Nationwide incidence and treatment pattern of benign prostatic hyperplasia in Korea

Abstract

Purpose: To investigate the incidence of benign prostatic hyperplasia (BPH) in Korea and treatment patterns for 3 years after the diagnosis in a nationwide database.

Materials and methods: We created a cohort of patients diagnosed of BPH between 2007 and 2011 from the Health Insurance Review & Assessment database, a nationwide database of reimbursement. The diagnosis of BPH was defined as having the diagnosis of BPH (N40.0 in International Classification of Diseases, 10th revision) as a primary or secondary diagnosis ≥2 times in 2008. The incidence of BPH in 2008 was calculated. Treatment patterns were determined in 3 months interval and traced for 3 years. The incidence and timing of surgery were also determined. For patients taking medications preoperatively, medication-free rate was calculated.

Results: The incidence of BPH was 2,105 per 100,000 men (mean age, 59.7±11.4 years), and increased with age. Surgery was performed for 7,955 patients (2.1%), half of the surgery being performed within the first 6 months. Transurethral resection of the prostate was the most commonly performed surgery. The proportion of treatment increased with age until the 7th decade of life. The patients taking medication for >1 year after the initial diagnosis was 21.4%. On average, 82% of patients became medication-free at postoperative 1 year. For patients taking preoperative anticholinergics, 1 year medication-free rate was 73.3%.

Conclusions: The incidence of BPH increased with age. Surgery was performed in 2.1% of patients. More than 4/5 patients discontinued medication after surgery, while patients taking preoperative anticholinergics were less likely to.

Keywords: Epidemiology; Lower urinary tract symptoms; Prostatic hyperplasia; Time-to-treatment.

Fig. 1. The incidence and distribution of benign prostatic hyperplasia (BPH). (A) The incidence of BPH (/100,000 persons) in 2008 according age group, (B) regional distribution, and (C) the type of hospital.

Fig. 2. Treatment trends according to age.

Fig. 3. Cumulative incidence of benign prostatic hyperplasia surgery after diagnosis at 3-month intervals. (A) Cumulative incidence, (B) cumulative incidence stratified by type of surgery. TURP, transurethral resection of the prostate; Open P, open prostatectomy; PVP, photoselective vaporization of the prostate; HoLEP, holmium laser enucleation of prostate.

Fig. 4. Incidence and type of surgical treatment during the 3 years of follow-up. TURP, transurethral resection of the prostate; PVP, photoselective vaporization of the prostate; Open P, open prostatectomy; HoLEP, holmium laser enucleation of prostate.

Fig. 5. Postoperative medication status of patients during the 3 years of follow-up. (A) Transurethral resection of the prostate, (B) photoselective vaporization of the prostate, (C) open prostatectomy, and (D) thermal therapy. A, alpha-blockers; B, 5-alpha reductase inhibitors; C, anticholinergics.