Evaluating the demographic profile and mapping the prevalence of overactive bladder in benign prostrate hypertrophy patients: a retrospective, observational study
Keywords:Benign prostrate hypertrophy, BPH, Overactive bladder, OAB, Treatment
Background: The objectives of the study was to evaluate the demographic profile of benign prostatic hyperplasia (BPH) patients and prevalence of overactive bladder (OAB) among these patients.
Methods: A real-world, retrospective, observational study (DEMO-2) on BPH patients was conducted across India from April-2021 to March-2022. Demographics, BPH characteristics, status of OAB, and their management were evaluated.
Results: A total of 5881 BPH patients were included with a mean age of 65.3 years and mean BPH duration of 3.2 years. Majority (80.98%) of the patients had associated comorbidity; hypertension (50.2%), diabetes (26.9%) and dyslipidemia (13%) were the most common. Majority (63%) of the patients complained of incomplete bladder emptying. In BPH patients, 29.9% had OAB. These patients had a higher mean prostate volume (44.96 vs. 42.17 cc) and prostate specific antigen (PSA) levels (4.11 vs. 3.79 ng/ml) versus BPH patients without OAB. For BPH, tamsulosin was the most prescribed drug (85.90%) followed by dutasteride (66.90%); tamsulosin + dutasteride was most common combination therapy (32.6%). In BPH patients with OAB, 82% received OAB medications and solifenacin (63.9%) was the most common medication.
Conclusions: Majority of the BPH patients were between the ages of 50-75 years. Tamsulosin was the most commonly prescribed medication in BPH patients. Combination of tamsulosin and dutasteride was the mainstay of treatment. OAB was seen in 29.9% of the BPH patients, and solifenacin was the most commonly utilized (63.1%) medication in BPH patients with OAB. About 18% of these patients did not receive any specific medication for OAB. Adequate treatment strategies need to be adopted for BPH patients with OAB.
Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol. 2005;7(9):S3-s14.
Thomas D, Chughtai B, Kini M, Te A. Emerging drugs for the treatment of benign prostatic hyperplasia. Expert Opinion on Emerging Drugs. 2017;22:201-12.
Rosen RC. Update on the relationship between sexual dysfunction and lower urinary tract symptoms/benign prostatic hyperplasia. Curr Opinion Urol. 2006;16:11-9.
Soler R, Averbeck MA, Koyama MAH, Gomes CM. Impact of LUTS on treatment-related behaviors and quality of life: A population-based study in Brazil. Neurourol Urodyn. 2019;38:1579-87.
Abrams P. Nocturia: the major problem in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO). Eur Urol Supplements. 2005;3:8-16.
Leron E, Weintraub AY, Mastrolia SA, Schwarzman P. Overactive Bladder Syndrome: Evaluation and Management. Curr Urol. 2018;11:117-25.
Stewart WF, Van Rooyen JB, Cundiff GW. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327-36.
McVary KT, Roehrborn CG, Avins AL. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185:1793-803.
Raina SK, Razdan S, Nanda R. Prevalence of neurological disorders in children less than 10 years of age in RS Pura town of Jammu and Kashmir. J Pediatr Neurosci. 2011;6:103.
Roehrborn C, Walsh PC, Reitik AB, Vaughan ED. Etioloy, pathothysiology, epidemiology and natural history of binign prostatichyperplasia. Campbell′ s Urolo. Philadelphia: WB Saunders Company. 2002.
De Nunzio C, Aronson W, Freedland SJ, Giovannucci E, Parsons JK. The correlation between metabolic syndrome and prostatic diseases. Eur Urol. 2012;61:560-70.
Meigs JB, Mohr B, Barry MJ, Collins MM, McKinlay JB. Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men. J Clin Epidemiol. 2001;54:935-44.
Joseph MA, Harlow SD, Wei JT. Risk factors for lower urinary tract symptoms in a population-based sample of African-American men. Am J Epidemiol. 2003;157:906-14.
Patel ND, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol. 2014;30:170-6.
Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2013;189:S102-6.
Parsons JK. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol. 2007;178:395-401.
Parsons JK, Messer K, White M. Obesity increases and physical activity decreases lower urinary tract symptom risk in older men: the Osteoporotic Fractures in Men study. Eur Urol. 2011;60:1173-80.
Muller RL, Gerber L, Moreira DM. Obesity is associated with increased prostate growth and attenuated prostate volume reduction by dutasteride. Eur Urol. 2013;63:1115-21.
Gupta A, Gupta S, Pavuk M, Roehrborn CG. Anthropometric and metabolic factors and risk of benign prostatic hyperplasia: a prospective cohort study of Air Force veterans. Urology 2006;68:1198-205.
Parsons JK, Bergstrom J, Barrett‐Connor E. Lipids, lipoproteins and the risk of benign prostatic hyperplasia in community‐dwelling men. BJU Int. 2008;101:313-8.
Sarma AV, Sauver JLS, Hollingsworth JM. Diabetes treatment and progression of benign prostatic hyperplasia in community-dwelling black and white men. Urology. 2012;79:102-8.
Parsons JK, Im R. Alcohol consumption is associated with a decreased risk of benign prostatic hyperplasia. J Urol. 2009;182:1463-8.
Parsons J. Lifestyle factors, benign prostatic hyperplasia, and lower urinary tract symptoms. Curr Opinion Urol. 2011;21:1-4.
Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E. Prevalence and characteristics of lower urinary tract symptoms in men aged≥ 80 years. Urology. 2008;72:318-321.
Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132:474-9.
Loeb S, Kettermann A, Carter HB. Prostate volume changes over time: results from the Baltimore Longitudinal Study of Aging. J Urol. 2009;182:1458-62.
Bosch J, Tilling K, Bohnen A, Bangma C, Donovan J. Establishing normal reference ranges for prostate volume change with age in the population‐based Krimpen‐study: Prediction of future prostate volume in individual men. Prostate. 2007;67:1816-24.
Bosch JR, Bangma CH, Groeneveld FP, Bohnen AM. The long-term relationship between a real change in prostate volume and a significant change in lower urinary tract symptom severity in population-based men: the Krimpen study. Eur Urol. 2008;53:819-27.
Roehrborn CG, McConnell JD, Lieber M. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. Urology. 1999;53:473-80.
Yi Q-T, Gong M, Chen C-H, Hu W, Zhu R-J. Epidemic investigation of benign prostatic obstruction with coexisting overactive bladder in Shanghai Pudong New Area and its impact on the health-related quality of life. BMC Urol. 2019;19:82.
Burnett AL, Walker DR, Feng Q. Undertreatment of overactive bladder among men with lower urinary tract symptoms in the United States: A retrospective observational study. Neurourol Urodyn. 2020;39:1378-86.
Chapple CR. A Comparison of Varying alpha-Blockers and Other Pharmacotherapy Options for Lower Urinary Tract Symptoms. Rev Urol. 2005;7(4):S22-30.
Tewari A, Narayan P. Alpha-adrenergic blocking drugs in the management of benign prostatic hyperplasia: interactions with antihypertensive therapy. Urology. 1999;53:14-20.
Amory JK, Wang C, Swerdloff RS. The effect of 5α-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J Clin Endocrinol Metabol. 2007;92:1659-65.
McConnell JD, Roehrborn CG, Bautista OM. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Eng J Med. 2003;349:2387-98.
Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G. Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology. 2002;60:434-41.
Roehrborn CG, Malice M-P, Cook TJ, Girman CJ. Clinical predictors of spontaneous acute urinary retention in men with LUTS and clinical BPH: a comprehensive analysis of the pooled placebo groups of several large clinical trials. Urology. 2001;58:210-6.
Madhuvrata P, Cody JD, Ellis G, Herbison GP, Hay-Smith EJ. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2012;1:Cd005429.
McVary KT, Roehrborn C, Avins A. AUA guidelines: Management of BPH. Bethesda: American Urological Association, Education and Research, Inc. 2010.