Abstract
Purpose
We conducted the study to investigate the relationship between anogenital distance (AGD) and benign prostatic hyperplasia (BPH) related lower urinary tract symptoms (LUTS).
Methods
From May 2018 to January 2020, 220 subjects: 110 men with BPH-related LUTS (BPH-LUTS group) and 110 men without any urination complaints (control group) were selected. Clinical questionnaires, detailed physical examinations, including AGDas (distance between the anus and posterior base of the scrotum) and AGDap (distance between the anus and upper penis) measurements, and blood tests were all assessed.
Results
The two groups were similar in terms of basic features (P > 0.05). The AGDap and AGDas in the control group were significantly shorter than the BPH-LUTS group (P < 0.001). Adjusted multivariate analyses showed that AGDas was significantly related to International Prostate Symptom Score (IPSS), post-voiding residual volume (PVR), total prostate volume (TPV) and maximum urine flow rate (Qmax) (P = 0.002, P = 0.009, P = 0.001, P = 0.028, respectively). However, the associations between AGDap and IPSS score, PVR, TPV, Qmax and total testosterone (TT) were all negligible (P > 0.05 for all). The associations between TT and BPH-LUTS related evaluations were also negligible (P > 0.05 for all). Furthermore, the study revealed that the AGDas cut-off values for mild, moderate, and severe symptom (based on IPSS score) in BPH-LUTS cases were 27.4 mm and 46.8 mm [area under curve (AUC): 0.802 and AUC: 0.779, respectively], respectively.
Conclusion
Longer AGDas was related to more severe BPH related symptoms. It may be useful to consider AGD as a marker for BPH-LUTS. Further well-designed studies are remained to be done to explore the intriguing problem.
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Data Availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Thorpe A, Neal D (2003) Benign prostatic hyperplasia. The Lancet 361:1359–1367
Mazur DJ, Helfand BT, McVary KT (2012) Influences of neuroregulatory factors on the development of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction in aging men. Urologic Clinics 39:77–88
Lee C, Kozlowski JM, Grayhack JT (1997) Intrinsic and extrinsic factors controlling benign prostatic growth. Prostate 31:131–138
Ørsted DD, Bojesen SE (2013) The link between benign prostatic hyperplasia and prostate cancer. Nat Rev Urol 10:49
Toprak T, Şahin A, Akgul K et al (2019) The relationship between anogenital distance and lifelong premature ejaculation. Andrology-Us 22:131–139
Faqi AS, Dalsenter PR, Merker H, Chahoud I (1998) Reproductive toxicity and tissue concentrations of low doses of 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin in male offspring rats exposed throughout pregnancy and lactation. Toxicol Appl Pharm 150:383–392
Hsieh MH, Breyer BN, Eisenberg ML, Baskin LS (2008) Associations among hypospadias, cryptorchidism, anogenital distance, and endocrine disruption. Curr Urol Rep 9:137–142
Thankamony A, Ong KK, Dunger DB, Acerini CL, Hughes IA (2009) Anogenital distance from birth to 2 years: a population study. Environ Health Persp 117:1786–1790
Priskorn L, Bang AK, Nordkap L et al (2018) Anogenital distance is associated with semen quality but not reproductive hormones in 1106 young men from the general population. Hum Reprod 34:12–24
Macleod DJ, Sharpe RM, Welsh M et al (2010) Androgen action in the masculinization programming window and development of male reproductive organs. Int J Androl 33:279–287
Sudhakar HH, Manjunatha R, Madhusudhana HR (2015) Relationship between second to fourth digit ratios and benign prostatic hyperplasia in aging men. Journal of clinical and diagnostic research: JCDR 9: PC01
Na YQ, Ye ZQ, Sun YH (2014) Guideline for Urology Diseases Diagnosis and Treatment in China, 4th edn. People’s Medical Publishing House, Beijing, pp 253–254
Swan SH, Main KM, Liu F et al (2005) Study for future families research team: decrease in anogenital distance among male infants with prenatal phthalate exposure. Environ Health Perspect 113:1056–1061
Lenz B, Bouna-Pyrrou P, Mühle C, Kornhuber J (2018) Low digit ratio (2D: 4D) and late pubertal onset indicate prenatal hyperandrogenziation in alcohol binge drinking. Prog Neuropsychopharmacol Biol Psychiatry 86:370–378
Zheng Z, Cohn MJ (2011) Developmental basis of sexually dimorphic digit ratios. Proc Natl Acad Sci 108:16289–16294
Walder DJ, Andersson TL, McMillan AL, Breedlove SM, Walker EF (2006) Sex differences in digit ratio (2D: 4D) are disrupted in adolescents with schizotypal personality disorder: altered prenatal gonadal hormone levels as a risk factor. Schizophr Res 86:118–122
Bailey AA, Hurd PL (2005) Depression in men is associated with more feminine finger length ratios. Pers Indiv Differ 39:829–836
Bang AK, Carlsen E, Holm M et al (2005) A study of finger lengths, semen quality and sex hormones in 360 young men from the general Danish population. Hum Reprod 20:3109–3113
Maldonado Cárceles AB, Sánchez Rodríguez C, Vera Porras EM et al (2017) Anogenital distance, a biomarker of prenatal androgen exposure is associated with prostate cancer severity. Prostate 77(4):406–411
Sahin A, Kutluhan MA, Toprak T et al (2019) Assesment of anogenital distance as a marker in diagnosis of prostate cancer. Archivio Italiano di Urologia e Andrologia. https://doi.org/10.4081/aiua.2019.3.163
Wang MQ, Wang Y, Yan JY et al (2016) Prostatic artery embolization for the treatment of symptomatic benign prostatic hyperplasia in men ≥75 years: a prospective single-center study. World J Urol 34(9):1275–1283
Kaplan SA (2017) Re: association between benign prostatic hyperplasia, body mass index, and metabolic syndrome in Chinese men. J Urol 197(3):770–772
Dean A, Sharpe RM (2013) Clinical review: Anogenital distance or digit length ratio as measures of fetal androgen exposure: relationship to male reproductive development and its disorders. The Journal of clinical endocrinology and metabolism 98(6):2230–2238
Biancardi MF, Perez APS, Caires CRS et al (2015) Prenatal exposure to testosterone masculinises the female gerbil and promotes the development of lesions in the prostate (Skene’s gland). Reprod Fertil Dev 27(7):1000–1011
De Nunzio C, Salonia A, Gacci M, Ficarra V (2020) Inflammation is a target of medical treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia. World J Urol 1–9
Wang C, Luo F, Zhou Y et al (2016) The therapeutic effects of docosahexaenoic acid on oestrogen/androgen-induced benign prostatic hyperplasia in rats. Exp Cell Res 345(2):125–133
Akanni OO, Abiola OJ, Adaramoye OA (2017) Methyl Jasmonate Ameliorates Testosterone Propionate-induced Prostatic Hyperplasia in Castrated Wistar Rats. Phytother Res 31(4):647–656
Maldarine JS, Sanches BD, Cabral ÁS et al (2019) Prenatal exposure to finasteride promotes sex-specific changes in gerbil prostate development. Reprod Fertil Dev 31(11):1719–1729
Kutluhan MA, Şahin A, Ürkmez A, et al (2020) The relationship between anogenital distance and benign prostate hyperplasia‐related lower urinary tract symptoms. Andrologia:e 13589.
Older RA, Watson LR (1996) Ultrasound anatomy of the normal male reproductive tract. J Clin Ultrasound 24(8):389–404
Funding
This work was supported by the Zhao Yi-Cheng Medical Science Foundation, China [Grant No. ZYYFY2018031].
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Study design: Yi Lu, Xiaoqiang Liu; Data collection: Yuxuan Song, Kang Liu, and Shujun Fan; Data analysis: Shangren Wang, Kang Liu, Kechong Zhou, and Yuxuan Song; Yi Lu wrote the article and all authors revised the manuscript.
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The study (No. 201801) was approved by the Ethics Committee of Tianjin Medical University General Hospital (TMUGH), on January 26, 2018. The study was conducted in compliance with the principles of the Declaration of Helsinki, the principles of Good Clinical Practice and in accordance with all applicable regulatory requirements. This manuscript involves human participants.
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Lu, Y., Fan, S., Song, Y. et al. The association between anogenital distance and benign prostatic hyperplasia related lower urinary tract symptoms in Chinese aging men. World J Urol 39, 2645–2653 (2021). https://doi.org/10.1007/s00345-020-03511-6
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DOI: https://doi.org/10.1007/s00345-020-03511-6