Prostate volume, LUTS scale, and uroflowmetry of benign prostate hyperplasia patients with type 2 diabetes mellitus

Introduction

Benign prostate hyperplasia (BPH) is an enlargement of the prostate due to abnormal proliferation or apoptosis failure of the epithelial or stroma tissues. In Indonesia, approximately 2.5 million men aged 60 and above suffer from lower urinary tract symptoms (LUTS) and put BPH as the second-highest prevalence in Indonesia urology clinics after urolithiasis [1][2]. Its symptoms include urinary incontinence, polyuria, and a weak urine stream [3].

LUTS, associated with BPH, commonly develops in type 2 diabetes mellitus (T2DM) patients [4]. According to the World Health Organization, Indonesia ranks the seventh largest worldwide with an estimated 10 million patients and is predicted to grow to 21.257 million patients in 2030¹. T2DM is a chronic metabolic disease caused by the failure of the body to maintain normal glucose levels because of higher-than-normal insulin resistance (hyperinsulinemia) [5]. In hyperinsulinemia, the IGF-1 level in serum increases, which may bind with the IGF-1 receptor on the prostate, resulting in prostate cell proliferation being more active [6]. This causes microvascular and macrovascular complications and manifests as multiple systemic disorders [7].

Presently, available data on the correlation between BPH and T2DM is very limited. Therefore, this research aims shed light on this matter by comparing the prostate volume, International Prostate Symptom Score (IPSS) or LUTS scale, and uroflowmetry of benign prostate hyperplasia patients with type 2 diabetes mellitus.

This study aimed to compare the prostate volume, IPSS score (LUTS scale), and uroflowmetry of benign prostate hyperplasia (BPH) patients with type 2 diabetes mellitus.

Materials and methods

Research design. An analytical retrospective observational study using the medical records between 2011 and 2015.

Ethical clearance. This is an analytical retrospective observational study that obtains the medical records of BPH patients; thus, the ethical clearance certificate is not available.

Data collection and analysis. The clinical parameters used for comparison were prostate volume, IPSS or LUTS scale, and urine flow rate using uroflowmetry. The maximum urine flow rate (Q max) was calculated electronically as milliliters of urine passing per second.

The data was collected with consecutive sampling by excluding medical records that do not contain all three clinical parameters. Statistical analysis was performed using the Chi-square test + Yates correction from the website socialstatisic. com (https://www.socscistatistics.com/tests/chisquare2/Default2.aspx).

Patient consent. All patients have already given their consent for this study.

Results

Prostate volume. All included participants in this study have an average age of 63 years old (63.1 years for T2DM patients and 63.7 years for non-T2DM patients). The prostate volume of < 20 ml was more common in the diabetic BPH group (8 patients — 72.7%), while 66% (34 patients) of the non-diabetic group recorded to have a volume of > 30% (Table). The Chi-square test showed no significant difference in the prostate volume between these groups (p > 0.05).

International prostate symptom score (IPSS). Based on the International Prostate Symptom Score (IPSS), each group had the same percentage for the moderate and severe categories, with 54.54% in the diabetic BPH group and 41.17% in the non-diabetic one. However, those results yield an insignificant difference (p > 0.05) (Table).

Q max value. Uroflowmetry test was conducted to evaluate the flow of urine on BPH patients. In this study, from the 11 BPH patients with T2DM, 3 patients have Q max of < 10 ml/s, 3 patients have Q max of 10 – 14 ml/s, and 3 patients have Q max > 15 ml/s. Moreover, of the 51 BPH patients without T2DM, 29 patients have Q max < 10 ml/s, 9 patients have Q max of 10 – 14 ml/s, and the remaining 13 patients have Q max x > 15 ml/s. Nevertheless, there was no significant difference in the Q max score between BPH patients with and without T2DM (p > 0.05) (Table).

Discussion

BPH may lead to urinary retention and may be worsened by T2DM. In this study, diabetic and non-diabetic BPH patients were compared using three clinical parameters, namely prostate volume, IPSS, and Q max. This study found insignificant differences in prostate volume in both groups, indicating that T2DM does not increase prostate volume. Furthermore, these findings contradict previous research that revealed diabetic BPH patients have higher prostate volume than non-diabetic BPH patients (p < 0.05) [8][9].

The inconsequential IPSS values between groups in this research were consistent with A. Otunctemur et al. (2015) which found that T2DM does not exacerbate LUTS symptoms in BPH patients [8]. Moreover, the Q max, an indicator to diagnose an enlarged prostate, showed no significant differences in both groups. It indicates that T2DM does not affect Q max in BPH patients [8][10].

This study observed that T2DM has no notable effect on the prostate volume, IPSS, and Q max in BPH patients. However, the correlation between T2DM and BPH remains unclear. Moreover, other variables were not included, such as BMI, estrogen level, and serum glucose may also influence the results of this study [11].

Conclusion

No significant differences in prostate volume, IPSS (LUTS scale), and uroflowmetry were observed between BPH patients with and without T2DM. Further research is needed to analyze the correlation between diabetes with BPH and LUTS.