Management of the BPH Syndrome in Germany: Who Is Treated and How?

Abstract

Objectives: To review the available data on contemporary management of symptomatic benign prostatic hyperplasia (BPH) within the German healthcare system. Methods: Information was obtained from articles published in scientific journals retrieved through searches in Medline and Embase. In addition, preliminary data from the first representative German survey on lower urinary tract symptoms (LUTS) were obtained (‘Herner LUTS-Study’, a community-based survey in Herne, a city within the industrial complex called the Ruhr Area). Finally, the recently established German guidelines for the diagnosis and treatment of the BPH-Syndrom (BPS) were reviewed. Results: Only few studies are published in the literature analysing the current concepts of management of BPH in Germany. These studies show that there is variation in the concepts of conservatory and surgical management of BPH. The German BPH guidelines suggest watchful waiting for patients with mild LUTS (total I-PSS ≤7) and medical therapy or surgery for those with moderate to severe LUTS (I-PSS >7). There was no final consensus on the role of phytotherapy in the German treatment guidelines, due to the lack of clinical data. α₁-Blockers and finasteride (for prostates >40 ml) are recommended medical treatment approaches. Transurethral resection of the prostate (TUR-P) is considered to be the standard surgical procedure. Preliminary data from the Herner LUTS-Study show, that approximately 30% of men aged 50–80 years have moderate to severe LUTS (i.e. total I-PSS score >7). About a third of these men currently seek healthcare. Conclusions: LUTS and BPS are a highly prevalent condition in Germany. With the estimate that the number of men over the age of 65 will almost double in Germany within the next 30 years, it will be a challenge in the next millennium to find the healthcare resources for the management of BPS.