Diabetes and Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms—What do We Know?

Purpose

Benign prostatic hyperplasia and associated lower urinary tract symptoms are highly prevalent in older men and represent a substantial challenge to public health. Apart from the prevalence of benign prostatic hyperplasia increasing with age, little is understood regarding its etiology and natural history. Increasing evidence recently pointed toward relationships between diabetes and benign prostatic hyperplasia/lower urinary tract symptoms. We present an overview of the current understanding of clinical and epidemiological research on diabetes and benign prostatic hyperplasia/lower urinary tract symptoms, the hypothesized pathophysiological mechanisms linking the conditions and recommendations for future directions for research.

Materials and Methods

A structured, comprehensive literature review was done to identify studies of the relationships between benign prostatic hyperplasia and lower urinary tract symptoms, and diabetes in older men.

Results

A substantial proportion of the existing body of literature supports an association between diabetes and benign prostatic hyperplasia/lower urinary tract symptoms. However, failure to differentiate lower urinary tract symptoms from benign prostatic hyperplasia contributed to some of the confusing evidence in studies including more specific benign prostatic hyperplasia measurements. This could be due in part to the largely cross-sectional analyses, the use of select or different study populations, limited sample sizes and inadequate control of potential confounders.

Conclusions

Diabetes may substantially influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms in older men. Further prospective, longitudinal analyses of the impact of diabetes and its etiological mechanisms on benign prostatic hyperplasia/lower urinary tract symptoms may identify novel interventions to prevent, diagnose and treat these highly prevalent conditions.

Key Words: urinary tract, prostatic hyperplasia, diabetes mellitus, aging, urination disorders

Abbreviations and Acronyms: BPH, benign prostatic hyperplasia, IGF, insulin-like growth factor, I-PSS, International Prostate Symptom Score, LUTS, lower urinary tract symptoms