The independent association of non-alcoholic fatty liver disease with lower urinary tract symptoms/benign prostatic hyperplasia and erectile function scores.

OBJECTIVES: To evaluate the association between non-alcoholic fatty liver disease (NAFLD) and lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and erectile function. PATIENTS AND METHODS: In all, 356 men diagnosed with LUTS/BPH were evaluated retrospectively between January 2016 and March 2018. Anthropometric and laboratory data were collected. According to the liver echogenicity degree, patients were divided into four NAFLD groups: Grade 0 was considered as normal with no NAFLD, whilst Grades 1-3 NAFLD had increasing fat deposits. LUTS symptoms, prostate-specific antigen (PSA) levels, prostate volumes (PVs), and five-item version of the International Index of Erectile Function (IIEF-5) scores were compared statistically between the NAFLD grades.
RESULTS: PSA levels did not differ between the groups. The International Prostate Symptom Score (IPSS), PV and post-voided residual urine volume (PVR) were significantly greater in men with higher NAFLD grades. Conversely, the maximum urinary flow rate (Qmax ) and IIEF-5 score were lower in men with higher NAFLD grades. The NAFLD grade, rather than being metabolic syndrome (MetS) positive, affected prostate parameters and IIEF-5 scores. NAFLD grade correlated positively with IPSS, PV and PVR, whereas there was a negative correlation with Qmax and IIEF-5 score. Age and NAFLD were independent predictors of IPSS, PV, Qmax , and PVR on multivariate analysis.
CONCLUSION: We found that NAFLD was an independent predictive factor for IPSS, PV, Qmax , PVR and IIEF-5 score. MetS was only a significant predictive factor for IIEF-5 score, thus NAFLD may identify patients at high risk of LUTS better than MetS.