Skip to main content

Epidemiology and Pathophysiology of LUTS/BPO

  • Chapter
  • First Online:
  • 1031 Accesses

Abstract

The prevalence of benign prostatic hyperplasia (BPH) is strongly related to age, ranging from 8 % in men in their 50s to roughly 90 % in men older than 80 years. Although aging represents the strongest risk factor for this, chronic progressive disease, obesity, and metabolic syndrome have been recently shown to be associated with an increased risk of BPH.

The etiology of BPH is still largely unsolved. However, tissue remodeling together with hormonal alterations and chronic inflammation have been recently proposed to be involved in its pathogenesis. The onset of symptoms is determined by prostatic enlargement, which consequently leads to bladder outlet obstruction and changes in the detrusor muscle function, finally resulting in LUTS.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474–9.

    PubMed  CAS  Google Scholar 

  2. Boyle P. New insights into the epidemiology and natural history of benign prostatic hyperplasia. Prog Clin Biol Res. 1994;386:3–18.

    PubMed  CAS  Google Scholar 

  3. Barry MJ, Fowler Jr FJ, O’Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148(5):1549–57; discussion 64.

    PubMed  CAS  Google Scholar 

  4. Homma Y, Kawabe K, Tsukamoto T, et al. Estimate criteria for diagnosis and severity in benign prostatic hyperplasia. Int J Urol. 1996;3(4):261–6.

    Article  PubMed  CAS  Google Scholar 

  5. Homma Y, Kawabe K, Tsukamoto T, et al. Epidemiologic survey of lower urinary tract symptoms in Asia and Australia using the international prostate symptom score. Int J Urol. 1997;4(1):40–6.

    Article  PubMed  CAS  Google Scholar 

  6. Chute CG, Panser LA, Girman CJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol. 1993;150(1):85–9.

    PubMed  CAS  Google Scholar 

  7. Roehrborn CG. The epidemiology of acute urinary retention in benign prostatic hyperplasia. Rev Urol. 2001 Fall;3(4):187–92.

    PubMed  CAS  Google Scholar 

  8. Bosch JL, Kranse R, van Mastrigt R, Schroder FH. Reasons for the weak correlation between prostate volume and urethral resistance parameters in patients with prostatism. J Urol. 1995;153(3 Pt 1):689–93.

    PubMed  CAS  Google Scholar 

  9. Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E. Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years. Urology. 2008;72(2):318–21.

    Article  PubMed  Google Scholar 

  10. Girman CJ, Jacobsen SJ, Tsukamoto T, et al. Health-related quality of life associated with lower urinary tract symptoms in four countries. Urology. 1998;51(3):428–36.

    Article  PubMed  CAS  Google Scholar 

  11. Overland GB, Vatten L, Rhodes T, et al. Lower urinary tract symptoms, prostate volume and uroflow in Norwegian community men. Eur Urol. 2001;39(1):36–41.

    Article  PubMed  CAS  Google Scholar 

  12. Chicharro-Molero JA, Burgos-Rodriguez R, Sanchez-Cruz JJ, del Rosal-Samaniego JM, Rodero-Carcia P, Rodriguez-Vallejo JM. Prevalence of benign prostatic hyperplasia in Spanish men 40 years old or older. J Urol. 1998;159(3):878–82.

    Article  PubMed  CAS  Google Scholar 

  13. Zhang SJ, Qian HN, Zhao Y, et al. Relationship between age and prostate size. Asian J Androl. 2013;15(1):116–20.

    Article  PubMed  Google Scholar 

  14. Roehrborn CG, McConnell J, Bonilla J, et al. Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol. 2000;163(1):13–20.

    Article  PubMed  CAS  Google Scholar 

  15. Girman CJ, Panser LA, Chute CG, et al. Natural history of prostatism: urinary flow rates in a community-based study. J Urol. 1993;150(3):887–92.

    PubMed  CAS  Google Scholar 

  16. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol. 2005;173(4):1256–61.

    Article  PubMed  Google Scholar 

  17. Kirby RS, Kirby M, Fitzpatrick JM. Benign prostatic hyperplasia: counting the cost of its management. BJU Int. 2010;105(7):901–2.

    Article  PubMed  Google Scholar 

  18. Issa MM, Regan TS. Medical therapy for benign prostatic hyperplasia – present and future impact. Am J Manag Care. 2007;13 Suppl 1:S4–9.

    PubMed  Google Scholar 

  19. Abdollah F, Briganti A, Suardi N, et al. Metabolic syndrome and benign prostatic hyperplasia: evidence of a potential relationship, hypothesized etiology, and prevention. Korean J Urol. 2011;52(8):507–16.

    Article  PubMed  Google Scholar 

  20. De Nunzio C, Aronson W, Freedland SJ, Giovannucci E, Parsons JK. The correlation between metabolic syndrome and prostatic diseases. Eur Urol. 2012;61(3):560–70.

    Article  PubMed  Google Scholar 

  21. McNeal J. Pathology of benign prostatic hyperplasia. Insight into etiology. Urol Clin North Am. 1990;17(3):477–86.

    PubMed  CAS  Google Scholar 

  22. Zhao Y, Peng J, Zheng L, Yu W, Jin J. Transforming growth factor beta1 mediates apoptotic activity of angiotensin II type I receptor blocker on prostate epithelium in vitro. Prostate. 2010;70(8):899–905.

    PubMed  CAS  Google Scholar 

  23. Roehrborn CG. Pathology of benign prostatic hyperplasia. Int J Impot Res. 2008;20 Suppl 3:S11–8.

    Article  PubMed  Google Scholar 

  24. Wilson JD, Roehrborn C. Long-term consequences of castration in men: lessons from the Skoptzy and the eunuchs of the Chinese and Ottoman courts. J Clin Endocrinol Metab. 1999;84(12):4324–31.

    Article  PubMed  CAS  Google Scholar 

  25. Stone NN, Clejan SJ. Response of prostate volume, prostate-specific antigen, and testosterone to flutamide in men with benign prostatic hyperplasia. J Androl. 1991;12(6):376–80.

    PubMed  CAS  Google Scholar 

  26. Jeong YB, Kwon KS, Kim SD, Kim HJ. Effect of discontinuation of 5alpha-reductase inhibitors on prostate volume and symptoms in men with BPH: a prospective study. Urology. 2009;73(4):802–6.

    Article  PubMed  Google Scholar 

  27. Parsons JK, Palazzi-Churas K, Bergstrom J, Barrett-Connor E. Prospective study of serum dihydrotestosterone and subsequent risk of benign prostatic hyperplasia in community dwelling men: the Rancho Bernardo Study. J Urol. 2010;184(3):1040–4.

    Article  PubMed  CAS  Google Scholar 

  28. Liao CH, Li HY, Chung SD, Chiang HS, Yu HJ. Significant association between serum dihydrotestosterone level and prostate volume among Taiwanese men aged 40–79 years. Aging Male. 2012;15(1):28–33.

    Article  PubMed  CAS  Google Scholar 

  29. Thomas JA, Keenan EJ. Effects of estrogens on the prostate. J Androl. 1994;15(2):97–9.

    PubMed  CAS  Google Scholar 

  30. Prins GS, Huang L, Birch L, Pu Y. The role of estrogens in normal and abnormal development of the prostate gland. Ann N Y Acad Sci. 2006;1089:1–13.

    Article  PubMed  CAS  Google Scholar 

  31. Roberts RO, Jacobson DJ, Rhodes T, Klee GG, Leiber MM, Jacobsen SJ. Serum sex hormones and measures of benign prostatic hyperplasia. Prostate. 2004;61(2):124–31.

    Article  PubMed  CAS  Google Scholar 

  32. Vermeulen A, Kaufman JM, Goemaere S, van Pottelberg I. Estradiol in elderly men. Aging Male. 2002;5(2):98–102.

    PubMed  CAS  Google Scholar 

  33. De Marzo AM, Platz EA, Sutcliffe S, et al. Inflammation in prostate carcinogenesis. Nat Rev Cancer. 2007;7(4):256–69.

    Article  PubMed  Google Scholar 

  34. De Nunzio C, Kramer G, Marberger M, et al. The controversial relationship between benign prostatic hyperplasia and prostate cancer: the role of inflammation. Eur Urol. 2011;60(1):106–17.

    Article  PubMed  Google Scholar 

  35. Steiner GE, Newman ME, Paikl D, et al. Expression and function of pro-inflammatory interleukin IL-17 and IL-17 receptor in normal, benign hyperplastic, and malignant prostate. Prostate. 2003;56(3):171–82.

    Article  PubMed  CAS  Google Scholar 

  36. Steiner GE, Stix U, Handisurya A, et al. Cytokine expression pattern in benign prostatic hyperplasia infiltrating T cells and impact of lymphocytic infiltration on cytokine mRNA profile in prostatic tissue. Lab Invest. 2003;83(8):1131–46.

    Article  PubMed  CAS  Google Scholar 

  37. Handisurya A, Steiner GE, Stix U, et al. Differential expression of interleukin-15, a pro-inflammatory cytokine and T-cell growth factor, and its receptor in human prostate. Prostate. 2001;49(4):251–62.

    Article  PubMed  CAS  Google Scholar 

  38. Royuela M, de Miguel MP, Ruiz A, et al. Interferon-gamma and its functional receptors overexpression in benign prostatic hyperplasia and prostatic carcinoma: parallelism with c-myc and p53 expression. Eur Cytokine Netw. 2000;11(1):119–27.

    PubMed  CAS  Google Scholar 

  39. Giri D, Ittmann M. Interleukin-8 is a paracrine inducer of fibroblast growth factor 2, a stromal and epithelial growth factor in benign prostatic hyperplasia. Am J Pathol. 2001;159(1):139–47.

    Article  PubMed  CAS  Google Scholar 

  40. Wang L, Yang JR, Yang LY, Liu ZT. Chronic inflammation in benign prostatic hyperplasia: implications for therapy. Med Hypotheses. 2008;70(5):1021–3.

    Article  PubMed  Google Scholar 

  41. Sarma AV, Parsons JK, McVary K, Wei JT. Diabetes and benign prostatic hyperplasia/lower urinary tract symptoms – what do we know? J Urol. 2009;182(6 Suppl):S32–7.

    Article  PubMed  Google Scholar 

  42. Alexandraki K, Piperi C, Kalofoutis C, Singh J, Alaveras A, Kalofoutis A. Inflammatory process in type 2 diabetes: the role of cytokines. Ann N Y Acad Sci. 2006;1084:89–117.

    Article  PubMed  CAS  Google Scholar 

  43. Gustafson B, Hammarstedt A, Andersson CX, Smith U. Inflamed adipose tissue: a culprit underlying the metabolic syndrome and atherosclerosis. Arterioscler Thromb Vasc Biol. 2007;27(11):2276–83.

    Article  PubMed  CAS  Google Scholar 

  44. Murdolo G, Smith U. The dysregulated adipose tissue: a connecting link between insulin resistance, type 2 diabetes mellitus and atherosclerosis. Nutr Metab Cardiovasc Dis. 2006;16 Suppl 1:S35–8.

    Article  PubMed  Google Scholar 

  45. McNeal JE. Origin and evolution of benign prostatic enlargement. Invest Urol. 1978;15(4):340–5.

    PubMed  CAS  Google Scholar 

  46. Gacci M, Eardley I, Giuliano F, et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2011;60(4):809–25.

    Article  PubMed  Google Scholar 

  47. McVary KT, Rademaker A, Lloyd GL, Gann P. Autonomic nervous system overactivity in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2005;174(4 Pt 1):1327–433.

    Article  PubMed  Google Scholar 

  48. Anumanthan G, Tanaka ST, Adams CM, et al. Bladder stromal loss of transforming growth factor receptor II decreases fibrosis after bladder obstruction. J Urol. 2009;182(4 Suppl):1775–80.

    Article  PubMed  CAS  Google Scholar 

  49. Williams AM, Simon I, Landis PK, et al. Prostatic growth rate determined from MRI data: age-related longitudinal changes. J Androl. 1999;20(4):474–80.

    PubMed  CAS  Google Scholar 

  50. Roberts RO, Jacobsen SJ, Jacobson DJ, Rhodes T, Girman CJ, Lieber MM. Longitudinal changes in peak urinary flow rates in a community based cohort. J Urol. 2000;163(1):107–13.

    Article  PubMed  CAS  Google Scholar 

  51. Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997;158(2):481–7.

    Article  PubMed  CAS  Google Scholar 

  52. McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349(25):2387–98.

    Article  PubMed  CAS  Google Scholar 

  53. Roehrborn CG. Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. BJU Int. 2006;97(4):734–41.

    Article  PubMed  CAS  Google Scholar 

  54. Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Treatment for benign prostatic hyperplasia among community dwelling men: the Olmsted County study of urinary symptoms and health status. J Urol. 1999;162(4):1301–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alberto Briganti .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Briganti, A., Gandaglia, G. (2014). Epidemiology and Pathophysiology of LUTS/BPO. In: Chapple, C., Tubaro, A. (eds) Male LUTS/BPH Made Easy. Springer, London. https://doi.org/10.1007/978-1-4471-4688-9_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4688-9_2

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4687-2

  • Online ISBN: 978-1-4471-4688-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics