1. Sakeena Hawkins, MENP Student
Modifiable Risk Factors, Demographics, Serious Morbidities Related to Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) in Older African American Men
Introduction: Benign prostatic hyperplasia (BPH) is a major health concern for aging men. BPH is associated with urinary voiding dysfunction and lower urinary tract symptoms (LUTS), which negatively affects quality of life. Studies have shown that older African Americans have a similar, or greater risk to develop BPH and LUTS compared to Caucasian men. There are several specific symptoms that are associated with BPH and LUTS. It is important to identify these symptoms in order to better understand these diseases and who are more susceptible to them. It is even more important to identify the risks associated with BPH and LUTS to decrease symptoms or even possibly prevent them. The purpose of this literature review is to identify modifiable risks, demographics, and serious morbidities related to BPH and LUTS in older African American men.
Purpose: The purpose of this literature review is to identify modifiable risks, demographics, and serious morbidities related to BPH and LUTS in older African American men.
Methods: A computerized search of literature was conducted using Academic Search Complete, MEDLINE, and Wiley Online Library. The following search terms were used during the searches for this literature review: benign prostatic hyperplasia, Male BPH, Lower urinary tract symptoms, LUTS, older African American men, black men, Modifiable risk factors, causes, demographics, and serious morbidities.
Conceptual Framework
The topic of this literature review is based on evidence based nursing research that covers the concepts of risk factors, demographics, and morbidities of BPH and LUTS in older African American men. Research educates and advises practice by supplying evidence for effective practices for teaching and nursing care delivery. Education is paramount for learning. Faculty should educate based on research evidence, teaching/learning theories, and needs of the practice arena. “The practice setting is where students are educated and evidence-based nursing care is delivered to patients or clients; it also provides the experiences from which nurses identify future research topics and new nursing theories.” (Thompson, 2017)
There will be two fundamental assumptions made related this concept. The first assumption is that comorbidities are closely related to BPH and LUTS. The second assumption is that the relationship factors associated with hormones and growth factors are still unclear. An initial literature search revealed that the risk factors associated with BPH and LUTS are genetics, age, lifestyle, hormones and inflammation/ As described below, the risk factors associated with BPH and LUTS becomes clearer when viewed within this literature review.
Conclusion:. In summary, BPH and LUTS are of significant importance to public health. Current disease trends in the United States suggest that the number of men suffering from these conditions will swell markedly in the very near future. The rapid aging of the US population, coupled with the obesity and diabetes epidemics is poised to substantially increase the prevalence of BPH and LUTS within the general population and place even greater burdens on finite health care resources. Although the relatively immutable consequences of age substantially affect the development of BPH and LUTS, many modifiable variables contribute as well. These factors may be manipulated to delay onset, prevent progression, or attenuate symptoms.
Results and Discussion There was an overall 29.7 percent of men that reported having moderate to severe LUTS, with the prevalence increasing with age. The majority of men were married or living with a partner, had high school education or equivalent, and reported an annual income of less than 50,000. Overall, 44 percent were current smokers and 52.4 percent consumed alcohol. However, the prevalence of smoking and drinking decreased with age. Almost one third of the population of the study were obese. Twenty-two percent reported that they never engaged in vigorous physical activity, that proportion increasing above 40 percent in me aged 50 years or older. However, increased physical activity and exercise have been robustly and consistently linked with decreased risks of BPH surgery. Very few men reported having a vasectomy but more than half reported a history of sexually transmitted infections. Over fifty percent reported a history of hypertension. 9.4 percent reported history of heart disease and 16.4 percent of men reported having diabetes. The prevalence being between 25 percent and 30 percent in men over age 60 years. The men between that ages of years experienced more than a double increase in the odds of moderate to severe LUTS. Men with who had completed high school had slightly reduced odds of having moderate to severe irrigative symptoms. Men with incomes over 30,000 experienced reduced risks of moderate to severe LUTS and irrigative symptoms than those of lower income. Marital status was not associated with urinary symptoms. Both current and former smokers were at increased odds of having moderate to severe LUTS in comparison with never smokers. Current smoking of >20 cigarettes per day was associated with obstructive and irrigative symptoms. Former smokers were at increased risk of experiencing obstructive symptoms.. Like exercise, moderate alcohol intake also appears to be protective against multiple outcomes related to BPH. Former alcohol drinkers when compared with never drinkers, had approximately doubled the odds of moderate to severe LUTS, while currently heavy drinkers had nearly tripled the increase. There was no consistent pattern of association between increased body mass in LUTS. The odds of moderate to severe LUTS, including obstructive and irrigative symptoms, were elevated among men with history of hypertension, heart disease, or diabetes. History of sexually transmitted diseases was associated with urinary symptom severity.
Background and significance‘: The US population ages, the occurrence and regularity of BPH and LUTS is rapidly increasing. BPH and LUTS have a distinct association with serious medical morbidities and diminished health-related quality of life. Age play a vital role in the etiology of BPH and LUTS. However, recent observation at the population level have acknowledged that modifiable risk factors are also likely key components. Things that increase risks include, smoking, alcohol diabetes, hypertension and heart disease. Specific symptoms associated with the BPH and LUTS include frequency, urgency, nocturnal, difficulty initiating urination, sense of incomplete bladder emptying, decreased force of stream, and interruption of stream. In previous studies of the risk factors of BPH and LUTS, the focus has only been on white populations. Between September 1996 and January 1998, a population sample was performed on African American men ages in Flint Michigan. In this sample, the authors assessed the role of putative sociodemographic, lifestyle, and medical history risk factors in moderate to severe LUTS.
References
 American Urology Association (2010). American Urological Association guideline: management of benign prostatic hyperplasia (BPH). Retrieved from website:
Montie, J. E., Joseph, M. A., Schottenfeld, D., Harlow, S. D., Wei, J. T., Sarma, A. V., Dunn, R. L., Doerr, K. M. (2003). Risk Factors for Lower Urinary Tract Symptoms in a Population-based Sample of African-American Men. American Journal of Epidemiology, 157, 10,
Parsons, J. K. (2010). Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors. Current Bladder Dysfunction Reports, 5, 4,
Jacobsen, S. J. (January 01, 2007). Risk factors for benign prostatic hyperplasia. Current Urology Reports, 8, 4,