Impact of Obesity on Clinical Presentation and Surgical Outcomes in Patients with Benign Prostate Hyperplasia Receiving Greenlight Laser Prostatectomy

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Abstract

Objective

To investigate the impact of body mass index (BMI) on preoperative characteristics, lower urinary tract symptoms (LUTS), intraoperative variables, surgical outcomes and postoperative complications.

Methods

This is a retrospective observational study including 891 benign prostate hyperplasia (BPH) patients who underwent GreenLight Laser photoselective vaporization of the prostate (PVP) between 2014 and 2020. Clinical characteristics, uroflowmetry parameters, and surgery related parameters were extracted from electronic health records. Patients were categorized into different weight groups based on Taiwanese populations’ BMI criteria. Statistical analyses, involving descriptive statistics, correlation analyses, and independent t-tests, were employed to examine associations between BMI and relevant variables.

Results

Pearson’s correlation analysis indicated a negative correlation between BMI (r = −0.172, p < 0.001) and age, and positive correlations with total prostate volume (TPV) (r = 0.123, p < 0.001) and transition zone volume (TZV) (r = 0.083, p = 0.017). Obese patients were found to be younger (p=0.007) and have larger TPVs (p=0.010) but showed no significant differences in International Prostate Symptom Scores (IPSS) scores when compared to non-obese patients. Notably, obese patients had lower preoperative and postoperative post-void residual (PVR), whereas non-obese patients exhibited a more significant PVR reduction post-surgery. BMI did not significantly affect surgical parameters or postoperative complications.

Conclusion

In BPH patients treated with PVP, obese individuals were younger with larger prostates but had similar IPSS scores compared to non-obese patients. Obese patients had lower pre and post-surgery PVR, while non-obese patients saw greater PVR improvements. BMI plays a nuanced role BPH patients’ characteristics.

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Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

Leandra Abarca-Gómez, Ziad A Abdeen, Zargar Abdul Hamid … (2019)

Summary Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Funding Wellcome Trust, AstraZeneca Young Health Programme.

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Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants

Emily Sonestedt, Kim Overvad (2016)

Summary Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world’s men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world’s poorest regions, especially in south Asia. Funding Wellcome Trust, Grand Challenges Canada.

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Benign prostatic hyperplasia.

Dominique Dana Marie Thomas, Leanna Laor, Tania Hossack … (2016)

Benign prostatic hyperplasia (BPH), which causes lower urinary tract symptoms (LUTS), is a common diagnosis among the ageing male population with increasing prevalence. Many risks factors, both modifiable and non-modifiable, can increase the risk of development and progression of BPH and LUTS. The symptoms can be obstructive (resulting in urinary hesitancy, weak stream, straining or prolonged voiding) or irritative (resulting in increased urinary frequency and urgency, nocturia, urge incontinence and reduced voiding volumes), or can affect the patient after micturition (for example, postvoid dribble or incomplete emptying). BPH occurs when both stromal and epithelial cells of the prostate in the transitional zone proliferate by processes that are thought to be influenced by inflammation and sex hormones, causing prostate enlargement. Patients with LUTS undergo several key diagnostic investigations before being diagnosed with BPH. Treatment options for men with BPH start at watchful waiting and progress through medical to surgical interventions. For the majority of patients, the starting point on the treatment pathway will be dictated by their symptoms and degree of bother.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Interv Aging

Journal ID (iso-abbrev): Clin Interv Aging

Journal ID (publisher-id): cia

Title: Clinical Interventions in Aging

Publisher: Dove

ISSN (Print): 1176-9092

ISSN (Electronic): 1178-1998

Publication date (Electronic): 09 December 2024

Publication date Collection: 2024

Volume: 19

Pages: 2071-2083

Affiliations

[1 ]Medical Foundation, Chang Gung Memorial Hospital, Linkou Branch , Taoyuan City, Taiwan

[2 ]Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch , Taoyuan City, Taiwan

[3 ]Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch , Taoyuan City, Taiwan

[4 ]Department of Medicine, Chang Gung University , Taoyuan City, Taiwan

[5 ]Division of Urology, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital , New Taipei City, Taiwan

Author notes

Correspondence: I-Hung Shao, Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch , No. 5, Fusing Street, Gueishan District, Taoyuan City, Taiwan, Tel +886 3 328 1200 #2103, Email ehomeshao68@gmail.com

[*]

These authors contributed equally to this work

Author information

Po-Han Chen http://orcid.org/0009-0000-2656-6764

Ruei-Je Chang http://orcid.org/0009-0007-0035-2996

Kai-Jie Yu http://orcid.org/0000-0003-3656-8856

Cheng-Keng Chuang http://orcid.org/0000-0001-6154-1220

I-Hung Shao http://orcid.org/0000-0002-4832-0113

Article

Publisher ID: 472579

DOI: 10.2147/CIA.S472579

PMC ID: 11645433

PubMed ID: 39678145

SO-VID: 1d9c3ca7-146e-4cc3-b911-89e1f54a0f37

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 06 May 2024

Date accepted : 09 November 2024

Page count

Figures: 1, Tables: 4, References: 35, Pages: 13

Funding

Funded by: grants from The Chang Gung Memorial Hospital Research Foundation (grant nos. CMRPG3N0041);

The present study was supported by grants from The Chang Gung Memorial Hospital Research Foundation (grant nos. CMRPG3N0041).

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Impact of Obesity on Clinical Presentation and Surgical Outcomes in Patients with Benign Prostate Hyperplasia Receiving Greenlight Laser Prostatectomy

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Most cited references 34

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants

Benign prostatic hyperplasia.

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