Epidemiology of prostatic disorders in the city of Barcelona

[Techniques and current practice of urodynamics. Problems and traps]

Development of urodynamics particularly during the past decade are highlighted, as well as a number of issues to be faced in the near future: research into the etiopathogenesis of different conditions, finding more sensitive and specific diagnostic procedures to overcome the current ones, establishing more comprehensive indications for urodynamics examinations and, as a result of all the above achieving greater improvement of certain surgical procedures. Both the technique and interpretation of the different urodynamic examinations, as well as the more recent innovations, implementation issues and controversies are detailed to a highly up-to-date level. Neuromodulation and ambulatory urodynamics deserve thoughtful consideration in this paper. Finally, attention is given to the controversies and future challenges such as urodynamic research providing accurate diagnosis of lower urinary tract obstruction in women, establishing the indication of urodynamic studies in women with urinary exertional incontinence, outlining the indications of neuromodulation and ambulatory urodynamics, applicability of artificial intelligence systems, improvement of artificial sphincter materials, tissue growth for bladder enlargement and actual prevention of myelodysplasia.

The epidemiology of benign prostatic hyperplasia: a study in Greece

OBJECTIVE

To assess the epidemiology of benign prostatic hyperplasia (BPH) in a case-control study in greater Athens, Greece.

PATIENTS AND METHODS

The study comprised 184 patients surgically treated for BPH within one year of its diagnosis (cases) and 246 patients with no symptoms of BPH who were treated in the same hospitals for minor diseases or conditions (controls). All cases and controls were permanent residents of the greater Athens area, Greece. The data were assessed using unconditional logistic regression.

RESULTS

After controlling for age and education, cases and controls had similar distributions for height, body mass index, sibship size and birth order in the parental family, marital status, number of offspring and a series of previous medical diagnoses or surgical operations. The sole exception was surgery for haemorrhoids, that appeared to be related to the incidence of BPH, possibly by chance. There was no evidence that vertex baldness, tobacco smoking, alcohol consumption or coffee drinking increased the risk for BPH. Men who had spent most of their lives in a rural rather than an urban environment appeared to be at reduced risk for BPH.

CONCLUSION

The lifestyle factors assessed here have no major effect on the aetiology of BPH.

Is there an association between cigarette smoking and gland size in benign prostatic hyperplasia?

Several studies have implied a potential inhibitory effect of smoking on the development of clinical benign prostatic hypertrophy (BPH). None of these studies compared gland size and smoking habits. We prospectively test the hypothesis that the identified "negative risk factor" that cigarette smoke has on the development of clinical BPH is mediated through inhibition of gland growth. One hundred and ninety-five men underwent transrectal ultrasonography with prostate volume calculations. A self-administered questionnaire detailing smoking habits was completed by the subjects. Correlations were looked for between various smoking habit parameters and gland size. Prostate gland size did not differ between current smokers, ex-smokers, and never smokers. Prostate volume did not correlate with smoking years (duration of exposure), nor with intensity of exposure (cigarette packyears). Smoke-mediated changes in enzymatic and endocrine pathways that regulate prostatic growth have been well documented. However, whatever "protective" effects smoke may have on BPH, they are not mediated via direct inhibition on gland growth. Alternatively, cigarette smoke may be involved in changing the dynamic component of BPH. Further testing, with special emphasis on irritative and obstructive symptoms, may help elucidate this possibility.

Mortality from benign prostatic hyperplasia: worldwide trends 1950-92

STUDY OBJECTIVE

To provide a systematic overview of worldwide trends in mortality from benign prostatic hyperplasia (BPH) over the past four decades.

DESIGN

This was a descriptive analysis based on age adjusted mortality rates for BPH between 1950 and 1992 for 41 countries from five continents.

SETTING

Official death certifications from the World Health Organization database.

MAIN RESULTS

In the 1950s, the highest age adjusted (on the world standard population) mortality rates for BPH in Europe were in Denmark (22.8/100,000) and Germany (18.1), followed by Scandinavian countries, the UK, and Switzerland. Italy had rates around 10/100,000, and rates were lower in eastern and southern Europe (5-8/100,000). Between 1950 and 1990, a fall of over 90%, or even 95%, was observed in most western European countries. Thus, in the early 1980s, overall mortality from BPH ranged between 0.5 and 1.5/100,000 in most western European countries. In proportional terms, similar reductions were registered in other developed countries of North America, Asia (that is, Japan or Singapore), and Oceania. A fall in rates was also observed in eastern Europe and in Latin America, particularly from the late 1970s onwards, although these reductions were generally much smaller. Thus, in the early 1990s, most countries in these areas had BPH rates between 1 and 5/100,000. The pattern of trends was, at least qualitatively, similar at younger ages, although most falls were proportionally greater.

CONCLUSIONS

The most probable interpretation of these trends is that therapeutic improvements--including more widespread and timely surgery, introduction of less invasive techniques, such as transurethral prostatectomy, and possibly the development of medical treatments--have had a favourable and substantial impact on BPH mortality. There are, however, areas of the world, including several countries of western Europe and South America, where rates are still very high.

[Changing the epidemiological surveillance into the public health surveillance. Work Group on Information Systems in Public Health]

Although epidemiological surveillance include originally a strategic function, beyond epidemic control, in Spain the communicable diseases control system has been the only surveillance scheme. This system suffer a severe crisis, probably due to the scarce uses of the information and/or because the system produce exclusively information about communicable diseases or outbreaks. In the last few years, information sources and procedure have been developed out of the official surveillance, such as cancer register, traffic accidents or air contamination statistics and so on. Moreover, national and regional health plans which signify specific health objectives entail information tools with ability to rank and evaluate the interventions. The principal health information system useful to surveillance has been described. We conclude that the expression public health surveillance define much better the functions of a) monitoring and evaluation of the health policy and b) detection and research of epidemics. Finally, we identify some elements for the change, such as: a) to include information related to adverse effects of the sanitary interventions, and environmental and occupational hazards; b) to facilitate the access of information by means of self-operating database and c) to make comparable the different information sources.

Urinary symptoms: prevalence and severity in British men aged 55 and over

OBJECTIVE

To measure the prevalence and severity of urinary symptoms among men aged 55 and over in the British population.

DESIGN

Cross sectional population survey using a postal questionnaire.

SETTING

North West Thames health region.

SUBJECTS

1480 men aged 55 years and over randomly selected from 8 general practices.

MAIN OUTCOME MEASURES

Self reported frequency and severity of urinary symptoms, their bothersomeness and previous prostate surgery.

RESULTS

The response rate among eligible subjects was 78%. The prevalence of moderate and severe symptoms was 204 per 1000, rising from 160 per 1000 in the 55-59 age group to 259 per 1000 in the 70-74 age group and declining after the age of 80 to 119 per thousand in the 85+ age group. Twelve per cent of men reported previous prostate surgery, and the probability of having had surgery increases steadily with age. About a third of those undergoing surgery have recurrence or persistence of symptoms after surgery. Of men with moderate and severe symptoms, 27.9% reported that their symptoms were a medium or big problem, 36.9% reported that their symptoms interfered with their daily activities at least some of the time, and 43.1% were unhappy or 'felt terrible' about the prospect of a future with their current symptoms.

CONCLUSION

The prevalence of urinary symptoms in men is lower than previously reported, although there is a substantial number of men who are bothered by, or who find their lives adversely effected by them.

Prevalence and detection of micturition problems among 2,734 elderly men

In previous studies symptom prevalence of micturition problems in the population appeared to be high. Our study supports these data and adds retrospective data on doctor visits, with 25% reporting a doctor visit during the last 5 years for a micturition problem. However, all symptoms (hematuria, dysuria, incontinence and symptoms possibly related to benign prostatic hyperplasia) showed substantial numbers of patients who were not sufficiently motivated or did not have the opportunity to visit a doctor for diagnosis and advice. Multiple logistic regression analysis showed a number of symptoms that independently predict doctor visits for benign prostatic hyperplasia and related diseases (frequent urination at night, frequent urination during the day, incomplete emptying, dysuria and incontinence). We conclude that the iceberg phenomenon applies to the number of patient visits and the predictive value of symptoms for prognosis of several prostate diseases.