Evidence elicited from the current study did not demonstrate an increase in the risk of developing BPH-related complications with an increased BMI. No significant differences were noted in the development of AUR, bladder stone and diverticulum formation; between patients with increased BMI (overweight and obese) and those with normal BMI. A relationship between higher BMIs and elevated PSA, poorer uroflow, increased incidence of retention, and larger prostate volume were expected to be seen, however our study demonstrated a relationship that was NOT statistically significant.
The metabolic syndrome is common in Arabian Gulf countries especially Saudi Arabia. It comprises a number of disorders—including insulin resistance, hypertension and central abdominal obesity—that all act as risk factors for cardiovascular diseases. Accumulating evidence now exists to link urological diseases to the metabolic syndrome (Hammarsten et al. 1998). Most established aspects of the metabolic syndrome are primarily linked to benign prostatic hyperplasia (BPH) and prostate cancer (Hammarsten et al. 1998; Hammarsten & Högstedt 1999; Hammarsten & Högstedt 2001; Hammarsten & Högstedt 2002; Hammarsten et al. 2009). Fasting plasma insulin, in particular, was linked to BPH and all subtypes of prostate cancer namely: incidental, aggressive and lethal prostate cancer (Hammarsten & Högstedt 2002). Medical treatment is thought to be less efficacious in obese patients with symptomatic BPH than normal weight patients (Lee et al. 2011). Overall, the results of studies on urological aspects of the metabolic syndrome seem to indicate that BPH and prostate cancer are recently considered as two aspects of the metabolic syndrome, and that an increased insulin level is a common underlying aberration that promotes both BPH and clinical prostate cancer (Nandeesha et al. 2006).
Affluence associated with prosperity in wealthy countries has resulted in some serious health problems due to overindulgence in the consumption of high calorie foods and sugar sweetened beverages, and intake of excessive amounts of fast and fatty food. Obesity follows with all its sequences, especially when living a sedentary life and lack of protective regular physical activities against cardiovascular diseases (Guo et al. 2005).
The main concern with the metabolic syndrome is the cardiovascular diseases, mainly coronary artery disease (CAD) as this is a leading cause of death. Furthermore, an association between benign prostatic hyperplasia and primary hypertension was reported (Guo et al. 2005). The relationships between body mass index and lower urinary tract symptoms (LUTS) were also reported. The links of central obesity and lack of physical exercise to some medical conditions are all illustrated in Figure 1.
Obesity is measured by several methods, but for practical purposes and simplicity, it is represented in clinical urology by WC or BMI (Hammarsten & Högstedt 1999). Recent data suggested a relationship between the WC and health parameters, mainly diabetes, hypertension, prostate volume (PV), voiding and sexual dysfunction (Hammarsten & Högstedt 1999).Diabetes mellitus has been extensively discussed as a risk factor for many urological disorders, mainly voiding and sexual dysfunction (Ochiai et al. 2005; Li et al. 2005). Furthermore, there is evidence that type 2 diabetes mellitus is associated to, linked to, or even a direct sequel of obesity through the development of insulin resistance (Parsons et al. 2006).The resultant hyperinsulinemia (Parsons et al. 2009; Ozden et al. 2007; Keto et al. 2011; De Nunzio et al. 2012) plays a major role in the pathophysiological changes that occur in the genitourinary system and throughout the whole human body as shown in Figure 1.
Evidence from a large prospective study indicates that a progressive increase in the BMI is associated with progressive increase in PV and attenuated response to treatment with 5-alpha reductase inhibitors (Kaplan & Wilson 2007; Muller et al. 2012; Lee et al. 2011; Roehrborn et al. 2006). In our opinion this finding has an important relevant therapeutic implication in the medical treatment of obese men with BPH. This also warrants further research studies on the relationship between the degree of obesity and unresponsiveness to medical therapy and the development of complications of BPH such as retention of urine, bladder stones and diverticula formation.
