Treatment for benign prostatic hyperplasia among community dwelling men: The Olmsted County study of urinary symptoms and health status
Treatment for benign prostatic hyperplasia among community dwelling men: The Olmsted County study of urinary symptoms and health status
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DOI：
10.1016/s0022-5347(05)68271-7
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发表时间：
1999-10-01
影响因子：
6.6
通讯作者：
Lieber, MM
中科院分区：
文献类型：
--
作者：
Jacobsen, SJ;Jacobson, DJ;Lieber, MM
目的：我们描述治疗良性前列腺增生症（BPH）的男性参与奥姆斯特德县研究的泌尿系统症状和健康状况的男性在10,000 personal-years of following.Materials和方法：一个队列的2,115名男性40至79岁的随机选择从一个枚举的奥姆斯特德县，明尼苏达州的人口（55%的应答率）。参与者完成了先前验证的基线问卷调查，以评估症状的严重程度，并将其排入便携式尿量计。25%的随机子样本进行经直肠超声成像的前列腺，以确定前列腺体积和血清前列腺特异性抗原的测量。随访包括回顾性审查社区医疗记录和完成一个两年一次的问卷调查，以确定发生的医疗和手术治疗BPH在随后的6 years.Results：在超过10,000人年的后续167名男子进行了治疗，产生的总发病率为16.0/1000人年。任何治疗的风险都有明显的年龄相关性增加，从40至49岁男性的3.3/1000人-年增加到70岁或以上男性的30/1,000人-年以上。中度至重度症状的男性（美国泌尿学会症状指数大于7），降低的峰值尿流率（小于12 ml）。每秒）、前列腺肥大（大于30 ml.）或升高的血清前列腺特异性抗原（1.4ng/ml）。ml.或更高）的BPH治疗风险是未治疗者的4倍。在同时调整所有测量值后，（风险比2.3，95%置信区间[CI] 1.1，4.7），降低的峰值流速（风险比2.7，95% CI 1.4，5.3）和中度至重度症状（风险比5.3，95% CI 2.5，11.1）分别独立预测后续治疗。虽然在研究期间重复联系和泌尿学测量的可用性可能影响了该队列的治疗决定，数据表明，治疗在老年男子中很常见，近四分之一的人在80岁时接受治疗。此外，这些数据表明，患有中度至重度下尿路症状、流速受损或前列腺增大的男性更有可能接受治疗，其风险增加幅度与不良结局（如急性尿潴留）相关的风险增加幅度相似。
Purpose: We describe treatments for benign prostatic hyperplasia (BPH) among men participating in the Olmsted County study of urinary symptoms and health status among men during 10,000 person-years of followup.Materials and Methods: A cohort of 2,115 men 40 to 79 years old was randomly selected from an enumeration of the Olmsted County, Minnesota population (55% response rate). Participants completed a previously validated baseline questionnaire to assess symptom severity and voided into a portable urometer. A 25% random subsample underwent transrectal sonographic imaging of the prostate to determine prostate volume and measurement of serum prostate specific antigen. Followup included retrospective review of community medical records and completion of a biennial questionnaire to determine the occurrence of medical and surgical treatment for BPH in the subsequent 6 years.Results: During more than 10,000 person-years of followup 167 men were treated, yielding an overall incidence of 16.0/1,000 person-years. There was a strong age related increase in risk of any treatment from 3.3/1,000 person-years for men 40 to 49 years old to more than 30/1,000 person-years for those 70 years old or older. Men with moderate to severe symptoms (American Urological Association symptom index greater than 7), depressed peak urinary flow rates (less than 12 ml. per second), enlarged prostate (greater than 30 ml.) or elevated serum prostate specific antigen (1.4 ng./ml. or greater) had about 4 times the risk of BPH treatment than those who did not. After adjustment for all measures simultaneously an enlarged prostate (hazard ratio 2.3, 95% confidence interval [CI] 1.1, 4.7), depressed peak flow rate (hazard ratio 2.7, 95% CI 1.4, 5.3) and moderate to severe symptoms (hazard ratio 5.3, 95% CI 2.5, 11.1) at baseline each independently predicted subsequent treatment.Conclusions: While repeat contact and availability of urological measurements during the study period may have influenced treatment decisions in this cohort, the data demonstrate that treatment is common in elderly men with nearly 1 in 4 receiving treatment in the eighth decade of life. Furthermore, these data suggest that men with moderate to severe lower urinary tract symptoms, impaired flow rates or enlarged prostates are more likely to undergo treatment, with increases in risk of similar magnitude to those associated with adverse outcomes, such as acute urinary retention.