PubMed Health⌕ Search

Biomedical subjects

J L Bosch

Publications and source records attributed to J L Bosch.

At least 19 recordsLinked to original sources
PubMed2000

Strong effects of definition and nonresponse bias on prevalence rates of clinical benign prostatic hyperplasia: the Krimpen study of male urogenital tract problems and general health status.

OBJECTIVE: To estimate the prevalence of benign prostatic hyperplasia (BPH) in the community, and study the influence of BPH definition, age and response bias on prevalence rates. Subjects and methods A community-based longitudinal study of 3924 men aged 50-75 years was conducted in a Dutch municipality (Krimpen) near Rotterdam. Data from those responding were collected using self-administered questionnaires, and during visits to the health centre and outpatient clinic of the urology department. The questionnaires included symptom scores on general well being (Inventory of Subjective Health, ISH) and lower urinary tract symptoms (International Prostate Symptom Score, IPSS). A short version of the questionnaire (including the IPSS and ISH) was sent to a random sample of those not responding. All subjects participating fully underwent a physical examination, uroflowmetry, transrectal ultrasonometry of the prostate and had their prostate specific antigen level measured. Age-specific prevalence rates of BPH were estimated using different definitions, based on one or more of symptom severity, prostate volume and maximum flow rate. The influence of response bias was estimated using the questionnaires. RESULTS: The response rate was 50% (full participants). Of those not responding, 55% completed a short version of the questionnaire (partial participants). Compared with full participants, partial participants had a lower IPSS and slightly lower ISH. The prevalence rates of clinical BPH in the study population was 9-20% (95% confidence interval, 8-11% to 22-27%) depending on the definition used. After adjusting for nonresponse bias, the age-group specific prevalences for 5-year age strata were 1.1-1.8 times lower for all BPH definitions used. CONCLUSIONS: The prevalence rates of clinical BPH depend largely on the definition used and increase strongly with age. The effect of age is stronger when more variables are included in the definition. Adjustment for response bias results in substantially lower prevalence rates.

Age Distribution↗
PubMed2000

Sacral nerve neuromodulation in the treatment of patients with refractory motor urge incontinence: long-term results of a prospective longitudinal study.

PURPOSE: Conservative treatment rarely results in a durable cure of patients with urge incontinence and bladder overactivity. Instrumental and surgical procedures often have significant side effects and less than optimal results. We developed a technique of sacral nerve neuromodulation using chronic unilateral electrical stimulation of the S3 sacral nerve to inhibit the micturition reflex to provide effective nondestructive alternative therapy for patients whose condition is refractory to conservative treatment. MATERIALS AND METHODS: Of 85 patients 45 who responded to a test with a temporary electrode underwent implantation of a permanent S3 sacral nerve electrode coupled to a pulse generator. Treatment results were evaluated by urodynamic studies and voiding/incontinence diaries documenting pad use, incontinence episodes, voiding frequency and voided volume. Partial success and cure were defined as 50% to 90% and more than 90% improvement, respectively, in pad use and/or incontinence episodes. RESULTS: Of 45 patients 18 (40%) were cured at an average followup of 47.1 months and 9 (20%) achieved partial success. Median number of pads used and median number of incontinence episodes daily had decreased from 5.4 to 1.2 (p = 0.0001) and 7.1 to 1.3 (p = 0.0001), respectively, 6 months after implantation. Subsequently these results remained almost constant for 5 years. Bladder overactivity disappeared in 19 of the 44 patients (43%). The repeat intervention rate was 37.7% and there was no permanent injury or nerve damage. CONCLUSIONS: Sacral nerve neuromodulation is safe, effective and durable in patients with urge incontinence refractory to conservative treatment.

Adolescent↗
PubMed1999

Health-related quality of life after angioplasty and stent placement in patients with iliac artery occlusive disease: results of a randomized controlled clinical trial. The Dutch Iliac Stent Trial Study Group.

BACKGROUND: To assess the quality of life in patients with iliac artery occlusive disease, we compared primary stent placement versus primary angioplasty followed by selective stent placement in a multicenter randomized controlled trial. METHODS AND RESULTS: Quality-of-life assessments were completed by 254 patients in a telephone interview. Assessment measures consisted of the RAND 36-Item Health Survey 1.0, time tradeoff, standard gamble, rating scale, health utilities index, and EuroQol-5D. The interviews were performed before treatment and after 1, 3, 12, and 24 months. When the 2 treatments were compared, no significant difference was observed (P>0.05). All measurements showed a significant improvement in the quality of life after treatment (P<0.05). The RAND 36-Item Health Survey measures physical functioning, role limitations caused by physical problems, and bodily pain and the EuroQol-5D were the most sensitive to the impact of revascularization. CONCLUSIONS: Health-related quality of life improves equally after primary stent placement and primary angioplasty with selective stent placement in the treatment of intermittent claudication caused by iliac artery occlusive disease.

Aged↗
PubMed1999

[Satisfactory long-term results with a sphincter prosthesis in patients with urinary incontinence due to an intrinsic urinary sphincter deficiency: evaluation of 86 patients].

OBJECTIVE: Evaluation of the results of treatment with an artificial urinary sphincter in 86 patients with urinary incontinence due to intrinsic sphincter deficiency. DESIGN: Retrospective. METHODS: In the period 1982-1997 an artificial urinary sphincter (American Medical Systems, Minnetonka, Minnesota, USA) was inserted in the Academic Hospital Rotterdam-Dijkzigt, Department of Urology, the Netherlands, in 86 patients (15 women and 71 men) aged 8-84 years. All patients suffered from urinary incontinence due to intrinsic sphincter deficiency. A 'good' result was defined as being completely dry or using a maximum of one pad per day. During follow-up visits, the pad counts were registered and the pumping characteristics of the prosthesis were checked. In case of deterioration of the continence status a re-evaluation was started using imaging modalities and urodynamic studies. RESULTS: After an average follow-up of 41 months 76% of the patients were either completely dry or used a maximum of one incontinence pad per day. Urinary continence had markedly improved in another 7% of the patients. One or more reoperations due to mechanical or non-mechanical problems with the prosthesis had to be performed in 37 patients (43%). CONCLUSION: The artificial urinary sphincter can give excellent results as far as urinary continence is concerned, if the price of a relatively large number of revisions is accepted, in a population of patients to whom, in most cases, no other treatment options apply.

Adolescent↗
PubMed1999

Testicular prostheses: body image and sexual functioning.

OBJECTIVES: To evaluate retrospectively the body image and sexual functioning in patients who have a testicular prosthesis (TP). PATIENTS AND METHODS: The medical charts were evaluated for 30 adult patients who received 32 TPs between 1985 and 1997. A questionnaire was mailed to each patient, asking about body image, satisfaction with the implant and with sexual functioning. RESULTS: Of the 30 patients, 22 (73%) replied; their mean (range) age was 30 (18-47) years. Most of the patients had a silicone gel-filled TP. No complications were reported in 25 (83%) patients and 80% reported no sexual problems; 20% felt uncomfortable in intimate contacts, 68% found their body image improved after having a TP, 58% were satisfied with their current sexual life, 90% had no erectile dysfunction and 45% reported premature ejaculation. CONCLUSIONS: Patients who have lost a testis for any reason should be informed about the availability of a TP. Prostheses were well accepted and no systemic disease was reported. Almost all patients reported an improvement in their body image. Sexual life and performance were apparently not compromised by having a TP. New surgical procedures are recommended to improve the cosmetic appearance of a TP in the scrotum.

Adult↗
PubMed1998

Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease. Dutch Iliac Stent Trial Study Group.

BACKGROUND: Percutaneous transluminal angioplasty (PTA) is a safe, simple, and successful treatment for intermittent claudication caused by iliac-artery occlusive disease. Primary stent placement has been proposed as more effective than PTA. We compared the technical results and clinical outcomes of two treatment strategies-primary placement of a stent across the stenotic segment of the iliac artery, or primary PTA followed by selective stent placement when haemodynamic results were inadequate. METHODS: We randomly assigned 279 patients with intermittent claudication, recruited from departments of vascular surgery, either to direct stent placement (group I, n=143) or primary angioplasty (group II, n=136), with subsequent stent placement in case of a residual mean pressure gradient greater than 10 mm Hg across the treated site. The main inclusion criterion was intermittent claudication on the basis of iliac-artery stenosis of more than 50%, proven by angiography. All patients had a clinical assessment before intervention and at 3, 12, and 24 months. Clinical success was defined as improvement of at least one clinical category. Secondary endpoints were initial technical results, procedural complications, cumulative patency as assessed by duplex ultrasonography, and quality of life. FINDINGS: In group II, selective stent placement was done in 59 (43%) of the 136 patients. The mean follow-up was 9.3 months (range 3-24). Initial haemodynamic success and complication rates were 119 (81%) of 149 limbs and 6 (4%) of 143 limbs (group I) versus 103 (82%) of 126 limbs and 10 (7%) of 136 limbs (group II), respectively. Clinical success rates at 2 years were 29 (78%) of 37 patients and 26 (77%) of 34 patients in groups I and II, respectively (p=0.6); however, 43% and 35% of the patients, respectively, still had symptoms. Quality of life improved significantly after intervention (p<0.05) but we found no difference between the groups during follow-up. 2-year cumulative patency rates were similar at 71% versus 70% (p=0.2), respectively, as were reintervention rates at 7% versus 4%, respectively (95% CI -2% to 9%). INTERPRETATION: There were no substantial differences in technical results and clinical outcomes of the two treatment strategies both at short-term and long-term follow-up. Since angioplasty followed by selective stent placement is less expensive than direct placement of a stent, the former seems to be the treatment of choice for lifestyle-limiting intermittent claudication caused by iliac artery occlusive disease.

Adult↗
PubMed1998

Morbidity and quality of life in patients with orthotopic and heterotopic continent urinary diversion.

OBJECTIVES: To evaluate morbidity and quality of life (QOL) in patients with continent urinary diversion. METHODS: Morbidity and neobladder function were analyzed in 56 consecutive patients with bladder substitutions. QOL assessment was performed using the Sickness Impact Profile (SIP), supplemented with a detailed voiding and continence questionnaire. RESULTS: Mean age was 44.7 years. Mean follow-up was 41 months. Thirty-one men and 25 women were treated for transitional cell carcinoma (n = 22) or benign conditions (n = 34). In 33 patients, orthotopic (20 Mainz pouch and 13 ileal neobladder) substitutions were performed and in 23, heterotopic substitutions (Indiana pouch) were performed. Early complications required five open reinterventions. Late complications (at more than 3 months) included ureteric stenosis in 5 patients. In 38 patients (68%), full urinary continence was achieved. Spontaneous micturition was possible in 61% of orthotopic substitutions, whereas 15% of patients were required to perform intermittent catheterization only and 24% exhibited a combined voiding pattern. Compared to age-matched reference values, SIP scores showed a negative impact of heterotopic or orthotopic diversion in the SIP categories of emotion, recreation, and social interaction. The latter category included a statement about sexual activity, which was decreased in 50% of patients. In the category of emotion, orthotopic substitutions compared favorably to heterotopic substitutions (P = 0.02). CONCLUSIONS: The morbidity profile is comparable to previous reports. QOL assessment using the SIP revealed a minor advantage for an orthotopic placement which was due to a relatively small number of patients. Most importantly, QOL was found to be favorable for both types of bladder substitute placement.

Adolescent↗
PubMed1998

Neuromodulation: urodynamic effects of sacral (S3) spinal nerve stimulation in patients with detrusor instability or detrusor hyperflexia.

The aim of this study was to determine the urodynamic effects of sacral (S3) nerve stimulation in patients with urge incontinence due to detrusor overactivity which has been refractory to conservative treatment. A total of 24 patients with idiopathic detrusor instability and five with neurogenic hyperreflexia were studied urodynamically before and 6 months after a permanent S3 foramen electrode implant. The urodynamic studies at follow-up were done with the stimulus on. Clinically, the average voiding frequency, the number of leakage episodes and pad use per 24 h decreased significantly. Improvement in several urodynamic parameters was noted. In the idiopathic as well as in the neurogenic group, the correlation between symptomatic and urodynamic improvement was incomplete. Neuromodulation leads to improvement of several urodynamic parameters in patients with urge incontinence due to detrusor overactivity which has been refractory to conservative treatment and appears to be a valuable treatment option in these patients.

Adult↗
PubMed1998

The artificial urinary sphincter in men incontinent after radical prostatectomy: 5 year actuarial adequate function rates.

OBJECTIVE: To determine the success (as both continence and revision rates) of the artificial urinary sphincter (AUS) in men incontinent after radical prostatectomy, and thus improve the preoperative counselling provided for these patients. PATIENTS AND METHODS: The AUS was implanted in 27 men incontinent after radical prostatectomy (mean age 69 years, range 59-75) at a mean (range) interval of 20 (4-60) months after surgery. The Kaplan-Meier method of survival analysis was used to determine the 'primary adequate function' (PAF) rate and the 'additional procedure-assisted adequate function' (APA-AF) rate. Adequate function was defined as satisfactory continence (use of at most one pad per 24 h) in combination with good AUS function. PAF was defined when no revisions of the AUS were required and APA-AF when one or more revisions of one or more parts of the AUS were required; a complete exchange or explantation of the AUS defined failure, i.e. the end of APA-AF. RESULTS: At a mean follow-up of 35 months, 81% of the patients had achieved satisfactory continence. However, the 5 year PAF and APA-AF rates, based on the Kaplan-Meier curves, were 49% and 71%, respectively. CONCLUSIONS: Implantation of an AUS can provide excellent continence rates in patients incontinent after radical prostatectomy, but only at the expense of a considerable re-operation rate. The outcome is best represented by Kaplan-Meier curves of the PAF and the APA-AF.

Aged↗
PubMed1998

Diagnosis and grading of detrusor instability using a computerized algorithm.

PURPOSE: Detrusor instability and hyperreflexia are characterized by involuntary detrusor contractions in the filling phase of the voiding cycle. The diagnosis is made when urodynamic evaluation reveals such contractions. To compare patients and evaluate treatment a method is needed to quantify the degree of instability. We developed an instability parameter based on the area under the curve of involuntary detrusor contractions on conventional filling cystometry. MATERIALS AND METHODS: We developed an automatic method to calculate the area under the curve of involuntary detrusor contractions in conventional filling cystometry. Logistic regression was used to construct decision rules to differentiate stable from unstable bladders. These rules, derived from a group of 100 children, were applied to a second group of 77 who were independently assessed by 3 urodynamics experts. RESULTS: Typically 88% of the second group were correctly classified as stable or unstable by the automatic procedure. In the unstable subgroup there was poor correlation between the calculated instability parameter and the instability score assigned by the experts. Most likely this difference occurred because the experts based their opinion mainly on the amplitude of the highest unstable contraction and the percentage of filling time that instability was found. CONCLUSIONS: The proposed method of automatically grading detrusor instability based on the area under detrusor contractions differs from the intuitive method used by experts. Since no standard is available, it cannot be concluded which method is better. Our proposed method is objective and it results in a single physical value.

Algorithms↗
PubMed1998

Iliac arterial occlusive disease: cost-effectiveness analysis of stent placement versus percutaneous transluminal angioplasty. Dutch Iliac Stent Trial Study Group.

PURPOSE: To evaluate the relative benefits and cost-effectiveness of treating iliac arterial occlusive disease with various interventions. MATERIALS AND METHODS: Cost-effectiveness was analyzed in a hypothetical cohort of patients with intermittent claudication caused by an iliac arterial stenosis. Primary stent placement, percutaneous transluminal angioplasty (PTA), and PTA with selective stent placement were analyzed. Reduction in the risk of failure after primary stent placement versus that after PTA with selective stent placement, quality of life, and cost data were derived from results of a randomized, controlled trail. Complication rates, patency results, and the reduction in risk of failure were derived from a published meta-analysis. RESULTS: PTA with selective stent placement yielded equivalent complication rates, patency results, and quality-of-life outcomes compared with those of primary stent placement, and the latter cost +957 less (95% confidence interval = +726, +1,188). PTA with selective stent placement was more expensive than PTA alone but yielded higher patency results (relative risk of long-term failure, 0.61; 95% confidence interval = 0.49, 0.75) and quality-adjusted life expectancy (0.2 quality-adjusted life year [QALY] gained) and had an incremental cost-effectiveness ratio of less than +20,000 per QALY gained. CONCLUSION: PTA with selective stent placement is a cost-effective treatment strategy compared with primary stent placement or PTA alone in the treatment of intermittent claudication caused by an iliac arterial stenosis.

Angioplasty, Balloon↗
PubMed1997

Urodynamic effects of various treatment modalities for benign prostatic hyperplasia.

PURPOSE: I studied the effects of various treatments for benign prostatic hyperplasia on urethral resistance. MATERIALS AND METHODS: I reviewed the literature on urodynamic effects of treatments for benign prostatic hyperplasia. Articles that reported pretreatment and posttreatment values of relevant urodynamic parameters were analyzed. Average before and after treatment values of maximum flow rate and detrusor pressure at maximal flow rate for every study were plotted on an Abrams-Griffiths nomogram and classified as obstructed, equivocal or nonobstructed. Average values of maximum flow rate and detrusor pressure at maximal flow rate were calculated for the total number of patients treated by a certain modality. RESULTS: Based on this analysis, the rank order of urodynamic efficacy was that open prostatectomy is more effective in reducing urethral resistance than is transurethral prostatectomy. These treatments diminish obstruction better than laser treatment or transurethral incision of the prostate, which again are more effective than balloon dilation, alpha-blockers or transurethral microwave thermotherapy. Finally, androgen deprivation performs better than placebo treatment. CONCLUSIONS: The rank order of urodynamic efficacy as determined in this analysis shows a high level of agreement with reported rank order of symptomatic efficacy of various modalities. After placebo treatment there is no significant change in urethral resistance. This finding indicates that pressure-flow studies are a sensitive way to compare active to placebo treatment and that pressure-flow studies have excellent long-term reproducibility.

Electrosurgery↗
PubMed1997

Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease.

PURPOSE: To estimate and compare the results of percutaneous transluminal angioplasty (PTA) and stent placement to treat aortoiliac occlusive disease. MATERIALS AND METHODS: A meta-analysis was performed of data in six PTA studies (1,300 patients) and eight stent placement studies (816 patients) published in 1990 or later that met the inclusion criteria. Proportions were combined by means of a random-effects model. Failure-time data were pooled with and pooled without adjustment for differences in case mix. RESULTS: The immediate technical success rate in the PTA group was 91%; the rate was higher in the stent group (96%), but the difference was not statistically significant [corrected]. Complication and mortality rates were not statistically significantly different. Analyzed data included technical failures and were adjusted for lesion type and disease severity. Four-year primary patency rates were 65% for stenoses versus 54% for occlusions after PTA to treat claudication and were 53% for stenoses versus 44% for occlusions after PTA to treat critical ischemia. These rates were 77% for stenoses versus 61% for occlusions after stent placement to treat claudication and 67% for stenoses versus 53% for occlusions after stent placement to treat critical ischemia. The risk of long-term failure was reduced by 39% after stent placement compared with PTA. CONCLUSION: Stent placement and PTA yielded similar complication rates, but the technical success rate was higher after stent placement and the risk of long-term failure was reduced.

Angioplasty, Balloon↗
PubMed1997

Sacral rhizotomies and electrical bladder stimulation in spinal cord injury. Part I: Clinical and urodynamic analysis. Dutch Study Group on Sacral Anterior Root Stimulation.

OBJECTIVES: To present the clinical and urodynamic results of the treatment of neurogenic bladder dysfunction in spinal cord injury by sacral rhizotomies and electrical bladder stimulation with the Finetech-Brindley stimulator during a 3-year inclusion and study period. METHODS: 226 patients with spinal cord lesion and urological problems due to hyperreflexia of the bladder were screened for sacral rhizotomies and electrical bladder stimulation. In 52 patients complete posterior sacral root rhizotomies were performed and a Finetech-Brindley sacral anterior root stimulator implanted. All patients were screened and followed with a standard protocol. RESULTS: Complete continence during daytime was achieved in 73% of patients with 6-month follow-up and in 86% at night. Significant increase in bladder capacity and bladder compliance was achieved in all patients. Residual urine was reduced significantly, resulting in a decrease of the incidence of urinary tract infections. CONCLUSIONS: The treatment of neurogenic bladder dysfunction in spinal cord injury by anterior sacral root stimulation with the Finetech-Brindley stimulator in combination with sacral posterior root rhizotomy produces excellent results with limited morbidity.

Adolescent↗
PubMed1997

Using the ICSOoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS-'BPH' Study. International Continence Society--Benign Prostatic Hyperplasia.

OBJECTIVE: To present and describe the validity and reliability of the International Continence Society-Benign Prostatic Hyperplasia study quality-of-life (ICSQoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle-aged and elderly men. PATIENTS AND METHODS: The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS-'BPH' study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS-'BPH' study questionnaire which includes six items addressing general and specific aspects of QoL (the ICSQoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICSmale questionnaire) and generic health status, as measured by the Short Form (SF-36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test-retest analysis. RESULTS: The ICSQoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICSQoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test-retest reliability, but their internal consistency was poor, confirming that ICSQoL questions should not be combined into a score. General ICSQoL items were closely related with most domains of the SF-36 and the EuroQol. CONCLUSION: ICSQoL items may be used individually or as a group in research studies or in clinical practice.

Aged↗
PubMed1995

Prostate specific antigen in a community-based sample of men without prostate cancer: correlations with prostate volume, age, body mass index, and symptoms of prostatism.

The correlation between both prostate specific antigen levels (PSA) and prostate specific antigen density (PSAD) and age, prostate volume parameters, body mass index, and the International Prostate Symptom Score (IPSS) were studied in a community-based population. A sample of 502 men aged 55 through 74 years was evaluated, excluding those with a serum PSA above 10 ng/ml, those with biopsy proven prostate cancer, and those who had previously undergone a prostate operation. PSA and PSAD did not correlate with the body mass index. Weak correlations were found between PSA and age (r = 0.25; P < 0.001), PSAD and age (r = 0.17; P < 0.001) and between PSA and the total prostate volume (r = 0.58; P < 0.001). PSA did not correlate independently with age after adjustment for volume (P = 0.22). The finding that PSAD correlates with age (r = 0.17; P < 0.001) is partly explained by the incomplete volume adjustment of PSAD which is proved by the positive correlation between PSAD and prostate volume (r = 0.26; P < 0.001). In the main target age-range for prostate cancer screening there is a poor basis for the use of age-specific reference values or volume adjustment for PSA levels in order to increase the clinical usefulness of this serum marker. Comparison of the results of the present study and studies conducted in others regions shows that there may be significant differences in PSA values per age stratum. Further studies are needed to clarify the reasons for these differences.

Aged↗
PubMed1995

Natural history of benign prostatic hyperplasia: appropriate case definition and estimation of its prevalence in the community.

There is no consensus about a case definition of benign prostatic hyperplasia (BPH). In the present study, BPH prevalence rates were determined using various case definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism, prostate volume increase, and bladder outflow obstruction. The aim of this study--in a community-based population of 502 men (55-74 years of age) without prostate cancer--was to determine the relative impact on prevalence rates of the inclusion of these different parameters (and of different cutoff values for these parameters) in a case definition of BPH. There is agreement that age is the dominant determinant of BPH. However, of 28 different case definitions that were formulated, only eight gave a statistically significant increase in the prevalence of BPH with age. The highest overall prevalence of 19% (95% confidence interval [CI], 15-23%) occurred using the definition that combines a prostate volume > 30 cm3 and an International Prostate Symptom Score (IPSS) > 7. The lowest prevalence rate of 4.3% (95% CI, 2-6%) occurred using the definition that combines a prostate volume > 30 cm3, an IPSS > 7, a maximum flow rate < 10 mL/s, and the presence of a postvoid residual urine volume > 50 mL. Thus, prevalence rates depend very much on the parameters used in a case definition. Follow-up will establish which men will eventually request a workup and treatment for BPH and will help determine the best clinical definition of BPH.

Age Factors↗