Benign prostatic hyperplasia (BPH) is one of the most common urological disorders affecting elderly men and is characterized by non-malignant enlargement of the prostate gland.1 The condition develops primarily in the transitional zone of the prostate and may cause compression of the prostatic urethra, resulting in bladder outlet obstruction and lower urinary tract symptoms (LUTS).2 BPH represents an important public health concern because its prevalence increases with advancing age, and it can significantly affect the quality of life, physical comfort, sleep, and daily activities of affected individuals.

The exact cause of BPH is multifactorial and is associated with ageing, hormonal changes, genetic predisposition, and metabolic abnormalities. Androgens, particularly dihydrotestosterone (DHT), play an important role in prostatic growth and maintenance.3 In addition to age and hormonal influences, obesity, diabetes mellitus, hypertension, dyslipidaemia, and physical inactivity have been investigated as potential risk factors associated with BPH development and progression.4 However, the strength of these associations varies across populations, and further clinical research is required to understand their contribution to disease severity and outcomes.5

Patients with BPH commonly present with urinary frequency, urgency, nocturia, hesitancy, a weak urinary stream, intermittency, straining during urination, and a sensation of incomplete bladder emptying.6 These symptoms may progress gradually and can interfere with sleep, social activities, and overall well-being. In some patients, untreated or progressive disease may lead to acute urinary retention, recurrent urinary tract infections, bladder stones, haematuria, and, in severe cases, impairment of renal function.7 The severity of symptoms does not always correspond directly to prostate size; therefore, comprehensive clinical assessment is essential for determining disease burden and selecting appropriate treatment.8

The diagnosis of BPH is based on clinical history, physical examination, digital rectal examination, and relevant investigations. Assessment may include the International Prostate Symptom Score (IPSS), urinalysis, serum prostate-specific antigen (PSA) when clinically indicated, measurement of post-void residual urine, uroflowmetry, and ultrasonography.9 These investigations help evaluate symptom severity, urinary obstruction, prostate characteristics, and the presence of complications. Treatment options depend on symptom severity, prostate size, associated comorbidities, patient preferences, and the risk of disease progression.10 Management may include lifestyle modifications, pharmacological treatment with alpha-blockers or 5-alpha-reductase inhibitors, combination therapy, and surgical intervention in patients with severe symptoms or complications.11

Clinical outcomes among elderly men with BPH vary considerably according to baseline disease severity, comorbid conditions, treatment adherence, and the response to medical or surgical management.12 Although many patients experience symptomatic improvement with appropriate treatment, others may develop persistent urinary symptoms, acute urinary retention, recurrent infections, or the need for surgical intervention.13 Furthermore, age-related comorbidities may complicate treatment decisions and influence recovery and long-term outcomes.14 Identifying the factors associated with adverse clinical outcomes is therefore essential for improving patient selection, optimizing treatment strategies, and reducing disease-related complications.

In Pakistan, BPH represents a relevant clinical challenge because elderly men may present late due to limited awareness, embarrassment regarding urinary symptoms, financial barriers, or delayed access to specialized urological services.15 Local hospital-based evidence regarding the risk factors, clinical presentation, treatment patterns, and outcomes of BPH remains important for guiding clinical practice and improving patient care.16 Understanding the characteristics of affected patients can also help identify individuals who require closer monitoring or early intervention.

Therefore, the present study aims to evaluate the risk factors and clinical outcomes of benign prostatic hyperplasia among elderly male patients attending a tertiary care hospital. The study will assess demographic characteristics, associated comorbidities, presenting urinary symptoms, relevant clinical findings, treatment approaches, and outcomes, including symptomatic improvement and complications. The findings may contribute to a better understanding of BPH in the local population and support evidence-based approaches to the diagnosis, management, and follow-up of elderly men with this common urological condition.

Study Design: A hospital-based cross-sectional study was conducted to evaluate the risk factors and clinical outcomes of benign prostatic hyperplasia (BPH) among elderly male patients. Study Setting: The study was conducted in the Department of Urology, Ayub Teaching Hospital, Abbottabad, Khyber Pakhtunkhwa, Pakistan. Study Duration: The study was conducted over a period of 12 months, from January 2025 to December 2025. Study Population: The study population comprised elderly male patients diagnosed with benign prostatic hyperplasia who attended the outpatient department or were admitted to the Department of Urology during the study period. Sample Size and Sampling Technique: A sample size of 150 patients was proposed for the study. Patients were recruited using a non-probability consecutive sampling technique, according to the eligibility criteria. Inclusion Criteria • Male patients aged 60 years and above. • Patients with a clinical diagnosis of benign prostatic hyperplasia. • Patients who provided informed consent to participate in the study. Exclusion Criteria • Patients with confirmed prostate cancer. • Patients with a history of previous prostate surgery. • Patients with urethral stricture or other urological conditions that could independently explain the urinary symptoms. • Patients who declined to participate. Data Collection Procedure: Data were collected using a structured questionnaire and clinical assessment. Demographic information, including age, residence, and relevant medical history, was recorded. Potential risk factors included obesity, diabetes mellitus, hypertension, family history of BPH, physical inactivity, and smoking history. Clinical information included presenting symptoms such as urinary frequency, urgency, nocturia, hesitancy, weak urinary stream, straining, and incomplete bladder emptying. Relevant investigations, including digital rectal examination, prostate-specific antigen (PSA) when indicated, ultrasonography, post-void residual urine measurement, and uroflowmetry, were recorded when available. The International Prostate Symptom Score (IPSS) was used to assess the severity of lower urinary tract symptoms where applicable. Assessment of Clinical Outcomes: Clinical outcomes were assessed according to the documented response to treatment and the presence of complications. Outcomes included symptomatic improvement, persistent lower urinary tract symptoms, acute urinary retention, urinary tract infection, bladder stones, and the requirement for surgical intervention. Treatment modalities, including medical management and surgery, were also documented. Since the study employed a cross-sectional design, outcomes were assessed at the time of evaluation or from available clinical records rather than through prospective long-term follow-up. Statistical Analysis: Data were entered and analyzed using IBM SPSS Statistics. Quantitative variables, such as age and PSA levels, were summarized as mean and standard deviation or median and interquartile range, depending on their distribution. Categorical variables, including risk factors, presenting symptoms, treatment modalities, and complications, were expressed as frequencies and percentages. Associations between potential risk factors and clinical outcomes were assessed using the chi-square test or Fisher’s exact test, as appropriate. A p-value of less than 0.05 was considered statistically significant. Ethical Considerations: Ethical approval was obtained from the relevant institutional ethical review committee before commencement of the study. Written informed consent was obtained from participants, and confidentiality was maintained throughout data collection and analysis. Patient information was used exclusively for research purposes.

A total of 150 elderly male patients with benign prostatic hyperplasia (BPH) were included in this proposed results format. The demographic characteristics, potential risk factors, clinical presentation, and treatment outcomes are summarized in the following tables.

Table 1. Demographic characteristics of patients (n = 150)

Table 2. Potential risk factors and associated comorbidities (n = 150)

Table 3. Clinical presentation of BPH (n = 150)

Table 4. Treatment modalities and clinical outcomes (n = 150)

Table 5. Association between selected risk factors and symptom severity

Benign prostatic hyperplasia (BPH) is a common urological condition among elderly men and represents an important cause of lower urinary tract symptoms, impaired quality of life, and urinary complications. The present study was designed to evaluate the risk factors, clinical presentation, and outcomes of BPH among elderly male patients attending Ayub Teaching Hospital, Abbottabad. The main areas of interest include age-related disease patterns, associated comorbidities, severity of urinary symptoms, and the response to medical and surgical treatment. Age is one of the most important factors associated with BPH. The frequency and severity of prostatic enlargement generally increase with advancing age because of age-related hormonal changes and alterations in prostatic tissue growth. The predominance of patients aged 60–69 years in the proposed study results may reflect early symptomatic presentation among elderly men; however, the actual age distribution should be confirmed from the collected data. Similar age-related patterns have been described in epidemiological studies of BPH, which demonstrate that histological prostatic enlargement becomes increasingly common as men grow older. The association between BPH and metabolic comorbidities is another important consideration. Diabetes mellitus, hypertension, obesity, and dyslipidaemia have been investigated as potential contributors to the development and progression of lower urinary tract symptoms. Insulin resistance, chronic inflammation, altered autonomic activity, and metabolic disturbances may contribute to changes in prostate growth and bladder function. However, these conditions may coexist with BPH without necessarily being its direct cause. Therefore, identifying these comorbidities is clinically useful for assessing the overall health status of patients and planning individualized management. The clinical presentation of BPH varies among patients. Nocturia, weak urinary stream, increased urinary frequency, hesitancy, and incomplete bladder emptying are common manifestations. Nocturia may be particularly troublesome because it disrupts sleep and negatively affects daily functioning. Nevertheless, urinary symptoms in elderly men may also arise from diabetes, urinary tract infection, overactive bladder, or other urological disorders. A careful clinical assessment is therefore necessary to establish the likely cause of symptoms and distinguish uncomplicated BPH from disease associated with complications. Urinary symptom severity is an important determinant of treatment selection and clinical outcomes. The American Urological Association (AUA) guideline emphasizes that evaluation should consider symptom burden, patient characteristics, and the potential contribution of bladder dysfunction and systemic diseases rather than relying on prostate size alone. The European Association of Urology (EAU) similarly emphasizes the multifactorial nature of male lower urinary tract symptoms. These recommendations support the use of standardized symptom assessment and appropriate investigations in the evaluation of patients with suspected BPH. 17 The proposed study results indicate that nocturia was the most frequently reported symptom, followed by weak urinary stream and urinary frequency. This pattern is clinically plausible and consistent with the recognized spectrum of lower urinary tract symptoms associated with BPH. However, nocturia is not specific to BPH and may also be associated with diabetes mellitus, sleep disorders, and other medical conditions. Therefore, the interpretation of this finding should take account of relevant comorbidities and the clinical assessment of each patient. Regarding treatment, medical therapy is commonly used to relieve bothersome urinary symptoms, whereas surgical intervention may be appropriate for patients with inadequate response to medication, severe symptoms, or complications such as recurrent urinary retention. The AUA guideline amendment by Sandhu and colleagues discusses evidence-based medical and procedural treatment options, including alpha-blockers, 5-alpha-reductase inhibitors, combination therapy, and surgical approaches. The choice of treatment should be individualized according to symptom severity, prostate characteristics, comorbidities, treatment response, and patient preferences.18 Clinical outcomes are also influenced by timely diagnosis, treatment adherence, and the presence of associated diseases. Persistent urinary symptoms may require reassessment of the diagnosis, medication regimen, bladder function, or degree of urinary obstruction. Acute urinary retention, recurrent urinary tract infections, and bladder stones require particular attention because they may indicate clinically significant disease or associated complications. The present study can help describe the burden of these outcomes among patients attending Ayub Teaching Hospital, although a cross-sectional design cannot establish the long-term effectiveness of a particular treatment or determine whether a risk factor directly caused an adverse outcome. The findings may be valuable in the local context because hospital-based studies can help identify the common clinical presentations and comorbidities of elderly men seeking urological care in Abbottabad. Nevertheless, comparisons with other populations should be made cautiously because differences in age distribution, referral patterns, diagnostic criteria, access to healthcare, and treatment practices may influence the reported findings. A systematic review by Lee and colleagues found that the prevalence of BPH varies across populations but generally increases with age, supporting the importance of age-specific assessment and healthcare planning.19 Several limitations should be considered. First, the hospital-based design limits the generalizability of the findings to the wider community. Second, the cross-sectional nature of the study restricts assessment of disease progression and long-term treatment outcomes. Third, information on some risk factors and symptoms may be affected by incomplete medical records or recall bias. Finally, associations between comorbidities and clinical outcomes should not be interpreted as evidence of causation. In conclusion, BPH is an important cause of urinary symptoms among elderly men and may be associated with substantial clinical burden. Assessment of age, metabolic comorbidities, symptom severity, and complications can support appropriate clinical management. Further prospective studies involving longer follow-up are recommended to identify predictors of disease progression and evaluate treatment outcomes in the local population.

Benign prostatic hyperplasia (BPH) is an important urological condition among elderly men, commonly presenting with nocturia, weak urinary stream, urinary frequency, and hesitancy. Associated comorbidities, including hypertension, diabetes mellitus, obesity, and physical inactivity, may contribute to the overall clinical burden and should be considered during patient assessment. Appropriate diagnosis, individualized treatment, and regular follow-up are essential for improving urinary symptoms and identifying complications such as acute urinary retention, urinary tract infections, and bladder stones. Medical management remains an important treatment approach, while surgical intervention may be required in selected patients with severe symptoms or complications. Further prospective studies with long-term follow-up are recommended to identify predictors of disease progression and evaluate treatment outcomes among elderly men with BPH.