The autonomic nervus system function in benign prostatic hyperplasia
Distrurbances of the autonomie nervus system (ANS) function play a pivotal role in some cardiological and urological disorders,however,little is known about ANS activity in patiens with benign prostatic hyperplasia (BPH).The aetiology of BPH is complex.The incidence of BPH increases with age.Aging also includes ANS dysfunction with increased sympathetic drive.Recent studies show that ANS dysfunction may be strongly involved in the pathogenesis of Bph and secondary lower urinary tract symptoms (LUTS),however,its pathophysiological mechanism are still under investigation.Heart rate variability (HRV) analysis is widely used to estimate the activity of the cardiovascular autonomie regulatory system,reflecting both sympathetic and parasympathetic components.The aim of the stydy is to estimate the ANS activity in BPH patients with LUTS using frequency domain analysis parameters of HRV. Additionally,the relationship of ANS activity to subjective measures of LUTS,objective measures of BPH,as well biochemical and biometrical variables were investigated.The study was performed on 50 men(30 patients with moderate LUTS(8-19 points) and 20 men with low complains LUTS(0-7points) served as a control group).The cohort of patients was asked to complete IPSS and quality of life questionnaires. We performed biometrical,biochemical measurements and urological estimations.Fasting plasma levels o ; f adrenaline, noradrenaline were measured by immunochemistry in both groups. Additionally,a serum sample was obtained for Prostate Specific Antigen and its derivatives analysis.ANS activity was assessed by HRV measurements in resting conditions,after simulation with deep breating and by tilt test.In the HRV recording,frequency domain analysis parameters were calculated according to fast Fourier transformation and the correlation for ANS activity parameters vs.BPH variables were analysed.The heart variability assessment generally demonstrates the over-stimulation of the sympathetic component of ANS at rest in patients with BPH and secondary LUTS,when compared to control group.These sympathetic overdrive correlated when compared to control group.These sympathetic overdrive correlated with high noradrenaline leves et rest in patients.Autonomic tests confirmed ANS dysfunction in this group of patients.In deep breating and in the tilt up tests,impaired parasympathetic response of ANS to stimulation was observed. Understanding the Ans profile in BPH pathophysiology could be a nesessery condition for the proper selection of patients with LUTS,who can benefit from pharmacological modulation of sympathetic or parasympathetic components of ANS activitv.