Yaşlanan Erkekte Benign Prostat Hiperplazisine Bağlı Alt Üriner Sistem Semptomları İle Vitamin D Seviyesi Arasındaki İlişki

Year 2020, Volume: 15 Issue: 2, 115 - 120, 12.06.2020

Musab Ali Kutluhan , Tuncay Toprak

https://doi.org/10.33719/yud.639300

Abstract

Amaç: 40 yaşın üzerindeki erkeklerde vitamin D düzeyleri ile benign prostat hiperplazisi (BPH) ne bağlı alt üriner sistem semptomları (AÜSS) arasındaki ilişkiyi belirlemeyi amaçladık.
Gereç Ve Yöntemler: Çalışmamıza Ocak 2019- Nisan 2019 tarihleri arasında kliniğimize BPH’ya bağlı AÜSS ile başvuran 48 hasta (BPH grubu) ile AÜSS olmayan ve rutin ürolojik kontrole gelen 52 hasta (Kontrol grubu) dahil edildi. Her iki grubun vitamin D, total PSA, total testosteron değerleri, IPSS skorları, prostat hacimleri ve üroflowmetrideki maksimum idrar hızı (Qmax) değerlendirildi.
Bulgular: BPH grubundaki 48 hastanın yaş ortalaması 65,37 ± 7,24, kontrol grubundaki 52 hastanın yaş ortalaması 64,09 ± 8,22 idi. BPH ve kontrol grupları arasında 25 hidroksi vitamin D değerlerinin ortalama değerleri açısından istatistiksel olarak anlamlı bir fark vardı (p <0.001). BPH grubundaki hastalar alt gruplarına göre incelendiğinde; Orta AÜSS (33 hasta) ve şiddetli AÜSS (15 hasta) grubu arasında 25 hidroksi vitamin D düzeyi açısından istatistiksel olarak anlamlı fark yoktu (p> 0.05).
Sonuç: Çalışmamız BPH ve AÜSS olan hastalarda 25 hidroksi vitamin-D düzeylerinin şikayeti olmayan benzer yaş grubundakilerden düşük olduğunu göstermiştir. Buna dayanarak, vitamin D düzeylerinde artış olan hastaların semptomlarında bir iyileşme olabileceği düşünülmektedir. Bu konuda kesin bir karara varmak için, daha fazla sayıda randomize kontrollü prospektif çalışmaya ihtiyaç vardır.

Keywords

Vitamin D , benign prostat hiperplazisi , alt üriner sistem semptomları

The Relationship Between Benign Prostate Hyperplasia Related Lower Urinary Tract Symptoms And Vitamin D Level in Aging Male

Abstract

Objective: We aimed to determine the relationship between vitamin D levels and benign prostate hyperplasia BPH) related lower urinary tract symptoms (LUTS) in men over 40 years of age.
Material and Methods: The study was conducted prospectively between January and April 2019 and included 48 patients who presented to the outpatient clinic with lower urinary tract symptoms and who had not received medical or surgical treatment due to BPH (BPH group) and 52 healthy men (Control group) who did not have lower urinary tract symptoms and applied to the outpatient clinic for routine urological control. Vitamin D, total PSA, total testosterone values, IPSS scores, prostate volumes and maximum urinary velocity in uroflowmetry (Q max) of both groups were evaluated.
Results: The mean age of 48 patients with benign prostatic hyperplasia in BPH group was 65.37 ± 7.24 and in control group without urinary tract symptoms was 64.09 ± 8.22. There was a statistically significant difference between BPH and control groups in terms of the mean values of 25 hydroxy vitamin-D values (p< 0.001). When the patients diagnosed with BPH were examined according to their subgroups; there was no statistically significant difference in terms of 25 hydroxy vitamin D level between moderate LUTS (33 patients) and severe LUTS (15 patients) groups(p> 0.05).
Conclusion: Our study has shown that in patients with BPH and LUTS, 25 hydroxy vitamin D levels were lower than those in the similar age group without any complaints. Based on this, it was thought that there might be an improvement in the symptoms of patients with increasing vitamin D levels. To reach a final judgment on this subject, larger number of randomized controlled prospective studies are needed.

Keywords

Vitamin D , benign prostate hyperplasia , , lower urinary tract symptoms

References

• 1. Abrams P, Cardozo L, Fall M. Et. al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn, 2002, 21(2): 167- 78
• 2. Martin SA, Haren MT, Marshall VR. et. al. Prevalence and factors associated with uncomplicated storage and voiding lower urinary tract symptoms in community-dwelling Australian men. World J Urol, 2011Apr; 29(2): 179- 84
• 3. Chapple CR, Wein AJ, Abrams P. et. al: Lower urinary tract symptoms revisited: a broader clinical perspective. Eur Urol 2008 Sep; 54(3): 563-569
• 4. De la Rosette JJ, Witjes WP, Schafer W. et. al: Relationships between lower urinary tract symptoms and bladder outlet obstruction: results from the ICS-“BPH” study. Neurourol Urodyn 1998; 17(2): 99-108
• 5. Story MT, Livingston B, Baeten L. et. al: Cultured human prostate-derived fibroblasts produce a factor that stimulates their growth with properties indistinguishable from basic fibroblast growth factor. Prostate 1989; 15(4): 355-365
• 6. Sivritepe R, Basat S, Ortaboz D. Association of vitamin D status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems in patients with type 2 diabetes mellitus. Aging Male. 2019 Jun; 22(2): 156- 162.
• 7. Ucak S, Sevim E, Ersoy D. et. al. Evaluation of the relationship between microalbuminuria and 25-(OH) vitamin D levels in patients with type 2 diabetes mellitus. Aging Male. 2019 Jun; 22(2): 116- 120.
• 8. Basat S, Sivritepe R, Ortaboz D. et. al. The relationship between vitamin D level and erectile dysfunction in patients with type 2 diabetes mellitus. Aging Male. 2018 Jun;21(2):111-115.
• 9. Hennenberg M, Stief CG, Gratzke C. Pharmacology of the lower urinary tract. Indian J Urol. 2014; 30(2): 181–8.
• 10. Galunska B, Gerova D, Kosev P. et. al. Serum 25-hydroxy vitamin D levels in Bulgarian patients with prostate cancer: A pilot study. Clin Lab. 2015; 61(3- 4): 329– 35
• 11. Colli E, Rigatti P, Montorsi F. et. al. BXL628, a novel vitamin D3 analog arrests prostate growth in patients with benign prostatic hyperplasia: A randomized clinical trial. Eur Urol. 2006; 49(1): 82– 6.
• 12. Yoo S, Oh S, Kim HS. et. al.Impact of serum 25-OH vitamin D level on lower urinary tract symptoms in men: a step towards reducing overactive bladder. BJU Int. 2018 Oct; 122(4): 667- 672.
• 13. Crescioli C, Ferruzzi P, Caporali A. et. al. Inhibition of prostate cell growth by BXL-628, a calcitriol analogue selected for a phase II clinical trial in patients with benign prostate hyperplasia. Eur J Endocrinol. 2004; 150(4): 591– 603.
• 14. Morelli A, Vignozzi L, Filippi S. et. al. BXL-628, a vitamin D receptor agonist effective in benign prostatic hyperplasia treatment, prevents RhoA activation and inhibits RhoA/Rho kinase signaling in rat and human bladder. Prostate. 2007; 67(3): 234–47.
• 15. Garraway WM, Collins GN, Lee RJ. High prevalence of benign prostatic hypertrophy in the community. Lancet. 1991; 338(8765): 469– 471
• 16. Espinosa G, Esposito R, Kazzazi A. et. al. Vitamin D and benign prostatic hyperplasia - a review. Can J Urol. 2013 Aug; 20(4): 6820– 6825
• 17. Penna G, Fibbi B, Amuchastegui S. et al. The vitamin D receptor agonist elocalcitol inhibits il-8-dependent benign prostatic hyperplasia stromal cell proliferation and inflammatory response by targeting the rhoa/rho kinase and nf-kappab pathways. Prostate. 2009 Apr ; 69(5): 480– 493
• 18. Schwartz GG. Vitamin D in blood and risk of prostate cancer: Lessons from the selenium and vitamin E cancer prevention trial and the prostate cancer prevention trial. Cancer Epidemiol Biomarkers Prev. 2014; 23(8): 1447– 9.
• 19. Elshazly MA, Sultan MF, Aboutaleb HA. et. al. Vitamin D deficiency and lower urinary tract symptoms in males above 50 years of age Urol. Ann. 2017; 9(2): 170- 173
• 20. Vaughan CP, Johnson TM, Goode PS. et. al. Vitamin D and lower urinary tract symptoms among US men: Results from the 2005-2006 National Health and Nutrition Examination Survey. Urology. 2011; 78(6): 1292– 7
• 21. Park SG, Yeo JK, Cho DY. et. al. Impact of metabolic status on the association of serum vitamin D with hypogonadism and lower urinary tract symptoms/ Bening prostate hyperplasia Aging Male. 2018 Mar; 21(1): 55- 59
• 22. Caretta N, Vigili de Kreutzenberg S, Valente U. et al. Hypovitaminosis D is associated with lower urinary tract symptoms and bening prostate hyperplasia in type 2 diabetes Andrology 2015 Nov; 3(6): 1062-7