The only clearly defined risk factors for BPH are age and the presence of elevated
androgens in the blood. But there are other factors that can influence the prevalence of
clinical disease such as metabolic syndrome, diabetes, obesity, hypertension, diet and
heredity.
Clinical BPH often occurs within the same family. If one or more first-degree relatives
have had BPH, then a person is at greater risk of developing the disease. The probability
of developing BPH and the rates of occurrence and progression of LUTS increase
significantly with age. In a study of 278 men with an average age of 58 years, it was
shown that prostate volume increased at an average rate of 0.6ml per year.
Although the severity of symptoms cannot be directly related to prostate volume, having a
large prostate volume is a risk factor for developing LUTS (a larger prostate is
associated with an increased risk of urinary retention).
Data support that the metabolic syndrome may influence the natural course regarding the
development of BPH and BOO. Metabolic syndrome includes hypertension, dyslipidemia,
glucose intolerance, obesity, and insulin resistance with compensatory hyperinsulinemia.
In a meta-analysis it was shown that the obese, the elderly, patients with low HDL
cholesterol values and patients with metabolic syndrome had a significantly higher total
prostate volume.
Diabetes mellitus as a cause of bladder dysfunction can manifest either as overactivity
or as poor detrusor function. Diet has been reported as a risk factor for the development
of BPH. High amounts of vegetables and soy products in the diet may explain the lower
rate of BPH in Eastern compared to Western countries. The association of alcohol, diet,
and other lifestyle factors with obstructive uropathy was investigated in a cohort of
6,581 Japanese-American men, 846 of whom were later diagnosed with BPH (after 17 years of
follow-up). Total alcohol intake was inversely associated with the risk of developing
obstructive uropathy or BPH (i.e., reduced risk of developing the disease).
In the present study purpose is to evaluate the symptoms of the lower urinary tract in
patients with BPH; the International Prostate Symptom Score (IPSS) questionnaire will be
used, which is a modification of the AUA Symptom Index by adding a question that
evaluates the quality of life in relation to the disease.
Both the AUA index and the IPSS questionnaire, although not specific for BPH, prostate
volume, urine flow rate, residual urine volume after voiding or bladder obstruction, have
been validated and are sufficiently sensitive for be used in symptom assessment and
treatment selection. Although the assessment of specific symptoms is necessary for the
treatment outcome of LUTS due to BPH, it is also important to have a simpler approach
that addresses the patients' perception of the severity and change of their symptoms.
The Patient Global Impression of Severity (PGI-S) questionnaire assesses the patient's
overall impression of the severity of his condition due to BPH symptoms and is a record
of perception of the patient in a simple, valid and easily administered manner in
clinical practice. The Patient Global Impression of Change (PGI-C) is the questionnaire
it assesses the patient's overall impression of the change in their condition due to a
treatment choice and is widely used in studies to assess chronic pain and/or for the
patient's self-assessment of the overall improvement of a treatment.