Risk Factors for Male Lower Urinary Tract Symptoms: The Role of Metabolic Syndrome and Androgenetic Alopecia in a Latin American Population

Higher Levels of Serum Uric Acid Have a Significant Association with Lower Incidence of Lower Urinary Tract Symptoms in Healthy Korean Men

Gout has been correlated with the risk of incident benign prostatic hyperplasia. In line with increasing prevalence of hyperuricemia, the aim of this study was to investigate the relationship between serum uric acid (SUA) level and the incidence of lower urinary tract symptoms (LUTS) among clinically healthy middle-aged men. We performed a cohort study in 101,091 Korean men without LUTS at baseline who completed health checkups between 2011 and 2016. LUTS were evaluated using the International Prostate Symptom Score, where a score ≥ 8 was defined as significant LUTS. Men were divided into six groups according to their SUA levels in mg/dL (<5.5, 5.5−6.4, 6.5−7.4, 7.5−8.4, 8.5−9.4, and ≥9.5). Throughout the follow-up—encompassing a total of 358,982.6 person years—13,424 people had significant LUTS (37.3 per 1000 person years for incidence rate). The multivariable models demonstrated that the highest level of SUA (≥9.5 mg/dL) was related to the lowest risk of significant LUTS compared with the reference category (<5.5 mg/dL) (0.77 (95% CI 0.59−0.99) for adjusted HR). In this large cohort composed of middle-aged men, higher SUA levels were related to a reduced risk of LUTS. This result suggests another potential role of SUA in restraining LUTS. Additional studies are needed to explain the underlying biological mechanisms of this phenomenological relationship.

Lower urinary tract symptoms and functional ability in older adults: a community-based cross-sectional study

OBJECTIVES

Functional ability, or the ability to live actively in older age, is essential for healthy ageing. This study assessed the association between the five types of lower urinary tract symptoms (LUTS) and functional ability among community-dwelling older adults (≥65 years old).

DESIGN

A cross-sectional study.

SETTING

Community-dwelling older adults (≥65 years old) randomly selected from the basic resident register of Kashiwa city as part of the Kashiwa study.

PARTICIPANTS

The study included 916 community-dwelling older adults (481 male participants) in Japan.

OUTCOME MEASURES

A self-administered questionnaire was used to collect data regarding LUTS, which included frequency, nocturia, urgency, urinary incontinence and overactive bladder (OAB). Functional ability was measured using the Japan Science and Technology Agency Index of Competence. Sex-stratified logistic regression analyses were conducted, adjusting age, obesity, alcohol consumption, polypharmacy and comorbidities.

RESULTS

Male participants experienced symptoms of frequency, nocturia, urgency, urinary incontinence and OAB at rates of 68.0%, 89.0%, 16.0%, 3.7% and 4.3%, respectively. Female participants experienced these symptoms at rates of 68.3%, 80.0%, 11.0%, 7.4% and 8.5%, respectively. Among male participants, lower functional ability was only associated with nocturia (≥3 times/night) (adjusted OR (AOR): 1.71, 95% CI 1.05 to 2.79). Contrarily, lower functional ability among female participants was significantly associated with frequency (AOR: 1.61, 95% CI 1.04 to 2.49), urgency (AOR: 2.06, 95% CI 1.08 to 3.95) and OAB (AOR: 2.43, 95% CI 1.15 to 5.11).

CONCLUSION

The different associations between LUTS and functional ability by sex might be related to differences in the effect of comorbidities and physical fatigue. Our results help clarify the multifaceted effects of LUTS in old age, the need for early detection and treatment of LUTS, and the importance of maintaining functional ability.

Metabolic syndrome is associated with prostate enlargement: a systematic review, meta-analysis, and meta-regression on patients with lower urinary tract symptom factors

BACKGROUND

Metabolic syndrome (MetS) is defined by at least three of the following five criteria: blood pressure ⩾130/85 mmHg, fasting blood glucose ⩾5.6 mmol/l, triglycerides concentration ⩾1.7 mmol/l, waist circumference ⩾102 cm (for men), and high-density lipoprotein cholesterol concentration <1.03 mmol/l (for men). MetS has been associated with worse lower urinary tract symptoms (LUTS) and higher International Prostate Symptom questionnaire scores.

MATERIALS AND METHODS

MEDLINE, Cochrane, ClinicalTrials.gov, and SCOPUS were critically appraised for all peer-reviewed manuscripts that suitably fulfilled our protocol's inclusion criteria established a priori. Meta-analytical and meta-regression calculations were performed in R using the Sidik-Jonkman and Hartung-Knapp random effects model and predefined covariates.

RESULTS

A total of 70 studies (n = 90,206) were included in qualitative synthesis. From these, 60 studies focused on MetS and LUTS: 44 reported positive correlations, 5 reported negative correlations, 11 reported no association, and 10 studies focused on MetS and total prostate volume (TPV). MetS positively correlated with moderate LUTS [odds ratio (OR)  = 1.56, 95% confidence interval (CI) = 1.35-1.80], severe LUTS (OR = 2.35, 95% CI = 1.82-3.03), overactive bladder (OAB; OR = 3.2, 95% CI = 1.6-5.8), and nocturia severity (OR = 2.509, 95% CI = 1.571-4.007) at multivariate analysis. A total of 30 studies (n = 22,206) were included in meta-analysis; MetS was significantly associated with higher TPV (mean differences = 4.4450 ml, 95% CI = 2.0177-6.8723), but no significant predictive factors for effect sizes were discovered.

CONCLUSION

Our meta-analysis demonstrates a significant association between the aggravating effects of MetS, which commonly coexists with obesity and benign prostate enlargement.

Drinking Frequency but not Years may be Associated with Lower Urinary Tract Symptoms: Result from a Large Cross-Sectional Survey in Chinese Men

Objective

To evaluate the effect of the drinking frequency and years on lower urinary tract symptoms (LUTS) in a large Chinese male population.

Methods

The current data were obtained from a consecutive series of 3,229 men aged 18–79 who participated in a routine physical examination in Fangchenggang First People’s Hospital, Guangxi, China. During a face-to-face interview, the detailed demographic variables about alcohol consumption, potential confounding factors were collected. LUTS were assessed by International Prostate Symptom Score (IPSS) and defined as total LUTS, irritative (IRR) and obstructive (OBS) symptoms, respectively. Multivariate logistic regression analysis was used to evaluate the risk of total LUTS, IRR and OBS symptoms affected by alcohol consumption.

Results

The prevalence of moderate to severe LUTS was 8.3% and apparently increased with age (P<0.001). A significant distribution presented in age, alcohol consumption, BMI, cigarette smoking, education attainment and hypertension among different strata of LUTS severity (P<0.05). Men who drank 1–2 times per week were less likely to have OBS symptoms (OR=0.45, 95%CI=0.29–0.70) regardless of age (OR=0.52, 95%CI=0.33–0.82) or multivariate adjusted (OR=0.52, 95%CI=0.33–0.83). Nevertheless, we did not observe a significant negative or positive association presented between drinking years and the risk of total LUTS, OBS and IRR symptoms.

Conclusion

The current results imply that moderate drinking frequency may be protective against LUTS, and drinking years did not relate to worsening or improving LUTS.

Urinary biomarkers of inflammation and tissue remodeling may predict bladder dysfunction in patients with benign prostatic hyperplasia

PURPOSE

To evaluate the expression of urinary biomarkers of inflammation and tissue remodeling in patients with BPH undergoing surgery and evaluate the association of biomarkers with postoperative urodynamic outcomes MATERIALS AND METHODS: We analyzed urine samples from 71 patients treated with TURP from 2011 to 2017. Urinary levels of epidermal growth factor (EGF), matrix-metalloproteinase-1 (MMP-1), interleukin-6 (IL-6), nerve growth factor (NGF) and monocyte-chemoattractant protein-1 (MCP-1) (by commercial ELISA kit) were measured, adjusted by urinary creatinine (Cr) and analyzed according to patients clinical and urodynamic characteristics (baseline and 12-month postoperative urodynamic) RESULTS: MMP-1/Cr levels were significantly higher among subjects with higher detrusor pressure on preoprative urodynamic. MCP-1/Cr levels were significantly higher amongs subjects with preoperative DO. Preoperative levels of NGF/Cr (0.13 vs 0.08, p = 0.005) and MMP-1/Cr (0.11 vs 0.04, p = 0.021) were predictors of persistent DO 12 months after surgery. The following factors were shown to be useful for predicting the persistence of DO in the postoperative period: NGF/Cr, with an AUC of 0.77 (95% CI 0.62-0.92) (p = 0.006), and MMP-1/Cr, with an AUC of 0.72 (95% CI 0.56-0.88) (p = 0.022).

CONCLUSIONS

MMP-1/Cr was associated with higher detrusor pressure and MCP-1/CR with DO. NGF/Cr and MMP-1/Cr were shown to be predictors of persistent postoperative DO.

The impact of Diabetes Mellitus on Lower urinary tract symptoms (LUTS) in both male and female patients

INTRODUCTION

Contemporary studies examine the connection of Diabetes Mellitus (DM) with Lower urinary tract symptoms (LUTS), alone or associated with other factors of the metabolic syndrome. However, little research has occurred concerning patients with diabetes of both genders and sexes without other diseases of the lower urinary tract. The aim of this study is to examine the relationship between DM and LUTS.

METHODS

The study enrolled 110 patients with DM and 134 healthy individuals. The IPSS questionnaire was used for the evaluation of symptoms from lower urinary tract. Data was analyzed with univariate and multivariate logistic regression using SPSS v.24.

RESULTS

Analysis with moderate/severe LUTS as dependent variable and plausible confounding factors (age group, BMI, hypertension, dyslipidemia, years with DM and reported HbA1c) as covariates revealed that only HbA1c levels correlated independently with the presence of moderate/severe LUTS (p = 0,024, OR:2,729, CI:1,144-6,509) in diabetic women, while there was no statistically significant difference between male groups. HbA1c levels' correlation with IPSS-voiding and IPSS- storage score was not statistically significant. Quality of life is also affected in women with diabetes mellitus (p: 0,02).

CONCLUSION

Only an increase in HbA1c was independently connected with a deterioration of LUTS in the female group.

Central obesity indicating a higher prevalence of lower urinary tract symptoms: A case-control matching analysis from a Chinese cross-sectional study in males

OBJECTIVE

The aim of this study was to explore the association between central obesity and lower urinary tract symptoms (LUTS) among men in southern China, and test the hypothesis that central obesity measured by the waist-to-hip ratio (WHR) is a predictor of the severity of LUTS.

METHODS

In all, 4303 men from the Fangchenggang Area Male Healthy and Examination Survey (FAMHES) were included in this study. LUTS were assessed by the International Prostate Symptom Score (IPSS), whereas central obesity was evaluated by the WHR. The association between WHR and LUTS was tested using logistic and Cox regression analyses.

RESULTS

After screening, 2917 participants were in the study. Univariate analysis indicated significant differences in WHR in the presence of LUTS (P = .012). After stratification by age, logistic regression indicated that LUTS were more frequent in 60-year-old men with a higher WHR (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.21-6.89) compared with participants <40 years old. Cox regression analysis after pairing of 252 LUTS cases and 252 control subjects from the 2917 eligible participants according to age (±5 years), indicated that central obesity (WHR ≥0.9) may be significantly associated with moderate or severe LUTS (OR 1.95, 95% CI 1.16-3.26). The associations between central obesity and straining (OR 2.44, 95% CI 1.40-4.24) and weak stream (OR 2.37, 95% CI 1.27-4.45) were significant after multivariate adjustment.

CONCLUSIONS

Males with central obesity are at increased risk of LUTS, and increased WHR is associated with worsened straining and weak stream. Further investigations are needed to confirm these associations.

Prevalence and risk factors of lower urinary tract symptoms in Chinese adult men: a multicentre cross-sectional study

There has been no previous population-based study reporting the prevalence and risk factors of male lower urinary tract symptoms (LUTS) among men in mainland China. This cross-sectional study was conducted from 2013 to 2014 in three representative provinces of China: Guangdong, Hubei and Jiangsu. 3250 individuals participated in the interviews, which involved a questionnaire covering sociodemographic characteristics, lifestyle, dietary patterns and the International Prostate Symptom Score (IPSS). Blood was collected for lipids, glucose, insulin and reproductive hormone tests. The incidences of LUTS and its obstructive and irritative symptoms were calculated. Risk factors for LUTS were identified using multivariable logistic regression analysis. The prevalence of moderate to severe LUTS and its obstructive and irritative symptoms was 14.3%, 13.1% and 16.1%, respectively, and increased with age. The prevalence in Guangdong was much lower than that in Hubei and Jiangsu in different ages. Increased fasting plasma glucose and decreased HDL-C levels were associated with an increased risk of moderate to severe LUTS (OR = 1.30, 95% CI: 1.02–1.65 and OR = 2.06, 95% CI: 1.08–3.94, respectively). Free testosterone < 0.22 ng/ml decreased the risk of moderate to severe LUTS and obstructive and irritative symptoms by about 20–30%. An inadequate daily intake of vegetables, fruit and water significantly increased the risk of LUTS by 1.3–to 2.0 times. In conclusion, the prevalence of LUTS in Chinese men is high and increases with age. Dietary patterns may be critical for the development of LUTS. Thus, dietary modifications could be a useful strategy for preventing the development of LUTS.

Association between male pattern baldness and prostate disease: A meta-analysis

BACKGROUND

Male pattern baldness (MPB) has been associated with an increased risk of prostate cancer (PC) as well as benign prostatic hyperplasia (BPH). We performed a meta-analysis to quantitatively determine the level of risk of PC and BPH in individuals with baldness.

METHODS

A systematic literature search was conducted using several databases. We calculated pooled odds ratios (OR) and 95% CIs.

RESULTS

In total, 17 studies comprising 68,448 participants were eligible for the meta-analysis and showed that MPB is associated with an increased risk of aggressive PC (OR = 1.59; 95% CI: 1.36-1.86; P<0.001) as well as BPH (OR = 1.26; 95% CI: 1.05-1.51; P = 0.01). There was statistically significant association between vertex baldness and PC (OR = 1.18; 95% CI: 1.05-1.32; P = 0.006). No statistically significant association between vertex, frontal plus vertex hair loss pattern, and BPH were identified.

CONCLUSIONS

MPB is associated with an increased risk of PC and BPH. Despite our findings, further studies, preferably prospective cohort studies, are required to better elucidate these relationships and to advance knowledge in this field.

The Impact of Central Obesity on Storage Luts and Urinary Incontinence After Prostatic Surgery

In the developed and developing countries, the overall prevalence of central obesity in the elderly men is growing. In addition, the progressive aging of male population increased the possibilities of coexisting morbidities associated with obesity such as lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) or to prostate cancer (PCa) needing primary treatment, including radical prostatectomy (RP), which can further adversely affect the quality of life. Simple and radical prostatectomy are the most common surgical procedures in urologic unit all over the world for BPE and PCa, respectively. After both interventions, patients can present bothering storage LUTS that can worsen all the other clinical outcomes. Preset study will review the role of central obesity as a risk factor for storage LUTS or urinary incontinence, after prostatic surgery for BPE or PCa.

Male Lower Urinary Tract Symptoms and Cardiovascular Events: A Systematic Review and Meta-analysis

CONTEXT

The correlation among metabolic syndrome, lower urinary tract symptoms (LUTS), and cardiovascular disease (CVD) is well established. In particular, CVD has been proposed as a potential risk factor for both LUTS progression and severity.

OBJECTIVE

To evaluate whether LUTS severity can be considered as a significant risk factor of major adverse cardiac events (MACE) in the male population.

EVIDENCE ACQUISITION

A systematic literature search was performed using PubMed, Google Scholar, and Scopus. The combination of the following keywords was adopted in a free-text strategy: benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) and cardiovascular, cardio, major adverse cardiac events, MACE, heart disease, heart, myocardial infarction, myocardial, infarction, stroke, ischemic events, ischemic, cardiac death, coronary syndrome. We included all cross-sectional and longitudinal trials enrolling men and comparing the prevalence or incidence of MACE in men with moderate to severe LUTS compared with those without LUTS or with mild LUTS. The studies in which only nocturia was evaluated were excluded from the analysis.

EVIDENCE SYNTHESIS

Of 477 retrieved articles, 5 trials longitudinally reported the incidence of MACE in patients with moderate to severe LUTS in comparisons to those with mild or no LUTS and 10 studies reported the prevalence of history of MACE at enrollment. All were included in the present meta-analysis. Among cross-sectional studies, 38 218 patients and 2527 MACE were included in the meta-analysis. The mean age of enrolled patients was 62.2±8.0 yr. Presence of moderate to severe LUTS significantly increased the risk of reported history of MACE (p<0.001). Metaregression analyses showed that the risk of MACE was lower in older patients and higher in those with diabetes. The association between LUTS-related MACE and diabetes was confirmed in a multivariate regression model after adjusting for age (adjusted r=0.498; p<0.0001). Longitudinal trials included 25 494 patients and 2291 MACE. The mean age of enrolled patients was 52.5±5.5 yr, and mean follow-up was 86.8±22.1 mo. Presence of moderate to severe LUTS was associated with an increased incidence of MACE compared with the rest of the sample (odds ratio: 1.68; 95% confidence interval, 1.13-2.50; p=0.01).

CONCLUSIONS

Men with moderate to severe LUTS seem to have an increased risk of MACE. A holistic approach in considering the morbidities of aging men should be strongly encouraged and represents an important role for the practicing urologist.

PATIENT SUMMARY

We evaluated whether the severity of lower urinary tract symptoms could be considered as a significant risk factor for major adverse cardiac events (MACE) in the male population. We demonstrated that men with moderate to severe LUTS have an increased risk of MACE.