The impact of the treatment of benign prostatic hyperplasia with lower urinary tract symptoms on quality of life, a scoping literature review aided by AI

Benign prostatic hyperplasia (BPH) refers to a non-cancerous condition characterized by hyperplastic changes in stromal and epithelial cells. BPH can cause lower urinary tract symptoms (LUTS) that decrease quality of life (QoL). The International Prostate Symptom Score (IPSS) is a validated tool used to assess and guide the management of LUTS. This scoping review evaluated the difference in IPSS and QoL in patients with BPH and LUTS before and after medical or interventional treatment. A PubMed search was conducted using: (Benign prostatic hyperplasia OR lower urinary tract symptoms) AND (erectile dysfunction OR depression OR disability-adjusted life year OR quality of life), which yielded 7143 results over 10 years. With the use of artificial intelligence (AI), 31 articles were included in the study. Randomized control trials, prospective clinical trials, prospective and retrospective cohort studies, and meta-analyses were included. IPSS and IPSS-QoL measurements before and after intervention were required. Data was assessed in three categories “overall”, “medical” and “interventional”. Mean age, IPSS and QoL scores before and after intervention were calculated, as well as the Pearson correlation between baseline IPSS and QoL. Thirteen articles were categorized as medical while 18 were categorized as interventional. Pearson correlation between IPSS and QoL for overall, medical and interventional articles were r = 0.72, 0.79 and 0.36, respectively. There was an improvement in the QoL score by 1.28 points, 1.40 points, 2.49 points for overall, medical, and interventional groups, respectively. This study quantified the improvement in QoL after medical and interventional treatment of BPH. There is a strong correlation between the severity of BPH symptoms and the reduction of QoL. Improvement of BPH symptoms with medical and surgical treatments is associated with significant improvement in QoL.

Benign prostatic hyperplasia; Lower urinary tract symptoms; Quality of life; Intervention

[1] Devlin CM, Simms MS, Maitland NJ. Benign prostatic hyperplasia—what do we know? BJU International. 2021; 127: 389–399.

[2] Welch G, Weinger K, Barry MJ. Quality-of-life impact of lower urinary tract symptom severity: results from the health Professionals follow-up study. Urology. 2002; 59: 245–250.

[3] Foo KT. What is a disease? What is the disease clinical benign prostatic hyperplasia (BPH)? World Journal of Urology. 2019; 37: 1293–1296.

[4] Zhang AY, Xu X. Prevalence, burden, and treatment of lower urinary tract symptoms in men aged 50 and older: a systematic review of the literature. SAGE Open Nursing. 2018; 4: 2377960818811773.

[5] D’Agate S, Wilson T, Adalig B, Manyak M, Palacios-Moreno JM, Chavan C, et al. Model-based meta-analysis of individual International Prostate Symptom Score trajectories in patients with benign prostatic hyperplasia with moderate or severe symptoms. British Journal of Clinical Pharmacology. 2020; 86: 1585–1599.

[6] 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 Andrology and Urology. 2019; 8: 529–539.

[7] Wei J, Zhang S, Wang B, Ke M, Liu S, Yang Z, et al. A multicenter retrospective study of transurethral prostate split for benign prostate hyperplasia. Translational Andrology and Urology. 2022; 11: 213–227.

[8] Otaola-Arca H, Álvarez-Ardura M, Molina-Escudero R, Fernández MI, Páez-Borda Á. A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: efficacy, sexual function, quality of life, and complications. International Brazilian Journal of Urology. 2021; 47: 131–144.

[9] Sokhal AK, Sankhwar S, Goel A, Singh K, Kumar M, Purkait B, et al. A prospective study to evaluate sexual dysfunction and enlargement of seminal vesicles in sexually active men treated for benign prostatic hyperplasia by alpha-blockers. Urology. 2018; 118: 92–97.

[10] Castro-Díaz D, Díaz-Cuervo H, Pérez M. Benign prostatic hyperplasia and its treatment: impact on quality of life and sexual function. Actas Urologicas Españolas. 2013; 37: 233–241. (In Spanish)

[11] Yang T, Hsiao P, Yang H, Liao C, Chiang H, Chien K. Body mass index and age are predictors for symptom improvement after high-power laser vaporization for benign prostatic hyperplasia. Journal of the Formosan Medical Association. 2015; 114: 268–273.

[12] Zhou W, Mao D, Li L, Liu G, Gao G, Li H, et al. Clinical analysis of transurethral holmium laser enucleation in the treatment of benign prostatic hyperplasia with prostatic inflammation: a prospective research study. Frontiers in Surgery. 2022; 9: 1026657.

[13] Dogan K, Erbagci A, Sen H, Kervancioglu S, Erturhan MS, Seckiner İ, et al. Clinical outcomes of prostatic artery embolization in patients with benign prostatic hyperplasia: a prospective clinical study. Turkish Journal of Urology. 2022; 48: 215–221.

[14] Wei H, Guo B, Tu Y, Hu X, Zheng W, Zhang D, et al. Comparison of the efficacy and safety of transurethral laser versus open prostatectomy for patients with large-sized benign prostatic hyperplasia: a meta-analysis of comparative trials. Investigative and Clinical Urology. 2022; 63: 262–272.

[15] Roehrborn CG, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Convective thermal therapy: durable 2-year results of randomized controlled and prospective crossover studies for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Journal of Urology. 2017; 197: 1507–1516.

[16] Tiscione D, Gallelli L, Tamanini I, Luciani LG, Verze P, Palmieri A, et al. Daidzein plus isolase associated with zinc improves clinical symptoms and quality of life in patients with LUTS due to benign prostatic hyperplasia: results from a phase I–II study. Archivio Italiano di Urologia, Andrologia. 2017; 89: 12–16.

[17] Ko WJ, Han HH, Ham WS, Lee HW. Daily use of sildenafil 50mg at night effectively ameliorates nocturia in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: an exploratory multicenter, double-blind, randomized, placebo-controlled study. The Aging Male. 2017; 20: 81–88.

[18] Kang YJ, Kim KH, Seo Y, Lee KS. Effect of transurethral resection of the prostate on storage symptoms in patients with benign prostatic hyperplasia of less than 30 ml. The World Journal of Men’s Health. 2013; 31: 64.

[19] Sato R, Sano A, Watanabe K, Matsushita Y, Watanabe H, Tamura K, et al. Effects of changes in erectile function after holmium laser enucleation of the prostate on postoperative outcomes in patients with benign prostatic hyperplasia. In Vivo. 2022; 36: 2960–2964.

[20] Kim SW, Lee WC, Kim MT, Ko K, Lee WK, Lee C, et al. Effects of low-dose tamsulosin on sexual function in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Korean Journal of Urology. 2013; 54: 697–702.

[21] Kim JH, Lee KS, Kim TH. Evaluation of clinical outcomes of prostatic urethral lift for benign prostatic hyperplasia: an Asian population study. The World Journal of Men’s Health. 2020; 38: 338–344.

[22] Theil G, Richter M, Schulze M, Köttig T, Patz B, Heim S, et al. Extract from Cucurbita pepo improves BPH symptoms without affecting sexual function: a 24-month noninterventional study. World Journal of Urology. 2022; 40: 1769–1775.

[23] Hu Y, Dong X, Wang G, Huang J, Liu M, Peng B. Five-year follow-up study of transurethral plasmakinetic resection of the prostate for benign prostatic hyperplasia. Journal of Endourology. 2016; 30: 97–101.

[24] Bilhim T, Costa NV, Torres D, Pinheiro LC, Spaepen E. Long-term outcome of prostatic artery embolization for patients with benign prostatic hyperplasia: single-centre retrospective study in 1072 patients over a 10-year period. Cardiovascular and Interventional Radiology. 2022; 45: 1324–1336.

[25] Zhou Z, Zheng X, Wu J, Gao Z, Xu Z, Cui Y. Meta-analysis of efficacy and safety of tadalafil plus tamsulosin compared with tadalafil alone in treating men with benign prostatic hyperplasia and erectile dysfunction. American Journal of Men’s Health. 2019; 13: 1557988319882597.

[26] D’Agate S, Wilson T, Adalig B, Manyak M, Palacios‐Moreno JM, Chavan C, et al. Model-based meta-analysis of individual international prostate symptom score trajectories in patients with benign prostatic hyperplasia with moderate or severe symptoms. British Journal of Clinical Pharmacology. 2020; 86: 1585–1599.

[27] Cantwell AL, Bogache WK, Richardson SF, Tutrone RF, Barkin J, Fagelson JE, et al. Multicentre prospective crossover study of the ‘prostatic urethral lift’ for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. BJU International. 2014; 113: 615–622.

[28] Kim BS, Kim T-H, Kim KH, Kim BH, Ha JY, Cho DH, et al. Patient-reported goal achievement after treating male benign prostatic hyperplasia with alpha-adrenergic antagonist: a 12-week prospective multicenter study. Urology Journal. 2019; 16: 386–391.

[29] Salem R, Hairston J, Hohlastos E, Riaz A, Kallini J, Gabr A, et al. Prostate artery embolization for lower urinary tract symptoms secondary to benign prostatic hyperplasia: results from a prospective FDA-approved investigational device exemption study. Urology. 2018; 120: 205–210.

[30] Carnevale FC, Moreira AM, de Assis AM, Antunes AA, Cristina de Paula Rodrigues V, Srougi M, et al. Prostatic artery embolization for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: 10 years’ experience. Radiology. 2020; 296: 444–451.

[31] Sun I, Yoo S, Park J, Cho SY, Jeong H, Son H, et al. Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes. Scientific Reports. 2019; 9: 8261.

[32] Pisco JM, Bilhim T, Costa NV, Torres D, Pisco J, Pinheiro LC, et al. Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia. European Urology. 2020; 77: 354–362.

[33] Asare GA, Afriyie D, Ngala RA, Appiah AA, Anang Y, Musah I, et al. Shrinkage of prostate and improved quality of life: management of BPH patients with croton membranaceus ethanolic root extract. Evidence-Based Complementary and Alternative Medicine. 2015; 2015: 365205.

[34] Takahashi R, Sumino Y, Miyazato M, Nishii H, Oshiro T, Mimata H, et al. Tadalafil improves nocturia and nocturia-related quality of life in patients with benign prostatic hyperplasia (KYU-PRO Study). Urologia Internationalis. 2020; 104: 587–593.

[35] Takeda M, Yokoyama O, Lee SW, Murakami M, Morisaki Y, Viktrup L. Tadalafil 5 mg once-daily therapy for men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results from a randomized, double-blind, placebo-controlled trial carried out in Japan and Korea. International Journal of Urology. 2014; 21: 670–675.

[36] McVary KT, Roehrborn CG. Three-year outcomes of the prospective, randomized controlled Rezūm system study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Urology. 2018; 111: 1–9.

[37] Miller LE, Chughtai B, McVary K, Gonzalez RR, Rojanasarot S, DeRouen K, et al. Water vapor thermal therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: systematic review and meta-analysis. Medicine. 2020; 99: e21365.

[38] Agarwal A, Eryuzlu LN, Cartwright R, Thorlund K, Tammela TLJ, Guyatt GH, et al. What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women. European Urology. 2014; 65: 1211–1217.

[39] Perchon LFG, Pintarelli VL, Bezerra E, Thiel M, Dambros M. Quality of life in elderly men with aging symptoms and lower urinary tract symptoms (LUTS). Neurourology and Urodynamics. 2011; 30: 515–519.

[40] Cannarella R, Condorelli RA, Barbagallo F, La Vignera S, Calogero AE. Endocrinology of the aging prostate: current concepts. Frontiers in Endocrinology. 2021; 12: 554078.

[41] O’leary MP. Validity of the “bother score” in the evaluation and treatment of symptomatic benign prostatic hyperplasia. Reviews in Urology. 2005; 7: 1–10.

[42] Jindan L, Xiao W, Liping X. Evolving role of silodosin for the treatment of urological disorders—a narrative review. Drug Design, Development and Therapy. 2022; 16: 2861–2884.

[43] Gao B, Lu S, Bhojani N, Zorn KC, Chughtai B, Elterman D. Office-based procedures for BPH. Current Urology Reports. 2021; 22: 63.

[44] Franco JV, Jung JH, Imamura M, Borofsky M, Omar MI, Escobar Liquitay CM, et al. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. Cochrane Database of Systematic Reviews. 2021; 7: CD013656.

[45] Hughes T, Harper P, Somani BK. Treatment algorithm for management of benign prostatic obstruction: an overview of current techniques. Life. 2023; 13: 2077.

[46] Spivak L, Morozov A, Shpikina A, Enikeev D, Rapoport L. Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem? Current Opinion in Urology. 2021; 31: 451–455.