BPH gelişiminde aşırı kilonun yeri

Turhan ÇAŞKURLU,Osman Nuri AKBULUT,Serdar ARISAN,Ömer Onur ÇAKIR,Soner GÜNEY,Erbil ERGENEKON

Özet

Aşırı kilonun BPH gelişimindeki rolünü araştıran bu çalışmamızda kliniğimize AÜSS’leri ile baş vuran, 50 hasta çalışma kapsamına alınarak ürolojik değerlendirme yapıldı. Vücut Kitle İndeksi (VKİ) hesaplanarak şişman olup olmadıkları araştırıldı. Hastaların bel kalça oranları hesaplandı ve abdominal aşırı kilo varlığı araştırıldı. Yıllık prostat büyüme hızı, TRUS ile hesaplandı. Hastaların ilk başvuru tarihlerindeki ortalama total prostat volümü 38.62 ml, transizyonel zon volümü ise 22.2ml olarak saptanırken 1 yıl sonraki kontrollerde ortalama total prostat volümü 40.16 ml iken ortalama transizyonel zon volümü ise 23,41 ml olarak saptandı. Ortalama yıllık prostat volüm artışı oranı 1,1357 ml/yıl ortalama yıllık transizyonel zon volüm artış oranı ise 1.0553 ml/yıl olarak saptandı. Yıllık Non-TZV artışı ise 0.08 ml/yıl olarak saptandı. Vücut Kitle indeks (VKİ) sınırı olarak 25.4 altında olan grup ile 25.4’ün üstünde olan grup karşılaştırıldığında, 25.4’ün altında olanlarda yıllık prostat büyüme oranı 0.9636 ml/yıl iken 25.4 üstünde olanlar da 0.9446 ml/yıl bulundu ve bu sonuç istatistiksel olarak anlam taşımıyordu. Yıllık transizyonel zon büyüme oranı, VKİ 25.4’ün altında olanlarda 1.1986 ml/yıl iken 25.4’ün üstünde olanlarda 1.1033 olarak saptandı ve bu sonuçlar istatistiksel olarak anlamlı değildi. Oysa Bel/Kalça oranına bakıldığında yıllık prostat büyüme oranı ve yıllık transizyonel zon büyüme oranı arasında pozitif bir korelasyon saptandı ve bu sonuçlar İstatistiksel olarak anlamlı idi. Bizim sonuçlarımıza göre BPH etiyolojisinde genel obeziteden ziyade abdominal obezite anlamlıdır.

Abstract

Introduction: BPH is one of the most important diseases affecting the quality of life and is commonly seen after the fourth decade in males. Although it is a very common disease, the etiology is still not known exactly. Recently, apoptosis and some growth factors with uncertain effects were thought to play important roles in its etiology. Hormonal changes trigger the differentiation of prostate levels in the aging body. However, there may be lots of unknown factors accelerating the BPH development. In this study, we evaluated the role of obesity on BPH. Materials and Methods: Between May and September 2001, 50 patients with average 62.6 years of age, who admitted to our comprehensive Clinic of Sisli Etfal Teaching and Research Hospital with lower urinary tract symptoms (LUTS) were studied. Urologic examinations and biochemical tests were applied to all patients and prostate growth rate /year (PGR/yr) was evaluated. Body-mass index (BMI) and waist-hip ratio (WHR) were used as obesity and abdominal obesity criteria, respectively. International prostate symptom score Index (IPSS), digital rectal examination (DRE), Prostate specific antigen (PSA), uroflowmetry, were used for urologic evaluations. Trans-rectal ultrasonography (TRUS) was used to calculate PGR/yr. All the parameters above were reevaluated at the first year or follow-up. SPSS was used to analyze all the statistical parameters with PGR/yr (TPGR and TZVGR). Results: BMI and WHR were used to determine obesity and the relation of obesity between PGR/yr. At the first day, mean total prostate volume (TPV) was 38.62 ml, mean transitional zone volume (TZV) was 22.2, and at the first year of follow-up they were 40.16 ml (difference 1.54) and 23.41 ml (difference 1.21) respectively. It is estimated that, mean total prostate volume increment was 1.1357ml/yr, mean TZV increment was 1.0553ml/yr and non-TZV increment was 0.08/yr. There were statistically significant correlations between TPV and TZV (rs=0.97, p<0.0001), TPV and non-TZV (rs=0.77, p<0.00001), TZV and non TZV (rs=0.59, p<0.0001). PGR was estimated as 1.1357, PGR/yr was 1.039 for <65yr and was 1.208 for >65yr. There was no statistically significant difference among those groups. PGR/yr was compared in two groups with <25.4 BMI and >25.4 BMI with no statistical significance. TZGR/yr was 0.9636 and 0.9446 in <25.4 BMI and >25.4 BMI groups, respectively and was not statistically significant (p>0.943). However, there were positive correlations and statistically significant differences between WHR- PGR/yr and WHR-TZGR/yr. Conclusion: Increased estrogen levels of obese patients change the testosterone/estrogen ratio. And also in obese, increased sympathetic activity and active growth factors were found due to metabolic disorders. In patients with metabolic disorders; increased physical activity, proper nutrition, fibrous diets were determined to decrease symptoms of BPH. According to our results, we determined that abdominal obesity may be a risk factor of BPH rather than obesity.