BERKELEY, CA (UroToday.com) - For the first time, our study has found a significant relationship between non-alcoholic fatty liver disease (NAFLD) with benign prostate hyperplasia (BPH) in men and overactive bladder (OAB) in women. We found that men with NAFLD had significantly increased prostate volumes. Additionally, women with NAFLD had also increased risk for overactive bladder (OAB).
BPH, OAB, and NAFLD are very commonly diagnosed disorders in health-care seeking. We thought a clinical relationship and pathogenetic interactions could be a worthwhile exploring in the evaluation of these patients. The common factor amongst these disorders is the relationship with metabolic syndrome and insulin resistance. However, metabolic syndrome is a large family including cardiovascular diseases such hypertension and coronary artery disease, diabetes and associated complications, Alzheimer’s disease, erectile dysfunction, atherosclerosis and embolism. NAFLD is accepted as the hepatic component of this family and has gained importance in recent years for its role in insulin resistance and hepatic dysfunction.
During the last ten years, an increasing number of studies have put forth a relationship between BPH, lower urinary tract symptoms, and metabolic syndrome. Hammarsten was the first to report that patients with faster growing prostates had higher insulin and lower high-density lipoprotein (HDL-) cholesterol levels than those with slowly growing prostates. However, two years ago, we realized that women with OAB have an increased risk for metabolic syndrome. In addition, we found that women with OAB have an increased risk for insulin resistance. Since NAFLD is a chronic inflammatory disease and hepatic steatosis induces hyperglycaemia, dyslipidaemia, and chronic inflammation, thereby inducing insulin resistance, molecular etiopathogenesis of BPH, OAB and NAFLD may have common interactions. We discussed these pathogenetic mechanisms in our study and concluded that common preventive and theurapeutic strategies could be developed in management of both NAFLD, BPH, and OAB.
Our findings confirm the hypothesis that BPH and OAB are aspects of metabolic syndrome. It has been shown that people with NAFLD have an increased mortality rate due to liver and cardiovascular diseases. Additionally, men and women with nocturia have higher mortality rates compared to subjects without. Metabolic syndrome has been reported to be associated with nocturia and doubles the risk of death. Therefore, men with BPH and women with OAB may also have higher mortality rates due to common molecular etiopathogenesis with NAFLD and metabolic syndrome and these conditions could be predictors of general health status.
- Hammarsten J, Hoghstedt B. Hyperinsulinaemia as a risk factor for developing benign prostatic hyperplasia. Eur Urol 2001;39:151-158.
- Uzun H, Zorba OU. Metabolic syndrome in female patients with overactive bladder. Urology.2012;79:72–75.
- Uzun H, Yılmaz A, Kemik A, Zorba OU, Kalkan M. Association of insulin resistance with overactive bladder in female patients. Int Neurourol J 201216:18181-186.
- Uzun H, Ogullar S, Unal H, Zorba OU, Yazar S, Kalkan M. Non-alcoholic fatty liver disease is asscociated with benign prostate hyperplasia in men and overactive bladder in women. Scand J Urol Mar 26 (Epub ahead of print).
Hakkı Uzun as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology
Recep Tayyip Erdoğan University School of Medicine