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Davis AT Collection. Davis PT Collection. Murtagh Collection. About Search. Enable Autosuggest. Previous Chapter. Next Chapter. Lee M Lee, Mary. Chapter Benign Prostatic Hyperplasia. DiPiro J. Joseph T. DiPiro, et al. Accessed September 25, When we examined the prevalence rate according to age, we found that the prevalence rate increased with age.
The p-values were calculated using one-way analysis of variance for continuous variable and chi-square test for categorical variables. The average age of the BPH group was In the subscores of the IPSS, the score for weak urinary stream was highest 3. In the survey questions about quality of life, the overall inconvenience of the patients due to their current urinary symptoms was used for the score; the scores were divided from 0 as very satisfied to 6 as very dissatisfied.
The quality of life score was significantly higher in the BPH group 3. The p-values were calculated using independent t-test for continuous variable and chi-square test for categorical variables. In this study, we conducted a correlation analysis to determine whether epidemiologic factors marital status, education level, smoking status, alcohol consumption status, BMI, and regular exercise and comorbidities hypertension and diabetes influenced the risk of BPH.
A statistically significant factor was smoking status. The reason the epidemiologic factors including lifestyle did not show a significant correlation may be that this study was based on a cross-sectional design that did not clearly show a sequential relationship by time. In the case of the BPH group, the patients' uncomfortable urinary status could have already influenced changes in health behavior.
Because in current Korean society the population is aging, the older population is rapidly increasing. Additionally, the incidence of metabolic syndrome, which is a risk factor for BPH, and the number of patients with obesity are also annually increasing owing to westernized eating habits. BPH and LUTS could lead to social problems caused by the increase in annual medical expenses related to serious complications such as falls, depression, and reduced quality of life, particularly in the elderly [ 4 , 5 , 6 ].
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In this situation, it is necessary to conduct systematic epidemiologic investigations of the prevalence rate of BPH in Korea. Although methods exists for the diagnosis of BPH, including taking the patient's medical history and recording urinary symptoms, prostate volume measurement by digital rectal examination and transrectal ultrasonography, peak urinary flow rate Qmax , and residual urine measurement, accurate diagnostic criteria have not been established.
Garraway et al. Bosch et al. In a study targeting males aged 40 years and older in Spain. Chung et al. In this study, BPH diagnosis was based on the symptom score and the prostate volume, and urof lowmetry examination was excluded. The reason the uroflowmetry examination was excluded was as follows.
First, Blanker et al. Jakobsen et al. Therefore, those authors proposed criteria for BPH as an IPSS of 8 points or higher and a prostate volume by transrectal ultrasonography of 25 mL or more. In addition, the prevalence rates were The reasons for the differences in the prevalence rate are as follows. First, there were variables in the epidemiologic investigation, such as the selection of the target group and regional differences in the population.
Second, the diagnostic criteria for BPH differed in each investigation. The prevalence rate in Seongnam was much higher than in other regions because the study was an epidemiologic investigation targeting the elderly population 65 years old and above. Although Lee et al. In this study, the survey and the epidemiologic investigation were performed by interviewers who were sufficiently trained; unlike other authors' measurement of the prostate volume by digital rectal examination, it could be thought that the reliability would be high because the prostate volume was accurately measured by transrectal ultrasonography.
Epidemiologic research on BPH has greatly evolved over the past several years, and many epidemiologic data have been accumulated. Even though age and genetics play an important role as causes of BPH, it is notable that lifestyle factors such as metabolic syndrome or cardiovascular disease, which can be corrected, have a considerable impact on the natural progression of BPH [ 16 ]. Additionally, other studies have shown that the risk of BPH and LUTS is significantly increased in people with heart disease [ 17 , 18 , 19 ].
In other previous studies, a correlation was observed in which the more the amount of fat increased, the more the prostate volume increased. In several research studies, weight, BMI, and waistline all showed a significant correlation with prostate volume [ 20 , 21 , 22 ]. The reason for this may be that the cross-sectional design of this study did not clearly show the sequential relationship of time. The study criteria were also vague because there are few studies related to BMI and prostate volume in Asia, including Korea.
In addition, whereas some studies reported that there was a reverse protective effect of smoking on BPH and LUTS, other studies reported that the risk level increased or showed no change [ 21 ]. Therefore, it is necessary to conduct more studies on the correlation between smoking and BPH. There were several limitations to the current study. First, the subjects were not a random sample of the population because we recruited subjects through a prostate health screening campaign.
Second, we did not consider the difference in the population distribution by age in Yangpyeong County and the study group. Third, although prevalence was the number of cases of the condition at a particular point in time, the participants of this study were recruited over 3 years August-September , August , and August in an effort to collect more participants.
Consequently, the results of this epidemiologic research investigating the BPH prevalence rate in a rural Korean area showed a lower value than in other countries. One reason for this may be that the ratio of relatively younger males in their 40s to 50s was somewhat higher in this epidemiologic investigation than in other studies. Second, there may have been an influence of diet, with a focus on vegetables in the rural area compared with the westernized diet of high meat consumption in urban areas.
Although our study did not survey the eating habits of the individuals, in a study performed to evaluate food intake of the elderly residing in different regions of Korea, the intake of meats was significantly higher in urban elderly than in rural elderly [ 23 ]. Third, the different diagnostic criteria of BPH applied in each study could be a cause of the differences in prevalence rates. In this study, the prevalence rate of BPH was estimated by targeting males aged 40 years and older in a rural Korean area.
The results showed that the prevalence rate of BPH in males aged 40 years and older in Yangpyeong County was When classifying the men according to age, the prevalence rate of BPH increased with age.
The IPSS also increased with age. Many elderly patients with BPH are poor surgical candidates, and many younger patients find the risk of sexual dysfunction associated with TURP to be unacceptable. The availability and use of these newer procedures vary regionally.
Transurethral incision of the prostate TUIP is an endoscopic procedure using only one or two incisions to reduce constriction of the urethra without removing any of the prostate gland. TUIP can be performed as an outpatient procedure. It is generally offered as a treatment option for younger patients in whom fertility and antegrade ejaculation are important issues.
Outcomes are similar to those with TURP, but the procedure takes less time to perform and causes less bleeding. Long-term satisfaction and retreatment rates have not been adequately studied. Transurethral microwave thermotherapy TUMT is a single-session, minimally invasive outpatient treatment in which a microwave antenna is placed in a urethral catheter.
Microwave energy causes deep, rapid tissue heating, while a cooling system circulates water to protect adjacent tissue. General or spinal anesthesia is not needed, and the procedure takes about one hour. Limited studies have shown a 65 percent decrease in subjective urinary symptoms and a 45 percent improvement in objective flow rates. Two years after undergoing TUMT, 7.
No major complications, including incontinence and sexual dysfunction, have been reported in patients treated with TUMT. Another minimally invasive procedure is ablation of the prostate by electrode or laser. Some early studies showed that this procedure was associated with an increase in methicillin-resistant Staphylococcus aureus infections, possibly because all necrotic tissue was not removed or tissue coagulation was overzealous.
Transurethral vaporization of the prostate TUVP or transurethral electrovaporization of the prostate TVP is now performed using endoscopic electrosurgical equipment to remove prostatic tissue with limited coagulation. The procedure provides urinary symptom reduction similar to that of TURP, with less postoperative irritation, urinary retention, blood loss, or risk of hyponatremia.
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As with TUMT, no tissue is obtained; thus, it is not possible to assess patients for concurrent prostatic malignancy. Transurethral needle ablation of the prostate TUNA involves the placement of radiofrequency needles in the prostate. The procedure is safe and can be performed using local anesthesia. However, results may be limited, because the bladder neck and median prostate lobe cannot be treated.
Initial studies showed that AUA symptom scores decreased from 21 to 7 and maximum urinary flow rates increased from 10 to 15 mL per second in patients who underwent TUNA. The 14 percent treatment failure rate at two-year follow-up is similar to that for TURP. In the past, transurethral balloon dilation of the prostate was used as a safe, minimally invasive treatment for BPH.
However, the retreatment rate was high. Urethral stents can be placed to maximize the success of the dilation, but the stents are susceptible to infection or encrustation and reblockage. Because of the high complication rate, stent placement is usually reserved for use in patients who are high-risk surgical candidates with a short life expectancy. To date, no large-scale studies have compared the results of the many treatments for BPH. Treatment costs vary widely Tables 1 and 2 26 , and the availability of less invasive surgical options also varies considerably.
Although surgery tends to be more expensive than medical treatment, it is often more effective. However, a more recent Canadian study 29 showed increasing use of the less invasive surgical procedures. Montvale, N.
Cost to the patient will be higher, depending on prescription filling fee. Cost effectiveness of microwave thermotherapy in patients with benign prostatic hyperplasia: part II—results. Urology ;—7. With the wide range of treatments that are available for BPH, patient preference plays an important role. Some patients may be willing to live with the residual symptoms of a less efficacious therapy that has fewer side effects, whereas others may consider the same symptoms to represent treatment failure.
Already a member or subscriber? Log in. Dull completed a family practice residency at Fairview Hospital, Cleveland. Bahnson completed postgraduate training in surgery and urology at Northwestern University Medical School, Chicago. Address correspondence to Pamela Dull, M. Rardin Family Practice Center, N. High St.
Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. McConnell JD. Benign prostatic hyperplasia: diagnosis and treatment. Benign Prostatic Hyperplasia Guideline Panel.here
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Rockville, Md. Austin O, Ricer RE. Prostate cancer screening: an appraisal of the PSA test. Fam Pract Recert. J Urol. Denis LJ. Diagnosing benign prostatic hyperplasia versus prostate cancer. Br J Urol. American Urological Association. Policy statements. Retrieved May , from www. American Cancer Society updates prostate cancer screening guidelines. Using complementary medications to treat BPH. Patient Care. The use of standardized extract of red clover isoflavones for the alleviation of BPH symptoms [French]. Lowe FL. Phytotherapy in the management of benign prostatic hyperplasia.