Connections between lower urinary tract symptoms related to benign prostatic enlargement and metabolic syndrome with its components: a systematic review and meta-analysis

Figures & data

Figure 1. Flow Diagram of included studies.

Table 1. Studies on the association between MetS components, and LUTS.

Year	Authors	Country	Number of samples	BPH definition	Mets components definition	MetS features and BPH findings	NOS quality Score
2014	Zhang et al.	China: cross-sectional	394	LUTS (IPSS); PSA; TRUS; PV	FPG (≥110 mg/dl)	PV was correlated with FINS (r = 0.421, p = 0.001), but no FPG (r = 0.091, p = 0.364) or HbA1c levels (r = 0.153, p = 0.127)	5
2014	Russo et al.	Italy: cross-sectional	544	LUTS (IPSS); PSA; TRUS; PV	IDF	IR was an independent predictor of severe LUTS (IPSS≥20) (OR = 2.0, 9,5% CI 1.20-3-34)	5
2014	Vanella et al.	Italy: experimental	132	LUTS (IPSS); PSA; TRUS; PV	IDF	No differences of IPSS, IPSS-voiding, IPSS-storage and PV in men with and without MetS.	5
2014	De Nunzio et al.	Italy: observational	431	LUTS (IPSS); PSA; PV	NCEP ATP III	On multivariate analysis, the presence of MetS was associated with an increased risk of an IPSS storage subscore ≥4 (OR: 1.782; p = 0.03)	5
2014	Kim et al.	Korea: retrospective	4076	LUTS (IPSS); PSA; PV	NCEP ATP III	In the larger PV group ( ≥ 28 mL), the age-adjusted OR for having moderate-to-severe LUTS was significantly lower in subjects with MetS (OR: 0.666; p < 0.01) and in subjects with MS having 4 or 5 risk factors (OR: 0.612; p < 0.05).	4
2013	Gacci et al.	Italy: cross-sectional	271	Prostatectomy for moderate/severe LUTS due to BPH	AHA/NHLBI criteria or previous diagnosis of type 2 diabetes	Inflammatory score (p = 0.049), lower uroflowmetric parameters (p = 0.0008) IPSS (p = 0.064)	5
2013	Park et al.	Korea: retrospective study	1224	PV, LUTS (IPSS)	NCEP ATP III	IPSS, TPV>30 mL, and PVR>50 mL significantly increased with an increasing of number of MetS components (p < 0.001)	4
2012	Byun et al.	Korea: retrospective study	420	PV, LUTS (IPSS)	NCEP ATPIII AHA/NHLBI	PSA and PV was correlated with MetS and with number of MetS components (p < 0.001)	4
2012	Yang et al.	Taiwan: prospective study	708	LUTS (IPSS) PSA, DRE, PV	NCEP ATP III	MetS group have lower IPSS score (p = 0.05). The negative association between voiding score, severity of LUTS, and MetS became higher as the number of MetS increased (p < 0.01).	4
2012	Gao et al.	China: cross-sectional	3103	LUTS (IPSS); PSA; PV	NCEP ATP III	The presence of MetS was not associated with the severity of LUTS (OR: 0.97), but its subcategories of moderate or severe storage symptoms were inversely related to MetS (OR: 0.64).	5
2011	Ohgaki et al.	Japan: observational	900	LUTS (IPSS); PSA; PV	NCEP ATP III; IDF; JASSO	In the younger and older men, LUTS was observed equally in those with and without the MetS	4
2011	Yim et al.	Korea: retrospective study	848	TRUS, PSA, DRE	NCEP ATP III	PV is not significantly larger in the MS group (18.4 versus 17.8 cc; p = 0.225), but in pt. with elevated FPG and WC is (p = 0.001).	4
2011	Jeong et al.	Korea: retrospective study	1357	LUTS (IPSS) PSA, DRE, TRUS	NCEP on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults guidelines	PV and BPE is higher MetS pt. (p < 0.001). No differences in IPSS or voiding or storage subscore were noted. Diabetes and obesity are risk factors for BPE (p < 0.001)	4
2010	Lee et al.	Taiwan: cross-sectional	639	LUTS (IPSS), PSA, PV	NCEP on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults guidelines	Subjects with ED had significantly higher prevalence of MetS (p < 0.01, OR = 2.30, 95% CI: 1.44–3.69)	4
2009	Wang et al.	Taiwan: case-control convenience sample from diabetes clinic and health fair Age <45	226	LUTS (IPSS); FR/PVR	DM defined by American Diabetes Association criteria	IPSS (6.1 versus 4.1, p = 0,0001), storage symptoms (2.7 versus 2.0, p = 0.02), voiding symptoms (3.5 versus 2.1 p < 0.001)	5
2009	Kupelian et al.	USA: observational	1899	LUTS (IPSS); PV; PSA	NCEP ATP III	Increased odds of the MetS were observed in men with mild to severe LUTS (OR: 1.68). A statistically significant association was observed between the MetS and a voiding symptom score of 5 or greater (OR: 1.73) but not for a storage symptom score of 4 or greater (OR: 0.94). These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older).	5
2008	Park et al.	Korea: retrospective study (KLoSHA)	348	LUTS (IPSS), PV, PSA	NCEP ATP III	No significant differences in IPSS score (p > 0.05)	4
2007	Ozden et al.	Turkey: prospective study	78	PSA, TP, TZ	NCEP ATP III	Higher, BMI, FPG, serum triglyceride, PSA levels, lower serum HDL-C, compared with Pt. without MetS (p < 0.05). TP growth rate and TZ growth rate higher in Pt. MetS (0.64 ml/yr and 0.93 ml/yr, p < 0.05)	5
2005	Rohrmann et al.	USA: cross-sectional study	878	LUTS (IPSS)	NCEP ATP III	Diabetes, hypertension and HbA1c are positively associated with LUTS. No statistically significant associations between FPG and LUTS	5

PSA =  prostate-specific antigen, PV = prostate volume, FPG =  fasting plasma glucose, WC =  waist circumference, LUTS = lower urinary tract symptoms, IPSS = International Prostate Symptom Score, FINS = fasting insulin, HbA1c = glycosylated hemoglobin, FR/PVR = flow rate/post-void residual, HOMA-IR = Homeostasic model of assessment index, TP =  total prostate, TZ =  transitional zone, DRE = digital rectal examination, NCEP ATP III = National Cholesterol Education Program Expert Panel Adult Treatment Panel III, AHA/NHLBI 0 American Heart Association and the National Heart, Lung, and Blood Institute.

Figure 2. International Prostate Symptom Score (IPSS) (A), Voiding IPSS (B), Storage IPSS (C) and prostate volume (D) in patients with and without metabolic syndrome (MetS). CI=confidence interval; SD=standard deviation.

Figure 3. Risk of having moderate-to-severe lower urinary tract symptoms (IPSS ≥ 8) expressed as odds ratio (OR [95% CI]) in patients with metabolic syndrome (A), in patients with waist circumference ≥90 cm (or ≥ 90 cm for Asians) (B), with HDL < 40 mg/dl (C), with triglycerides ≥ 150 mg/dl (D), in patients with elevated fasting glucose (≥6.1 mmol/L or 110 mg/dL) (E).CI = confidence interval; Homa-index = homeostatic model assessment index.