Roles of urine oxidative stress biomarkers and heart rate variability in BPH patients

Jiang Y1, Wu Y1, Kuo H1

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 113
Male Lower Urinary Tract Symptoms
Scientific Podium Short Oral Session 16
Thursday 28th September 2023
10:30 - 10:37
Theatre 102
Benign Prostatic Hyperplasia (BPH) Molecular Biology Prospective Study Bladder Outlet Obstruction
1. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
Presenter
Links

Abstract

Hypothesis / aims of study
Excessive oxidative stress and hypoxia-related inflammation resulting from cyclic ischemia-reperfusion injury are considered to play important roles in the progression of benign prostatic hyperplasia (BPH) and subsequent bladder tissue remodeling.. Autonomic nervous system (ANS) function might also be involved. This study aimed to investigate the roles of urine oxidative stress biomarkers and ANS function assessed with heart rate variability (HRV) in BPH patients.
Study design, materials and methods
We prospectively enrolled 40 clinically diagnosed BPH patients, of which 23 and 17 received medical and surgical treatment, respectively. All patients were followed up for 3 months, and the successful outcome was defined as a global response assessment (GRA) of ≧2. Clinical symptom scores, uroflowmetry, the quantification of urine biomarkers, and the examinations of HRV were compared at baseline and at 3 months. The targeted analytes in urine include oxidative stress biomarkers (8-hydroxy-2 deoxyguanosine [8-OHdG], F2-isoprostane, total antioxidant capacity [TAC]), hypoxia-related inflammatory cytokines (TNFα, IL-1β, IL-6, and, IL-8), and prostaglandin E2 (PGE2). Linear regression analysis with Pearson correlation was carried out to determine the relationship between the changes of urine biomarker levels/ HRV parameters and the changes of clinical characteristics in BPH patients receiving treatments.
Results
After treatment, 75% (30 of 40) of BPH patients reported a successful outcome, including 73.9% (17 of 23) and 76.5% (13 of 17) in medical and surgical treatment, respectively. After treatment, BPH patients had significant improvements in International Prostate Symptom Score (IPSS), quality of life score (QoL), and maximal urinary flow rate (Qmax) (Table 1). The levels of F2-isoprostane, IL-1β, and TNF-α in urine significantly decreased after treatment, especially in the successful outcome group. In comparison with the non-successful outcome group, the successful outcome group had a significantly lower level of TNF-α in urine before treatment, and a significant increase in low frequency/ high frequency (LF/ HF) ratio after treatment.

After treatment for BPH, there were significant correlations between the changes of urine biomarkers (including 8-OHdG, F2-isoprostane, TAC, PGE2, IL-8, and TNF-α) and the changes of clinical characteristics (Table 2). The changes of the LF/ HF ratio also negatively correlated with the changes of IPSS-V (IPSS voiding subscore), IPSS, and bladder capacity (BC).
Interpretation of results
This clinical study demonstrated the significant roles of urine oxidative stress biomarkers and HRV in BPH patients. The successful treatment outcome group had a significantly lower level of TNF-α in urine before treatment. The lower level of TNF-α in urine before treatment, indicating less severity in oxidative stress, was associated with better treatment outcomes. It suggested that there might be better treatment outcomes in the earlier stage of BPH progression influenced by oxidative stress. After treatment, the levels of oxidative stress biomarkers in urine significantly decreased, and the changes in urine biomarkers were correlated with the changes in clinical characteristics, including clinical symptoms and uroflowmetry parameters. This suggests that the treatment effectively reduced oxidative stress in BPH progression to achieve clinical therapeutics, which were shown in the changes of urine oxidative stress biomarkers. Urine oxidative stress biomarkers might have diagnostic and prognostic roles in BPH patients. Additionally, after treatment, the successful treatment group had a significant increase in LF/ HF ratio, and the changes of the LF/ HF ratio negatively correlated with the changes of IPSS-V, IPSS, and BC. These indicated that ANS function might be involved in the pathogenesis of treated BPH, and be a potential clinical biomarker reflecting the clinical symptoms and bladder function in BPH patients.
Concluding message
Non-invasive examinations of urine oxidative biomarkers (including hypoxia-related inflammatory cytokines) might reflect the changes of oxidative stress within the bladder in treated BPH patients, and correlated with the changes in clinical characteristics. The evaluation of ANS function, assessed using HRV, may provide insight into the pathogenesis of treated BPH. Both urine oxidative stress biomarkers and ANS function play potentially crucial roles in the evaluation of BPH.
Figure 1 Table 1
Figure 2 Table 2
Disclosures
Funding This study was funded by the Ministry of Science and Technology (Taiwan) with grant number MOST 110-2628-B-303-003-. Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Institutional Review Board and Ethics Committee of Buddhist Tzu Chi General Hospital Helsinki Yes Informed Consent Yes
Citation

Continence 7S1 (2023) 100831
DOI: 10.1016/j.cont.2023.100831

04/11/2024 10:49:32