How widespread are urinary symptoms in the general population?

This study examined the prevalence of benign prostatic hyperplasia (BPH) and urinary symptoms among men in the general population. Researchers reported a considerably high prevalence of urinary symptoms, which was higher among older men, and progressed over 3 years for most men.

BPH can lead to bothersome urinary symptoms that can significantly affect quality of life. The enlargement of the prostate gland can squeeze or partly block the urethra (urine tract), causing an obstruction of urine flow. However, not all men experience urinary symptoms to the same extent and symptoms may progress at different rates.

BPH-related urinary symptoms are believed to become more common with the ageing population. A better understanding of how common (prevalent) and severe urinary symptoms are will help in targeting and optimizing treatment options.

The aim of this study was to examine the prevalence of BPH and urinary symptoms among men in the general population.

8,627 men aged between 48 and 79 were included from the general population (in Germany). A questionnaire measured the prevalence and severity of BPH and urinary symptoms. A follow-up questionnaire at 3 years measured the progression of urinary symptoms. A total of 7,821 men completed the follow-up questionnaire.

75.3% of men from the general population reported mild urinary symptoms. 22% reported moderate symptoms and a further 2.7% reported severe urinary symptoms. Moderate urinary symptoms were more common among men aged 70 years or more (28.6%) compared to younger men aged 50 to 59 (15.4%). Severe urinary symptoms were also more common in the older age group (4.2%) than in the younger age group (1.6%).

22.8% of men had a diagnosis of BPH at the time of the study. 4.5% of men were using medication for BPH and a further 4.2% were treated with BPH surgery. 58.6% of men with severe symptoms reported a diagnosis of BPH. However, only 24% of men with severe symptoms were treated with medication or surgery.

Nocturia (the need to wake up and pass urine during nighttime) was the most common BPH-related urinary symptom. About 55% of men reported getting up once per night, and about 27% reported getting up at least twice per night. Weak urine stream and frequency of urination were the symptoms that progressed most strongly across the 3 years.

At 3 years, 29.8% of men indicated to have moderate urinary symptoms with a further 4% reporting severe symptoms. Overall, 58.4% of men reported a worsening of symptoms since the previous questionnaire. In contrast, 27.1% of men reported an improvement during the same period. Worsening symptoms were more common among older men. 

Researchers concluded that a considerable proportion of men are affected by urinary symptoms, with and without a previous diagnosis of BPH, which increases with age. Symptoms over a 3-year period progressed in the majority of men with many men not undergoing any treatment.