LOWER URINARY TRACT SYMPTOMS AND METABOLIC SYNDROME S115

28. Link CL and McKinlay JB: Does America’s ex-panding waistline increase the likelihood of uro-logic symptoms? Results from the Boston AreaCommunity Health (BACH) study. J Urol, suppl.,2008; 179: 141, abstract 398.

29. Cellek S, Rodrigo J, Lobos E et al: Selectivenitrergic neurodegeneration in diabetes mellitus -a nitric oxide-dependent phenomenon. Br J Phar-macol 1999; 128: 1804.

30. Kasturi S, Russell S and McVary KT: Metabolicsyndrome and lower urinary tract symptoms sec-ondary to benign prostatic hyperplasia. Curr Urol

EDITORIAL COMMENTS

REFERENCES

diet—with LUTS and BPH (reference 7 i

31. McVary KT, Monnig W, Camps JL Jr et al: Silde-nafil citrate improves erectile function and urinarysymptoms in men with erectile dysfunction andlower urinary tract symptoms associated withbenign prostatic hyperplasia: a randomized dou-ble-blind trial. J Urol 2007; 177: 1071.

32. McVary KT, Roehrborn CG, Kaminetsky JC et al:Tadalafil relieves lower urinary tract symptomssecondary to benign prostatic hyperplasia. J Urol2007; 177: 1401.

33. Ponholzer A and Madersbacher S: Lower urinarytract symptoms and erectile dysfunction; links fordiagnosis, management and treatment. Int J Im-

n article). sitate elucidation

34. Shenfeld OZ, Meir KS, Yutkin V et al: Do athero-sclerosis and chronic bladder ischemia really playa role in detrusor dysfunction of old age? Urology2005; 65: 181.

35. Brown JS, Wessells H, Chancellor MB et al:Urologic complications of diabetes. DiabetesCare 2005; 28: 177.

36. Starer P and Libow L: Cystometric evaluation ofbladder dysfunction in elderly diabetic patients.Arch Intern Med 1990; 150: 810.

37. Ueda T, Yoshimura N and Yoshida O: Diabeticcystopathy: relationship to autonomic neuropathydetected by sympathetic skin response. J Urol

Rep 2006; 7: 288. pot Res 2007; 19: 544. 1997; 157: 580.

The authors showed a significant association be-tween MetS and LUTS. Given that abdominal obe-sity, diabetes and hypertension have all been inde-pendently associated with LUTS it is not surprisingthat a syndrome comprised of these conditions isalso associated with LUTS. However, other studieshave found no relationship between MetS andLUTS.1 It would be interesting for the authors toreassess these findings after controlling for the useof �-blockers and diuretics which can impact LUTSand were likely used by a number of study partici-pants.

One critical point is the difference between gen-eral and abdominal obesity. Traditionally BMI hasbeen used to define general obesity. However, ab-dominal obesity more closely approximates visceraladiposity and is recommended as a risk indicator.Adipose tissue, once considered only a storage res-ervoir, is now regarded as a complex endocrine or-gan that responds to various afferent signals bysecreting bioactive substances, called adipokines,which are involved in coordination of neuroendo-crine function and have a key role in the regulationof several body systems.2 It is the visceral, intra-abdominal fat that is the most metabolically active,

and obesity related morbidity. Abdominal obesitycan be approximated by waist-to-hip ratio or mea-sures of waist circumference. Studies using BMIalone as a measure of obesity have often not re-vealed relationships between LUTS and obesity, asnoted by the authors. Thus, further investigationsshould use abdominal obesity measures and not sim-ply BMI.

The findings presented become increasingly sig-nificant as society weighs the costs of deliveringhealth care to a population with an increased inci-dence of obesity/MetS. It has been estimated thatmore than 1 billion people are currently overweightand the prevalence in children has considerably in-creased.3 The possibility of pharmaceutically target-ing the adipokine system, thus influencing a neu-roendocrine pathway that might impact LUTS, isintriguing. Modifiable risk factors have not beendelineated for LUTS. Further investigations into theimpact of weight reduction and physical exercise onLUTS are warranted to help health professionalsconstruct optimal management strategies.

Brett A. Laven

Clinic of Urology

and directly correlated with metabolic syndrome Milwaukee, Wisconsin

1. Gupta A, Gupta S, Pavuk M et al: Anthropometricand metabolic factors and risk of benign pros-tatic hyperplasia: a prospective cohort study of

2. Fain JN, Madan AK, Hiler ML et al: Comparison of therelease of adipokines by adipose tissue, adipose tissuematrix, and adipocytes from visceral and subcutaneousabdominal adipose tissues of obese humans. Endocri-

3. Daniels SR, Arnett DK, Eckel RH et al: Over-weight in children and adolescents: pathophys-iology, consequences, prevention, and treat-

Air Force veterans. Urology 2006; 68: 1198.nology 2004; 145: 2273.

ment. Circulation 2005; 111: 1999.

This community based cohort study confirms the re-sults of prior analyses linking the metabolic syndrometo an increased risk of LUTS, and adds to a growingbody of evidence supporting robust associations of mod-ifiable risk factors—including obesity, diabetes and

1,2

These observations are important because theysuggest the existence of modifiable pathways forLUTS/BPH that may present novel targets forprevention and treatment. Development of newtherapies focused on modifiable factors will neces-

of the physiological mechanisms