World Journal of Urology

, Volume 37, Issue 7, pp 1347–1352 | Cite as

Cholecalciferol for the prophylaxis against recurrent urinary tract infection among patients with benign prostatic hyperplasia: a randomized, comparative study

  • Ahmed S. Safwat
  • Ahmad Hasanain
  • Ahmed Shahat
  • Mostafa AbdelRazek
  • Hazem Orabi
  • Samir K. Abdul Hamid
  • Amany Nafee
  • Sally Bakkar
  • Mohamed Sayed
Original Article



To explore the role of cholecalciferol for the prophylaxis against recurrent urinary tract infection (UTI) in patients with benign prostatic hyperplasia (BPH).


Our randomized, uncontrolled prospective study included 389 naïve BPH patients with moderate/severe symptoms, consecutively. The patients were randomly allocated to two groups; group-A included 193 patients who received tamsulosin, while group-B included another 196 patients who received tamsulosin with cholecalciferol. The study population was followed up for 2 years after the start of the treatment. For all the patients enrolled, clinical evaluation, imaging studies (abdominal and trans-rectal ultrasonography), and laboratory investigations [including urinalysis, urine culture with antibiotic susceptibility testing for positive cultures and estimation of prostate-specific antigen (PSA) level] were provided.


The incidence rate of recurrent UTI was 9% among the study population; it was significantly higher among group-A patients compared to those of group-B (13.5% vs. 4.6%, p 0.003, OR 2.7, 95% CI 1.5–4.3). Compared to patients of group-A, those of group-B developed a significantly lower level of PSA at the end of treatment period (0.16 ± 0.03 ng/mL vs. 0.27 ± 0.08 ng/mL, p 0.043, OR 1.9, 95% CI 1.2–6.8).


Adjuvant cholecalciferol supplementation may be protective against recurrent UTI among patients with BPH receiving tamsulosin therapy without extra adverse effects.


Cholecalciferol Urinary tract infection Tamsulosin Benign prostatic hyperplasia 



Benign prostatic hyperplasia


Urinary tract infection


American Urological Association Symptom Index


Prostate-specific antigen


Post-void residue


Author contributions

ASS: project development, data collection, data analysis, and manuscript writing. AH: project development, data collection, data analysis, and manuscript writing. AS: data collection and manuscript writing. MA: manuscript revision and manuscript editing. HO: manuscript revision and manuscript editing. SKA: data collection and manuscript writing. AN: data collection and manuscript editing. SB: data collection and manuscript editing. MS: manuscript revision and manuscript editing.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

345_2018_2536_MOESM1_ESM.docx (56 kb)
Supplementary Figure 1: Flow chart of the study cases with BPH


  1. 1.
    Schaeffer AJ, Nicolle LE (2016) Urinary tract infections in older men. N Engl J Med 374:562–571CrossRefPubMedGoogle Scholar
  2. 2.
    Berry SJ, Coffey DS, Walsh PC et al (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479CrossRefPubMedGoogle Scholar
  3. 3.
    Harper M, Fowlis G (2007) Management of urinary tract infections in men. Trends Urol Gynecol Sex Health 12:30–35CrossRefGoogle Scholar
  4. 4.
    Pourmand G, Abedi AR, Karami AA et al (2010) Urinary infection before and after prostatectomy. Saudi J Kidney Dis Transpl 21:290–294PubMedGoogle Scholar
  5. 5.
    Holick MF, Binkley NC, Bischoff-Ferrari HA et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930CrossRefGoogle Scholar
  6. 6.
    Bhalla AK, Amento EP, Clemens TL et al (1983) Specific high-affinity receptors for 1,25-dihydroxyvitamin D3 in human peripheral blood mononuclear cells: presence in monocytes and induction in T lymphocytes following activation. J Clin Endocrinol Metab 57:1308–1310CrossRefGoogle Scholar
  7. 7.
    White JH (2008) Vitamin D signaling, infectious diseases, and regulation of innate immunity. Infect Immun 76:3837–3843CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Juzeniene A, Ma LW, Kwitniewski M et al (2010) The seasonality of pandemic and non-pandemic influenzas: the roles of solar radiation and vitamin D. Int J Infect Dis 14:e1099–e1105CrossRefPubMedGoogle Scholar
  9. 9.
    Kearns MD, Alvarez JA, Seidel N et al (2015) Impact of vitamin D on infectious disease. Am J Med Sci 349:245–262CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    van der Starre WE, van Nieuwkoop C, Paltansing S et al (2011) Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection. J Antimicrob Chemother 66:650–656CrossRefPubMedGoogle Scholar
  11. 11.
    Lipsky BA (1989) Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment. Ann Intern Med 110:138–150CrossRefPubMedGoogle Scholar
  12. 12.
    Ulleryd P, Zackrisson B, Aus G et al (1999) Prostatic involvement in men with febrile urinary tract infection as measured by serum prostate-specific antigen and transrectal ultrasonography. BJU Int 84:470–474CrossRefPubMedGoogle Scholar
  13. 13.
    Adorini L (2005) Intervention in autoimmunity: the potential of vitamin D receptor agonists. Cell Immunol 233:115–124CrossRefPubMedGoogle Scholar
  14. 14.
    Norman AW (2006) Vitamin D receptor: new assignments for an already busy receptor. Endocrinology 147:5542–5548CrossRefPubMedGoogle Scholar
  15. 15.
    Chromek M, Slamová Z, Bergman P et al (2006) The antimicrobial peptide cathelicidin protects the urinary tract against invasive bacterial infection. Nat Med 12:636–641CrossRefPubMedGoogle Scholar
  16. 16.
    Hertting O, Holm Å, Lüthje P et al (2010) Vitamin D induction of the human antimicrobial Peptide cathelicidin in the urinary bladder. PLoS One 5:e15580CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bikle DD (2008) Vitamin D and the immune system: role in protection against bacterial infection. Curr Opin Nephrol Hypertens 17:348–352CrossRefPubMedGoogle Scholar
  18. 18.
    Eklund D, Persson HL, Larsson M et al (2013) Vitamin D enhances IL-1β secretion and restricts growth of Mycobacterium tuberculosis in macrophages from TB patients. Int J Mycobacteriol 2:18–25CrossRefPubMedGoogle Scholar
  19. 19.
    Gombart AF, Borregaard N, Koeffler HP (2005) Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25-dihydroxyvitamin D3. FASEB J 19:1067–1077CrossRefPubMedGoogle Scholar
  20. 20.
    Jorde R, Sollid ST, Svartberg J et al (2016) Prevention of urinary tract infections with vitamin D supplementation 20,000 IU per week for five years results from an RCT including 511 subjects. Infect Dis (Lond) 48:823–828CrossRefGoogle Scholar
  21. 21.
    Espinosa G, Esposito R, Kazzazi A et al (2013) Vitamin D and benign prostatic hyperplasia—a review. Can J Urol 20:6820–6825PubMedGoogle Scholar
  22. 22.
    Adorini L, Penna G, Fibbi B et al (2010) Vitamin D receptor agonists target static, dynamic, and inflammatory components of benign prostatic hyperplasia. Ann NY Acad Sci 1193:146–152CrossRefPubMedGoogle Scholar
  23. 23.
    Kristal AR, Arnold KB, Schenk JM et al (2008) Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol 167:925–934CrossRefPubMedGoogle Scholar
  24. 24.
    Colli E, Rigatti P, Montorsi F et al (2006) BXL628, a novel vitamin D3 analog arrests prostate growth in patients with benign prostatic hyperplasia: a randomized clinical trial. Eur Urol 49:82–86CrossRefPubMedGoogle Scholar
  25. 25.
    Peehl DM, Skowronski RJ, Leung GK et al (1994) Antiproliferative effects of 1,25-dihydroxyvitamin D3 on primary cultures of human prostatic cells. Cancer Res 54:805–810PubMedGoogle Scholar
  26. 26.
    Murthy S, Agoulnik IU, Weigel NL (2005) Androgen receptor signaling and vitamin D receptor action in prostate cancer cells. Prostate 64:362–372CrossRefPubMedGoogle Scholar
  27. 27.
    Yee SW, Campbell MJ, Simons C (2006) Inhibition of vitamin D3 metabolism enhances VDR signalling in androgen-independent prostate cancer cells. J Steroid Biochem Mol Biol 98:228–235CrossRefPubMedGoogle Scholar
  28. 28.
    Penna G, Fibbi B, Amuchastegui S et al (2009) The vitamin D receptor agonist elocalcitol inhibits IL-8-dependent benign prostatic hyperplasia stromal cell proliferation and inflammatory response by targeting the RhoA/Rho kinase and NF-κB pathways. Prostate 69:480–493CrossRefPubMedGoogle Scholar
  29. 29.
    Badalian SS, Rosenbaum PF (2010) Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey. Obstet Gynecol 115:795–803CrossRefPubMedGoogle Scholar
  30. 30.
    Murphy AB, Nyame YA, Batai K et al (2017) Does prostate volume correlate with vitamin D deficiency among men undergoing prostate biopsy? Prostate Cancer Prostatic Dis 20:55–60CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ahmed S. Safwat
    • 1
  • Ahmad Hasanain
    • 2
  • Ahmed Shahat
    • 1
  • Mostafa AbdelRazek
    • 3
  • Hazem Orabi
    • 1
  • Samir K. Abdul Hamid
    • 4
  • Amany Nafee
    • 5
  • Sally Bakkar
    • 6
  • Mohamed Sayed
    • 1
  1. 1.Department of Urology and Nephrology HospitalAssiut UniversityAssiutEgypt
  2. 2.Department of Tropical Medicine and GastroenterologyAssiut UniversityAssiutEgypt
  3. 3.Department of UrologySouth Valley UniversityQenaEgypt
  4. 4.Department of Medicine (Nephrology Unit)Assiut UniversityAssiutEgypt
  5. 5.Department of Microbiology and ImmunologyAssiut UniversityAssiutEgypt
  6. 6.Department of BiochemistryAssiut UniversityAssiutEgypt

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