Obesity affects several body systems and is the cause of numerous diseases. Earlier studies have shown a relationship between obesity and lower urinary tract symptoms, but the mechanism is not known. Obesity also has important implications for urology in a time when it is becoming more and more “ubiquitous.” Two recent studies in the journal BJU INT suggest that bariatric surgery can rapidly reduce the frequency and severity of lower urinary tract symptoms, according to Medscape Medical News. “It is not surprising that many lower urinary tract symptoms and medical problems associated with obesity improved after surgery. What is truly amazing is the significance of the fact that the improvement in these problems, including urinary function, was so rapid, occurring even before significant weight loss.” Andrew, a senior author at Wellington Hospital, commented in a story, “The relationship between this phenomenon and insulin resistance is potentially quite significant.” This finding begs us to ponder: why is this happening and how best to deal with it? Metabolic Syndrome Correlates with Severity of LUTS Dr. Pourya and his colleagues from the Department of Urology at St. Louis Hospital in Paris, France, conducted the first study. They studied 4666 men, aged 55-100 years, who had seen a general practitioner for more than 12 days in mid-December 2009. On the basis of the International Prostate Symptom Score (IPSS), hypertension, hyperlipidemia, hyperglycemia, and abdominal obesity, the subjects were diagnosed with lower urinary tract symptoms (LUTS). The researchers explored the relationship between metabolic syndrome (whose components include hypertension, hyperlipidemia, high blood glucose levels, and abdominal obesity) and the severity of LUTS and analyzed body mass index (BMI), age, and prostate-specific antigen. According to the National Cholesterol Program Adult Treatment Panel (NCEP/ATP) recommended III criteria, 51.5% of the patients had metabolic syndrome and 47% were treated for LUTS. There is a strong association between the metabolic syndrome and LUTS, and the risk of LUTS increases with the number of components of the metabolic syndrome. There was a positive correlation between the metabolic syndrome and the severity of LUTS, as determined by IPSS, urine storage and voiding scores. Multivariate analysis found that all components of the metabolic syndrome except HDL cholesterol were independently associated with high IPSS and LUTS treatment. In addition, metabolic syndrome was positively associated with prostate volume. Prevention of these controllable factors through dietary changes and increased physical exercise has profound public health implications. Rapid Symptom Relief After Bariatric Surgery In the second study, Dr. Serger et al. from Dunedin Hospital in New Zealand conducted a prospective cohort study of the effects of bariatric surgery on LUTS. The researchers assessed LUTS in men using the IPSS and in women using the Bristol Lower Urinary Tract Symptoms Questionnaire for Women. The researchers recorded the patients’ blood glucose, insulin, and prostate-specific antigen levels and assessed insulin resistance using homeostasis modeling. The researchers evaluated patients preoperatively, 6-8 weeks postoperatively, and 1 year postoperatively, and detected the statistical significance of weight loss, change in BMI, total symptom score, and individual symptoms using the Bonferroni method of multiple test correction. The study included 70 patients who completed one or more postoperative follow-up visits. Relative to baseline levels, patients experienced significant reductions in body weight and BMI after surgery, as well as significant reductions in overall symptoms at 6 weeks postoperatively that were maintained up to 1 year postoperatively. In the linear regression study, changes in baseline total symptom scores, internal homeostasis model assessment, and pre- and postoperative insulin levels predicted changes in total symptom scores, but the amount of total weight loss did not. “Interestingly, our study found that improvement in LUTS can occur rapidly after bariatric surgery, and this improvement appears to be independent of time course and degree of weight loss.” The article’s co-author, Dr. Richard from Wakefield Hospital in Wellington, New Zealand, said in a press release, “Instead, there are indications that improvements in LUTS are associated with improvements in insulin resistance, which can improve immediately after bariatric surgery.”