RELATION OF TOTAL CHOLESTEROL TO PROSTATE VOLUME AND INTRAVESICAL PROSTATIC PROTRUSION IN BENIGN PROSTATIC HYPERPLASIA PATIENTS

Objective: To determine the relationship between total cholesterol, prostate volume, and intravesical prostatic protrusion in patients with benign prostatic hyperplasia. Material & Methods: This study used a cross-sectional method, carried out at the Paru and Bina Sehat Hospital in Jember. The sample in this study was BPH patients who met the inclusion criteria taken through medical record data from October 2019 to January 2020 Results: Samples on this study amounted to 33 patients. In this study, there was a difference between normal and high cholesterol with prostate volume in BPH patients (p = 0.00) and there was a significant relationship between cholesterol and prostate volume with strong correlation strength (p = 0.00 and r = 0.751) while the difference between high and normal cholesterol with IPP obtained insignificant results (p = 0.211) and the correlation between cholesterol and IPP obtained an insignificant relation with weak correlation strength (p = 0.217 and r = 0.221). Conclusion: There is a significant relationship between total cholesterol and prostate volume and a significant difference in prostate volume between normal and high total cholesterol in BPH patients, while there is no significant result between total cholesterol and intravesical prostatic protrusion in BPH patients.


INTRODUCTION
Benign Prostatic Hyperplasia (BPH) is a condition of increasing numbers of prostatic epithelial cells and stromal cells. Prostate enlargement can result in obstruction of the urinary tract which can cause various clinical symptoms. BPH is one of the diseases of the urological system that often occurs in older men and America BPH cases are the second 1 most common cause of death in men over 55 years. The incidence of BPH in Indonesia varies as much as 24-30% of urology cases treated in several hospitals, one of which is Dr. Soetomo hospital in the span of 10 2 years (1993-2002) recorded 1.948 cases.
The prevalence of hypercholesterolemia at the age of 55-64 years increased by 15.5% compared 3 to ages 25-34 years which was as much as 9.3%. Enlarged prostate involves the stromal gland compartment. One of the causes of BPH depends on the stimulation of androgens, especially DHT whose work is influenced by cholesterol in the blood circulation and pathogenesis of lipid levels indirectly 4 affect the enlargement of the prostate gland.

OBJECTIVE
The purpose of this study was to determine the relationship between total cholesterol and prostate volume and intravesical prostatic protrusion in patients with benign prostatic hyperplasia.

MATERIAL & METHODS
This research uses an observational analytic design and cross-sectional method with a consecutive sampling technique. The sample in this study was selected according to inclusion criteria with a sample size of 33 respondents. The inclusion criteria in this study were BPH patients with more than 50 years of age, total cholesterol levels had been measured in the laboratory and an examination with Transabdominal Ultrasound. The exclusion criteria of this study were BPH patients with a history of carcinoma of the prostate and obesity. The data in the study were analyzed with SPSS 23 with the Mann-Whitney comparison test and the Spearman correlation test. The results in table 2 with Mann-Whitney test results of Prostate Volume and total cholesterol obtained p = 0.000 (p < 0.001). These results indicate there are significant differences between normal and high total cholesterol levels with prostate volume. The highest total cholesterol level results were found in prostate volume ≥ 51 cc, as many as 10 samples (30.3%) of 33 BPH patient samples, while normal total cholesterol levels were found most in prostate volume with a volume range of 31-50 cc (48.5%) with a total of 16 of 33 samples. The comparison of the ranks of the high cholesterol group is higher than normal cholesterol. A higher rating indicates a larger prostate volume so that the prostate volume is directly proportional to total cholesterol. The results in table 3. showed a significant correlation between total cholesterol and prostate volume (p = 0.000).  Table 5. have the same result with weak correlation.

DISCUSSION
The average age of BPH patients in this study was 65 years. The youngest and oldest ages in with an increase in prostate volume. Another study with a cohort study design in the Chinese population obtained significant results between HDL cholesterol and triglycerides on prostate volume and insignificant results on total cholesterol and LDL cholesterol. The difference in results in this study can be due to the inadequate number of samples and 10 different research methods. The relation between cholesterol and BPH is associated with cholesterol as a metabolic precursor in the synthesis of steroid 11 hormones namely androgens. Some hormone derivatives made by cholesterol are progesterone, 12 17 β-estradiol, and testosterone.
Total cholesterol is the amount between 13 HDL, LDL, and Tg cholesterol. Dyslipidemia has a negative effect on prostate cells which increases the occurrence of inflammation of the prostate so that it becomes one of the important factors that play a role in the development of BPH. This is evidenced by the significant results on the increase of Tg in BPH patients with Prostate Inflammatory Score (IS) and LDL cholesterol which have a role in increasing the occurrence of inflammation and remodeling of 14 prostate tissue in BPH. . The results of the study of the relationship of total cholesterol and intravesical prostatic protrusion tested comparatively with Mann-Whitney showed insignificant results with the results of p = 0.211 (p > 0.05), statistically, the Spearman correlation test results between the two variables do not have a significant relationship and have Weak correlation with the value of p = 0.217 (p > 0.05) and r = 0.221. The intravesical prostatic protrusion is a prostate protrusion of the bladder which if there is a large protrusion, can obstruct the urinary tract, causing symptoms of LUTS.
The results of this study are supported by a previously stated relationship between HDL 15 cholesterol and IPP (p = 0.01). HDL cholesterol is one part of total cholesterol in addition to Tg and LDL cholesterol. Research in India with a cross-sectional study design and a sample of 114 BPH patients showed different results from this study. Third-degree IPP has a relationship with Tg and HDL cholesterol. The study showed that Tg and HDL cholesterol affected prostate protrusion against the bladder at a large IPP size with an IPP value > 10 mm which in this [16][17] case could cause symptoms of LUTS.
Cholesterol components that show a positive correlation with prostate enlargement are HDL and Tg. No studies are linking total cholesterol and LDL cholesterol with an increase in the degree of IPP so that cholesterol cannot significantly ascertain the degree of IPP. The mechanism of prostate enlargement, the onset of prostate protrusion and the effect of cholesterol on a prostate protrusion in BPH is unclear but in the study, it was explained that increased serum lipids can increase prostatic muscle tone activity and sympathetic nervous system activity so that triggering LUTS. Limitations in this study are the time and IPP data that is difficult to obtain at the hospital where the study is so that the [15][16] number of samples obtained is limited.

CONCLUSION
Total cholesterol is a risk factor in increasing prostate volume and both of them correlate. There is a significant difference in prostate volume between normal and high total cholesterol in BPH patients and total cholesterol is not related to the intravesical prostatic protrusion in BPH patients in the Paru Hospital and Bina Sehat Hospital in Jember.