METABOLIC
SYNDROME
CORRELATES
WITH
PERI-URETHRAL
FIBROSIS
SECONDARY TO CHRONIC PROSTATE INFLAMMATION: EVIDENCE OF A LINK IN
A COHORT OF PATIENTS UNDERGOING RADICAL PROSTATECTOMY
Cantiello F1,2, Cicione A1,2, Salonia A2,3, Briganti A2,3, Autorino R4, Bevacqua M1, Manno S1,
Damiano R1,2
1
UO di Urologia, Università Magna Graecia di Catanzaro
2
Doctorate Research Programme in Urology, Università Magna Graecia di Catanzaro
3
Urological Research Institute, Università Vita-Salute San Raffaele, Milano
4
UO di Urologia, Seconda Università degli Studi di Napoli
Objectives: To investigate the pathologic relationship between metabolic syndrome (MetS) and
peri-urethral fibrosis status secondary to chronic prostate inflammation.
Methods: Peri-urethral prostate tissue from 80 consecutive patients who underwent retropubic
radical prostatectomy for prostate cancer was analyzed. Patients were divided in two groups
according to whether they had or not a diagnosis of MetS ( defined according to the National
Cholesterol Education Program’s Adult Treatment Panel III criteria) . We circumferentially
performed 16 peri-urethral core bench biopsies on each radical prostatectomy specimen to evaluate
the extent of peri-urethral inflammatory infiltrate and collagen and elastin amount. Spearman
correlation analysis tested the association between variables. Furthermore, the data were used to
define a bivariate logistic regression model in which the presence (>50% collagen amount for each
patients) or absence (≤ 50% collagen amount) of peri-urethral fibrosis was analyzed after adjusting
for clinical and pathological variables.
Results: A significant difference was found between the two groups in terms of International
Prostatic Symptoms Score [ IPSS (p<0.05)] and urodynamics findings (all p<0.05). At histological
assessment, patients with MetS showed a more extended inflammatory infiltrate and higher periurethral collagen amount along with a lower peri-urethral elastin amount (all p<0.05). A positive
correlation was observed between inflammation, IPSS, Bladder Outlet Obstruction Index (BOOI)
and collagen amount, while inflammation was inversely correlated with elastin amount. On
bivariate logistic regression analysis, prostate inflammation and MetS emerged as the only
independent predictors of peri-urethral fibrosis (respectively OR1.73, 95%CI 1.086-2.568 and
OR1.52, 95%CI 1.144 2.194)
Discussion: Chronic prostatic inflammation has been postulated as a potential etiological agent in
the development of benign prostatic hyperplasia. However, lower urinary tract symptoms (LUTS)
are not always associated with prostate enlargement in the elderly male population; likewise,
patients without benign prostatic enlargement may actually complain of LUTS and ultimately
experience urinary retention, especially those presenting with chronic prostate inflammation. Our
study confirmed the hypothesis that MetS – interpreted as a low-grade, chronic inflammation state may have a role in promoting prostate inflammation and, consequently, fibrotic changes within the
peri-urethral prostate tissue secondary to chronic inflammation. It can be arbitrarily speculated that
the peri-urethral fibrosis may cause LUTS through a decreased urethral flexibility, compromising
the ability of the prostatic urethra to enlarge itself and to adequately accommodate urinary flow
during micturition.
Conclusions: Our experimental findings show that MetS represent a independent risk factor for
prostate inflammation and fibrotic changes within the peri-urethral prostate tissues secondary to
inflammation.