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Abstract

Background:

Prostatic growth has been thought to be the systemic manifestation of some metabolic derangements in recent studies. Nonalcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, might be closely linked with benign prostate hyperplasia and lower urinary tract symptoms (BPH/LUTS). Several studies have been conducted regarding NAFLD and BPH/LUTS association. However, the results are yet to reach a clear conclusion. We aimed to gather these studies' results to make a more robust analysis through a systematic review and meta-analysis.

Methods:

We systematically searched Pubmed-Medline, Cochrane Library, and Science Direct databases. We excluded all experimental studies, case reports, and reviews. Our search was restricted to the English language. We used standard mean difference for BPH/LUTS-related parameters. We identified the study qualities by the Newcastle–Ottawa Scale. We conducted a publication bias analysis.

Results:

A total of six studies involving 7089 participants fulfilled the inclusion criteria. Our meta-analysis revealed that patients with NAFLD have larger prostate volume [0.553 (0.303–0.802), P ˂ 0.001; Q = 97.41; P-value for heterogeneity = P < 0.0001; I ² = 94.86%]. However, the summary effect size of the other parameters of BPH/LUTS (prostate-specific antigen and international prostate symptom score) computed in our meta-analysis did not yield significant results.

Conclusions:

The prostate size was larger in patients with NAFLD, but the meta-analysis did not reach a significant result for LUTS among the studies. These results should be tested with well-designed studies, in particular, to clarify the association of LUTS with NAFLD.

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References

Berry

, Coffey

, Walsh

, et al. The development of human benign prostatic hyperplasia with age. J Urol, 1984; 132(3):474–479; doi: 10.1016/s0022-5347(17)49698-4

Roberts

, Jacobson

, Rhodes

, et al. Serum sex hormones and measures of benign prostatic hyperplasia. Prostate, 2004; 61(2):124–131; doi: 10.1002/pros.20080

Nicholson

, Ricke

. Androgens and estrogens in benign prostatic hyperplasia: Past, present and future. Differentiation, 2011; 82(4–5):184–199; doi: 10.1016/j.diff.2011.04.006

Shao

, Shi

, Liu

, et al. Epithelial-to-mesenchymal transition and estrogen receptor alpha-mediated epithelial dedifferentiation mark the development of benign prostatic hyperplasia. Prostate, 2014; 74(9):970–982; doi:10.1002/pros.22814

Nickel

, Roehrborn

, O'Leary

, et al. The relationship between prostate inflammation and lower urinary tract symptoms: Examination of baseline data from the REDUCE trial. Eur Urol, 2008; 54(6):1379–1384; doi: 10.1016/j.eururo.2007.11.026

Xia

, Zhao

, Chen

, et al. The underlying mechanism of metabolic syndrome on benign prostatic hyperplasia and prostate volume. Prostate, 2020; 80(6):481–490; doi: 10.1002/pros.23962

Yoo

, Oh

, Park

, et al. The impacts of metabolic syndrome and lifestyle on the prevalence of benign prostatic hyperplasia requiring treatment: A historical cohort study of 130 454 men. BJU Int, 2019; 123(1):140–148; doi: 10.1111/bju.14528

, Zhou

, Yang

, et al. The relationship between the clinical progression of benign prostatic hyperplasia and metabolic syndrome: A prospective study. Urol Int, 2016; 97(3):330–335; doi: 10.1159/000448484

Obika

, Noguchi

. Diagnosis and evaluation of nonalcoholic fatty liver disease. Exp Diabetes Res, 2012; 2012:145754; doi: 10.1155/2012/145754.

10.

Moher

, Liberati

, Tetzlaff

, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med, 2009; 151(4):264–269; doi: 10.7326/0003-4819-151-4-200908180-00135

11.

Stang

. Critical evaluation of the Newcastle–Ottowa Scale for assessing the quality of nonrandomized studies in meta-analysis. Eur J Epidemiol, 2010; 25(9):603–605; doi: 10.1007/s10654-010-9491-z

12.

Begg

, Mazumdar

. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994; 50(4):1088–1101.

13.

Egger

, Davey

, Schneider

, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997; 315(7109):629–634; doi: 10.1136/bmj.315.7109.629

14.

Uzun

, Oğullar

, Ünal

, et al. Non-alcoholic fatty liver disease is associated with benign prostate hyperplasia in men and with overactive bladder in women. Scand J Urol, 2013; 47(6):497–502; doi: 10.3109/21681805.2013.780258

15.

Russo

, Cimino

, Fragalà

, et al. Relationship between non-alcoholic fatty liver disease and benign prostatic hyperplasia/lower urinary tract symptoms: New insights from an Italian cross-sectional study. World J Urol, 2015; 33(5):743–751; doi: 10.1007/s00345-014-1392-4

16.

Song

, Kwon

, Doo

, et al. Is there any relation between the degree of fatty liver disease and severity of lower urinary tract symptoms?. Urology, 2016; 89:90–95; doi: 10.1016/j.urology.2015.11.030

17.

Privitera

, Russo

, La Vignera

, et al. Benign prostatic hyperplasia and intraprostatic inflammation are associated with liver inflammation: It's time for prevention. Andrology, 2018; 6(5):737–741; doi: 10.1111/andr.12505

18.

Eren

, Horsanali

. The independent association of non-alcoholic fatty liver disease with lower urinary tract symptoms/benign prostatic hyperplasia and erectile function scores. BJU Int, 2019; 124(2):329–335; doi: 10.1111/bju.14753

19.

Chung

, Yim

, Kim

, et al. Nonalcoholic fatty liver disease is associated with benign prostate hyperplasia. J Korean Med Sci, 2020; 35(22):e164; doi: 10.3346/jkms.2020.35.e164

20.

Xiong

, Zhang

, Tan

, et al. The association between metabolic syndrome and lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging males: Evidence based on propensity score matching. Transl Androl Urol, 2021; 10(1):384–396; doi: 10.2103/7/tau-20-1127

21.

Lee

, Peehl

. Molecular and cellular pathogenesis of benign prostatic hyperplasia. J Urol, 2004; 172:1784–1791; doi: 10.1097/01.ju.0000133655.71782.14

22.

Cohen

, Nunn

, Peehl

. Transforming growth factor-beta induces growth inhibition and IGF-binding protein-3 production in prostatic stromal cells: Abnormalities in cells cultured from benign prostatic hyperplasia tissues. J Endocrinol, 2000; 164(2):215–223; doi: 10.1677/joe.0.1640215

23.

Zou

, Gong

, Fang

, et al. Meta-analysis of metabolic syndrome and benign prostatic hyperplasia in Chinese patients. World J Urol, 2016; 34(2):281–289; doi: 10.1007/s00345-015-1626-0.

24.

Gacci

, Corona

, Vignozzi

, et al. Metabolic syndrome and benign prostatic enlargement: A systematic review and meta-analysis. BJU Int, 2015; 115(1):24–31; doi: 10.1111/bju.12728

25.

Wang

, Mao

, Lin

, et al. Body mass index and risk of BPH: A meta-analysis. Prostate Cancer Prostatic Dis, 2012; 15(3):265–272; doi: 10.1038/pcan.2011.65

26.

Ohgaki

, Hikima

, Horiuchi

, et al. Association between metabolic syndrome and male lower urinary tract symptoms in Japanese subjects using three sets of criteria for metabolic syndrome and International Prostate Symptom Score. Urology, 2011; 77(6):1432–1438; doi: 10.1016/j.urology.2010.12.024

27.

Yang

, Hsieh

, Chen

, et al. Metabolic syndrome is associated with reduced lower urinary tract symptoms in middle-aged men receiving a health checkup. Urology, 2012; 80(5):1093–1097; doi: 10.1016/j.urology.2012.08.002

28.

Gao

, Wang

, Zhang

, et al. Are metabolic syndrome and its components associated with lower urinary tract symptoms? Results from a Chinese male population survey. Urology, 2012; 79(1):194–201; doi: 10.1016/j.urology.2011.07.1399

29.

Roehrborn

, Boyle

, Gould

, et al. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology, 1999; 53(3):581–589; doi: 10.1016/s0090-4295(98)00655-4

30.

Bohnen

, Groeneveld

, Ruud Bosch

JLH

. Serum prostate-specific antigen as a predictor of prostate volume in the community: The Krimpen study. Eur Urol, 2007; 51(6):1645–1652; doi: 10.1016/j.eururo.2007.01.084

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