Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, VR, Italy.
Department of Urology, Polyclinic of Abano Terme, Piazza Cristoforo Colombo, 1, 35031, Abano Terme, PD, Italy.
Prostate Cancer Prostatic Dis. 2023 Dec;26(4):730-735. doi: 10.1038/s41391-022-00575-w. Epub 2022 Jul 22.
Evidence on clinical presentation of benign prostatic hyperplasia (BPH) is scarce, and studies involving outpatients are lacking. We aimed to provide an insight into the contemporary Italian scenario of BPH-affected outpatients using symptom scores (International Prostate Symptom Score [IPSS], BPH Impact Index [BII]), and to compare characteristics of patients with known BPH and those first-diagnosed at the visit.
"IMPROVING THE PATH" project working group designed a questionary prospectively administered to BPH-affected outpatients by urologists. A cross-sectional study was performed. Data were adjusted for patient age as a potential confounding factor.
Of 5815 patients enrolled, BPH was already diagnosed in 4144 (71.3%), and not in 1671 (28.7%). Patients with known BPH, compared to newly diagnosed, were older (median 68 versus [vs] 55), had more frequent smoking (smoker 27.2 vs 22.6%, and ex-smoker 16.4 vs 12.5%) and drinking habits (55.4 vs 45.1%), were more frequently affected by hypertension (60.0 vs 42.4%), obesity (15.3 vs 9.6%), diabetes (17.9 vs 12.5%), and cardiovascular diseases (14.2 vs 9.5%), p < 0.001. At IPSS, moderate and severe symptoms correlated with already known BPH (56.1 vs 47.3% and 24.8 vs 7.8%), whereas newly diagnosed patients showed milder symptoms (44.9 vs 19.1%), all p < 0.001. At BII, concern for one's health and time lost due to urinary problems were higher in patients with known BPH (p < 0.001). For these patients, the urologist changes at least one of the ongoing medications in 63.5%. For patients newly diagnosed, supplements/phytotherapeutics, alpha-blockers, and 5-alfa reductase inhibitors were prescribed in 54.6%, 21.6%, and 7.1%, respectively.
Despite medical treatment, natural history of BPH leads to a progressive deterioration of symptoms. This may reflect the difference between newly diagnosed patients and those with known BPH in lifestyle and associated comorbidities. A healthy lifestyle and treatments including local anti-inflammatory agents may delay worsening of symptoms and improve quality of life.
良性前列腺增生（BPH）的临床表现证据有限，且缺乏涉及门诊患者的研究。我们旨在通过症状评分（国际前列腺症状评分[IPSS]、BPH 影响指数[BII]）了解意大利当前门诊中 BPH 患者的情况，并比较已知 BPH 患者和初诊患者的特征。
“改善路径”项目工作组前瞻性地向泌尿科医生管理的 BPH 门诊患者设计了一份问卷。这是一项横断面研究。数据根据患者年龄这一潜在混杂因素进行了调整。
在纳入的 5815 名患者中，4144 名（71.3%）已被诊断为 BPH，1671 名（28.7%）未被诊断。与初诊患者相比，已知 BPH 患者年龄更大（中位数 68 岁 vs 55 岁），吸烟（吸烟者 27.2% vs 22.6%，曾吸烟者 16.4% vs 12.5%）和饮酒习惯（55.4% vs 45.1%）更常见，更常受高血压（60.0% vs 42.4%）、肥胖（15.3% vs 9.6%）、糖尿病（17.9% vs 12.5%）和心血管疾病（14.2% vs 9.5%）的影响，p<0.001。在 IPSS 中，中度和重度症状与已知 BPH 相关（56.1% vs 47.3%和 24.8% vs 7.8%），而初诊患者的症状较轻（44.9% vs 19.1%），均p<0.001。在 BII 中，已知 BPH 患者对自身健康的担忧和因尿问题而失去的时间更多（p<0.001）。对于这些患者，泌尿科医生会改变至少一种正在使用的药物，比例为 63.5%。对于新诊断的患者，54.6%、21.6%和 7.1%分别开了补充剂/植物疗法、α-受体阻滞剂和 5-α还原酶抑制剂。
尽管进行了药物治疗，BPH 的自然病程仍导致症状逐渐恶化。这可能反映了初诊患者和已知 BPH 患者在生活方式和相关合并症方面的差异。健康的生活方式和包括局部抗炎药物在内的治疗方法可能会延缓症状恶化并改善生活质量。
