Journal Pre-proof

Characterizing the benign prostatic hyperplasia literature: a

bibliometric analysis

Alan Paniagua Cruz BS , Kevin Y. Zhu , Chad Ellimoottil MD, MS ,

Casey A. Dauw MD , Aruna Sarma PhD ,
Ted A. Skolarus MD, MPH

PII: S0090-4295(19)31088-X
DOI: https://doi.org/10.1016/j.urology.2019.11.033
Reference: URL 21885

To appear in: Urology

Received date: 12 July 2019

Revised date: 21 October 2019
Accepted date: 25 November 2019

Please cite this article as: Alan Paniagua Cruz BS , Kevin Y. Zhu , Chad Ellimoottil MD, MS ,
Casey A. Dauw MD , Aruna Sarma PhD , Ted A. Skolarus MD, MPH , Characterizing the
benign prostatic hyperplasia literature: a bibliometric analysis, Urology (2019), doi:
https://doi.org/10.1016/j.urology.2019.11.033

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Characterizing the benign prostatic hyperplasia literature: a bibliometric analysis

Alan Paniagua Cruz, BSa, Kevin Y. Zhub, Chad Ellimoottil, MD, MSc,
Casey A. Dauw, MDc, Aruna Sarma, PhDc, Ted A. Skolarus, MD, MPHd
a
University of Michigan Medical School, Ann Arbor, MI, bUniversity of Michigan, Ann
Arbor, MI, cMichigan Medicine Department of Urology, Dow Division of Health Services
Research, Ann Arbor, MI, dVeterans Affairs Ann Arbor Healthcare System,
Ann Arbor, MI

Disclosures: This work was accepted as a moderated poster for the 2019 Annual
Meeting of the American Urological Association in Chicago, Illinois.

Funding: National Institutes of Health MICHR TL1 Fellowship: TL1TR002242.

Keywords: Research; funding; prostate; trends; impact; citation analysis

Abstract word count: 221

Manuscript word count: 2,740
Tables: 5
Figures: 1

Corresponding Author:
Ted A. Skolarus, MD, MPH, FACS
Associate Professor of Urology University of Michigan
Urology Section Chief
VA Ann Arbor Healthcare System
Research Investigator
VA HSR&D Center for Clinical Management Research
Phone: (734) 647-9712
Fax: (734) 232-2400
tskolar@med.umich.edu
ABSTRACT

OBJECTIVE: To characterize the current landscape and future directions of academic

benign prostatic hyperplasia (BPH) by using bibliometric analysis.

METHODS: We used the Web of Science Core CollectionTM to conduct a bibliometric

analysis of leading BPH articles. Bibliometric analyses are quantitative approaches

examining the impact of academic literature. We used the following search terms and

Boolean logic “(“benign prostat*”) AND (hyperplasia OR enlarg*)” and characterized the

100 most-cited BPH articles through 2018 including citations, journal, author, year, and

country.

RESULTS: The top 100 BPH articles were published between 1978 and 2012. Citations

ranged from 153 to 2,171 across 27 different journals, including 10 urology-specific

journals. The Journal of Urology was the most published journal (n=25), followed by

European Urology (n=17), and Urology (n=15). In general, the oldest 10 articles focused

on BPH etiology/pathogenesis, while the newest 10 focused on treatment. The 1990’s

was the most productive decade with nearly half of the top 100 articles (n=44). Twenty-

six different countries contributed to the top 100 articles, with the US (n= 74), Italy

(n=19), and Canada (n=12) being the most common.

CONCLUSIONS: This study represents the first bibliometric analysis of the leading BPH

articles impacting the academic literature. The focus has evolved from BPH

pathogenesis to treatment, perhaps reflecting a shift in research funding and capacity.

These findings may guide research priorities for this increasingly common condition.
ABBREVIATION KEY

BPH: benign prostatic hyperplasia

ACI: adjusted citation index

MCA: median citation per article

MCR: median citation per review

AAS: Altmetric Attention Score

INTRODUCTION

Benign prostatic hyperplasia (BPH) is an increasingly common urologic condition

that affects older men.1 The prevalence of BPH and its associated disability, ranging

from quality of life impairment to catheterization, renal impairment, and hospitalization,

make this disease a public health priority. Indeed, decades of research have provided

insights into BPH pathophysiology, diagnosis, treatment, cost, and outcomes.

While the current academic BPH literature is extensive, its current state has not

been well-characterized. Taking stock of current literature is important to identify clinical

and research gaps, as well as to guide future funding priorities. For example, assessing

the scientific literature has been used to guide research and practice priorities ranging

from tobacco prevention2 to national scientific agendas3 and return on research

investments.4 Despite the increasing relevance of BPH to our aging male population,

there are no empirical studies characterizing the most influential BPH articles currently

impacting the field. One increasingly common approach to assess the impact of

academic literature is bibliometric analysis.5 Using quantitative methods such as citation

network analysis, citation indices, and impact factors, bibliometrics can be used to

objectively evaluate the impact of articles, researchers, and journals for a given field.
This approach is increasingly applied to urology (e.g., hypospadias, ureteral reflux,

prostate cancer), though it has yet to be applied to BPH where its population-based

impact could be substantial.6-9

For these reasons, we conducted a bibliometric study to characterize the current

landscape of academic BPH literature. We examined the most commonly cited articles,

authors, institutions, countries, journals, and content areas impacting the field over time.

Not only do our novel findings highlight the most influential BPH literature to date, they

may also help guide research and funding priorities to advance the translation of BPH

research to practice.

METHODS

Web of Science Core Collection

The Web of Science™ is a subscription-based citation indexing service originally

created by the Institute of Scientific Information and now owned by Clarivate Analytics. 10

Through its platform, the Web of Science Core Collection™ connects to regional citation

indexes, patent data, and specialized citation indexes, covering book series, conference

proceedings, and over 33,000 journals.11 Similarly, Scopus™ and Google Scholar™ can

also be used for citation indexing. Although Scopus™ is believed to offer broader

content coverage, it only covers articles published after 1960. Furthermore, journals

present in Scopus™ and not Web of Science™ have been shown to have lower citation

impact, although it is unclear if this holds true for BPH literature. 10 Google Scholar™,

on the other hand, offers the most literary coverage, but “suffers from a lack of quality
control” resulting in numerous inaccuracies.10 For these reasons, we conducted our

study using the Web of Science™.

Search methodology

To identify the top cited articles in the BPH literature, we performed our search

through the Web of Science™ Database (v.5.31) on December 12th, 2018. A Boolean

search was conducted using the terms “(“benign prostat*”) AND (hyperplasia OR

enlarg*)” with the largest timespan allowed through the Web of ScienceTM (“all years

(1864 – 2019)”). In order to reduce English publication bias, we conducted our search

under the “all databases” option; which included the Web of Science™ Core Collection,

BIOSIS previews, Chinese Science Citation DatabaseSM, Current Contents Connect,

KCI Korean Journal Database, MEDLINE®, Russian Science Citation Index, ScIELO

Citation Index, and Zoological Record. We limited our results to articles and reviews and

sorted these by number of citations.

Literature review

Two authors (APC and KYZ) independently assessed the content of our search

results. They reviewed the titles of all identified articles and the abstracts of articles

requiring further content validation confirming that the article indeed included BPH

content. Any differences in opinion were resolved by discussion.

Bibliometric analysis

From the Web of Science™, we obtained information regarding authorship,

institution, country, category, and journal of publication. We further provided the h-index

and e-index for authors with multiple publications in the top 100 to highlight their overall

contribution to the scientific community. For example, an h-index of 33 means that an

author has published 33 papers with at least 33 citations. The e-index is used to

complement the h-index and represents the square root of excess citations not

incorporated into the h-index calculation. 12,13 Moreover, we retrieved the median

citation per article (MCA) and median citation per review (MCR) from Clarivate

Analytics’ Journal Citation Reports for journals that published the top 100. Unlike the

journal impact factor, which has become a misused and gameable metric, the median

citation per article/review is a more helpful representation of the total number of citations
14
a typical paper is expected to receive when published in a specific journal.

Citation indices

For the top 100 BPH articles, we then calculated an Adjusted Citation Index (ACI)

(average citations/years since publication) to standardize citation counts based on

publication age.9,15 As shown previously, this is one way to account for the higher

number of citations seen in older articles resulting from greater “exposure time.” For

instance, in 2019, an article published in 1969 with 100 citations would have an ACI of

2.0, while an article published 2009 with 35 citations would have an ACI of 3.5. Altmetric

Attention Scores (AAS) were also provided to offer insight into an article’s online

dissemination. AAS are weighted scores that reflect online attention an article has

received through different platforms (e.g., Facebook, Twitter, Wikipedia, News). 16 To

better understand the relationships between the ACI and publication characteristics, we

also studied the associations between ACI and number of authors, cited references,

MCA, MCR, AAS, and years since publication using non-parametric (Spearman’s)

correlation.17
 All analyses were conducted between December 2018 and October 2019. This

study was deemed exempt from the Institutional Review Board at the University of

Michigan.

RESULTS

Our initial search yielded 12,576 publications. After limiting our results to articles

and reviews, 7,932 publications remained. Next, we rank ordered each article according

to its number of citations and selected the first 100 as our top 100 BPH articles. All of

these articles were written in English and published between 1978 and 2012. As

illustrated in the Figure, nearly half (44%) of articles were published in the 1990’s,

followed closely by the 2000’s with 39%. Taken together, over 80% of the most

impactful BPH research was published in the last two decades.

We found total citation counts ranged from 153 to 2,171, with a median and

mean of 206.5 and 282 citations per article, respectively. Over 50% of total citations

were from the top 28 articles, with the three leading articles having over 1,000 citations

each. As shown in Table 1, the most cited article was published in 1992 by Barry et al.

and described the development and validation of the American Urological Association

symptom index for BPH. The second most cited article was from Berry et al. in 1984

and characterized the prevalence and development of BPH with age. The third most

cited article from McConnell et al. in 2003 presented randomized controlled trial results

from the Medical Therapy of Prostatic Symptoms Study (MTOPS) evaluating the long-
term effects of doxazosin, finasteride, and combination therapy, on the clinical

progression of BPH. In general, the oldest 10 articles in the top 100 focused on the

etiology and pathogenesis of BPH, while the newest 10 tended to examine BPH

treatment and outcomes.

After calculating the ACI in order to adjust for publication date, “The American

Urological Association symptom index for benign prostatic hyperplasia” by Barry et al.

remained the most frequently cited publication with an average of 83.1 citations per year

(Table 1). Calculating the ACI resulted in significant changes in citation ranks, with one

article moving up 71 positions in ranking and another article dropping 60. Only three

publications did not change positions, remaining in positions 1, 9, and 87. Seven of the

10 most cited articles remained in the top 10 after adjusting for publication year.

Furthermore, we found significant correlations between the ACI and years since

publication (rho= -0.62, p <0.001), number of authors (rho= 0.28, p = 0.005), MCA (rho=

0.48, p <0.001), and AAS (rho= 0.45, p <0.001). However, we did not find a correlation

between the ACI, total citation counts (p=0.97), or MCR (p=0.31).

We found 27 different journals were represented in our sample, including 10

urology-specific journals. As shown in Table 2, The Journal of Urology (MCA: 3, MCR:7)

was the most published journal with 25 top 100 BPH articles, followed by European

Urology (MCA: 9, MCR: 14) with 17, and Urology (MCA: 1, MCR:2) with 15. The New

England Journal of Medicine (MCA: 36, MCR: 26) was the most published general

medical journal with 9 articles, five of which were in our top 10 most cited list. The Web

of Science classified the majority of the articles under the Urology Nephrology category

(n=69).
 In terms of authorship, 7 authors had two or more first author publications, and

23 institutions had five or more BPH articles in the top 100 (Table 3 and Supplementary

Table 1, respectively). The most published author, C.G. Roehrborn (h-index: 78, e-

index: 99.2), had 9 first-authorships and 15 total articles in the top 100 BPH articles.

The success of C.G. Roehrborn coincided with The University of Texas System being

the most accomplished institution. Lastly, the United States had the most articles in the

top 100 (n=74), followed by Italy (n=19), and Canada (n=12) (Supplementary Table 2).

DISCUSSION

We characterized the top 100 most-cited articles in the BPH literature to date.

We found nearly a quarter of the articles were responsible for half of the total citations,

and that higher journal MCA, article AAS, and more co-authors were associated with an

increasing adjusted citation index. Ten urology-specific journals accounted for 69% of

the articles, with a few authors having more than a single publication in the top 100. All

of the publications in the top 100 were written in English, and the majority originated

from the United States and its institutions. In general, the oldest 10 articles in the top

100 focused on the etiology and pathogenesis of BPH, while the newest 10 tended to

examine BPH treatment and outcomes. Collectively, these findings suggest the most

cited BPH literature originates from a small subset of journals, authors, and countries

with an evolving focus on treatment and outcomes.

We discovered an interesting shift during the last few decades from attempts to

better understand the pathophysiology and characterize the evolving impact of BPH on

functional outcomes through a period of randomized medical therapy trials to the most
recent high-impact literature focused on efficacy of medical and surgical BPH

treatments. This could be due to the recent expansion of the BPH drug and surgical

therapy armamentarium. Indeed, there are over a dozen BPH treatment options ranging

from monotherapy with alpha-blocker drugs (e.g., tamsulosin) and combination therapy

with finasteride or dutasteride, to surgery using monopolar, bipolar, or various laser

techniques. This could also be reflective of research funding trends to study BPH. For

example, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

funded the “Minimally Invasive Surgical Therapy Consortium for Benign Prostatic

Hyperplasia” in 2003.18 This clinical trial looked to compare the efficacy and safety of

three BPH treatments: transurethral needle ablation (TUNA), transurethral microwave

therapy (TUMT), and medical therapy with alfuzosin and finasteride. Furthermore, in

July 2015, the NIDDK provided a research update on two independent studies

evaluating the role of fibrosis in BPH and its potential for development of future

therapies.19 Going forward, policy decisions regarding the best use of research funds to

advance prostate health for our aging population will need to consider these findings

and where the best value for the research investment may come from.

Our study adds to the growing characterization of the most cited literature in

urology and urologic diseases.6 Previous investigators have used bibliometric analyses

in prostate cancer, hypospadias, and vesicoureteral reflux.7-9 Similar to the other

studies, our study indicates a minority of articles are responsible for the majority of

citations. This phenomenon is not surprising, and well-described by Dr. Eugene

Garfield, the creator of the impact factor.20 At times, 20% of the articles can account for

80% of the citations.

 We found all of the top 100 articles were published in English, and the majority

were from the United States. Previous bibliometric analyses have shown similar

results,6-9 with US authors tending to cite US publications and US reviewers tending to

accept US manuscripts.21 Furthermore, countries with a higher gross national product

and those investing more in research and development tend to have higher biomedical

research output.22 These factors help explain the international distribution of our leading

BPH literature.

Our results showing a significant shift in article ranking when calculating the ACI

are also consistent with other investigators.9,15 Such large shifts can be due to older

articles with a high total citation count, but a diminishing citation rate, or to younger

articles with a high early citation count. By using the ACI, we attempted to account for

the influence of time on total citations. The use of total citations and ACI can both be

used to characterize articles as in this study. Interestingly, articles with a high total

citation count and low ACI are more likely to represent “historical interest, and may not

reflect current knowledge, controversy, and clinical applications of the topic.”15 This is

the case in our study with the 1978 article by McNeal et al. describing the origin and

evolution of benign prostate enlargement. While in the top 10 for total citations, after

adjustment, this article fell to 58 indicating its historical nature. Ideally, we would be able

to quantify citation velocity, to better appreciate an article’s impact on present-day

research and to see citation trends in “real time.”

Our study not only corroborates previous findings showing an association

between ACI, years since publication, and number of authors, but adds to the literature

by also showing associations with MCA, and AAS.17 The negative association between
ACI and years since publication in this study indicates a majority of our top 100 articles

were composed of older articles with decreasing citation rates. This is in line with

citation dynamics where a scientific article reaches its maximum citation rate 3 to 10

years after publication, and slowly declines afterward.23 Our findings also show that a

journal’s MCA positively correlates with ACI, underscoring the notion that article

submission to higher impact journals, on average, leads to higher citations. We

interestingly found a positive association between ACI and AAS, meaning that articles

with higher average citation counts, tended to receive more online attention as

calculated by Altmetrics’ algorithm. A similar association was previously described by

Huang et al., but this involved total citation counts.24 Further research is needed to see

if greater social media dissemination directly results in more citations.

Our study should be considered in the context of several limitations. First, there

is no known association between citation count and study quality. An article may be

both positively and negatively cited by other articles. Citations are also only capable of

measuring the impact of papers to authors of other papers, and do not measure the

impact of articles on clinical practice or patient outcomes.25 Nonetheless, citation indices

do provide an objective measure of impact for a given body of literature.5 Second,

authors may inflate their citation counts via self-citations. Although this is a possibility,

the broad author distribution in our top 100 articles indicates this would be unlikely to

impact our findings. Third, we only utilized one database when conducting our search.

As previously described, Web of Science™ is unique in that it includes older

publications when compared to other databases like Scopus™. Although none of our

top 100 articles were published before 1960, we believed it was important to not limit
our initial search. Furthermore, Web of Science™ provides greater transparency with

regard to coverage than do other resources, like Google Scholar™.10 Therefore, the

benefits of using Web of Science™ in this study outweigh potential limitations. Finally, it

is possible that our search did not provide an exhaustive review of the BPH literature.

However, the breadth of databases available through the Web of Science™, our study

time frame (1864 – 2019), and face-validity of our findings minimizes the risk our study

has missed highly-cited BPH literature.

In conclusion, this study is the first bibliometric analysis characterizing the

leading BPH literature to date. We found the most cited BPH articles originate from a

small subset of journals, authors, and countries. These findings may be used to guide

research and funding priorities for this increasingly common condition.

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FIGURE LEGEND

Figure. Publication decade of the top 100 articles in BPH literature.

The 1990’s were the most prolific decade with almost 50% (n=44) of the publications for

the top 100 articles. Furthermore, greater than 80% of the publications occurred in the

last two decades.

Table 1. The top 100 cited articles in BPH.

Rank First Author Year Article Total ACI Adjusted Altmetric

Citations Rank Attention
Score
1 Barry, MJ 1992 The American- 2171 83.1 1 12
Urological-Association
symptom index for
benign prostatic
hyperplasia
2 Berry, SJ 1984 The development of 1493 43.5 4 405
human benign
prostatic hyperplasia
with age
3 McConnell, 2003 The long-term effect of 1169 77.7 2 40
JD doxazosin, finasteride,
and combination
therapy on the clinical
progression of benign
prostatic hyperplasia
4 Gormley, GJ 1992 The effect of 866 33.0 7 141
finasteride in men with
benign prostatic
hyperplasia
5 McConnell, 1998 The effect of 778 37.3 6 14
JD finasteride on the risk
of acute urinary
retention and the need
for surgical treatment
among men with
benign prostatic
hyperplasia
6 Lepor, H 1996 The efficacy of 572 25.6 11 6
terazosin, finasteride,
or both in benign
prostatic hyperplasia
7 McVary, KT 2011 Update on AUA 524 68.7 3 10
guideline on the
management of benign
prostatic hyperplasia
8 Roos, NP 1989 Mortality and 504 17.0 29 10
reoperation after open
and trans-urethral
resection of the
prostate for benign
prostatic hyperplasia
9 Roehrborn, 2002 Efficacy and safety of a 479 29.4 9 3
CG dual inhibitor of 5-
alpha-reductase types
1 and 2 (dutasteride) in
men with benign
prostatic hyperplasia
10 McNeal, JE 1978 Origin and evolution of 453 11.1 58 *
benign prostatic
enlargement
11 Wasson, JH 1995 A comparison of 426 17.8 25 1
transurethral surgery
with watchful waiting
for moderate
symptoms of benign
prostatic hyperplasia
12 Luo, J 2001 Human prostate 394 22.5 14 *
cancer and benign
prostatic hyperplasia:
molecular dissection
by gene expression
profiling
13 Roehrborn, 2010 The effects of 377 42.1 5 8
CG combination therapy
with dutasteride and
tamsulosin on clinical
outcomes in men with
symptomatic benign
prostatic hyperplasia:
4-year results from the
combat study
14 Wilson, JD 1980 The pathogenesis of 334 8.6 73 6
benign prostatic
hyperplasia
15 Boyle, P 1996 Prostate volume 332 14.9 30 3
predicts outcome of
treatment of benign
prostatic hyperplasia
with finasteride: meta-
analysis of randomized
clinical trials
16 Wei, JT 2005 Urologic diseases in 305 22.2 15 0
America project:
benign prostatic
hyperplasia
17 Nadler, RB 1995 Effect of inflammation 300 12.8 43 0
and benign prostatic
 hyperplasia on
elevated serum
prostate-specific
antigen levels
18 Barry, MJ 1993 Relationship of 296 11.7 51 0
symptoms of
prostatism to
commonly used
physiological and
anatomical measures
of the severity of
benign prostatic
hyperplasia
19 Mantzoros, 1997 Insulin-like growth 292 13.8 36 3
CS factor 1 in relation to
prostate cancer and
benign prostatic
hyperplasia
20 Peters, CA 1987 The effect of nafarelin 284 9.1 71 3
acetate, a luteinizing-
hormone-releasing
hormone agonist, on
benign prostatic
hyperplasia
21 Lepor, H 1998 Phase III multicenter 282 13.7 38 6
placebo-controlled
study of tamsulosin in
benign prostatic
hyperplasia
22 Glynn, RJ 1985 The development of 281 8.3 75 0
benign prostatic
hyperplasia among
volunteers in the
normative aging study
23 Barry, MJ 1995 Benign prostatic 280 12.1 46 20
hyperplasia specific
health-status
measures in clinical
research - how much
change in the
American-Urological-
Association symptom
index and the benign
prostatic hyperplasia
impact index is
perceptible to patients
24 Lepor, H 1992 A randomized, 280 10.7 62 3
placebo-controlled
multicenter study of the
efficacy and safety of
terazosin in the
treatment of benign
prostatic hyperplasia
25 McConnell, 1992 Finasteride, an 271 10.1 65 9
JD inhibitor of 5-alpha-
reductase, suppresses
prostatic
dihydrotestosterone in
men with benign
prostatic hyperplasia
26 Ahyai, SA 2010 Meta-analysis of 270 32.6 8 1
functional outcomes
and complications
following transurethral
procedures for lower
urinary tract symptoms
resulting from benign
prostatic enlargement
27 Clark, RV 2004 Marked suppression of 262 17.9 24 4
dihydrotestosterone in
men with benign
prostatic hyperplasia
by dutasteride, a dual
5 alpha-reductase
inhibitor
28 Peters, TJ 1997 The international 262 12.0 48 0
continence society
''benign prostatic
hyperplasia'' study: the
bothersomeness of
urinary symptoms
29 Kramer, G 2007 Is benign prostatic 255 21.9 16 7
hyperplasia (BPH) an
immune inflammatory
disease?
30 McVary, KT 2007 Sildenafil citrate 251 21.3 18 13
improves erectile
function and urinary
symptoms in men with
erectile dysfunction
and lower urinary tract
symptoms associated
 with benign prostatic
hyperplasia: a
randomized, double-
blind trial
31 McVary, KT 2007 Tadalafil relieves lower 250 21.4 17 9
urinary tract symptoms
secondary to benign
prostatic hyperplasia
32 Meigs, JB 2001 Risk factors for clinical 250 14.5 33 6
benign prostatic
hyperplasia in a
community-based
population of healthy
aging men
33 Isaacs, JT 1989 Etiology and disease 248 8.3 74 2
process of benign
prostatic hyperplasia
34 Parsons, JK 2006 Metabolic factors 242 19.4 21 1
associated with benign
prostatic hyperplasia
35 Hammarsten 2001 Hyperinsulinemia as a 240 13.4 40 24
,J risk factor for
developing benign
prostatic hyperplasia
36 Bartsch, G 1979 Light microscopic 238 6.1 96 3
stereological analysis
of the normal human-
prostate and of benign
prostatic hyperplasia
37 Kirby, RS 2003 Efficacy and tolerability 235 14.7 32 6
of doxazosin and
finasteride, alone or in
combination, in
treatment of
symptomatic benign
prostatic hyperplasia:
The Prospective
European Doxazosin
and Combination
Therapy (predict) trial
38 Wilt, TJ 1998 Saw palmetto extracts 234 11.6 52 18
for treatment of benign
prostatic hyperplasia -
a systematic review
39 Cordon- 1998 Distinct altered 232 11.4 56 0
Cardo, C patterns of p27(KIP1)
 gene expression in
benign prostatic
hyperplasia and
prostatic carcinoma
40 Nickel, JC 1999 Asymptomatic 229 12.0 47 3
inflammation and/or
infection in benign
prostatic hyperplasia
41 Roehrborn, 1999 Serum prostate- 228 11.5 54 0
CG specific antigen
concentration is a
powerful predictor of
acute urinary retention
and need for surgery in
men with clinical
benign prostatic
hyperplasia
42 Roehrborn, 1993 Serum prostate- 227 8.8 72 0
CG specific antigen as a
predictor of prostate
volume in men with
benign prostatic
hyperplasia
43 McNeal, J 1990 Pathology of benign 227 8.0 79 *
prostatic hyperplasia -
insight into etiology
44 Bent, S 2006 Saw palmetto for 222 17.2 28 40
benign prostatic
hyperplasia
45 Barry, MJ 1995 Patient reactions to a 218 9.3 70 3
program designed to
facilitate patient
participation in
treatment decisions for
benign prostatic
hyperplasia
46 Tan, AHH 2003 A randomized trial 217 14.3 34 6
comparing holmium
laser enucleation of the
prostate with
transurethral resection
of the prostate for the
treatment of bladder
outlet obstruction
secondary to benign
prostatic hyperplasia in
 large glands (40 to 200
grams)
47 Shapiro, E 1992 The relative proportion 217 8.1 78 0
of stromal and
epithelial hyperplasia is
related to the
development of
symptomatic benign
prostate hyperplasia
48 Carraro, JC 1996 Comparison of 214 9.6 69 3
phytotherapy
(permixon) with
finasteride in the
treatment of benign
prostate hyperplasia: a
randomized
international study of
1,098 patients
49 Ozden, C 2007 The correlation 209 17.5 26 0
between metabolic
syndrome and
prostatic growth in
patients with benign
prostatic hyperplasia
50 Hammarsten 1998 Components of the 209 10.0 66 0
,J metabolic syndrome -
risk factors for the
development of benign
prostatic hyperplasia
51 Barrow, JC 2000 In vitro and in vivo 204 11.0 59 3
evaluation of
dihydropyrimidinone c-
5 amides as potent
and selective alpha(1a)
receptor antagonists
for the treatment of
benign prostatic
hyperplasia
52 Stief, CG 2008 A randomized, 203 19.3 22 18
placebo-controlled
study to assess the
efficacy of twice-daily
vardenafil in the
treatment of lower
urinary tract symptoms
secondary to benign
 prostatic hyperplasia
53 Roehrborn, 2004 Alpha(1)-adrenergic 199 13.5 39 6
CG receptors and their
inhibitors in lower
urinary tract symptoms
and benign prostatic
hyperplasia
54 Verhamme, 2002 Incidence and 198 12.2 45 6
KMC prevalence of lower
urinary tract symptoms
suggestive of benign
prostatic hyperplasia in
primary care - the
triumph project
55 Te, AE 2004 Photoselective 195 13.7 37 0
vaporization of the
prostate for the
treatment of benign
prostatic hyperplasia:
12-month results from
the first united states
multicenter prospective
trial
56 Roehrborn, 2008 The effects of 189 17.4 27 34
CG dutasteride, tamsulosin
and combination
therapy on lower
urinary tract symptoms
in men with benign
prostatic hyperplasia
and prostatic
enlargement: 2-year
results from the
combat study
57 Barry, MJ 1990 Epidemiology and 187 6.6 93 *
natural-history of
benign prostatic
hyperplasia
58 Roehrborn, 2008 Tadalafil administered 186 18.2 23 7
CG once daily for lower
urinary tract symptoms
secondary to benign
prostatic hyperplasia: a
dose finding study
59 De Nunzio, 2011 The controversial 185 24.8 13 0
C relationship between
 benign prostatic
hyperplasia and
prostate cancer: the
role of inflammation
60 Montorsi, F 2004 Holmium laser 184 13.0 41 0
enucleation versus
transurethral resection
of the prostate: results
from a 2-center,
prospective,
randomized trial in
patients with
obstructive benign
prostatic hyperplasia
61 Carson, C 2003 The role of 184 11.7 50 25
dihydrotestosterone in
benign prostatic
hyperplasia
62 Oesterling, 1995 Benign prostatic 182 7.6 81 3
JE hyperplasia - medical
and minimally invasive
treatment options
63 Kawabe, K 2006 Silodosin, a new 180 14.8 31 6
alpha(1a)-
adrenoceptor-selective
antagonist for treating
benign prostatic
hyperplasia: results of
a phase iii randomized,
placebo-controlled,
double-blind study in
Japanese men
64 Maria, G 2003 Relief by botulinum 177 11.5 55 9
toxin of voiding
dysfunction due to
benign prostatic
hyperplasia: results of
a randomized,
placebo-controlled
study
65 Al-Ansari, A 2010 Green light hps 120-w 175 21.1 19 6
laser vaporization
versus transurethral
resection of the
prostate for treatment
of benign prostatic
 hyperplasia: a
randomized clinical
trial with midterm
follow-up
66 Dahle, SE 2002 Body size and serum 174 10.6 64 18
levels of insulin and
leptin in relation to the
risk of benign prostatic
hyperplasia
67 Barry, MJ 1995 Measuring disease- 174 7.3 84 6
specific health-status
in men with benign
prostatic hyperplasia
68 Nickel, JC 1996 Efficacy and safety off 173 7.8 80 1
finasteride therapy for
benign prostatic
hyperplasia: results of
a 2-year randomized
controlled trial (the
prospect study)
69 Mori, H 1990 Increased expression 173 6.0 97 0
of genes for basic
fibroblast growth-factor
and transforming
growth-factor type-
beta-2 in human
benign prostatic
hyperplasia
70 Roehrborn, 1996 The Hytrin community 171 7.5 83 3
CG assessment trial study:
a one-year study of
terazosin versus
placebo in the
treatment of men with
symptomatic benign
prostatic hyperplasia
71 Oelke, M 2012 Monotherapy with 170 25.7 10 8
tadalafil or tamsulosin
similarly improved
lower urinary tract
symptoms suggestive
of benign prostatic
hyperplasia in an
international,
randomized, parallel,
placebo-controlled
 clinical trial
72 Emberton, M 2003 Benign prostatic 170 10.7 63 10
hyperplasia: a
progressive disease of
aging men
73 Stoner, E 1994 Three-year safety and 170 6.9 89 0
efficacy data on the
use of finasteride in the
treatment of benign
prostatic hyperplasia
74 Gacci, M 2012 A systematic review 169 25.5 12 36
and meta-analysis on
the use of
phosphodiesterase 5
inhibitors alone or in
combination with
alpha-blockers for
lower urinary tract
symptoms due to
benign prostatic
hyperplasia
75 Thorpe, A 2003 Benign prostatic 169 10.8 61 0
hyperplasia
76 Berges, RR 1995 Randomized, placebo- 169 7.2 86 13
controlled, double-blind
clinical-trial of beta-
sitosterol in patients
with benign prostatic
hyperplasia
77 McVary, KT 2005 Autonomic nervous 167 12.6 44 2
system overactivity in
men with lower urinary
tract symptoms
secondary to benign
prostatic hyperplasia
78 Debruyne, 1998 Sustained-release 167 8.2 76 0
FMJ alfuzosin, finasteride
and the combination of
both in the treatment of
benign prostatic
hyperplasia
79 Giovannucci, 1994 Obesity and benign 166 6.9 88 0
E prostatic hyperplasia
80 Penna, G 2007 Seminal plasma 165 13.9 35 7
cytokines and
chemokines in prostate
 inflammation:
interleukin 8 as a
predictive biomarker in
chronic
prostatitis/chronic
pelvic pain syndrome
and benign prostatic
hyperplasia
81 Coffey, DS 1990 Clinical and 165 5.8 99 *
experimental studies of
benign prostatic
hyperplasia
82 Untergasser, 2005 Benign prostatic 164 11.9 49 0
G hyperplasia: age-
related tissue-
remodeling
83 Sandhu, JS 2004 High-power potassium- 162 11.5 53 0
titanyl-phosphate
photoselective laser
vaporization of
prostate for treatment
of benign prostatic
hyperplasia in men
with large prostates
84 Kaplan, SA 1995 Transurethral 162 6.8 90 0
electrovaporization of
the prostate - a novel
method for treating
men with benign
prostatic hyperplasia
85 Kuntz, RM 2006 Current role of lasers 161 12.8 42 0
in the treatment of
benign prostatic
hyperplasia (BPH)
86 Debruyne, F 2004 Efficacy and safety of 160 11.3 57 0
long-term treatment
with the dual 5 alpha-
reductase inhibitor
dutasteride in men with
symptomatic benign
prostatic hyperplasia
87 Kenny, B 1997 Pharmacological 159 7.3 85 9
options in the
treatment of benign
prostatic hyperplasia
88 Kyprianou, N 1996 Apoptotic versus 159 7.1 87 3
 proliferative activities in
human benign
prostatic hyperplasia
89 Hai, MA 2003 Photoselective 158 10.0 67 0
vaporization of the
prostate: initial
experience with a new
80 wktp laser for the
treatment of benign
prostatic hyperplasia
90 Fawzy, A 1995 Doxazosin in the 158 6.7 91 6
treatment of benign
prostatic hyperplasia in
normotensive patients
- a multicenter study
91 Theyer, G 1992 Phenotypic 157 5.8 98 *
characterization of
infiltrating leukocytes in
benign prostatic
hyperplasia
92 Chapple, CR 2011 Silodosin therapy for 156 20.0 20 12
lower urinary tract
symptoms in men with
suspected benign
prostatic hyperplasia:
results of an
international,
randomized, double-
blind, placebo- and
active-controlled
clinical trial performed
in Europe
93 Lepor, H 1998 Long-term evaluation 156 7.6 82 3
of tamsulosin in benign
prostatic hyperplasia:
placebo-controlled,
double-blind extension
of phase iii trial
94 Gillenwater, 1995 Doxazosin for the 156 6.6 92 3
JY treatment of benign
prostatic hyperplasia in
patients with mild-to-
moderate essential-
hypertension - a
double-blind, placebo-
controlled dose-
 response multicenter
study
95 Roehrborn, 2000 Serum prostate 155 8.2 77 0
CG specific antigen is a
strong predictor of
future prostate growth
in men with benign
prostatic hyperplasia
96 Griffiths, D 1989 Quantification of 154 5.1 100 0
urethral resistance and
bladder function during
voiding, with special
reference to the effects
of prostate size-
reduction on urethral
obstruction due to
benign prostatic
hyperplasia
97 Andriole, G 2004 Dihydrotestosterone 153 10.8 60 3
and the prostate: the
scientific rationale for 5
alpha-reductase
inhibitors in the
treatment of benign
prostatic hyperplasia
98 Di Silverio, F 2003 Distribution of 153 9.6 68 3
inflammation, pre-
malignant lesions,
incidental carcinoma in
histologically confirmed
benign prostatic
hyperplasia: a
retrospective analysis
99 Lepor, H 1995 Long-term efficacy and 153 6.4 94 0
safety of terazosin in
patients with benign
prostatic hyperplasia
100 Fulton, B 1995 Doxazosin - an update 153 6.4 95 0
of its clinical-
pharmacology and
therapeutic
applications in
hypertension and
benign prostatic
hyperplasia
*Indicates missing value.
Table 2. Journals in which the top 100 BPH articles were published.

No. Journal Total Median Median

Publications Citation Citation
Per Article Per
Review
1 Journal of Urology 25 3 7
2 European Urology 17 9 14
3 Urology 15 1 2
4 New England Journal of Medicine 9 36 26
Journal of Clinical Endocrinology
5 3 4 10
Metabolism
6 Prostate 3 3 1
7 Urologic Clinics of North America 3 1 3
8 American Journal of Epidemiology 2 3 5
9 BJU International 2 3 3
10 Journal of Medicinal Chemistry 2 5 *
11 Lancet 2 2 5
12 Medical Care 2 2 5.5
13 American Journal of Medicine 1 2 3
14 British Journal of Cancer 1 4 9
15 Canadian Medical Association Journal 1 3.5 2
16 Cancer Research 1 6 9
17 Drugs 1 4 3
18 Experimental Gerontology 1 2 4
19 Human Pathology 1 2 2.5
20 Investigative Urology 1 * *
Journal of the American Medical
21 1 23 20.5
Association
JNCI Journal of the National Cancer
22 1 3 3.5
Institute
23 Journal of Clinical Epidemiology 1 2 3
24 Journal of Endourology 1 1 3
25 Laboratory Investigation 1 2 3.5
26 Neurourology and Urodynamics 1 2 3
Prostate Cancer and Prostatic
27 1 2 5
Diseases
*indicates missing value.
Table 5. Origin of the top 100 articles by author.

No. Author First Total in h-index e-index

Author top 100
1 Roehrborn, CG 9 15 78 99.2
2 Barry, MJ 6 9 58 97.4
3 Lepor, H 5 8 43 62.6
4 McVary, KT 4 7 47 68.7
5 McConnell, JD 3 7 12 49.5
6 Nickel, JC 2 5 61 69.3
7 Hammarsten, J 2 2 12 30.2