The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates

https://doi.org/10.1016/j.ucl.2016.04.001Get rights and content

Section snippets

Key points

  • Prevalence and incidence rates for benign prostatic hyperplasia and lower urinary tract symptoms (BPH/LUTS) have not previously been summarized in the literature by age group, symptom severity, and/or race/ethnicity.

  • BPH/LUTS prevalence rates ranged from 50% to 75% among men 50 years of age and older to 80% among men 70 years of age and older. Overall incidence rates ranged from 8.5 to 41 cases/1000 person–years.

  • BPH/LUTS epidemiologic estimates generally increased with increasing age. Unmeasured

Benign Prostatic Hyperplasia

Clinical BPH is a histologic diagnosis of a progressive enlargement of the prostate gland resulting from nonmalignant proliferation of smooth muscle and epithelial prostate cells.5 BPH disease progression can lead to growth in the transition zone of the prostate gland, called benign prostatic enlargement (BPE), which results from proliferation of fibroblasts and epithelial glandular elements near the urethra.6, 7 Men with clinical BPH typically have prostate volumes of at least 20 mL.8

Lower Urinary Tract Symptoms

Fifty

Risk factors and comorbidities

Medical and lifestyle predictors of BPH/LUTS have been primarily studied despite the high disease burden that should prompt researchers to assess population-level BPH/LUTS sociodemographic and environmental risk factors.

Known risk factors associated with BPH/LUTS12, 13, 14, 15, 16 include

  • Age

  • Sedentary lifestyle

  • Lack of exercise

  • Smoking

  • Excessive alcohol consumption

  • Hypertension

  • Type II diabetes

  • Depression

  • Cardiovascular disease

  • Hyperlipidemia

  • Central obesity/waist circumference

  • Hypogonadism

  • Prostate

Prevalence/incidence

Disentangling BPH, LUTS, and BPH/LUTS prevalence and incidence rates reported in the literature is difficult due to the varying disease definitions and assessment methods used between studies.20 Because of these differences in disease definitions and reporting methods such as self-report qualitative and/or quantitative symptoms or diagnoses versus medical record reviews performed by trained medical professionals, BPH, LUTS, and BPH/LUTS estimates in the literature should be interpreted with

Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms Estimates: Comparison

The relationship between BPH, LUTS, bladder outlet obstruction, and benign prostatic enlargement is complex. This complexity can lead to problems with epidemiologic definitions between studies.

There are several factors that complicate BPH/LUTS prevalence and incidence rate comparisons. First, there is an insufficient consensus on the epidemiologic definition of BPH, LUTS, and BPH/LUTS. Different studies often calculate prevalence and incidence using different disease definitions and assessment

Clinical correlation

Worldwide, populations are aging. This correlates to an increase in the number of older men and an increase in life expectancy. As BPH/LUTS is an age-related disease that increases in prevalence and incidence as men get older, appropriate management and use of resources for BPH/LUTS, and other age-related conditions, is a major challenge for the health care system. Recently, there has been a shift from surgical procedures to medical therapy for BPH/LUTS treatment. This is thought to be a result

Summary

The number of men diagnosed with BPH/LUTS in the last decade has been increasing over time. Prostate enlargement, specifically BPH, has been shown to be associated with the symptomatic progression of LUTS. Numerous cross-sectional and longitudinal studies have provided data on BPH, LUTS, and BPH/LUTS prevalence and incidence rates and their increase over time and age-related associations. Each prevalence may be increasing due to an increase in BPH/LUTS disease awareness and diagnosis, the

First page preview

First page preview
Click to open first page preview

References (52)

  • W.M. Garraway et al.

    High prevalence of benign prostatic hypertrophy in the community

    Lancet

    (1991)
  • J.B. Meigs et al.

    Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men

    J Clin Epidemiol

    (2001)
  • A.V. Sarma et al.

    A population based study of incidence and treatment of benign prostatic hyperplasia among residents of Olmsted County, Minnesota: 1987 to 1997

    J Urol

    (2005)
  • P. Napalkov et al.

    Worldwide patterns of prevalence and mortality from benign prostatic hyperplasia

    Urology

    (1995)
  • A.M. De Marzo et al.

    Proliferative inflammatory atrophy of the prostate: implications for prostatic carcinogenesis

    Am J Pathol

    (1999)
  • C.J. Girman et al.

    Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate

    J Urol

    (1995)
  • C.G. Chute et al.

    The prevalence of prostatism: a population-based survey of urinary symptoms

    J Urol

    (1993)
  • P.P. Sagnier et al.

    Results of an epidemiological survey using a modified American Urological Association symptom index for benign prostatic hyperplasia in France

    J Urol

    (1994)
  • J.A. Chicharro-Molero et al.

    Prevalence of benign prostatic hyperplasia in Spanish men 40 years old or older

    J Urol

    (1998)
  • T. Rhodes et al.

    Longitudinal prostate growth rates during 5 years in randomly selected community men 40 to 79 years old

    J Urol

    (1999)
  • K. Ezz el Din et al.

    Correlation between uroflowmetry, prostate volume, postvoid residue, and lower urinary tract symptoms as measured by the International Prostate Symptom Score

    Urology

    (1996)
  • S.K. Van Den Eeden et al.

    Evaluating racial/ethnic disparities in lower urinary tract symptoms in men

    J Urol

    (2012)
  • J.T. Wei et al.

    The natural history of lower urinary tract symptoms in black American men: relationships with aging, prostate size, flow rate and bothersomeness

    J Urol

    (2001)
  • N. Masumori et al.

    Japanese men have smaller prostate volumes but comparable urinary flow rates relative to American men: results of community based studies in 2 countries

    J Urol

    (1996)
  • E.A. Platz et al.

    Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men

    Urology

    (2002)
  • K.M. Verhamme et al.

    Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care—the Triumph project

    Eur Urol

    (2002)
  • Cited by (0)

    Disclosure Statement: The author has no relevant financial information to disclose.

    View full text