R O Roberts

Brigham and Women's Hospital , Boston, MA, United States

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Publications (34)90.1 Total impact

  • Annals of Epidemiology - ANN EPIDEMIOL. 01/2004; 14(8):599-600.
  • Annals of Epidemiology - ANN EPIDEMIOL. 01/2004; 14(8):616-616.
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    ABSTRACT: The objectives of the study were to characterize male sexual functioning as related to age in community-dwelling older men. In 1989, a random sample of men aged 40-79 y (n=2115) without prior prostate surgery, prostate cancer, or other conditions known to affect voiding function (except benign prostatic hyperplasia) was invited (55% agreed) to participate in the Olmsted County Study of Urinary Symptoms and Health Status Among Men. In 1996, a previously validated male sexual function questionnaire was administered to the cohort. The questionnaire has 11 questions measuring sexual drive (two questions); erectile function (three) and ejaculatory function (two), as well as assessing problems with sex drive, erections, or ejaculation (three); and overall satisfaction with sex life (one). Each question is scored on a scale of 0-4, with higher scores indicating better functioning. Cross-sectional age-specific means (+/-s.d.) for drive, erections, ejaculation, problems, and overall satisfaction declined from 5.2 (+/-1.5), 9.8 (+/-2.5), 7.4 (+/-1.4), 10.7 (+/-2.2), and 2.6 (+/-1.0), respectively, for men in their 40s to 2.4 (+/-1.6), 3.3 (+/-3.4), 3.6 (+/-3.2), 7.7 (+/-3.8), and 2.1 (+/-1.2) for men 70 y and older (all P<0.001). The cross-sectional decline in function with age was not constant, with age-related patterns differing by domain. The percentage of men reporting erections firm enough to have intercourse in the past 30 days declined from 97% (454/468) among those in their 40s to 51% (180/354) among those in their 80s (P&<0.001). In age-adjusted analyses, men reporting regular sexual partners had statistically significantly higher levels of sex drive, erectile function, ejaculatory function, and overall satisfaction than those who did not report regular sexual partners. Sexual drive, erectile functioning, ejaculatory functioning, and overall sexual satisfaction in men show somewhat differing cross-sectional patterns of decline with advancing age. Active sexual functioning is maintained well into the 80s in a substantial minority of community-dwelling men.
    International Journal of Impotence Research 06/2003; 15(3):185-91. · 1.51 Impact Factor
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    ABSTRACT: To obtain community-based information about the incidence of interstitial cystitis, a chronic disabling condition of the bladder where knowledge is limited because there are no definitive diagnostic criteria. All residents of Olmsted County, MN, USA who had received a physician-assigned diagnosis of interstitial cystitis between 1976 and 1996 were identified through the resources of the Rochester Epidemiology Project. The clinical findings at diagnosis and during the follow-up were ascertained from the community medical records for each study subject. In all, 16 women and four men received a diagnosis of interstitial cystitis during the study period. The overall age- and sex-adjusted (95% confidence interval) incidence rate was 1.1 (0.6-1.5) per 100 000 population. The age-adjusted incidence rates were 1.6 per 100 000 in women and 0.6 per 100 000 in men (P = 0.04). The median (range) age at initial diagnosis was 44.5 (27-76) years in women and 71.5 (23-79) years in men (P = 0.26). The median number of episodes of care-seeking for symptoms before the diagnosis was one for women and 4.5 for men (P = 0.03). The median duration from the onset of symptoms until the first diagnosis was 0.06 and 2.2 years in women and men, respectively (P = 0.2). These findings suggest that the incidence of interstitial cystitis in the community is extremely low. Although the gender difference may be real, the trend toward a later diagnosis in men than in women suggests a potential for missed diagnosis in men. This might explain some of the gender difference in the incidence of interstitial cystitis in men and women.
    BJU International 03/2003; 91(3):181-5. · 3.05 Impact Factor
  • European Urology Supplements - EUR UROL SUPPL. 01/2003; 2(1):26-26.
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    ABSTRACT: The risk for long-term outcomes associated with benign prostatic hyperplasia (BPH) has not been well characterized. Untreated, BPH can lead to complications and negative outcomes, such as deterioration of bladder function, urinary tract infection, acute urinary retention (AUR), and surgery. A literature review was conducted to summarize the results of studies investigating the relationship of prostate volume and PSA with prediction of long-term outcomes in the absence of prostate cancer. In the studies reviewed, men with moderate to severe symptoms, depressed uroflow, prostatic enlargement and elevated PSA were at greater risk for developing subsequent AUR or surgery. Men with prostatic enlargement had a 3-fold higher risk for acute urinary retention and were 4 times more likely to have had any treatment for BPH. The results of these studies may assist physicians in discussing treatment options as well as long-term complications with patients.
    The Prostate 12/2001; 49(3):208-12. · 3.84 Impact Factor
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    ABSTRACT: To assess the temporal trends in the prevalence of pre-biopsy abnormalities in digital rectal examination (DRE) findings, serum prostate-specific antigen (PSA) levels, and cancer detection rates by abnormality in all men from the community who had a prostate biopsy. All Olmsted County, Minnesota residents who had their first prostate biopsy performed between January 1980 and December 1997 were identified (n = 1729). The complete medical records of these men were reviewed to determine the clinical findings at the time of the biopsy and the biopsy outcome. The prevalence of an abnormal DRE decreased from 69% in 1980 to 1986 to 45% in 1993 to 1997 (P <0.001). The prevalence of an isolated elevated PSA level (normal DRE) increased from 28% in 1987 to 1992 to 42% in 1993 to 1997 (P <0.001). In men diagnosed with cancer, 55% had an abnormal DRE in 1993 to 1997 (P <0.001). Prostate cancer was detected in 471 (37%) of 1280 men with an abnormal DRE or elevated PSA level noted within 6 weeks of the biopsy. The positive predictive value for prostate cancer was 61% (229 of 373) in men with an abnormal DRE and elevated PSA, 34% (166 of 494) in men with an elevated PSA only, and 18% (60 of 327) in men with an abnormal DRE only. The prevalence of an abnormal DRE at the time of biopsy has declined and that of an isolated elevated PSA has increased. However, nearly 40% of men with abnormalities in both PSA and DRE at the time of biopsy had a negative biopsy for prostate cancer. An increase in both the sensitivity and specificity of screening tests may further enhance the early detection of prostate cancer and potentially decrease the high negative biopsy rate.
    Urology 11/2000; 56(5):817-22. · 2.42 Impact Factor
  • R O Roberts, S J Jacobsen
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    ABSTRACT: Prostatitis is the third most important condition of the prostate. Problems in the diagnosis and classification of this condition, however, have hindered epidemiologic research. Consequently, our understanding of the incidence of prostatitis and factors that increase its probability is limited. Recent studies suggest that the prevalence of prostatitis is 5% to 9% among unselected men in the community. Based on estimates from national data, approximately 2 million men in the United States seek treatment for prostatitis each year. A number of recent studies suggest that genetic, behavioral, and environmental factors; age; inflammatory mediators; and oxidative stress may be risk factors for prostatitis. However, findings from most of these studies may at best be considered preliminary because of problems with small sample sizes or lack of generalizability. Nonetheless, these studies suggest hypotheses that should be tested in well-designed population-based studies.
    Current Urology Reports 09/2000; 1(2):135-41.
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    ABSTRACT: We assess temporal trends in prostate biopsy incidence, utilization and cancer yield in the community before and after the introduction of serum prostate specific antigen (PSA) to the community medical practice Study subjects comprised all Olmsted County men with a first prostate biopsy performed between January 1, 1980 and December 31, 1997. Medical records of all study subjects (1,729) were reviewed for clinical information from the first and all subsequent biopsies. Annual age adjusted prostate biopsy incidence increased from 113/100, 000 (95% confidence interval 76, 150) in 1980 to 487/100,000 (421, 554) in 1992 and decreased to 264/100,000 (219, 309) in 1997. For men 50 to 59 years old biopsy incidence increased 400% from 137/100, 000 in 1980 to 1986 to 686/100,000 in 1993 to 1997. Overall, there were 93/100,000 more negative biopsies and 49/100,000 more positive biopsies in 1993 to 1997 than in 1980 to 1986. The overall cancer yield of 36% was essentially unchanged across periods (p = 0.6). However, by age cancer yield decreased from 29% to 21% (1980 to 1986 versus 1993 to 1997) for men 50 to 59 years old but increased from 38% to 45% for those 70 to 79 years old. Overall cancer yield from prostate biopsies has changed little during the last 15 years. Increased cancer yield for men 70 years old or older has been offset by the decreased yield in younger men. Attention must now be given to diagnostic techniques which might reduce the incidence of negative biopsies and improve cancer yield in younger men.
    The Journal of Urology 06/2000; 163(5):1471-5. · 3.75 Impact Factor
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    ABSTRACT: We describe longitudinal changes in peak urinary flow rates in community dwelling men in Olmsted County, Minnesota. A cohort of 2,115 men 40 years old or older was randomly selected from the Olmsted County, Minnesota population. Peak urinary flow rates and the American Urological Association symptom index were assessed in all men at baseline and biennially, and in a 25% random subsample prostate volume was determined by transrectal ultrasonography. The annualized percentage change in peak urinary flow rate (slope) was assessed for 492 men in the subsample during 6 years of followup. Median peak urinary flow rate slope was -2.1% per year (25th percentile -4.0, 75th percentile -0.6). Peak urinary flow rate declined more rapidly with decreasing baseline rate, and increasing baseline age, prostate volume and symptom severity (all p = 0.001). When the variables were simultaneously adjusted for each other, a rapid decline (negative slope 4.5% or greater per year) was more likely in men 70 years old or older (odds ratio 46.4, 95% confidence intervals 16.8, 127.7) and those with a rate less than 10 ml. per second (42.0, 14.1, 125.3) at baseline compared to those 40 to 49 years old and those with a rate of 15 ml. or greater, respectively. Prostate volume and symptom severity were not statistically significant predictors of a rapid decline in peak urinary flow rate when variables were considered simultaneously. Despite variability in measurement of peak urinary flow rate, a consistent decline was observed when measured longitudinally in a community based cohort. Furthermore, this decline was associated with impairments in other physiological and anatomical measures of lower urinary tract function in an unselected cohort of men.
    The Journal of Urology 02/2000; 163(1):107-13. · 3.75 Impact Factor
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    ABSTRACT: We describe treatments for benign prostatic hyperplasia (BPH) among men participating in the Olmsted County study of urinary symptoms and health status among men during 10,000 person-years of followup. A cohort of 2,115 men 40 to 79 years old was randomly selected from an enumeration of the Olmsted County, Minnesota population (55% response rate). Participants completed a previously validated baseline questionnaire to assess symptom severity and voided into a portable urometer. A 25% random subsample underwent transrectal sonographic imaging of the prostate to determine prostate volume and measurement of serum prostate specific antigen. Followup included retrospective review of community medical records and completion of a biennial questionnaire to determine the occurrence of medical and surgical treatment for BPH in the subsequent 6 years. During more than 10,000 person-years of followup 167 men were treated, yielding an overall incidence of 16.0/1,000 person-years. There was a strong age related increase in risk of any treatment from 3.3/1,000 person-years for men 40 to 49 years old to more than 30/1,000 person-years for those 70 years old or older. Men with moderate to severe symptoms (American Urological Association symptom index greater than 7), depressed peak urinary flow rates (less than 12 ml. per second), enlarged prostate (greater than 30 ml.) or elevated serum prostate specific antigen (1.4 ng./ml. or greater) had about 4 times the risk of BPH treatment than those who did not. After adjustment for all measures simultaneously an enlarged prostate (hazard ratio 2.3, 95% confidence interval [CI] 1.1, 4.7), depressed peak flow rate (hazard ratio 2.7, 95% CI 1.4, 5.3) and moderate to severe symptoms (hazard ratio 5.3, 95% CI 2.5, 11.1) at baseline each independently predicted subsequent treatment. While repeat contact and availability of urological measurements during the study period may have influenced treatment decisions in this cohort, the data demonstrate that treatment is common in elderly men with nearly 1 in 4 receiving treatment in the eighth decade of life. Furthermore, these data suggest that men with moderate to severe lower urinary tract symptoms, impaired flow rates or enlarged prostates are more likely to undergo treatment, with increases in risk of similar magnitude to those associated with adverse outcomes, such as acute urinary retention.
    The Journal of Urology 11/1999; 162(4):1301-6. · 3.75 Impact Factor
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    R O Roberts, S J Jacobsen
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    ABSTRACT: Alcohol consumption and cigarette smoking were evaluated in relation to development of benign prostatic hyperplasia (BPH) among 29,386 members of the Health Professionals Follow-up Study. Men who were 40-75 years old in 1986 and free of prior BPH surgery, diagnosed cancer at baseline, and prostate cancer at baseline and during follow-up were followed for incidence of BPH surgery from 1986 to 1994. Cases were men who reported BPH surgery between 1986 and 1994 (n = 1,813) or who scored £15 points of 35 on seven lower urinary tract symptom questions modified from the American Urological Association symptom index in 1992 and 1994 (n = 1,786); noncases were men who scored ^7 points (n = 20,840). After controlling for age, race/ethnicity, body mass index, physical activity, and mutually for alcohol intake and smoking, moderate alcohol consumption was inversely related with total BPH (30.1-50 g/day vs. 0: odds ratio (OR) = 0.59, 95% confidence interval (Cl) 0.51-0.70; p trend < 0.0001), although the relation was attenuated at high intake (£50.1 g/day vs. 0: OR = 0.72, 95% Cl 0.57-0.90). Current cigarette smoking was positively related to total BPH only among those who smoked 35 or more cigarettes/day (compared with never smokers: OR = 1.45, 95% Cl 1.07-1.97). These findings suggest that moderate alcohol consumption and avoidance of smoking may benefit BPH. Am J Epidemiol 1999;149:106-15. alcohol drinking; cohort studies; prostatectomy; prostatic hyperplasia; risk factors; smoking
    American Journal of Epidemiology 09/1999; 150(3):321-2. · 4.78 Impact Factor
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    ABSTRACT: To assess the prevalence of combined fecal and urinary incontinence. A cross-sectional, community-based study. Olmsted County, Minnesota. Men (n = 778) and women (n = 762), aged 50 years or older, selected randomly from the population. Participants completed a previously validated self-administered questionnaire that assessed the occurrence of fecal and urinary incontinence in the previous year. The age-adjusted prevalence of incontinence was 11.1% (95% Confidence Interval (CI), 8.8-13.5) in men and 15.2% (95% CI, 12.5-17.9) in women for fecal incontinence; 25.6% (95% CI, 22.5-28.8) in men and 48.4% (95% CI, 44.7-52.2) in women for urinary incontinence; and 5.9% (95% CI, 4.1-7.6) in men and 9.4% (95% CI, 7.1-11.6) in women for combined urinary and fecal incontinence. The prevalence of fecal incontinence increased with age in men but not in women, from 8.4% among men in their fifties to 18.2% among men in their eighties (P for trend = .001). For women, the prevalence increased from 13.1% among 50-year-old women to 20.7% among women 80 years or older (P for trend = .5). Among persons with fecal incontinence, the prevalence of concurrent urinary incontinence was 51.1% among men and 59.6% among women (P = .001 and P = .003, respectively). Cross-sectionally, the age-adjusted, relative odds of fecal incontinence among persons with urinary incontinence was greater in men than in women (Odds Ratio (OR) = 3.0; 95% CI, 1.9-4.8 in men and OR = 1.8; 95% CI, 1.2-2.7 in women, P = .04). These findings suggest that persons with one form of incontinence are likely to have the other form as well. Despite the higher prevalence of urinary and fecal incontinence among women, the association between fecal incontinence and urinary incontinence was stronger among men than women. This finding, and the significant association between fecal incontinence and age observed in men but not in women, suggest that the etiologies may be more closely linked in men than in women.
    Journal of the American Geriatrics Society 08/1999; 47(7):837-41. · 4.22 Impact Factor
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    ABSTRACT: To estimate the annual rate of discharge for prostatectomy for benign prostatic hyperplasia (BPH) in black and white men from 1980 to 1994 using the National Hospital Discharge Survey. Overall and race-, age-, and year-specific utilization rates were estimated for the civilian population in the United States. Length of stay was calculated for each discharge, and the results were plotted over time. An expected number of discharges based on the rates observed in 1980 was estimated to determine the impact of decreased prostatectomy rates on the number of procedures that would have been expected in this aging population. Discharge rates for whites were within a narrow range (233.2 to 274.5 per 100,000) from 1980 through 1990 and then displayed a monotonic decline after 1991 to 131.3 per 100,000 in 1994. Rates for blacks were 10% to 24% lower from 1980 to 1991; the decline in discharge rates began in 1993 for blacks, and by 1994 the racial gap had closed. Length of stay decreased throughout the period but length of stay averaged 30% longer for blacks throughout. On the basis of the observed rates of 1980, there were more than 140,000 fewer prostatectomies performed for BPH in 1994 than would have been expected owing to the aging of the population. These data demonstrate that the black/white differences in prostatectomy for BPH that were observed in the 1980s have disappeared in recent years. Furthermore, rates have declined dramatically in all age- and race-specific groups. Further work is needed to determine whether this convergence in discharge rates is due to equalization of access to medical care or to differences in utilization of alternative therapies.
    Urology 07/1999; 53(6):1154-9. · 2.42 Impact Factor
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    ABSTRACT: We estimate the rate of prostate growth in randomly selected healthy community dwelling men. Prostate volume in an age stratified random sample of 631 white male residents of Olmsted County, Minnesota 40 to 79 years old without prior prostate surgery or prostate cancer was measured up to 4 times by transrectal ultrasound during a followup period of almost 7 years. Estimated prostate growth rates increased with increasing age. However, the estimated average annual change was 1.6% across all age groups. Estimated prostate growth rates were high depending on baseline prostate volume with higher growth rates for men with larger prostates. While there is wide variability in prostate growth rates on an individual level, prostate volume appears to increase steadily at about 1.6% per year in randomly selected community men.
    The Journal of Urology 05/1999; 161(4):1174-9. · 3.75 Impact Factor
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    ABSTRACT: To investigate the association of benign prostatic enlargement and health-related quality of life (HRQoL) assessed by validated questionnaires. Randomly selected men (n = 471) aged 40-79 years from Olmsted County, Minn. (USA) without prior prostate surgery or prostate cancer had a full urologic workup, including transrectal ultrasonography, in addition to completing questionnaires soliciting information about urinary symptom frequency, bother, degree of interference with daily activities and other measures of HRQoL. Disease-specific HRQoL was worse in older men, and men with more severe symptoms. Age-adjusted mean scores for symptom severity, bother and activity interference were about 50% worse for men with enlarged prostates (volume > 40 cm3). After adjusting for age, men with enlarged prostates were nearly 3 times (95% CI 1.6, 5.1) as likely to have moderate to severe symptoms, and about twice as likely to have bother (odds ratio 2.4; 95% CI 1.3, 4.2) or activity interference (odds ratio 1.8; 95% CI 1. 0, 3.2) relative to men with smaller prostates. HRQoL measures are worse in men who are older and, after adjusting for age, in men with increased urinary symptom frequency and enlarged prostate. The broader spectrum of patients provided by the community-based random sampling allows elucidation of these important relationships.
    European Urology 04/1999; 35(4):277-84. · 10.48 Impact Factor
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    ABSTRACT: We describe trends in prostate cancer mortality from 1980 to 1997, before and after the introduction of serum prostate specific antigen (PSA) testing to the community medical practice, and provide an update on trends in incidence since 1992. All men with a diagnosis of prostate cancer who died between 1980 and 1997 were identified and parts 1 and 2 of the death certificates were reviewed for a diagnosis of prostate cancer. In addition, all men with biopsy proved prostate cancer diagnosed between 1983 and 1995 were identified. The complete medical records of incident cases of prostate cancer were reviewed for signs and symptoms at diagnosis and for the first treatment received. Age adjusted, community mortality rates from prostate cancer increased from 25.8/100,000 men in 1980 to 1984 to a peak of 34/100,000 in 1989 to 1992, and have since declined to 19.4/100,000 in 1993 to 1997 (22% decline in mortality, 95% confidence interval 49% decline to 17% increase). The overall age adjusted incidence rates which peaked at 209/100,000 person-years in 1992 as previously reported declined to 108/100,000 in 1993 and 132/100,000 in 1995. A similar pattern was observed for organ confined cancers. However, incidence rates for regional or distant disease were suggestive of a continuing downward trend from 1989 to 1992 compared to 1993 to 1995 (12% decline per year, p = 0.07). These data demonstrate that despite the increase in prostate cancer mortality rates in the mid to late 1980s, mortality rates in 1993 to 1997 are lower than in the years before serum PSA testing. While chance cannot be ruled out, the data suggest that increased screening for prostate cancer, particularly through PSA testing, may have led to declines in mortality from prostate cancer.
    The Journal of Urology 03/1999; 161(2):529-33. · 3.75 Impact Factor
  • RO Roberts, SJ Jacobsen, WT Reilly
    Southern Medical Journal - SOUTHERN MED J. 01/1999; 92(11):1111-1112.
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    ABSTRACT: Barriers to prenatal care have been extensively investigated in low-income and inner-city communities. Less attention has been directed to the study of prenatal care among middle- and upper-class pregnant women. This study describes perceived barriers and factors associated with late initiation of prenatal care in a predominantly middle- to upper-class midwestern community. Consenting women in Olmsted County, Minnesota, who were attending a clinic for their first obstetric visit completed a self-administered questionnaire that queried the presence of factors making it difficult to receive prenatal care, perception about the importance of prenatal care, expectations at the first prenatal care visit, and sociodemographic factors. Of the 813 women aged 14 to 47 years, 692 (86%) had their first prenatal visit within the first trimester of pregnancy. Only 98 (12%) women reported external barriers to receiving prenatal care. These factors included difficulty in getting an appointment (46.9%), problems finding child care (26.5%), and lack of transportation (14.3%). In multivariable logistic regression analyses, late initiation of care was associated with patient perception of prenatal care as being less than very important (odds ratio [OR] = 4.1, 95% confidence interval [CI], 1.7-9.7); external barriers to prenatal care (OR = 2.9, 95% CI, 1.6-5.4); annual income < $17,000 (OR = 2.9, 95% CI, 1.5-5.7); and an unintended pregnancy (OR = 2.1, 95% CI, 1.3-3.5). Multiparous women and women older than 35 years were more likely to perceive prenatal care as less than very important (OR = 3.9, 95% CI, 2.5-14.6 and OR = 2.9, 95% CI, 1.2-6.8, respectively). These findings suggest that perceptions about the importance of prenatal care may play a greater role in the initiation of care among this group of women than is recognized. Women with more experience with pregnancy appear to place slightly less importance on prenatal care.
    The Journal of family practice 07/1998; 47(1):53-61. · 0.67 Impact Factor
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    ABSTRACT: To describe the occurrence of a physician-assigned diagnosis of prostatitis in a community-based cohort. A sampling frame of all Olmsted County, Minnesota, male residents was used to randomly select a cohort of men between 40 and 79 years old by January 1, 1990, to participate in a longitudinal study of lower urinary tract symptoms. The 2115 participants (response rate 55%) completed a previously validated self-administered questionnaire that assessed the prevalence of lower urinary tract symptoms, including a history of prostatitis. Subsequently, all inpatient and outpatient community medical records of participants were reviewed retrospectively for a physician-assigned diagnosis of prostatitis from the date of initiation of the medical record through the date of the last follow-up. The overall prevalence rate of a physician-assigned diagnosis of prostatitis was 9%. Men identified with the diagnosis of "prostatitis" had symptoms of dysuria and frequency and rectal, perineal, suprapubic, and lower back pain. Among men with a previous diagnosis of prostatitis, the cumulative probability of subsequent episodes of prostatitis was much higher (20%, 38%, and 50% among men 40, 60, and 80 years old, respectively). These findings indicate that the community-based prevalence of a physician-assigned diagnosis of prostatitis is high, of similar magnitude to that of ischemic heart disease and diabetes. Furthermore, once a man has an initial episode of prostatitis, he is more likely to suffer chronic episodes than men without a diagnosis. Although the pathologic mechanisms underlying these diagnoses are not certain, these data provide a first step toward understanding how frequently the diagnosis occurs in the community.
    Urology 05/1998; 51(4):578-84. · 2.42 Impact Factor

Publication Stats

2k Citations
90.10 Total Impact Points

Institutions

  • 2003
    • Brigham and Women's Hospital
      • Division of Urology
      Boston, MA, United States
  • 1994–2003
    • Mayo Foundation for Medical Education and Research
      • • Division of Epidemiology
      • • Department of Health Sciences Research
      • • Department of Urology
      Scottsdale, AZ, United States
  • 1996–2001
    • Mayo Clinic - Rochester
      • Department of Health Science Research
      Rochester, Minnesota, United States
  • 1999
    • Merck
      • Epidemiology
      Whitehouse Station, NJ, United States