Quality Indicators for Benign Prostatic Hyperplasia in Vulnerable Elders

Published in: Journal of the American Geriatrics Society, v. 55, no. S2, Oct. 2007, p. S253-S257

Posted on RAND.org on January 01, 2007

by Christopher S. Saigal

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Benign prostatic hyperplasia (BPH) is a highly prevalent benign neoplasm in older men. Lower urinary tract symptoms (LUTS) associated with BPH include urinary urgency, frequency, nocturia, incomplete emptying, decreased force of urinary stream, and urinary incontinence (UI). The prevalence of these symptoms rises with age. When comparing men aged 30 to 39 with men aged 70 and older, the prevalence of nocturia more than three times per night rises from 3% to 21%, the prevalence of incomplete emptying rises from6%to 22%, and the prevalence of a weak urinary stream rises from 0% to 57%. Untreated BPH can result in serious clinical sequelae, including acute urinary retention, urinary tract infection (UTI), bladder stone formation, gross hematuria, and rarely, renal failure. Treatment of BPH can often mitigate these outcomes. LUTS associated with BPH can have a significant effect on quality of life, which often compels men to seek care; in 2000, the rate of BPH-related physician office visits was 14,473 visits per 100,000 adult men. Effective medical and surgical therapies are available for BPH treatment. Medication (an alpha adrenergic antagonist, a 5-alpha reductase inhibitor, or both) is usually the initial treatment, whereas surgery (transurethral resection of the prostate (TURP), open simple prostatectomy, or one of the newer minimally invasive therapies) is generally reserved for cases of medication failures. National spending related to BPH in 2000 was estimated at $1.1 billion, exclusive of medication costs. METHODS: A total of 57 articles were considered in this review: one identified via a Web search, 24 through a literature search, and 31 through reference mining. One additional article was included after peer review. RESULTS: Of the 19 potential quality indicators (QIs), 13 were judged valid using the expert panel process, and six were rejected. One QI was moved to Urinary Incontinence because of fit with QIs in that condition. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described.

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