Published: 2016-12-18

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia among Ghanaian men: a hospital-based cross-sectional prospective study

Aboah Kenneth, Agyemang-Yeboah Francis, Gyase-Sarpong Kofi Christian, Laing Edwin Ferguson, Acheampong Emmanuel, Twumasi Frimpong Benjamin, Amoah George, Batu Nsenbah Emmanuella, Adutwumwaah Asamoah Portia


Background: Lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) are common in the elderly. This study sought to determine the prevalence of LUTS among patients visiting the urology clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana and to explore its presentation patterns.

Methods: Simple randomized sampling technique was used to recruit 225 subjects with a mean age of 67.96±14.57 (range=40-100years) in a prospective cross-sectional study. LUTS related characteristics and international prostate symptom score (IPSS) questionnaire were employed to obtain relevant data.

Results: The average IPSS of the studied participants was 17.52±7.83. Based on the IPSS, the prevalence of LUTS suggestive of BPH was 88.89%. Bladder storage symptoms were also recorded at 88.59% whilst prostate enlargement based on digital rectal examination (DRE) was 60.4% among the studied subjects.  PSA levels ≥4.0ng/ml gave a prevalence of 81.5%. The prevalence of prostate enlargement defined as PSA ≥1.5ng/ml was 85.23% among the studied subjects whilst 63.11% of the subjects examined had troublesome LUTS. Urgency was the most predominantly reported LUTS (93.3%) among the subjects studied.

Conclusions: This study has clearly shown that, the most prevalent urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia were bladder storage symptoms and urgency. These symptoms when present clinically therefore, suggest benign prostatic hyperplasia and that the prevalence estimates of LUTS in older men are relatively higher at diagnosis.



International prostate symptom score, Prevalence, Lower urinary tract symptoms, Digital rectal examination

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Parsons JK. Benign prostatic hyperplasia and male lower urinary tract symptoms: epidemiology and risk factors. Current bladder dysfunction reports. 2010;P5(4):212-8.

Skolarikos A, Thorpe A, Neal D. Lower urinary tract symptoms and benign prostatic hyperplasia. Minerva urologicae nefrologica. The Italian journal of urology and nephrology. 2004;56(2):109-22.

Pelman RS. Overview of overactive bladder, prostatitis, and lower urinary tract symptoms for the primary care physician. Reviews in urology. 2004,6(Suppl 1):S16.

Lee C, Kozlowski JM, Grayhack JT. Etiology of benign prostatic hyperplasia. The Urologic clinics of North America. 1995;22(2):237-46.

Grossfeld GD, Coakley FV: Benign prostatic hyperplasia: clinical overview and value of diagnostic imaging. Radiologic Clinics of North America. 2000;38(1):31-47.

Kuritzky L. Role of primary care clinicians in the diagnosis and treatment of LUTS and BPH. Reviews in urology. 2004;6(Suppl 9):S53.

Kuo H-C: Differential diagnosis of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia and non-benign prostatic hyperplasia. Incont Pelvic Floor Dysfunct. 2007;1(Suppl 1):3-6.

Su L, Guess HA, Girman CJ, Jacobsen SJ, Oesterling JE, Panser LA, et al. Adverse effects of medications on urinary symptoms and flow rate: a community-based study. Journal of clinical epidemiology. 1996;49(4):483-7.

Homma Y, Araki I, Igawa Y, Ozono S, Gotoh M, Yamanishi T, et al. Clinical guideline for male lower urinary tract symptoms. International journal of urology. 2009;16(10):775-90.

Kok ET, Bohnen AM, Jonkheijm R, Gouweloos J, Groeneveld FP, Thomas S, et al. Simple case definition of clinical benign prostatic hyperplasia, based on International Prostate Symptom Score, predicts general practitioner consultation rates. Urology. 2006;68(4):784-9.

Girman C. Population-based studies of the epidemiology of benign prostatic hyperplasia. British journal of urology Supplement. 1998,82(1):34-43.

Engström G, Walker-Engström M-L, Lööf L, Leppert J. Prevalence of three lower urinary tract symptoms in men-a population-based study. Family practice. 2003;20(1):7-10.

Cotran RS, Kumar V, Collins T, Robbins SL. Robbins pathologic basis of disease. 1999.

Sarma AV, Wei JT, Jacobson DJ, Dunn RL, Roberts RO, Girman CJ, et al. Comparison of lower urinary tract symptom severity and associated bother between community-dwelling black and white men: the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men’s Health Study. Urology. 2003;61(6):1086-91.

Adegun P, Popoola A. A survey of benign prostatic hyperplasia (BPH) amongst patients with prostatic disorders in Ado-Ekiti, Nigeria. Nig Med Pract. 2011;60(3-6):38-42.

Berhanu N. The safety and efficacy of trans-vesical prostatectomy done at a primary general hospital setting in Ethiopia. 2008.

Rao CN, Singh MK, Shekhar T, Venugopal K, Prasad MR, Saleem KL, et al. Causes of lower urinary tract symptoms (LUTS) in adult Indian males. Indian Journal of Urology. 2004;20(2):95.

Chokkalingam A, Yeboah E, Demarzo A, Netto G, Yu K, Biritwum R, et al. Prevalence of BPH and lower urinary tract symptoms in West Africans. Prostate cancer and prostatic diseases. 2012;15(2):170-6.

Kupelian V, Wei JT, O’Leary MP, Kusek JW, Litman HJ, Link CL, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Archives of Internal Medicine. 2006;166(21):2381-7.

Cruz F, Desgrandchamps F. New concepts and pathophysiology of lower urinary tract symptoms in men. European Urology Supplements. 2010,9(4):472-6.

Naing L, Winn T, Rusli B. Practical issues in calculating the sample size for prevalence studies. Archives of orofacial Sciences. 2006;1(1):9-14.

Norman R, Nickel J, Fish D, Pickett S. ‘Prostate‐related symptoms’ in Canadian men 50 years of age or older: prevalence and relationships among symptoms. British journal of urology. 1994;74(5):542-50.

Sagnier P, MacFarlane G, Richard F, Botto H, Teillac P, Boyle P. Results of an epidemiological survey using a modified American Urological Association symptom index for benign prostatic hyperplasia in France. The Journal of urology. 1994,151(5):1266-70.

Braun M, Sommer F, Haupt G, Mathers M, Reifenrath B, Engelmann U. Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical “Aging Male” symptoms? Results of the “Cologne Male Survey”. European urology. 2003;44(5):588-94.

Markland AD, Thompson IM, Ankerst DP, Higgins B, Kraus SR. Lack of disparity in lower urinary tract symptom severity between community-dwelling non-Hispanic white, Mexican-American, and African-American men. Urology. 2007;69(4):697-702.

Bock-Oruma AA, Dienye PO, Oghu IS: Prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care, Port Harcourt, Nigeria. South African Family Practice. 2013;55(5):467-72.

Andersson SO, Rashidkhani B, Karlberg L, Wolk A, Johansson JE. Prevalence of lower urinary tract symptoms in men aged 45-79 years: a population‐based study of 40 000 Swedish men. BJU international. 2004;94(3):327-31.

Haidinger G, Temml C, Schatzl G, Brössner C, Roehlich M, Schmidbauer CP, et al. Risk factors for lower urinary tract symptoms in elderly men. European urology. 2000;37(4):413-20.

Naslund M, Gilsenan A, Midkiff K, Bown A, Wolford E, Wang J. Prevalence of lower urinary tract symptoms and prostate enlargement in the primary care setting. International journal of clinical practice. 2007;61(9):1437-45.

Roehrborn CG, Girman CJ, Rhodes T, Hanson KA, Collins GN, Sech SM, et al. Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound. Urology. 1997;49(4):548-57.

Bosch J, Bohnen A, Groeneveld F. Validity of digital rectal examination and serum prostate specific antigen in the estimation of prostate volume in community-based men aged 50 to 78 years: the Krimpen Study. European urology. 2004;46(6):753-9.