The association of new-onset diabetes mellitus and medical therapy for benign prostatic hyperplasia: A population-based study

The association between lower urinary tract symptoms secondary to benign prostatic hyperplasia and multimorbidity among Chinese middle-aged and elderly males: evidence based on propensity score matching

Background

With the aging population, patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) often face multiple chronic conditions (multimorbidity), significantly impacting their quality of life. This study aims to determine the relationship between LUTS/BPH, multimorbidity, and various chronic diseases in middle-aged and elderly Chinese populations.

Methods

This cross-sectional study utilizes data from the China Health and Retirement Longitudinal Study (CHARLS), involving 6,645 residents aged 45 and above. Data on 14 chronic diseases were collected, with multimorbidity defined based on the presence of 2-5 chronic conditions. The number of chronic conditions was further categorized into five groups. Propensity score matching (PSM) was used to control for 11 confounding factors. Linear regression was employed to analyze the relationship between LUTS/BPH and the number of chronic conditions in middle-aged and elderly Chinese men before and after PSM. Both univariate and multivariate logistic regression analyses were used to explore the association between LUTS/BPH and multimorbidity as well as each chronic disease.

Results

The prevalence of multimorbidity was significantly higher among middle-aged and elderly individuals with LUTS/BPH compared to those without. Before PSM, LUTS/BPH was positively correlated with the number of chronic diseases (β=0.175, P<0.001), and the risk of multimorbidity significantly increased, showing a dose-response relationship. The risk of having at least two chronic diseases in patients with LUTS/BPH was 2.39 times higher than in those without LUTS/BPH [odds ratio (OR) =2.39, 95% confidence interval (CI): 2.04-2.80], and the risk of having five chronic diseases was 3.97 times higher (OR =3.97, 95% CI: 3.14-4.99). After PSM, 819 pairs were successfully matched. The positive correlation between LUTS/BPH and multimorbidity still existed, with the risks of having at least two and five chronic diseases being 2.37 times (OR =2.37, 95% CI: 1.94-2.90) and 3.69 times (OR =3.69, 95% CI: 2.62-5.29) higher, respectively. Among them, the risk of emotional/nervous/psychiatric problems was the highest in LUTS/BPH patients (OR =6.58, 95% CI: 2.22-28.13), while the risk of arthritis/rheumatism was the lowest (OR =1.60, 95% CI: 1.30-1.98).

Conclusions

In the Chinese population, LUTS/BPH is closely associated with multimorbidity and each of the 14 chronic diseases examined, with a dose-response relationship based on the number of chronic diseases defined within multimorbidity. It is imperative to incorporate LUTS/BPH into multimorbidity research and management. We recommend that clinicians and policymakers consider the increased risk of multimorbidity and various chronic diseases among male LUTS/BPH patients.

Risks and side effects in the medical management of benign prostatic hyperplasia

Benign prostatic hyperplasia affects up to 80% of men in their lifetime. It causes bladder outflow obstruction, leading to lower urinary tract symptoms, which can have a large impact on quality of life. Lifestyle modifications and pharmacotherapy are often offered as first-line treatments for patients. These include alpha blockers, 5-alpha-reductase inhibitors, phosphodiesterase-5 inhibitors, anticholinergics, B3-agonists, and desmopressin. While often well tolerated, these pharmacotherapies do have significant side effects, which both clinicians and patients should understand and discuss in order to make an informed treatment decision among alternatives. The purpose of this review is to provide a current overview of the risks and side effects of commonly used medications in benign prostatic hyperplasia management.

Potential side effects of currently available pharmacotherapies in male lower urinary tract symptoms suggestive of benign prostatic hyperplasia

INTRODUCTION

The drug classes of α1-adrenoceptor antagonists, 5α-reductase inhibitors, and phosphodiesterase type 5 inhibitors are guideline-recommended treatments of lower urinary tract symptoms suggestive of benign prostatic hyperplasia; muscarinic receptor antagonists and β3-adrenoceptor agonists are also recommended if storage symptoms are insufficiently addressed with one of the other three drug classes.

AREAS COVERED

We provide a narrative review (no formalized literature searches performed) of the tolerability of these drug classes with emphasis on the more recently introduced medications, on combination treatment, and on more lately emerging risks.

EXPERT OPINION/COMMENTARY

The tolerability profiles are distinct between drug classes but, with few exceptions, similar within a drug class. Within a drug, formulations with longer duration of action tend to have better tolerability. Efficacy gains using combination treatment at least partly come at a cost of lesser tolerability. Greater susceptibility to experience adverse events based on age, comorbidities, and comedications appears conceptually important but remains under-investigated in this therapeutic area.

Efficacy and Safety of 1470 nm Diode Laser Enucleation of the Prostate in Elderly Benign Prostatic Hyperplasia Patients

Objective: The aim of this study was to evaluate efficacy and safety of 1470 nm diode laser enucleation of the prostate (DiLEP) and plasmakinetic resection of the prostate (PKRP) in elderly benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms. Methods: A total of 123 elderly patients with BPH were randomized to undergo either 1470 nm DiLEP or PKRP by means of a random number table from September 2020 to April 2022. The perioperative and postoperative data were studied during a 3- and 6-month follow-up. Results: The patients treated with 1470 nm DiLEP had significantly decreased operation time (74.6 ± 17.0 vs 98.8 ± 18.9 minutes, p < 0.001), hemoglobin loss (1.06 ± 0.49 vs 1.59 ± 0.60 g/dL, p < 0.001), bladder irrigation time (22.1 ± 8.1 vs 33.9 ± 10.0 hours, p < 0.001), catheter duration (3.2 ± 1.3 vs 5.8 ± 1.0 days, p < 0.001), and hospital stay (7.6 ± 1.4 vs 9.6 ± 1.3 days, p < 0.001) compared with the PKRP group. Besides, International Index of Erectile Function-5 score of 1470 nm DiLEP group at postoperative 3- and 6-month follow-up was significantly higher than PKRP group. No differences achieving statistical significance were identified in total prostate-specific antigen, maximum urinary flow rate, International Prostate Symptom Score, quality-of-life score, and the postvoid residual urine volume, transient incontinence, urethral stricture, bladder neck contracture, and retrograde ejaculation at 3- and 6-month follow-up. Conclusions: 1470 nm DiLEP is safer than PKRP, with a smaller effect on sexual function, and it is comparable with the efficacy of PKRP, thus making it more suitable for elderly BPH patients. Clinical Trial Registration number: S2021-463-01.

Analysis of Risk Factors and Nursing Strategies for Postoperative Hemorrhage of Benign Prostatic Hyperplasia

This study is to investigate the risk factors analysis and nursing strategies for postoperative bleeding of benign prostatic hyperplasia (BPH). Totally, 240 BPH patients after surgical excision admitted to Hengshui People's Hospital between January 2019 and January 2020 were recruited. Of the 240 BPH patients, 20 had postoperative bleeding, accounting for 8.3% of all enrollments. Risk factors for postoperative bleeding included large prostate, diabetes, hypertension, urinary tract infection within 1 week before surgery, and the absence of epidural analgesia pumps. There were 87 patients receiving routine nursing (routine group) and 153 patients receiving routine nursing plus hemorrhage prevention care (study group). The study group had fewer cases of postoperative bleeding than the routine group. The influencing factors of postoperative bleeding in patients with prostatic hyperplasia include systemic and local factors, and corresponding hemorrhage prevention care should be performed based on the principle of evidence-based care to reduce the risk of postoperative bleeding.