Does diabetes affect lower urinary tract symptoms in patients with benign prostatic hyperplasia?

This study reviewed the effect of diabetes on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). The data suggested that LUTS were increased in patients with BPH that had diabetes compared to patients without diabetes.

Men above 50 years of age frequently experience LUTS due to benign prostatic hyperplasia (BPH). BPH or prostate gland enlargement can cause a block in urine flow from the bladder. LUTS include urgent urination, increased frequency of night urination (nocturia), problems with starting urination, weak urine stream or discontinuous flow (intermittency), dribbling, and incomplete voiding of urine from the bladder.

Multiple factors are related to BPH occurrence, including age, sex hormones, diet, obesity, and genetics. Diabetes may be a risk factor for BPH development and progression. Proteins known as insulin-like growth factors stimulate cell growth and can possibly increase the risk of prostate hyperplasia. Additionally, damaged blood vessels and the thickening or hardening of arteries associated with diabetes can potentially affect blood flow to the prostate. However, it is unclear whether diabetes aggravates LUTS in patients with BPH.

This review assessed the data of 18 studies that included 1685 patients with BPH and diabetes and 4653 patients with BPH without diabetes (controls). LUTS severity was assessed in patients using the International Prostate Symptom Score (IPSS) based on incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Prostate volume (PV), maximum flow rate (Qmax), and prostate-specific antigen (PSA, a protein made by the prostate that is increased in BPH) were determined.

The IPSS score for patients with BPH and diabetes was significantly higher compared to controls. Patients with BPH and diabetes had significantly higher prostate volumes compared to controls. The Qmax (quantity of urine eliminated per second) of patients with BPH and diabetes was significantly lower than that of the control group.

The study suggested that additional attention should be given to patients with BPH and diabetes as LUTS were increased in these patients compared to those without diabetes.

This review analyzed studies that did not include a randomized controlled trial design. This increased the possibility of introducing biased results. Large variations in the course of diabetes and BPH were seen in the studies that were analyzed. Further studies are needed.