Norman R W, Nickel J C, Fish D, Pickett S N
Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
Br J Urol. 1994 Nov;74(5):542-50. doi: 10.1111/j.1464-410x.1994.tb09181.x.
To determine the prevalence of symptoms associated with benign prostatic hyperplasia (BPH) in Canadian men, and to establish whether the traditional separation of these symptoms into obstructive and irritative categories is valid.
A probability sample of 508 Canadian men 50 years of age or older was surveyed by telephone. The survey questions and scoring system used were devised to allow estimation of symptom prevalence and were based on the frequency and severity of the symptoms. Using the data from respondents who had moderate to severe symptoms, a cluster analysis was utilized to analyse relationships among symptoms.
The most prevalent symptoms were nocturia (63%), weak stream (61%) and urinary frequency (46%). Urgency was reported by 18%, a sense of incomplete bladder emptying by 23%, intermittency by 18% and hesitancy by 13%. Using predefined cutoff scores, 23% of the respondents experienced moderate to severe symptoms associated with BPH; the prevalence of moderate to severe symptoms increased with age. The clusters were grouped on the basis of the symptoms driving them, with one cluster designated as 'moderates', two clusters designated as 'irritatives' and two designated as 'obstructives'. The moderates cluster was driven by respondents who had lower symptom scores evenly distributed across all symptoms. The irritatives and obstructives clusters were driven by respondents with higher scores for symptoms considered by convention to be irritative or obstructive in nature and, thus, were designated accordingly. Not all symptoms were discriminatory for irritative and obstructive symptom domains.
A large percentage of Canadian men 50 years of age or older experience symptoms commonly associated with BPH. The theoretical concept of irritative and obstructive symptom domains was supported partially by the cluster analysis. A clear typology of men with BPH symptoms could prove useful if treatments were found to be more effective for certain types of BPH symptoms. Thus these observations warrant further investigation into the differential effects of management approaches for BPH symptoms according to symptom clusters.
