Trends in adverse events of benign prostatic hyperplasia (BPH) in the USA, 1998 to 2008

Study Type – Harm (Cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? In clinical trials, oral medications for BPH have been effective at managing LUTS and preventing progression to urinary retention, urinary infections, and renal insufficiency. Population-level trends of these adverse outcomes are poorly characterized. We identified a 400% increase in hospitalizations for BPH with acute renal failure, indicating that severe adverse events of BPH persist despite widespread use of oral therapies in the USA. OBJECTIVE • To determine if the adverse events (AEs) of benign prostatic hyperplasia (BPH) have declined in tandem with increased use of oral therapy. MATERIALS AND METHODS • We used the Nationwide Inpatient Sample, a 20% sample of USA community hospitals, weighted to estimate national numbers to characterize the prevalence of AEs of BPH from 1998 to 2008. • We calculated the age-adjusted prevalence of BPH and associated conditions and analyzed prevalence trends with regression modelling. RESULTS • Of 134 million estimated eligible discharges during the study period, 7 464 730 (5.6%) had either a primary or secondary diagnosis of BPH. • The age-adjusted prevalence of BPH among all hospitalizations, irrespective of primary diagnosis, increased from 4.3% to 8% (P < 0.001) during the study period. • The age-adjusted prevalence of BPH as a primary diagnosis decreased from 0.88% to 0.48% (P < 0.001). • Discharges for BPH surgery decreased 51% (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.45–0.54, P-trend 400% (OR 4.28, 95% CI 3.22–5.71, P-trend <0.001). • There were no significant changes in discharges for primary BPH with urinary retention (P-trend = 0.636), bladder stones (P-trend = 0.117), or urinary infection (P-trend = 0.101) over time. CONCLUSIONS • Increased hospitalizations for BPH with acute renal failure and stable hospitalizations for other AEs of BPH indicate that severe AEs of BPH persist despite widespread use of oral therapies in the USA. • Further studies are needed to explain these trends.