Skip to main content

Advertisement

Log in

Relationship Between the Metabolic Syndrome and BPH-Related Voiding Dysfunction

  • BPH-Related Voiding Dysfunction (R Lee, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Benign prostatic hyperplasia (BPH) is a commonly occurring condition, affecting a vast number of men worldwide, and particularly in North America. Lower urinary tract symptoms (LUTS) are the bothersome consequences of bladder outlet obstruction that can result from BPH, and are likely to reduce the quality of life of individuals afflicted by this condition. The metabolic syndrome (MetS) is a condition characterized by a constellation of inter-related clinical findings that have recently increased in frequency. Recent studies have suggested that the MetS may be a contributor to BPH. Important associations between BPH and MetS include the relationship between LUTS and increased body habitus, as measured by obesity and waist circumference. Cardiovascular risk factors, which are important components of the MetS, may also be associated with BPH. The exact pathophysiology and mechanisms of these relationships however are yet to be determined. Likely contenders include a pro-inflammatory state, changes in testosterone level, and increased autonomic activity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Batsis JA, Nieto-Martinez RE, Lopez-Jimenez F. Metabolic syndrome: from global epidemiology to individualized medicine. Clin Pharmacol Ther. 2007;82(5):509–24.

    Article  CAS  PubMed  Google Scholar 

  2. Bostanci Y, Kazzazi A, Momtahen S, Laze J, Djavan B. Correlation between benign prostatic hyperplasia and inflammation. Curr Opin Urol. 2013;23(1):5–10.

    Article  PubMed  Google Scholar 

  3. Rom M, Schatzl G, Swietek N, Rucklinger E, Kratzik C. Lower urinary tract symptoms and depression. BJU Int. 2012;110(11 Pt C):E918–21.

    Article  PubMed  Google Scholar 

  4. Parsons JK. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol. 2007;178(2):395–401.

    Article  PubMed  Google Scholar 

  5. Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2009;182(6 Suppl):S27–31.

    Article  PubMed  Google Scholar 

  6. Kristal AR, Arnold KB, Schenk JM, Neuhouser ML, Weiss N, Goodman P, et al. Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. J Urol. 2007;177(4):1395–400.

    Article  PubMed  Google Scholar 

  7. Xie LP, Bai Y, Zhang XZ, Zheng XY, Yao KS, Xu L, et al. Obesity and benign prostatic enlargement: a large observational study in China. Urology. 2007;69(4):680–4.

    Article  PubMed  Google Scholar 

  8. Dahle SE, Chokkalingam AP, Gao YT, Deng J, Stanczyk FZ, Hsing AW. Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. J Urol. 2002;168(2):599–604.

    Article  CAS  PubMed  Google Scholar 

  9. Abdollah F, Briganti A, Suardi N, Castiglione F, Gallina A, Capitanio U, et al. Metabolic syndrome and benign prostatic hyperplasia: evidence of a potential relationship, hypothesized etiology, and prevention. Korean J Urol. 2011;52(8):507–16.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bhindi B, Margel D, Trottier G, Hamilton RJ, Kulkarni GS, Hersey KM, et al. Obesity is associated with larger prostate volume but not with worse urinary symptoms: analysis of a large multiethnic cohort. Prostatic diseases and male voiding dysfunction. 2014. doi:10.1016/j.urology.2013.07.039. This study showed a positive correlation between BMI and prostate volume. Interestingly, this particular cohort of patients did not show a relation between BMI and LUTS.

  11. Fritschi L, Tabrizi J, Leavy J. Risk factors for surgically treated benign prostatic hyperplasia in Western Australia. Public Health. 2007;121:781–9.

    Article  PubMed  Google Scholar 

  12. Gupta A, Gupta S, Pavuk M, Roehrborn CG. Anthropometric and metabolic factors and risk of benign prostatic hyperplasia: a prospective cohort study of Air Force veterans. Urology. 2006;68(6):1198–205.

    Article  PubMed  Google Scholar 

  13. Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2013;189(1 Suppl):S102–6. doi:10.1016/j.juro.2012.11.029.

    Article  PubMed  Google Scholar 

  14. Seim A, Hoyo C, Ostbye T, Vatten L. The prevalence and correlates of urinary tract symptoms in Norwegian men: the HUNT Study. BJU Int. 2005;96:88–92.

    Article  PubMed  Google Scholar 

  15. Rohrmann S, Smit E, Giovannucci E, Platz EA. Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III). Int J Obes. 2005;29:310–6.

    Article  CAS  Google Scholar 

  16. Platz EA, Kawachi I, Rimm EB, Colditz GA, Stampfer MJ, Willett WC, et al. Physical activity and benign prostatic hyperplasia. Arch Intern Med. 1998;158(21):2349–56.

    Article  CAS  PubMed  Google Scholar 

  17. Lee RK, Chung D, Chughtai B, Te AE, Kaplan SA. Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms. BJU Int. 2012;110:540. This important study revealed the relationship between waist circumference and prostate volume and prostate specific antigen. Additionally, the authors reported that men with larger waists also reported higher rates of erectile dysfunction and problems with ejaculation.

  18. Mondul AM, Giovannucci E, Platz EA, Urologic Diseases in America P. A prospective study of obesity and incidence and progression of lower urinary tract symptoms. J Urol. 2013.

  19. Laven BA, Orsini N, Andersson S. Birth weight, abdominal obesity and the risk of lower urinary tract symptoms in a population based study of Swedish men. J Urol. 2008;179(5):1891.

    Article  PubMed  Google Scholar 

  20. Parsons JK, Carter HB, Partin AW, Windham BG, Metter EJ, Ferrucci L, et al. Metabolic factors associated with benign prostatic hyperplasia. J Clin Endocrinol Metab. 2006;91(7):2562–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Muller RL, Gerber L, Moreira DM, Andriole GJ, Hamilton RJ, Fleshner NE, et al. Obesity is associated with increased prostate growth and attenuated prostate volume reduction by dutasteride. Eur Urol. 2013;63:1115–21.

    Article  CAS  PubMed  Google Scholar 

  22. Joseph MA, Wei JT, Harlow SD, Cooney KA, Dunn RL, Jaffe CA, et al. Relationship of serum sex-steroid hormones and prostate volume in African American men. Prostate. 2002;53(4):322–9.

    Article  CAS  PubMed  Google Scholar 

  23. Freedland SJ, Platz EA, Presti Jr JC, Aronson WJ, Amling CL, Kane CJ, et al. Obesity, serum prostate specific antigen and prostate size: implications for prostate cancer detection. J Urol. 2006;175(2):500–4.

    Article  PubMed  Google Scholar 

  24. Sarma AV, Jaffe CA, Schottenfeld D, Dunn R, Montie JE, Cooney KA, et al. Insulin-like growth factor-1, insulin-like growth factor binding protein-3, and body mass index: clinical correlates of prostate volume among Black men. Urology. 2002;59(3):362–7.

    Article  PubMed  Google Scholar 

  25. Soygur T, Kupeli B, Aydos K, Kupeli S, Arikan N, Muftuoglu YZ. Effect of obesity on prostatic hyperplasia: its relation to sex steroid levels. Int Urol Nephrol. 1996;28(1):55–9.

    Article  CAS  PubMed  Google Scholar 

  26. Hammarsten J, Hogstedt B, Holthuis N, Mellstrom D. Components of the metabolic syndrome-risk factors for the development of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 1998;1(3):157–62.

    Article  PubMed  Google Scholar 

  27. Rohrmann S, Crespo CJ, Weber JR, Smit E, Giovannucci E, Platz EA. Association of cigarette smoking, alcohol consumption and physical activity with lower urinary tract symptoms in older American men: findings from the third National Health and Nutrition Examination survey. BJU Int. 2005;96:77–82.

    Article  PubMed  Google Scholar 

  28. Martin S, Lange K, Haren MT, Taylor AW, Wittert G, Members of the Florey Adelaide Male Ageing S. Risk factors for progression and improvement of lower urinary tract symptoms in a prospective cohort of men. J Urol. 2013;191.

  29. Dal Maso L, Zucchetto A, Tavani A, Montella M, Ramazzotti V, Polesel J, et al. Lifetime occupational and recreational physical activity and risk of benign prostatic hyperplasia. Int J Cancer. 2006;118(10):2632–5.

    Article  CAS  PubMed  Google Scholar 

  30. Fowke JH, Phillips S, Koyama T, Byerly S, Concepcion R, Motley SS, et al. Association between physical activity, lower urinary tract symptoms (LUTS) and prostate volume. BJU Int. 2013;111(1):122–8. This article reported the importance of physical activity and its association with reduction in LUTS severity. The findings were more impressive in the obese population, further emphasizing the importance of BMI control over quality of life.

  31. Lagiou A, Samoli E, Georgila C, Minaki P, Barbouni A, Tzonou A, et al. Occupational physical activity in relation with prostate cancer and benign prostatic hyperplasia. Eur J Cancer Prev. 2008;17(4):336–9.

    Article  PubMed  Google Scholar 

  32. Parsons JK, Messer K, White M, Barrett-Connor E, Bauer DC, Marshall LM, et al. Obesity increases and physical activity decreases lower urinary tract symptom risk in older men: the Osteoporotic Fractures in Men study. Eur Urol. 2011;60(6):1173–80.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Penson DF, Munro HM, Signorello LB, Blot WJ, Fowke JH, Urologic Diseases in America P. Obesity, physical activity and lower urinary tract symptoms: results from the Southern Community Cohort Study. J Urol. 2011;186(6):2316–22.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Lacey Jr JV, Deng J, Dosemeci M, Gao YT, Mostofi FK, Sesterhenn IA, et al. Prostate cancer, benign prostatic hyperplasia and physical activity in Shanghai, China. Int J Epidemiol. 2001;30(2):341–9.

    Article  PubMed  Google Scholar 

  35. Parsons JK, Kashefi C. Physical activity, benign prostatic hyperplasia, and lower urinary tract symptoms. Eur Urol. 2008;53(6):1228–35.

    Article  PubMed  Google Scholar 

  36. Landsberg L. Diet, obesity and hypertension: a hypothesis involving insulin, the sympathetic nervous system, and adaptive thermogenesis. Q J Med. 1986;61:1081–90.

    CAS  PubMed  Google Scholar 

  37. McVary K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int. 2006;2:23–8.

    Article  Google Scholar 

  38. Ozden C, Ozdal OL, Urgancioglu G, Koyuncu H, Gokkaya S, Memis A. The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia. Eur Urol. 2007;51:199–203.

    Article  PubMed  Google Scholar 

  39. Mcvary KT, Razzaq A, Lee C, Venegas MF, Rademaker A, McKenna KE. Growth of the rat prostate gland is facilitated by the autonomic nervous system. Biol Reprod. 1994;51(1):99–107.

    Article  CAS  PubMed  Google Scholar 

  40. Silva J, Pinto R, Carvallho T, Coelho A, Avelino A, Dinis P. Mechanisms of prostate atrophy after glandular botulinum neurotoxin type a injection: an experimental study in the rat. Eur Urol. 2009;56:134–40.

    Article  CAS  PubMed  Google Scholar 

  41. Matityahou A, Rosenzweig N, Golomb E. Rapid proliferation of prostatic epithelial cells in spontaneously hypertensive rats: a model of spontaneous hypertension and prostate hyperplasia. J Androl. 2003;24:263–9.

    PubMed  Google Scholar 

  42. McVary K, Rademaker A, Lloyd GL, Gann P. Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2005;174:1327–433.

    Article  PubMed  Google Scholar 

  43. Nam SY, Lee EJ, Kim KR, Cha BS, Song YD, Lim SK. Effect of obesity on total and free insulin-like growth factor (IGF)-1, and their relationship to IGF-binding protein (BP)-1, IGFBP-2, IGFBP-3, insulin, and growth hormone. Int J Obes Relat Metab Disord. 1997;21:355–9.

    Article  CAS  PubMed  Google Scholar 

  44. Chokkalingam AP, Gao YT, Deng J, Stanczyk FZ, Sesterhenn IA, Mostofi FK. Insulin-like growth factors and risk of benign prostatic hyperplasia. Prostate. 2002;52:98–105.

    Article  CAS  PubMed  Google Scholar 

  45. Neuhouser ML, Schenk J, Song YJ, Tangen CM, Goodman PJ, Pollak M. Insulin-like growth factor-I, insulin-like growth factor binding protein-3 and risk of benign prostate hyperplasia in the prostate cancer prevention trial. Prostate. 2008;68:1477–86.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Rohrmann S, Giovannucci E, Smit E, Platz EA. Association of IGF-1 and IGFBP-3 with lower urinary tract symptoms in the third national health and nutrition examination survey. Prostate. 2007;67:1693–8.

    Article  CAS  PubMed  Google Scholar 

  47. Wallner LP, Hollingsworth JM, Dunn RL, Kim C, Herman WH, Sarma AV, et al. Hyperglycemia, hyperinsulinemia, insulin resistance, and the risk of BPH/LUTS severity and progression over time in community dwelling black men: the Flint Men’s Health Study. Urology. 2013;82(4):881–6.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Takeda M, Tang R, Shapiro E, Burnett AL, Lepor H. Effects of nitric oxide on human and canine prostates. Urology. 1995;45(3):440–6.

    Article  CAS  PubMed  Google Scholar 

  49. Bloch W, Klotz T, Loch C, Schmidt G, Engelmann U, Addicks K. Distribution of nitric oxide synthase implies a regulation of circulation, smooth muscle tone, and secretory function in the human prostate by nitric oxide. Prostate. 1997;33:1–8.

    Article  CAS  PubMed  Google Scholar 

  50. Chen IH, Tsai YS, Tong YC. Correlations among cardiovascular risk factors, prostate blood flow, and prostate volume in patients with clinical benign prostatic hyperplasia. Urology. 2012;79(2):409–14.

    Article  PubMed  Google Scholar 

  51. Paneni F, Beckman JA, Creager MA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Eur Heart J. 2013;34(31):2436–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Azadzoi KM, Tarcan T, Siroky MB, Krane RJ. Atherosclerosis-induced chronic ischemia causes bladder fibrosis and non-compliance in the rabbit. J Urol. 1999;161(5):1626–35.

    Article  CAS  PubMed  Google Scholar 

  53. Kozlowski R, Kershen RT, Siroky MB, Krane RJ, Azadzoi KM. Chronic ischemia alters prostate structure and reactivity in rabbits. J Urol. 2001;165(3):1019–26.

    Article  CAS  PubMed  Google Scholar 

  54. Azadzoi KM, Babayan RK, Kozlowski R, Siroky MB. Chronic ischemia increases prostatic smooth muscle contraction in the rabbit. J Urol. 2003;170(2 Pt 1):659–63.

    Article  PubMed  Google Scholar 

  55. Gustafson B, Hammarstedt A, Andersson CX, Smith U. Inflamed adipose tissue: a culprit underlying the metabolic syndrome and atherosclerosis. Arterioscler Thromb Vasc Biol. 2007;27(11):2276–83.

    Article  CAS  PubMed  Google Scholar 

  56. Vignozzi L, Morelli A, Sarchielli E, Comeglio P, Filippi S, Cellai I, et al. Testosterone protects from metabolic syndrome-associated prostate inflammation: an experimental study in rabbit. J Endocrinol. 2012;212(1):71–84.

    Article  CAS  PubMed  Google Scholar 

  57. Robert G, Descazeaud A, Nicolaiew N, Terry S, Sirab N, Vacherot F, et al. Inflammation in benign prostatic hyperplasia: a 282 patients’ immunohistochemical analysis. Prostate. 2009;69(16):1774–80.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Penna G, Mondaini N, Amuchastegui S, Degli Innocenti S, Carini M, Giubilei G, et al. Seminal plasma cytokines and chemokines in prostate inflammation: interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia. Eur Urol. 2007;51(2):524–33.

    Article  CAS  PubMed  Google Scholar 

  59. Vignozzi L, Gacci M, Cella I, Santi R, Corona G, Morelli A, et al. Fat boosts, while androgen receptor activation counteracts, BPH-associated prostate inflammation. Prostate. 2013;73(8):789–800.

    Article  CAS  PubMed  Google Scholar 

  60. Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Salonen R, et al. Sex hormones, inflammation and the metabolic syndrome: a population-based study. Eur J Endocrinol. 2003;149(6):601–8.

    Article  CAS  PubMed  Google Scholar 

  61. Laaksonen DE. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004;27(5):1036–41.

    Article  CAS  PubMed  Google Scholar 

  62. Nicholson TM, Ricke WA. Androgens and estrogens in benign prostatic hyperplasia: past, present and future. Differentiation. 2011;82(4–5):184–99.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Platz EA, Kawachi I, Rimm EB, Longcope C, Stampfer MJ, Willett WC, et al. Plasma steroid hormones, surgery for benign prostatic hyperplasia, and severe lower urinary tract symptoms. Prostate Cancer Prostatic Dis. 1999;2(5/6):285–9.

    Article  PubMed  Google Scholar 

  64. Hammarsten J, Damber J-E, Karlsson M, Knutson T, Ljunggren O, Ohlsson C, et al. Insulin and free oestradiol are independent risk factors for benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2009;12:160–5.

    Article  CAS  PubMed  Google Scholar 

  65. Shigehara K, Sugimoto K, Konaka H, Iijima M, Fukushima M, Maeda Y, et al. Androgen replacement therapy contributes to improving lower urinary tract symptoms in patients with hypogonadism and benign prostate hypertrophy: a randomised controlled study. Aging Male. 2011;14(1):53–8.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Udi Blankstein, Bilal Chughtai and Dean S. Elterman declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dean S. Elterman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Blankstein, U., Chughtai, B. & Elterman, D.S. Relationship Between the Metabolic Syndrome and BPH-Related Voiding Dysfunction. Curr Bladder Dysfunct Rep 9, 122–128 (2014). https://doi.org/10.1007/s11884-014-0230-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-014-0230-2

Keywords

Navigation