.034, P = .027) were the independent risk/protective factors related to enlarged PV among BPH patients. The nomogram illustrated the predictive risk of an enlarged prostate (>30 mL) in men. The area under the ROC curve value was 0.659 in the training cohort and 0.677 in an internal validation cohort.

CONCLUSIONS

Age, height and BMI were positive independent risk factors of enlarged PV in BPH patients, and FBG had a protective role.

The Role of Aquablation for the Surgical Treatment of LUTS/BPH

PURPOSE OF REVIEW

To explore the potential applicability of a novel, heat-free, and robotically controlled ablative therapy for surgical management of benign prostatic enlargement.

RECENT FINDINGS

With the emergence of new technology to provide personalized care and overcome the complications associated with options such as TURP, holmium laser enucleation of the prostate, GreenLight laser, or simple prostatectomy, Aquablation has been studied across a variety of prostate volumes. The functional outcome of Aquablation seems to be uncompromised by prostate volume. The sexual profile seems superior to TURP and the risk of retrograde ejaculation is lower. The robotic system provides a reproducible ablation, independent of prostate volume, without requiring extensive training for performing the procedure. The mean ablation time in the prostate as large as 150 ml does not exceed 9.1 min, and the blood transfusion rates do not seem to be higher than open prostatectomy.

Non-linear Relationship Between Body Mass Index and Lower Urinary Tract Symptoms in Korean Males

Objectives:

The purpose of this study was to evaluate the association between body mass index (BMI) and severe lower urinary tract symptoms (LUTS) in Korean males.

Methods:

This study was conducted on males aged ≥50 years who participated in the 2011 Korean Community Health Survey. LUTS severity was assessed using the Korean version of the International Prostate Symptom Score (IPSS) questionnaire, and was dichotomized as severe (IPSS >19) and non-severe (IPSS ≤19). BMI was divided into 6 categories: <18.5, 18.5-22.9, 23.0-24.9, 25.0-27.4, 27.5-29.9, and ≥30.0 kg/m². To evaluate the relationship between BMI and LUTS, a survey-weighted multivariate Poisson regression analysis was performed to estimate prevalence rate ratios (PRRs). Age, smoking status, alcohol intake, physical activity, educational level, household income, and comorbidities were adjusted for in the multivariate model.

Results:

A U-shaped relationship was detected between BMI and severe LUTS. Compared with a BMI of 23.0-24.9 kg/m², the PRR for a BMI <18.5 kg/m² was 1.65 (95% confidence interval [CI], 1.35 to 2.02), that for a BMI of 18.5-22.9 kg/m² was 1.25 (95% CI, 1.09 to 1.44), that for a BMI of 25.0-27.4 kg/m² was 1.20 (95% CI, 1.00 to 1.45), that for a BMI of 27.5-29.9 kg/m² was 1.11 (95% CI, 0.83 to 1.47), and that for a BMI ≥30.0 kg/m² was 1.85 (95% CI, 1.18 to 2.88).

Conclusions:

This study showed that both high and low BMI were associated with severe LUTS.

Major Acute Cardiovascular Events After Transurethral Prostate Surgery: A Population-based Analysis

OBJECTIVE

To test the prevalence and predictors of major acute cardiovascular events (MACE) after transurethral prostate surgery (TPS).

MATERIAL AND METHODS

The American College of Surgeons National Surgical Quality Improvement Program database (2011-2016) was queried for patients who underwent transurethral resection of the prostate, photoselective vaporization, or laser enucleation. MACE included: cerebrovascular events, cardiac arrest, myocardial infarction, deep venous thrombosis requiring therapy, and pulmonary embolism episodes occurred up to 30 days after discharge. Univariable and multivariable logistic regression models tested MACE predictors and effect of MACE on perioperative mortality. Within covariates significant at univariable analyses a stepwise selection, based on Akaike Information Criterion values, was performed to fit the most appropriate multivariable model.

RESULTS

Overall 44,939 patients were included in our analyses. Of these 365 (0.8%) had MACE within 30 days after surgery. The strongest MACE predictors were recent congestive heart failure (odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.2-3.7, P = .007), transfusions (OR: 2.5, 95% CI: 1.5-4.1, P <.001) and preoperative Systemic Inflammatory Response Syndrome or sepsis (OR: 2.6, 95% CI: 1.6-4.2, P <.001). Similarly, inpatient (OR: 2.0, 95% CI: 1.6-2.5, P <.001) and nonelective (OR: 1.5, 95% CI: 1.1-2.1, P = .012) patients experienced higher MACE rates. Perioperative mortality rates were statistical significantly higher in MACE patients (OR: 13.1, 95% CI: 8.2-21.0, P <.001).

CONCLUSION

Up to 1% of patients undergoing transurethral prostate surgery experience MACE. MACE are burdened by high mortality rates (up to 14% in MACE patients). Proper patient selection and postoperative monitoring are necessary to reduce MACE incidence and mortality rates.

Inhibition of the CXCL12/CXCR4 axis prevents periurethral collagen accumulation and lower urinary tract dysfunction in vivo

BACKGROUND

Several studies show that prostatic fibrosis is associated with male lower urinary tract dysfunction (LUTD). Development of fibrosis is typically attributed to signaling through the transforming growth factor β (TGF-β) pathway, but our laboratory has demonstrated that in vitro treatment of human prostatic fibroblasts with the C-X-C motif chemokine ligand 12 (CXCL12) chemokine stimulates myofibroblast phenoconversion and that CXCL12 has the capacity to activate profibrotic pathways in these cells in a TGF-β-independent manner. We have previously reported that feeding mice high-fat diet (HFD) results in obesity, type II diabetes, increased prostatic fibrosis, and urinary voiding dysfunction. The purpose of this study was to test the hypothesis that in vivo blockade of the CXCL12/CXCR4 axis would inhibit the development of fibrosis-mediated LUTD in HFD-fed mice.

METHODS

Two-month-old male senescence-accelerated mouse prone-6 mice were fed either a HFD or low-fat diet (LFD) for 8 months. Half of each dietary group were given constant access to normal water or water that contained the C-X-C chemokine receptor type 4 (CXCR4; CXCL12 receptor) antagonist CXCR4AIII. At the conclusion of the study, mice were weighed, subjected to oral glucose tolerance testing and cystometry, and lower urinary tract tissues collected and assessed for collagen content.

RESULTS

HFD-fed mice became significantly obese, insulin resistant, and hyperglycemic, consistent with acquisition of metabolic syndrome, compared with LFD-fed mice. Anesthetized cystometry demonstrated that HFD-fed mice experienced significantly longer intercontractile intervals and greater functional bladder capacity than LFD-fed mice. Immunohistochemistry demonstrated high levels of CXCR4 and CXCR7 staining in mouse prostate epithelial and stromal cells. Picrosirius red staining indicated significantly greater periurethral collagen deposition in the prostates of HFD than LFD-fed mice. Treatment with the CXCR4 antagonist CXCR4AIII did not affect acquisition of metabolic syndrome but did reduce both urinary voiding dysfunction and periurethral prostate collagen accumulation.

CONCLUSIONS

This is the first study to report that obesity-induced lower urinary tract fibrosis and voiding dysfunction can be repressed by antagonizing the activity of the CXCR4 chemokine receptor in vivo. These data suggest that targeting the CXCL12/CXCR4 signaling pathway may be a clinical option for the prevention or treatment of human male LUTD.

Prevalence and heritability of benign prostatic hyperplasia and LUTS in men aged 40 years or older in Zhengzhou rural areas

BACKGROUND

Benign prostate hyperplasia (BPH) is the most common disease among aging males, but no reports have addressed the prevalence of BPH in Zhengzhou. Therefore, we aimed to understand the prevalence of BPH in men aged 40 years or older in Zhengzhou's rural areas through a cross-sectional study and analyzed the correlation with epidemiologic factors and the heritability of the disease.

MATERIALS AND METHODS

A multistage sampling method was used to randomly select male respondents in Zhengzhou's rural areas. Men who were 40 years of age or older and their first-degree relatives were subjected to the International Prostate Symptom Score (IPSS) and related examinations. Heritability was calculated according to the prevalence of the first-degree relatives in the case and control groups.

RESULTS

The prevalence of BPH was 10.04%. Its prevalence increased with age, from 2.17% in men aged 40-44 years to 31.11% in men aged 80 years or older. The average volume of the prostate was 17.16 ± 7.96 mL, and the average IPSS was 5.89 ± 5.91. The analysis of the correlation between the associated risk factors and BPH revealed that prostatitis and a history of prostatic hyperplasia were significant factors. Obesity, smoking, drinking, diabetes, and hypertension were not correlated with BPH. Of the 94 first-degree relatives of the cases, 53 had BPH (56.38%); of the 106 first-degree relatives of the controls, five had BPH (4.72%). Heritability appeared to account for 40.48% of BPH cases. The heritability of incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia was 43.28, 71.37, 9.67, 5.67, 2.70, 53.36, and 19.12%, respectively.

CONCLUSION

The total prevalence of BPH in men aged 40 years or older in Zhengzhou's rural areas was 10.04%, and the heritability of prostatic hyperplasia was 40.48%.

Factors Associated with Bothersome Lower Urinary Tract Symptoms in Middle-Aged Men Receiving Health Checkup

The prospective study is to investigate the associations between serum testosterone levels and LUTS among middle-aged men ≥40 years receiving health check-up. Lower urinary tract symptoms were evaluated by the self-administered International Prostate Symptom Score questionnaire. Serum prostate specific antigen and total testosterone level were checked in all subjects. A total of 1752 men were enrolled into the study. The mean age was 55.6 ± 9.7 years. All study subjects were stratified into low, medium and high testosterone levels by two cut-off, 3.0 and 4.11 ng/mL. We found that testosterone levels were significantly associated with metabolic syndrome and body fat components. Compared to those with low testosterone levels, subjects with high and medium testosterone had a significantly higher IPSS (5.84 ± 5.55 vs 6.71 ± 5.68 and 6.34 ± 5.66, p = 0.032) and storage score (2.76 ± 2.29 vs 3.20 ± 2.49 and 2.90 ± 2.49; p = 0.009), and a more moderate/severe LUTS (IPSS ≧ 8) (26.5% vs 35.7% and 29.9%; p = 0.002). Multivariate analyses showed that high vs low testosterone levels (OR, 1.76; 95% CI, 1.26–2.45) and prostate volume ≧25 vs <25 mL (OR, 1.38; 95% CI, 1.04–1.82) significantly associated with the presence of moderate/severe LUTS. Pearson correlation analyses showed significantly positive correlations between testosterone level and IPSS in whole study sample (Pearson correlation coefficient, 0.066; p < 0.01) and in the subgroup of moderate/severe LUTS (Pearson correlation coefficient, 0.038; p < 0.05). In conclusion, high testosterone and prostate volume adversely impacted LUTS in our target population.

Comparison of bipolar plasmakinetic transurethral enucleation and resection of prostate gland in patients receiving anticoagulants and/or platelet aggregation inhibitors

BACKGROUND

The aim of this study was to evaluate the safety and efficacy of bipolar plasmakinetic enucleation of the prostate (BPEP) and bipolar plasmakinetic transurethral resection of prostate (B-TURP) for patients on oral anticoagulants (OA) and/or platelet aggregation inhibitors (PAI) with benign prostatic obstruction (BPO) and having a gland size of >60 g.

METHODS

Patient database of our hospital for the period of May 2012 to September 2017 was retrospectively reviewed for BPH patients with a gland size of >60 g who either underwent BPEP or B-TURP and were on OA and/or PAI. Patient demographic, perioperative, and follow-up data were analyzed.

RESULTS

There were no significant differences between the two surgical groups preoperatively. The mean operative time was lower in the BPEP group however, no statistical difference was found between them (P=0.77). There was significant difference in the mean resected tissue weight (52.11±17.92 vs. 77.19±17.78 g, P value ≤0.001), irrigation time and total hospital stay in favor of BPEP group. The blood loss observed in the B-TURP group and BPEP group was 2.57±0.36 and 1.45±0.44 g/dL, respectively, which was statistically significant (P<0.033). Eight and three patients of B-TURP and BPEP groups needed blood transfusion respectively. All patients were followed up for 12 months postoperatively. Both groups resulted in a significant improvement from baseline in terms of IPSS, QoL, Q-max, and PVRU volume values. No significant difference was found between them, however.

CONCLUSIONS

Both procedures are safe and effective options in patients who are on OA and/or PAI but BPEP is better in terms of low clot retention rate, less irrigation time and decreased hospital stay.

Prevalence, Burden, and Treatment of Lower Urinary Tract Symptoms in Men Aged 50 and Older: A Systematic Review of the Literature

We conducted a systematic review of literature from the years 2000 through 2017 on the prevalence and burden of lower urinary tract symptoms (LUTS) in men aged 50 and older, and medical treatments of and alternative nonmedical approaches to LUTS. EBSCOhost (Medline with Full Text) was searched for observational, experimental, and review studies in peer-reviewed journals in the English language. Our review found that LUTS were highly prevalent in the world and estimated to affect 2.3 billion people in 2018, with 44.7% being men. Men with LUTS suffer from not only burdensome symptoms such as nocturia and urgency but also adverse psychological consequences (e.g., anxiety and depression) and financial burden. Current medical treatments are clinically effective, but their efficacy is compromised by side effects and low compliance rates. Alternative nonmedical treatments for LUTS were also sought worldwide. There is evidence that lifestyle modifications such as pelvic muscle exercises and bladder training, physical activity, dietary modification, and nutritional supplements can alleviate LUTS and improve patient quality of life; however, evidence based on rigorous methodology remains minimal and cannot be generalized across populations. Evidence of effectiveness of weight loss programs to reduce LUTS is inconclusive. We conclude that although behavioral treatment is a promising approach to alleviating LUTS, especially when combined with medical treatments, well-designed randomized controlled and longitudinal clinical trials on behavioral treatments of LUTS are still needed. Minimally invasive procedures and neuromodulation therapy also show positive results of alleviating LUTS but require further research as well.

The Factors Affecting Lower Urinary Tract Functions in Patients Undergoing Laparoscopic Sleeve Gastrectomy

BACKGROUND

We prospectively assessed changes in the lower urinary system functions of women with morbid obesity following laparoscopic sleeve gastrectomy and the factors affecting these changes.

METHODS

Data from 40 females who had undergone laparoscopic sleeve gastrectomy due to morbid obesity (body mass index, BMI ≥ 40 kg/m²) between January 2014-2016 at S.B.U. Bursa Yuksek Ihtisas Training and Research Hospital were prospectively evaluated. The presence of comorbidities, onset of obesity, smoking, American Society of Anesthesiologists (ASA) score, pre and 12-month postoperative weights and BMIs, fasting blood glucose (FBG), blood urea nitrogen, creatinine, insulin, homeostatic model assessment-insulin resistance (HOMA-IR) test results, overactive bladder survey (OAB-Q) scores, volume of urination, and Qmax values obtained from uroflowmetry studies were recorded and assessed.

RESULTS

Statistically significant differences in weight, BMI, FBG, insulin, HOMA-IR score and creatinine values pre-operation, and the corresponding values obtained at 12 months post-operation were observed (all, p < 0.001). OAB-Q scores were observed to be statistically significantly lower in the postoperative period relative to those in the preoperative period (p < 0.001). Urination volume was statistically significantly higher during the postoperative period (p = 0.048) than during the preoperative period. Non-smoking patients showed a reduction in OAB-Q score and a statistically significant increase in urination volume during the postoperative period (p < 0.001, p = 0.011, respectively); smoking patients indicated a statistically significant reduction in OAB-Q score only during the postoperative period; however, urination volume was not statistically significant between two groups (p = 0.013, p = 0.303). In patients with an ASA score of 1, preoperative OAB-Q scores were statistically significantly lower (p = 0.035) than those obtained post-operation. Patients with childhood-onset obesity showed statistically significantly increased urination volumes during postoperative period in comparison with values obtained pre-operation (p = 0.042).

CONCLUSION

Improvements in lower urinary system functions were affected by patient-related factors, such as comorbidity, obesity onset, smoking, ASA score, and weight loss, following laparoscopic sleeve gastrectomy.

[How to prevent LUTS due to BPH development and progression]

OBJECTIVE

Our objective was to define potential risk factors for lower urinary tract symptoms (LUTS) related with benign prostatic hyperplasia (BPH).

METHOD

A non-systematic review of the scientific literature was conducted from the PubMed database to extract the most relevant scientific publications between 2000 and July 2018 and cross them with the recommendations of the AFU and the EA by combining the keywords HBP with diet, diet, physical activity, spa treatments, tobacco, alcohol, cardiovascular risk factors, testosterone or inflammation. A synthesis has been proposed in order to identify the important elements to proscribe or modify in order to limit the development and progression of LUTS/BPH.

RESULTS

LUTS due to BPH are clearly associated with erectile dysfunction, cardiovascular diseases and metabolic syndrome. Some reversible risk factors have been identified such as low physical activity, overweight and hypercaloric nutrition. Interventions such as increased physical activity, weight-loss, and a diet including vegetables, tomatoes, carrots, vitamin E, lycopene, selenium, carotene, correction of the metabolic syndrome, stress reduction, and a suitable urinary behavior may impact progression of the disease.

CONCLUSION

Education of the patients on reversible risk factors for LUTS due to BPH is crucial and should be included in everyday practice. Physical activity and weight-loss are the most important factors to take into account.

LEVEL OF EVIDENCE

5 consensus d'experts.

Adiponectin as a Potential Therapeutic Target for Prostate Cancer

Adipokines are bioactive proteins that mediate proliferation, metabolism, inflammation, and angiogenesis. Adiponectin is an important adipokine that exerts multiple key functions via its anti-metabolic syndrome and anti-inflammatory properties. A number of adiponectin receptors, AdipoR1, AdipoR2 and T-cadherin, have been identified. Recent studies have suggested the involvement of adiponectin and receptors in several cancers, including prostate, breast, endometrial, brain, and colon cancer. Altered levels of adiponectin expression, or its interacting receptors, in cancers can lead to dysregulation of signaling pathways. Our current review describes the molecular mechanisms underlying the anti-tumorigenesis activity of adiponectin and the role of its receptors in prostate carcinogenesis, and provides perspectives of adiponectin-mediated signaling as a potential target for therapy.

Impact of Testosterone Deficiency and Testosterone Therapy on Lower Urinary Tract Symptoms in Men with Metabolic Syndrome

Lower urinary tract function is modulated by neural, vascular and urethral and bladder structural elements. The pathophysiological mechanisms of lower urinary tract symptoms (LUTS) encompass prostate enlargement, alterations in urethra histological structure bladder fibrosis and alterations in pelvic neuronal and vascular networks, The complex pathophysiological relationship between testosterone (T) deficiency (TD) and the constellations LUTS, and metabolic dysfunction manifested in the metabolic syndrome (Met S) remains poorly understood. TD has emerged as one the potential targets by which Met S may contribute to the onset and development as well as worsening of LUTS. Because it has been recognized that treatment of men with Met S with T therapy ameliorates Met S components, it is postulated that T therapy may represent a therapeutic target in improving LUTS. Furthermore, the effect of TD on the prostate remains unclear, and often debatable. It is believed that T exclusively promotes prostate growth, however recent evidence has strongly contradicted this belief. The true relationship between benign prostatic hyperplasia, TD, and LUTS remains elusive and further research will be required to clarify the role of T in both benign prostatic hypertrophy (BPH) and LUTS as a whole. Although there is conflicting evidence about the benefits of T therapy in men with BPH and LUTS, the current body of literature supports the safety of using this therapy in men with enlarged prostate. As the population afflicted with obesity epidemic continues to age, the number of men suffering from Met S and LUTS together is expected to increase.

High glucose induces the proliferation of prostatic cells via downregulating MRE11

The aim of the present study was to investigate the candidate genes and pathways associated with benign prostatic hyperplasia (BPH) and diabetes. In vitro experiments were performed using normal prostatic epithelial RWPE-1 and HPr-1 cells. The cell lines were treated with a high-glucose solution and MTS and bromodeoxyuridine assays were used to assess cell viability. Transcriptome sequencing was used to screen the candidate genes. The expression of candidate genes was further verified by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blotting. A meiotic recombination 11 (MRE11) overexpression vector was designed and transfected into RWPE-1 cells to verify the function of MRE11. A streptozotocin-induced diabetic rat model was established and rat MRE11 levels were determined by RT-qPCR and immunohistochemical staining. High concentrations of glucose resulted in RWPE-1 and HPr-1 cells with high viability. Transcriptome sequencing revealed that MRE11 was downregulated when RWPE-1 cells were exposed to high-glucose conditions. When MRE11 was overexpressed, cell viability decreased and cell apoptosis was induced under high-glucose conditions. Prostatic tissues from rats were collected and assessed; MRE11 expression was observed to be decreased, which was consistent with the in vitro cell experiments. BPH may be associated with diabetes, as MRE11 expression in prostatic cells was decreased when exposed to high-glucose conditions. Therefore, MRE11 may have potential as a biomarker for the early diagnosis of BPH and diabetes.

Visceral adiposity index is associated with benign prostatic enlargement in non-diabetic patients: a cross-sectional study

OBJECTIVE

To evaluate the association between visceral adiposity index (VAI) - a novel indicator for the assessment of visceral adipose tissue and prostate enlargement in non diabetic patients.

MATERIAL AND METHODS

Four hundred patients who were admitted to the Urology clinic between January and December 2014 with complaints of BPH(benign prostatic hyperplasia )/LUTS(male lower urinary tract symptoms)were enrolled in this cross-sectional study. Patients were divided into two groups according to their prostate volume and international prostate symptom score (IPSS) value. They were compared in terms of age, body mass index (BMI), VAI, prostate volume, PSA, post micturional residual volume (PMRV), uroflowmetry Q max value, triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and fasting blood sugar (FBS).

RESULTS

Although univariate analyses reveal that age, BMI, waist circumference (WC), FBS, TG, HDL-C level and TG/HDL ratio were correlated with prostate volume, only age [1.125 OR (1.088-1.164), p = .00001], BMI [1.119 OR (1.040-1.204), p = .003], TG [1.043 OR (1.016-1.071), p = .002], HDL-C [0.923 OR (0.860-0.990), p = .025] and VAI [1.194 OR (1.110-1.305), p = .011] were statistically significant in multivariate analysis. A positive correlation was found between VAI value and prostate volume in the Spearman correlation test (r = 0.29, p = .00001). The calculated area under the curve (AUC) for prostate volumes of 30, 40 and 50 ml were 0.680 (0.621-0.738), 0.625 (0.570-0.681) and 0.590 (0.528-0.652), respectively.

CONCLUSION

Our study revealed a positive correlation between VAI and prostate volume. Our results are needed to be tested with well-designed randomized prospective cohort studies.

Adherence of Indonesian urologists to practice guidelines for the management of benign prostatic hyperplasia

Background

Clinical guideline is built to provide consistent, efficient, and high quality of medical care based on recent evidence. This study aimed to investigate the adherence of Indonesian urologists to clinical guidelines for the management of benign prostatic hyperplasia (BPH).

Materials and methods

This was a cross-sectional study using questionnaire conducted between January and June 2017. Respondents were Indonesian urologists registered as members of Indonesia Urological Association and had already practice in urology for at least 6 months. Questionnaires were sent via e-mail and Google Form. The level of adherence was measured using scoring system decided by authors' agreement. All data were processed using SPSS, version 23, and presented in descriptive fashion.

Results

Of 352 urologists who fulfilled inclusion and exclusion criteria, 209 (59.4%) respondents returned the questionnaire. Most of respondents (95.2%) used Indonesia Urological Association BPH guidelines as their clinical practice guidance. Routinely performed recommended examination, such as symptom scoring system, digital rectal examination, urinalysis, uroflowmetry, postvoid residual urine, and prostate imaging were used by 89.9%, 92.5%, 70.4%, 50.8%, 53.3%, and 98.6% respondents, respectively. After patient is diagnosed with BPH, most of respondents considered medical therapy (99%), surgical therapy (93%), and watchful waiting (78.4), with alpha-blocker as the drugs most preferred by respondents. For indication to perform surgery for BPH, only bladder stones, decreased renal function, and trial without catheter failure were considered by more than 85% of respondents. Open prostate surgery was performed by 54.8% respondents for the following reasons: large prostate volume, presence of bladder stone, unavailability of endourology equipments, abnormality of bladder, and residency training program. At last, this study found median (minimum–maximum) of Indonesian urologists adherence level toward BPH guidelines is 78.5% (28.6%–100%).

Conclusions

In general, Indonesian urologists have a good adherence toward guidelines. However, there is still wide variation of their adherence to it.

Molecular features and physiological roles of K+-Cl- cotransporter 4 (KCC4)

A K⁺-Cl^- cotransport system was documented for the first time during the mid-seventies in sheep and goat red blood cells. It was then described as a Na⁺-independent and ouabain-insensitive ion carrier that could be stimulated by cell swelling and N-ethylmaleimide (NEM), a thiol-reacting agent. Twenty years later, this system was found to be dispensed by four different isoforms in animal cells. The first one was identified in the expressed sequence tag (EST) database by Gillen et al. based on the assumption that it would be homologous to the Na⁺-dependent K⁺-Cl^- cotransport system for which the molecular identity had already been uncovered. Not long after, the three other isoforms were once again identified in the EST databank. Among those, KCC4 has generated much interest a few years ago when it was shown to sustain distal renal acidification and hearing development in mouse. As will be seen in this review, many additional roles were ascribed to this isoform, in keeping with its wide distribution in animal species. However, some of them have still not been confirmed through animal models of gene inactivation or overexpression. Along the same line, considerable knowledge has been acquired on the mechanisms by which KCC4 is regulated and the environmental cues to which it is sensitive. Yet, it is inferred to some extent from historical views and extrapolations.