title: An Asian multinational prospective observational registry of patients with benign prostatic hyperplasia, with a focus on comorbidities, lower urinary tract symptoms and sexual function.
abstract: OBJECTIVE
  To examine the characteristics, management practices and outcomes of patients presenting with symptoms of benign prostatic hyperplasia (BPH) in Asia, with a focus on comorbidities and sexuality.
  
  
  METHODS
  In this multinational prospective observational registry, eligible patients with BPH attending a urology clinic for the first time were enrolled. Details of comorbidities, sexuality and symptoms of BPH were collected through the International Prostate Symptom Score (IPSS), International Index of Erectile Dysfunction-5 (IIEF-5) and the Danish Prostate Symptom Score (DAN-PSS-1) questionnaires. The follow-up was scheduled at 1-3 or 3-6 months, depending on the treatment.
  
  
  RESULTS
  In 994 men aged 40-88 years the most common comorbidities were hypertension (38%) and obesity (36%). Nocturia was the most common symptom for consultation. A previous episode of acute urinary retention (AUR) was recorded in 12%. About 90% of the men had moderate-to-severe lower urinary tract symptoms (LUTS), and the severity increased with age. Sexual dysfunction was reported by 82%, and it correlated with the severity of LUTS. Of 918 sexually active men, only 20% had normal erectile function; 36%, 19% and 25% reported severe, moderate and mild erectile dysfunction (ED), respectively. BPH medication was started in 78%, 9% had surgery, and in 13% an approach of watchful waiting was adopted. In all, 89% of patients completed the follow-up. The symptoms of BPH resolved in 93% after surgery, in 83% on BPH medication and in 34% of those on 'watchful waiting'. Surgery, which led to a mean reduction of 17.0 IPSS points, was the most effective in improving LUTS. Improvement on the DAN-PSS-1 items of reduced erection and reduced ejaculation was higher with medication, while surgery led to better outcomes on the DAN-PSS-1 item of pain/discomfort on ejaculation. For ED, from baseline to after treatment, the mean IIEF-5 scores changed from 19.1 to 18, from 14.2 to 14.8, and from 4.5 to 5.5 for those with mild, moderate and severe ED at baseline, respectively. Only 2.3% of patients had an episode of AUR while on treatment. About 5.5% of patients on BPH medication and 6% of surgical patients reported adverse events.
  
  
  CONCLUSIONS
  Asian patients with BPH usually present with LUTS; sexual dysfunction is also very common. BPH medication is the most frequent treatment approach, followed by watchful waiting and surgery. Medication and surgery resulted in a greater reduction of LUTS and improvement in sexual dysfunction than watchful waiting. As Asian men remain sexually active even at advanced ages, sexual function should be assessed and discussed with the patient before deciding the management strategy for LUTS associated with BPH.
authors.affiliation: Gleneagles Medical Center, Singapore. mkli56@singnet.com.sg
authors.forename: Man-Kay
authors.initials: MK
authors.lastname: Li
authors.forename: Lester
authors.initials: L
authors.lastname: Garcia
authors.forename: Nelson
authors.initials: N
authors.lastname: Patron
authors.forename: Lei Chang
authors.initials: LC
authors.lastname: Moh
authors.forename: Murali
authors.initials: M
authors.lastname: Sundram
authors.forename: Somboon
authors.initials: S
authors.lastname: Leungwattanakij
authors.forename: Choosak
authors.initials: C
authors.lastname: Pripatnanont
authors.forename: Christopher
authors.initials: C
authors.lastname: Cheng
authors.forename: Man
authors.initials: M
authors.lastname: Chi-Wai
authors.forename: Ngai
authors.initials: N
authors.lastname: Loi-Cheong
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia / Q000453:epidemiology / Q000208:ethnology; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D053448:Prostatism / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011795:Surveys and Questionnaires