This was a hospital-based case–control study conducted to determine the association between cardiometabolic factors and benign prostatic hyperplasia (BPH) among adult men attending the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, Nigeria. The case–control design examined relationships between cardiometabolic risk factors and BPH by comparing exposures between patients diagnosed with BPH (cases) and adult male patients without BPH (unmatched controls). The study was conducted at UNTH, Ituku-Ozalla, a federal tertiary healthcare institution located in southeastern Nigeria. The hospital functions as a major referral center with a bed capacity of over 500 beds and more than 41 clinical departments providing specialized medical and surgical services to patients within Enugu State and neighboring regions. Recruitment of cases was carried out in the Urology Clinic and urology wards, while controls were recruited from the Surgical and Medical Outpatient Clinics and hospital wards among patients without a diagnosis of BPH.

The study population consisted of adult male patients aged 18 years and above attending outpatient clinics at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, Nigeria. The study was conducted within three months (3) period of time ranging from from July to September 2025. Participants were categorized into cases and controls based on clinical presentation and symptom assessment using the International Prostate Symptom Score (IPSS) questionnaire. Cases were adult men presenting with lower urinary tract symptoms (LUTS) consistent with benign prostatic hyperplasia, defined by an IPSS score ≥ 8, indicating moderate to severe symptoms. Controls were adult men aged 18 years and above attending the same hospital for non-urological conditions such as musculoskeletal complaints, hypertension follow-up, or routine medical check-ups, and who had no significant lower urinary tract symptoms (IPSS ≤7).

Participants were included if they were adults aged 18 years and above and provided written informed consent to participate in the study. Participants were excluded if they had a history of prostate cancer, prostatitis, or previous pelvic surgery; were currently receiving androgen deprivation therapy or 5α-reductase inhibitors (e.g., finasteride or dutasteride); had acute urinary tract infection, acute urinary retention, or neurogenic bladder; or were critically ill or unable to provide reliable responses to the study questionnaire.

A systematic random sampling technique was used to recruit participants until the required sample size was achieved. Eligible male patients attending the Urology Clinic who met the inclusion criteria were consecutively recruited as cases. For each recruited case, an unmatched control was selected from eligible adult male patients attending the Medical or General Outpatient Clinics during the same study period using systematic selection from the clinic attendance register.

Data were collected using a structured interviewer-administered questionnaire designed to obtain information on sociodemographic characteristics, clinical history, and cardiometabolic risk factors. The questionnaire was pretested among 20 adult patients attending another tertiary healthcare facility in Enugu State to assess clarity, wording, logical flow, and average completion time. Feedback obtained during the pretest was used to revise ambiguous items and improve overall structure. Data generated from the pretest were entered into SPSS version 27 to evaluate internal consistency of the questionnaire sections using Cronbach’s alpha reliability analysis, with a coefficient of α ≥ 0.7 considered acceptable for reliability.

Collected data were checked daily for completeness and consistency before entry into Microsoft Excel using predefined coding formats. Each questionnaire item was assigned numerical codes to facilitate statistical analysis; categorical variables were coded using numeric identifiers (e.g., 1 = Yes, 2 = No), while continuous variables such as age, body mass index, blood pressure, and biochemical measurements were entered as recorded values. After data entry, double-checking and validation procedures were conducted to minimize entry errors. The dataset was subsequently cleaned and exported to SPSS version 27 for statistical analysis. Data cleaning involved range checks, logical consistency assessment, and identification of outliers. Missing data were handled through initial verification against original questionnaires to correct entry omissions where possible. Variables with minimal missing responses were analyzed using complete-case analysis, while missing responses were coded as system-missing values and excluded from specific analyses without affecting overall dataset integrity.

Descriptive statistics including frequencies, proportions, means, and standard deviations were used to summarize sociodemographic characteristics and cardiometabolic exposure variables. Bivariate analysis was performed to examine crude associations between cardiometabolic determinants (obesity, hypertension, diabetes mellitus, dyslipidaemia, and metabolic syndrome) and the presence of benign prostatic hyperplasia (BPH). Crude odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were estimated. Variables showing clinical relevance or statistical association were entered into a multivariable logistic regression model to control for potential confounders such as age, alcohol use, smoking status, and physical activity level. Statistical significance was determined at a p-value < 0.05.

Ethical approval for this study was obtained from the Health Research Ethics Committee (HREC) of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, with approval reference number UNTH/HREC/2025/10/4198 and National Health Research Ethics Committee (NHREC) registration number NHREC/05/01/2008B-FWA00002458-1RB00002323. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki ( World Medical Association, 2013) for research involving human participants. Written informed consent was obtained from all participants after a detailed explanation of the study objectives, procedures, potential benefits, and possible risks. Participation was entirely voluntary, and respondents were informed of their right to decline participation or withdraw from the study at any stage without any effect on the quality of medical care received. Confidentiality and anonymity were strictly maintained by assigning unique identification codes instead of personal identifiers. All collected data were securely stored and accessed only by the research team for academic and research purposes.

A total of 300 respondents were included, comprising 150 controls and 150 BPH cases. Age distribution showed that controls were predominantly middle-aged (45–65 years), accounting for 81.3% (n = 122), whereas BPH cases were mainly older, with 50.7% (n = 76) classified as elderly (>65 years) compared with 18.7% (n = 28) among controls ( Table 1). The mean age was higher among cases (65 ± 8 years) than controls (60 ± 7 years), indicating increased occurrence of BPH with advancing age. With respect to marital status, the majority of respondents in both groups were married, representing 74.0% (n = 111) of controls and 78.7% (n = 118) of cases. Smaller proportions were single, divorced, or widowed, with comparable distributions across groups.

Occupational status demonstrated variation between groups. Among controls, most participants were engaged in informal/skilled labour (40.7%, n = 61) and formal/public sector employment (37.3%, n = 56). In contrast, BPH cases had a higher proportion of retired individuals (35.3%, n = 53), reflecting the older age profile of affected men. Educational attainment showed moderate differences, with tertiary education being most common among controls (34.7%, n = 52), while secondary education predominated among cases (36.0%, n = 54). The proportion of participants without formal education was similar in both groups. Residential location was comparable between groups, with most respondents residing in urban areas (46.7% of controls and 44.0% of cases). Regarding monthly income, a higher proportion of BPH cases earned less than ₦50,000 (41.3%, n = 62) compared with controls (32.0%, n = 48), while higher income categories were common among controls.

The analysis of diagnostic approaches among the 150 BPH cases revealed variation in methods used for confirming diagnosis ( Figure 1). Radiological assessment constituted the most frequently utilized diagnostic method, accounting for 46.0% of cases ( Figure 1). This was followed by clinical diagnosis using digital rectal examination (DRE), which represented 32.0% of diagnoses. Prostate-specific antigen (PSA) testing was the least utilized method, contributing 22.0% of confirmed cases.

Most participants (57.3%) reported having been diagnosed with BPH for 1–5 years, indicating ongoing clinical follow-up and management ( Figure 2). A smaller proportion (24.7%) had received their diagnosis within the past year, reflecting relatively recent detection of the condition. Meanwhile, 18.0% of patients had lived with BPH for more than five years, suggesting long-standing disease among a notable segment of cases.

Symptoms were generally minimal among controls but substantially more frequent and severe among BPH cases ( Table 2). Nearly half of the controls (49.3%) reported no symptom, whereas only 4.0% of BPH cases were symptom-free. Most BPH patients experienced moderate to severe symptoms, particularly scores 2 (32.7%) and 3 (22.0%). For intermittency, over half of controls (51.3%) reported no interruption of urinary flow compared with only 4.7% among cases. BPH participants commonly reported moderate symptoms, with 31.3% scoring 2 and 26.0% scoring 3, demonstrating pronounced urinary flow disruption. A similar pattern was observed for urgency, where 50.0% of controls had no urgency symptoms, while only 5.3% of BPH cases were symptom-free. Moderate urgency predominated among cases, particularly scores 2 (34.7%) and 3 (25.3%). Weak urinary stream was uncommon among controls, with 60.7% reporting no symptom. In contrast, BPH cases demonstrated widespread symptom presence, with comparable proportions reporting scores 2 (24.0%) and 3 (24.0%), reflecting clinically significant obstruction. For straining during urination, two-thirds of controls (66.0%) reported no difficulty, whereas only 2.7% of BPH patients were symptom-free. Higher symptom severity was common among cases, especially scores 2 (27.3%) and 3 (28.0%). Nocturia was the most prominent symptom overall. While 30.7% of controls reported no nighttime urination, only 4.7% of cases were without symptoms. The largest proportion of BPH patients reported waking to urinate three times per night (30.0%), followed by two times (23.3%) and four times (18.7%).

The mean body mass index (BMI) was similar in both groups, measuring 27.2 ± 3.5 kg/m ² among BPH cases and 27.1 ± 3.8 kg/m ² among controls, indicating that participants in both groups were generally within the overweight category ( Table 3). Most respondents were not engaged in any weight reduction lifestyle or medication, accounting for 79.3% of cases and 78.0% of controls, while only about one-fifth reported active weight management practices. Among those undertaking weight control measures, walking, running, or jogging was the most frequently reported lifestyle strategy (16.7% of cases and 13.3% of controls). Use of weight reduction medication was uncommon in both groups (2.7% of cases and 4.0% of controls). Assessment of family history of obesity revealed that over half of participants reported no such history (51.3% of cases and 58.7% of controls). A positive family history was reported by 26.7% of cases compared with 31.3% of controls, while uncertainty regarding family history was more common among BPH cases (22.0%) than controls (10.0%).

Overweight status was more common among BPH cases, accounting for 55.3%, compared with 44.0% among controls. In contrast, a normal BMI was observed more frequently among controls (32.7%) than cases (25.3%) ( Figure 3).

The mean systolic blood pressure was 132 mmHg among cases compared with 122 mmHg among controls, while mean diastolic blood pressure was 86 mmHg in cases and 79 mmHg in controls, indicating relatively elevated blood pressure among BPH patients ( Table 4). Use of antihypertensive medication was more common among cases, with 28.0% receiving treatment compared with 16.7% of controls. Hypertension-related symptoms were also reported more frequently among cases. Headache was present in 13.3% of cases compared with 6.0% of controls, while blurry vision occurred in 8.7% of cases and 2.7% of controls. Chest pain was reported by 5.3% of cases versus 2.0% of controls, and reduced urine output was slightly higher among cases (4.0%) compared with controls (1.3%). The proportion of participants reporting no hypertension-related symptoms was lower among cases (76.7%) than controls (93.3%). Additionally, a positive family history of hypertension was more common among cases (48.7%) compared with controls (35.3%), whereas absence of family history was higher among controls (52.0%) than cases (35.3%).

Normal blood pressure was more common among cases (35.3%) compared with controls (20.7%) ( Figure 4). Prehypertension showed the highest proportion among controls (62.7%) relative to cases (28.7%). In contrast, established hypertension occurred substantially more frequently among cases (33.3%) than controls (11.3%). Hypotension was uncommon in both groups, observed in 2.7% of cases and 5.3% of controls.

The analysis of blood sugar characteristics showed differences between men with benign prostatic hyperplasia and controls ( Table 5). The mean fasting blood sugar level was higher among BPH cases (104 mg/dL) compared with controls (96 mg/dL), with wider variability observed among cases (SD = 38) than controls (SD = 14) ( Table 5). A slightly greater proportion of cases were receiving medication for diabetes mellitus (12.0%) compared with controls (9.3%). Symptoms suggestive of hyperglycemia were more frequently reported among cases. Excessive urination was reported by 7.3% of cases compared with 4.7% of controls, while unusual thirst occurred in 8.0% of cases versus 4.7% of controls. Weight loss was also slightly higher among cases (4.0%) compared with controls (2.0%), whereas fatigue was reported equally in both groups (2.0% each). Participants reporting no diabetic symptoms were fewer among cases (83.3%) than controls (94.7%). Family history of diabetes mellitus was comparable between groups, reported by 39.3% of cases and 38.7% of controls; however, uncertainty regarding family history was higher among cases (22.7%) than controls (9.3%).

Normal blood sugar levels were observed at comparable proportions among cases (52.7%) and controls (52.0%). Hypoglycemia was uncommon in both groups, occurring slightly more among cases (5.3%) than controls (4.0%) ( Figure 5). Prediabetes was more frequent among controls (43.3%) compared with cases (27.3%). In contrast, diabetes mellitus showed a markedly higher prevalence among BPH cases (14.7%) than controls (0.7%).

The mean low-density lipoprotein (LDL) cholesterol level was similar in both groups, measuring 119 mg/dL among cases and 122 mg/dL among controls ( Table 6). Most participants in both groups were not receiving lipid-lowering medication, accounting for 90.7% of cases and 86.7% of controls, while only 9.3% of cases and 13.3% of controls reported current treatment. Clinical indicators suggestive of dyslipidemia were generally uncommon. Yellowish eyelid plaques were reported slightly more among cases (4.0%) compared with controls (1.3%). Chest pain was reported by 2.7% of cases and 5.3% of controls, whereas calf pain occurred in 1.3% of cases and 3.3% of controls. The majority of respondents reported none of these symptoms (93.3% of cases and 92.0% of controls). Regarding family history of high cholesterol, 31.3% of cases and 34.0% of controls reported a positive history, while uncertainty about family history was higher among cases (22.0%) compared with controls (12.0%).

The distribution of low-density lipoprotein (LDL) cholesterol categories showed differences between men with benign prostatic hyperplasia (BPH) and controls ( Figure 6). Near-optimal LDL levels constituted the largest proportion among BPH cases (52.7%) compared with 32.0% of controls. Normal LDL levels were more frequently observed among controls (26.7%) than cases (16.0%). Borderline-high LDL levels were relatively comparable between groups, accounting for 31.3% of controls and 30.0% of cases. Dyslipidaemia was more common among controls (10.0%) compared with only 1.3% of BPH cases.

Elderly age remained a strong and statistically significant predictor of BPH, with elderly men having nearly five times higher odds of BPH compared with middle-aged participants (AOR = 4.94; 95% CI: 2.31–10.55; p < 0.001) ( Table 7). Marital status was not independently associated with BPH after adjustment, as married (AOR = 2.54; p = 0.217), divorced (AOR = 5.68; p = 0.067), and widowed participants (AOR = 1.64; p = 0.583) did not reach statistical significance. In contrast, occupational status remained significant. Participants employed in the formal/public sector had significantly higher odds of BPH (AOR = 7.26; 95% CI: 1.85–28.54; p = 0.005), while retired individuals also demonstrated a significantly increased likelihood of BPH compared with unemployed participants (AOR = 6.82; 95% CI: 1.23–37.63; p = 0.028). Educational level, residential location, and monthly income were not independently associated with BPH following adjustment (p > 0.05). Similarly, BMI categories showed no statistically significant independent relationship with BPH. Blood pressure status demonstrated significant inverse associations with BPH. Participants with hypotension (AOR = 0.07; 95% CI: 0.01–0.54; p = 0.011) and pre-hypertension (AOR = 0.22; 95% CI: 0.11–0.47; p < 0.001) had significantly lower odds of BPH compared with individuals with normal blood pressure, whereas hypertension was not statistically significant (AOR = 1.87; p = 0.176). Blood glucose status also demonstrated independent associations with BPH. Prediabetes was associated with reduced odds of BPH (AOR = 0.48; 95% CI: 0.24–0.98; p = 0.045), whereas diabetes mellitus was significantly associated with increased odds of BPH (AOR = 19.51; 95% CI: 2.24–170.12; p = 0.007). Lipid profile analysis revealed that near-optimal LDL cholesterol was independently associated with increased odds of BPH (AOR = 4.42; 95% CI: 1.82–10.78; p = 0.001), while borderline-high LDL and dyslipidaemia were not statistically significant after adjustment.

1.

Routine metabolic screening should be incorporated into the clinical evaluation of men presenting with lower urinary tract symptoms to enable early detection and management of diabetes and other cardiometabolic conditions that may influence the progression of benign prostatic hyperplasia.