Lower urinary tract symptoms in patients with small prostates: Smooth muscle proliferation and calcification might be causative factors

Abstract

Objectives: The current study is designed to evaluate and compare the histological changes in the surgical samples of prostate taken from patients undergoing transurethral resection of prostate (TURP) for benign prostate hyperplasia (BPH) with different sizes.Methods: Prostate surgical tissue samples were obtained from BPH patients undergoing TURP after taking informed consent. Ultrasound measure of prostatic weight and prostate-specific antigen (PSA) levels were obtained from the patients along with other clinical and demographic details. Tissue samples were fixed, processed, sectioned and stained with hematoxylin and eosin and Masson's trichrome to look for histological features, specifically smooth muscle proliferation. Immunohistochemical expression of bone morphogenetic protein (BMP)-2 was recorded to assess the calcification potential.Results: Fifty-nine surgical samples were obtained from the patients of age range 50-90 years and body mass index (BMI) 15.6-33.3 kg/m 2 . The range of ultrasound measures of prostate weight was 20-137 g with PSA ranged 1.03-93.3 ng/mL. Patients with small-sized prostate had significant severe smooth muscle proliferation (P < .001). Prostate size/weight had significant positive association with BMI (P < 0.001, r = 0.543) and negative association with BMP-2 (P < 0.001, r = À0.654). Samples with severe smooth muscle proliferation were with increased BMP-2 expression (P < .001) and higher levels of PSA levels (P = 0.004). BMP-2 expression revealed positive significant association with PSA (P < .001, r = 0.432). Conclusion:From this study we conclude that BPH patients with small-sized glands and high PSA levels have increased smooth muscle proliferation and calcification potential causing the symptoms of lower urinary tract symptoms in these patients.

Analysis of risk factors for benign prostate enlargement with prostate calcification

“…Previous research has indicated that while it often arises as a consequence of scar tissue formation following prostatitis resolution, several factors, including chronic prostatitis, prostatic urine retention, prostatic duct stenosis, abnormalities in calcium and phosphorus metabolism, and psychosocial factors, may contribute to its development [12][13][14]. Epidemiological studies have also linked poor dietary habits (such as irregular breakfasts and consumption of fatty snacks), alcohol consumption, and certain work-related habits (like prolonged sitting, late-night work, and the habit of holding in urine) to an increased risk of calcification [15,16]. It was discovered that small calci-fication foci typically do not impact sperm quality; however, the formation of larger and coarser stones can have adverse effects.…”

Relationship between lower urinary tract symptoms and frailty

“…Lower urinary tract symptoms (LUTS) and frailty are common among older adults and remarkably affect their daily lives 1–9 . Both LUTS and frailty are related to multiple comorbidities and unfavorable outcomes, such as reduced physical activity, hospitalizations, falls, impaired cognition, and poor quality of life 10–19 . Furthermore, several studies have revealed close associations between LUTS and frailty 4–8 .…”

“…[1][2][3][4][5][6][7][8][9] Both LUTS and frailty are related to multiple comorbidities and unfavorable outcomes, such as reduced physical activity, hospitalizations, falls, impaired cognition, and poor quality of life. [10][11][12][13][14][15][16][17][18][19] Furthermore, several studies have revealed close associations between LUTS and frailty. [4][5][6][7][8] Since LUTS and frailty have complex relationships, it is difficult to define their association.…”