Editorial Comment from Dr Presicce et al. to Emerging links between non-neurogenic lower urinary tract symptoms secondary to benign prostatic obstruction, metabolic syndrome and its components. a systematic review

In 1998, Hammarsten et al. first proposed a possible causal association between metabolic abnormalities and the development of benign prostatic hyperplasia (BPH).1 Since then, an increasing number of studies have investigated this relationship with controversial conclusions. The discordant classifications used to define the presence of metabolic syndrome (MetS), the different prevalence of MetS and the ethnic disparities among the enrolled populations make comparisons difficult, and could explain the conflicting results of the available evidence. Notwithstanding all these limitations, a positive association between MetS and lower urinary tract symptoms (LUTS), particularly storage LUTS,2 seems to emerge as confirmed by the present review.3 The authors evaluated the current and higher‐quality evidence of the relationship between MetS and LUTS. Furthermore, Russo et al. have the merit of exploring the possible connection between LUTS/bladder outlet obstruction (BPO) and each single component of MetS. They found a positive association between MetS, the number of components and LUTS/BPO, and in particular the main endocrine metabolic abnormalities involved seem to be central obesity and hypertriglyceridemia.3 However, this is only the tip of the iceberg, and several questions about this promising topic remain unanswered.