Background: Benign Prostatic Hypertrophy (BPH) is a prevalent condition among older men, leading to significant health and economic burdens. The management of BPH is crucial in mitigating its impact on patients' quality of life, especially in resource-limited settings like Nigeria.

Objective: This study aims to evaluate the prevalence and risk factors of BPH among men aged 55-75 years in tertiary hospitals in Anambra, Nigeria, and to assess the effectiveness of various treatment modalities on patients' quality of life.

Methodology: A retrospective analysis was conducted on medical records of 100 male patients diagnosed with BPH between 2017 and 2022. Data were collected on demographic characteristics, medical history, clinical presentation, diagnostic findings, treatment modalities, and patient-reported outcome measures (PROMs). Descriptive statistics summarized patient characteristics, prevalence rates, and risk factor distribution. Regression analysis identified potential risk factors associated with BPH, and statistical tests compared treatment outcomes.

Results and Findings: The study revealed a high prevalence of BPH among the study population, with common comorbidities including hypertension (48%) and diabetes (22%). Family history was a significant risk factor (38%). The most prevalent symptoms were increased urinary frequency (80%) and weak urine stream (70%). Alpha-blockers were the most common medication (55%), and transurethral resection of the prostate (TURP) was the primary surgical intervention (30%). Significant symptom improvement was reported by 65% of patients, with 72% noting an improved quality of life. Long-term follow-up showed sustained quality of life improvement in 68% of patients.

Conclusion: BPH poses a substantial health burden, with comorbidities exacerbating its impact. Effective management requires a comprehensive approach that includes early diagnosis, multidisciplinary care, and patient-tailored treatment strategies.

Recommendations: Based on the findings, the implementation of robust screening and early intervention programs, especially for individuals with a family history of prostate disease using detailed diagnostic data to guide personalized treatment plans as well as incorporating patient-reported outcome measures to evaluate treatment effectiveness and enhance patient satisfaction is recommended.

Benign Prostate Hypertrophy (BPH), also known as benign prostatic hyperplasia, is a common condition that affects men as they age. It is characterized by the non-cancerous enlargement of the prostate gland, which can lead to a variety of urinary symptoms. These symptoms include increased frequency and urgency of urination, difficulty starting and maintaining urination, weak urine stream, and the sensation of incomplete bladder emptying. The exact cause of BPH is not fully understood, but it is believed to be related to hormonal changes that occur as men get older. The condition significantly impacts the quality of life, causing discomfort, sleep disturbances, and affecting daily activities [1]. In chronic diseases, the quality of life of a patient, which reflects their overall health, is a critical measure for assessing the effectiveness of treatments. Health-related quality of life (HRQOL) refers to the subjective experience of a disease and its treatment on an individual's physical, psychological, and social well-being. The increasing interest in HRQOL outcomes aligns with the growing recognition of the importance of a patient's perception of their health condition following medical interventions. Benign Prostatic Hyperplasia (BPH) presents a substantial financial and health burden worldwide, affecting millions of men, particularly as they age. The World Health Organization (WHO) reports that BPH is one of the most common conditions affecting the prostate gland, with its prevalence increasing with age [2,3]. Globally, the economic impact of BPH is considerable, with annual direct healthcare costs estimated to exceed billions of dollars due to frequent medical visits, diagnostic procedures, and treatments. The economic burden is particularly pronounced in low- and middle-income countries where healthcare infrastructure is less developed and out-of-pocket expenditures are high. BPH also significantly impairs the quality of life and overall health of affected individuals. According to the Global Burden of Disease Study 2019, BPH is a leading cause of lower urinary tract symptoms (LUTS), which include increased urinary frequency, urgency, nocturia, and incomplete bladder emptying. These symptoms can lead to serious complications such as acute urinary retention, recurrent urinary tract infections, and renal insufficiency if not managed appropriately [4]. This growing health burden reveals the critical need for improved awareness, early diagnosis, and effective management strategies to reduce the impact of BPH on individuals and healthcare systems globally.

The treatment of BPH includes several modalities ranging from lifestyle changes and medications to surgical interventions. Medications commonly prescribed include alpha-blockers, which relax the muscles of the prostate and bladder neck to ease urination, and 5-alpha-reductase inhibitors, which shrink the prostate [5]. Surgical options, such as transurethral resection of the prostate (TURP), are considered for more severe cases. Each treatment option comes with its own benefits and potential side effects. For instance, while medications can provide symptom relief, they may also cause dizziness, retrograde ejaculation, and other side effects [6]. Surgical interventions, though more definitive, carry risks such as bleeding, infection, and potential sexual dysfunction [7]. Studies have shown that the choice of treatment can significantly impact the quality of life for men with BPH. A study conducted by Roehrborn with a sample size of 1,200 men across multiple countries utilized a randomized controlled trial methodology to compare the effectiveness of combination therapy (alpha-blockers and 5-alpha-reductase inhibitors) with monotherapy [8]. The findings indicated that combination therapy provided superior symptom relief and improved quality of life compared to monotherapy. However, it also highlighted an increase in adverse effects, underscoring the need for personalized treatment plans based on patient-specific factors and preferences. In Africa, specifically Nigeria, the burden of BPH is exacerbated by limited access to healthcare resources, socio-economic challenges, and a lack of specialized medical facilities. A study by Ajayi in Nigeria, which included 500 men from both urban and rural settings, utilized a cross-sectional survey methodology to assess the prevalence and impact of BPH. The study revealed a high prevalence of BPH symptoms, with significant negative impacts on quality of life, particularly in rural areas with limited access to medical care. The study recommended improving healthcare infrastructure and increasing awareness about BPH and its treatment options to better manage the condition in these settings.

Moreover, Ojewola conducted a descriptive cross-sectional study among 305 community-dwelling men in Southwest Nigeria to assess knowledge, attitudes, and screening practices regarding prostatic diseases [9]. The study found that only 32.5% of respondents were aware of BPH, and a mere 10.2% had undergone screening for prostate cancer. Educational and occupational status significantly influenced knowledge and attitudes, highlighting the need for targeted education and awareness programs. Another study by Agbugui examined the bacteriology of urine specimens from men with symptomatic BPH, finding that 44.7% had bacterial infections, with Escherichia coli being the most common isolate [10]. These findings underscore the importance of considering bacterial infections in the management of BPH and the need for effective antibiotic stewardship. Nneoma Igwe and Israel Eshiet conducted a retrospective descriptive assessment of 102 patients diagnosed with BPH in a tertiary hospital in Eastern Nigeria [11]. Their study aimed to assess the incidence, treatment patterns, and direct cost of managing BPH. They found an incidence rate of 6.7%, with 99% of patients receiving pharmacological interventions, primarily a combination of alpha blockers and 5-alpha reductase inhibitors. The mean number of hospital visits per year was 4.4, with patients incurring significant out-of-pocket expenses, totalling approximately N4, 966,080 ($12,810 USD) annually. This highlights the financial burden of BPH treatment and the need for cost-effective management strategies to prevent complications and reduce costs. A global perspective is provided by Awedew, who conducted a systematic analysis of BPH's burden across 204 countries and territories from 2000 to 2019 [12,13]. Using GBD 2019 analytical and modelling strategies, the study found that the global prevalence of BPH increased from 51.1 million cases in 2000 to 94.0 million in 2019. The age-standardized prevalence remained stable, but the absolute burden increased significantly, especially in low and middle-income countries. The study highlighted the rising strain on health systems due to the increasing prevalence and emphasized the importance of monitoring and planning for future healthcare needs to manage the growing burden of BPH. This paper aims to build on existing research by examining the impact of various treatment modalities on the quality of life of men with BPH in tertiary hospitals across Africa, with a focus on Nigeria. In evaluating patient-reported outcomes and clinical measures, this research seeks to provide insights into optimizing treatment strategies and improving healthcare delivery for BPH patients in resource-limited settings. The findings are expected to inform healthcare policies and enhance patient management practices to better address the needs of men suffering from BPH in these regions.

This study is a retrospective analysis of medical records of male patients aged 55-75 years diagnosed with Benign Prostate Hypertrophy (BPH) between 2017 and 2022 in tertiary hospitals in Anambra State. The study aims to determine the prevalence and risk factors of BPH in this population and evaluate the effectiveness of different treatment options on patients’ quality of life. The study population comprises male patients aged 55-75 years diagnosed with BPH in the selected tertiary hospitals. A sample size of 100 patients will be obtained using a systematic random sampling technique. Medical records of these patients will be retrieved and reviewed for relevant data. This sampling method ensures equal probability of selection for all eligible patients, enhancing the study’s representativeness. Data will be collected through a retrospective review of patient medical records. Information extracted will include demographic characteristics (age, occupation, marital status), medical history (comorbidities, family history of prostate disease), clinical presentation (symptoms, duration), diagnostic findings (prostate-specific antigen [PSA] levels, prostate volume, uroflowmetry), treatment modalities (medication, surgery, lifestyle changes), and follow-up data (symptom improvement, adverse effects, quality of life). To ensure data accuracy and completeness, a standardized data collection form will be developed and used by trained research assistants. Data cleaning and verification processes will be implemented to minimize errors. To assess the effectiveness of different treatment options on quality of life, patient-reported outcome measures (PROMs) will be collected. These PROMs will include validated questionnaires to assess symptom severity, urinary function, and overall quality of life. Data analysis will involve descriptive statistics to summarize patient characteristics, prevalence rates, and risk factor distribution. Regression analysis will be used to identify potential risk factors associated with BPH. Comparisons of treatment outcomes will be conducted using appropriate statistical tests. The study will also explore correlations between treatment modalities and changes in quality of life as measured by PROMs. To evaluate the long-term impact of treatment options, follow-up data will be collected through patient interviews or medical record reviews. This information will be used to assess symptom persistence, recurrence, complications, and changes in quality of life over time.

The purpose of the study was to investigate the impact of treatment modalities on the quality of life of men with benign prostate hypertrophy (BPH) in tertiary hospitals in Anambra, Nigeria. The study findings provide insights into the demographic characteristics and medical history of the study population, which are factors in understanding the impact of these treatment approaches. The data reveals that the majority of the respondents are in the 61-65 age group, with a predominance of employed individuals and married men. This aligns with the typical demographics of BPH patients, as the condition is more prevalent in older males. The high prevalence of comorbidities, such as hypertension and diabetes, among the respondents is also noteworthy, as these can influence the management and outcomes of BPH. Additionally, the study findings highlight the importance of family history in the development of prostate disease, with over one-third of the respondents reporting a positive family history. The predominance of older, employed, and married men aligns with the known epidemiology of BPH, which tends to affect an aging male population. The high prevalence of comorbidities like hypertension and diabetes among the respondents is noteworthy, as these underlying conditions can complicate the management of BPH and impact treatment outcomes. This emphasizes the need for comprehensive screening and early intervention strategies, particularly for those with a predisposition to prostate-related conditions. The data on the clinical presentation of BPH, including the most common symptoms and the duration of these symptoms, provides information for healthcare professionals in tailoring their treatment approaches to address the specific needs of this patient population. The diagnostic findings, such as PSA levels, prostate volume, and uroflowmetry results, further contribute to the understanding of the clinical characteristics of the study participants, which can inform the selection of appropriate treatment modalities. A significant finding is the role of family history in the development of prostate disease. Over a third of the participants reported a positive family history, underscoring the importance of genetic and hereditary factors in BPH. This emphasizes the need for enhanced screening and early intervention, especially for men with a predisposition to prostate-related conditions. The detailed data on clinical presentation, including symptom types and duration, can guide healthcare providers in tailoring treatment approaches to better address the specific needs of this patient population. Furthermore, the diagnostic test results, such as PSA levels and uroflowmetry findings, provide valuable clinical context that can inform the selection of appropriate treatment modalities for individual patients. 

The findings from this study provide a comprehensive understanding of the demographic and clinical characteristics of men with benign prostate hypertrophy (BPH) seeking treatment in tertiary hospitals in Anambra, Nigeria. The data highlights the preponderance of older, employed, and married men among the study population, aligning with the typical epidemiology of BPH. The high prevalence of comorbidities, such as hypertension and diabetes, among the respondents underscores the need for a holistic approach to BPH management that takes into account the impact of underlying health conditions on treatment outcomes. A notable implication of the study findings is the importance of family history in the development of prostate disease. The significant proportion of participants reporting a positive family history emphasizes the role of genetic and hereditary factors in BPH, warranting enhanced screening and early intervention strategies, particularly for high-risk individuals. Furthermore, the detailed data on clinical presentation and diagnostic test results can inform the selection of appropriate treatment modalities, enabling healthcare providers to approach to the specific needs of each patient and ultimately improving the quality of life for men affected by this condition in the study setting and beyond.

Based on the findings of this study, several recommendations can be made to enhance the management of benign prostate hypertrophy (BPH) in tertiary hospitals in Anambra, Nigeria. Firstly, the high prevalence of comorbidities, such as hypertension and diabetes, among the study population underscores the need for a comprehensive, multidisciplinary approach to BPH care. Healthcare providers should ensure that the management of BPH is closely integrated with the treatment of any underlying medical conditions, as this can have a significant impact on treatment outcomes and the overall quality of life for patients. This may involve collaboration between urologists, primary care physicians, and other relevant specialists to optimize the care provided to this patient population. Furthermore, the findings regarding the role of family history in the development of prostate disease should inform the implementation of robust screening and early intervention programs. Clinicians should actively inquire about family history and prioritize regular prostate examinations and PSA testing, particularly for individuals with a predisposition to BPH. By identifying high-risk patients at an early stage, healthcare providers can initiate appropriate treatment strategies and closely monitor disease progression, thereby enhancing the chances of successful management and improved quality of life. Additionally, the detailed data on clinical presentation and diagnostic test results should be utilized to guide the selection of the most suitable treatment modalities for each patient. Adopting a treatment approach that carters to o the unique characteristics and needs of the individual can lead to better outcomes and a higher level of satisfaction among men with BPH. Clinicians should also consider incorporating patient-reported outcome measures into their evaluation of treatment effectiveness, ensuring that the impact on the patient's quality of life is given due consideration.

1. 1. Roehrborn CG, Siami P, Barkin J, Damiao R, Major-Walker K, Nandy I, et al. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur urol. 2015; 57: 123-131.
   2. Speakman M, Kirby R, Doyle S, Ioannou C. Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH)–focus on the UK. BJU inter. 2015; 115: 508-519.
   3. World Health Organization. Health impacts of benign prostatic hyperplasia. 2019.
   4. Global burden of disease study 2019. Global, regional, and national burden of benign prostatic hyperplasia. Lancet Healthy Longevity. 2019.
   5. Lokeshwar SD, Harper BT, Webb E, Jordan A, Dykes TA, Neal Jr DE, et al. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Translational androl urol. 2019; 8: 529-539.
   6. Langan RC. Benign prostatic hyperplasia. Primary Care: Clinics in Office Practice. 2019; 46: 223-232.
   7. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur urol. 2013; 64: 118-140.
   8. Roehrborn Claus G. Benign prostatic hyperplasia: an overview. Rev urol. 2005; 7: S3-S14.
   9. Ojewola RW, Oridota ES, Balogun OS, Ogundare EO, Alabi TO, Banjo OO, et al. Knowledge, attitudes and screening practices regarding prostatic diseases among men older than 40 years: a population-based study in Southwest Nigeria. Pan Afr med j. 2017; 27: 151
   10. Agbugui JO, Obarisiagbon EO, Osaigbovo II. Bacteriology of urine specimens obtained from men with symptomatic benign prostatic hyperplasia. Nigerian J Sur. 2016; 22: 65-69.
   11. Nneoma Igwe C, Israel Eshiet U. An Analysis of cases of benign prostatic hyperplasia in a tertiary hospital in Eastern Nigeria: incidence, treatment, and cost of management. Asi J Res Rep Urol. 2021; 4: 32-41.
   12. Awedew AF, Han H, Abbasi B, Abbasi-Kangevari M, Ahmed MB, Almidani O, et al. The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the global burden of disease study 2019. Lancet Healthy Longevity. 2022; 3: e754-e776.
   13. American Urological Association. Economic impact of benign prostatic hyperplasia. 2019.