Benign Prostatic Hyperplasia (BPH) is a common, non-cancerous enlargement of the prostate gland that typically affects men as they grow older. This condition often leads to lower urinary tract symptoms (LUTS) such as frequent urination, weak urine stream, nocturia and a constant feeling of incomplete bladder emptying.1,2 While BPH is not life-threatening, it can have a considerable impact on daily comfort, sleep patterns and overall quality of life. Fortunately, it is a manageable condition with a wide range of treatment options—from lifestyle changes and medications to minimally invasive procedures and surgical solutions like transurethral resection of the prostate (TURP) [3,4].

Despite being so prevalent, awareness and understanding of BPH remain surprisingly limited, especially in rural parts of India. Many men perceive urinary symptoms as a normal part of aging and often delay seeking medical help. In regions like Kangra district in Himachal Pradesh, where geographical challenges, limited access to specialized care and lower health literacy prevail, awareness of urological issues tends to be even lower [5,6]. Cultural stigma around   discussing men’s 

health issues and a lack of routine health screenings contribute to delayed diagnoses and missed opportunities for early intervention.

Research across various Indian settings has shown that while some awareness of urinary symptoms exists, there is very little understanding about BPH as a medical condition and even less about the treatment options available—particularly surgical ones. As a result, many men continue to suffer unnecessarily or turn to informal or ineffective remedies. Increasing awareness could help reduce disease progression and improve both personal outcomes and the broader healthcare burden [7,8].

With this context in mind, the present study aims to evaluate the level of public knowledge regarding BPH and its surgical treatment options among adult males in Kangra. By exploring how well people recognize the symptoms, understand treatment pathways and respond to the condition, this study hopes to highlight key areas where health education efforts are most needed. Ultimately, better awareness could encourage timely medical consultation, improve treatment outcomes and contribute to healthier aging for men in this region.

Research Design

This study was designed as a descriptive, cross-sectional survey to assess the level of public awareness and understanding regarding Benign Prostatic Hyperplasia (BPH) and its surgical treatment options among adult males in Kangra district, Himachal Pradesh. The primary objective was to evaluate how well individuals recognized the symptoms of BPH, were aware of its progression and understood available surgical interventions.

Study Area and Population

The study was carried out in Kangra, a district located in the hill state of Himachal Pradesh, India. Known for its geographical diversity and a mix of rural and semi-urban populations, Kangra presents a relevant setting to explore public health awareness in a region where access to specialized healthcare is often limited. The target population comprised adult males aged 40 years and above, as this age group is most commonly affected by BPH.

Study Duration

Data collection was conducted over a period of three months, from January to March 2025. This period allowed for adequate online outreach and ensured sufficient response volume for analysis.

Sample Size and Sampling Technique

A total of 400 participants were included in the study. The sample size was calculated based on a 95% confidence level, an anticipated awareness prevalence of 50% and a 5% margin of error. An additional margin was accounted for to compensate for incomplete responses. A combination of convenience and purposive sampling techniques was employed to recruit participants through digital platforms. The link to the survey was distributed via community groups, local health forums and social messaging platforms like WhatsApp and Facebook.

Inclusion Criteria

Participants were included if they met the following criteria:

• Male residents of Kangra district

• Aged 40 years and above

• Able to understand and respond in Hindi or English

• Provided informed digital consent before participation

Exclusion Criteria

Exclusion criteria included:

• Individuals with a previously diagnosed prostatic malignancy or urological condition unrelated to BPH

• Incomplete or inconsistent questionnaire responses

• Respondents unwilling to provide informed consent

Study Tool – Structured Questionnaire

Data were collected using a structured, pre-validated questionnaire developed in consultation with urologists, public health specialists and researchers. The questionnaire was designed to be easily understandable and was available in both Hindi and English. It consisted of three main sections:

• Socio-demographic Information: Age, education level, occupation, income and residential status (urban or rural)

• Knowledge and Awareness Assessment: Twenty multiple-choice questions evaluating knowledge of BPH symptoms, risk factors, screening methods, treatment modalities and awareness of surgical options such as TURP

• Health-seeking Behavior: Questions exploring past urological symptoms, prior consultation with healthcare providers, perception of surgical treatment and barriers to seeking timely care

Scoring and Classification

Each correct answer in the knowledge section was given one point. Based on the total score, participants were categorized into four knowledge levels:

• Very Good Knowledge: ≥80% correct

• Good Knowledge: 60–79% correct

• Fair Knowledge: 41–59% correct

• Poor Knowledge: <40% correct

This scoring helped to identify patterns of awareness and highlight critical knowledge gaps.

Data Collection Procedure

The questionnaire was administered exclusively online through Google Forms. The link was shared widely across digital platforms, including social media groups, local health forums and community networks. Respondents

Table 1: Socio-Demographic Characteristics of Participants (Kangra) 

were informed about the purpose of the study and were required to provide digital consent before beginning the questionnaire. No in-person data collection was conducted.

Data Analysis

All responses were compiled and cleaned using Microsoft Excel. Descriptive statistical analysis was performed to summarize socio-demographic characteristics, knowledge scores and health-seeking behavior. Frequencies and percentages were used to present the data in a clear and comprehensible format.

Ethical Considerations

This study followed ethical research practices, ensuring voluntary participation, anonymity and confidentiality. Participants were made aware of their right to withdraw at any time without providing a reason.

The study included 400 respondents from Kangra district, with a diverse representation across age groups, genders, educational levels and occupations. The majority of participants (35.0%) were in the 26–35 years age group, followed by 30.0% aged 36–45 years, 20.0% aged 18–25 years and 15.0% aged 46 years and above. Males constituted 55.0% of the sample, while females made up 45.0%, indicating balanced gender participation, even though the focus was primarily on male health awareness. In terms of education, most participants had an undergraduate degree (34.0%) or secondary education (31.0%), while 15.0% held a postgraduate degree, 14.0% had completed primary school and 6.0% reported having no formal education. Occupationally, respondents were spread across various sectors, with office workers (23.0%) and homemakers (22.5%) being the most represented groups, followed by teachers (16.0%), students (15.0%), healthcare professionals (12.5%) and others (11.0%). A slightly higher proportion of participants belonged to rural areas (57.0%) compared to urban areas (43.0%), ensuring a representative view of both settings.

Overall, participants showed a satisfactory level of knowledge about BPH and its management. A large proportion correctly identified the primary function of the prostate gland (80.0%) and understood BPH as a non-cancerous enlargement (77.0%). Most respondents (84.0%) recognized difficulty in urination as a common symptom, while 74.0% were aware of the non-association between BPH and prostate cancer risk. Awareness regarding treatment options was moderate to high, with 75.0% identifying surgery as a common treatment for severe cases and 78.0% correctly understanding the TURP procedure. Knowledge of minimally invasive techniques (72.0%) and the importance of lifestyle changes (71.0%) was somewhat lower. Additionally, 79.0% acknowledged the need to disclose medications prior to surgery and 73.0% were aware of urinary retention as a risk of untreated BPH. Awareness of asymptomatic presentation in early stages (70.0%) and risk factors such as age (81.0%) and obesity (75.0%) was fair. However, slightly fewer participants recognized BPH-related complications like urinary tract infections (68.0%) and post-surgical bleeding (72.0%). While 83.0% correctly identified urologists as the specialists who perform BPH surgeries, only 67.0% were aware of the possibility of recurrence after surgical treatment. These findings indicate that although foundational knowledge was strong, there remains room for improvement in understanding long-term management and complications.

Knowledge scores were categorized into four levels to assess the depth of understanding among participants. Of the total respondents, 160 individuals (40.0%) achieved a "Very Good" knowledge score, answering 80% or more questions correctly. The largest group, consisting of 168 participants (42.0%), demonstrated "Good" knowledge, with scores ranging between 60–79%. A smaller portion, 56 respondents (14.0%), fell into the "Fair" category with scores between 41–59%, while only 16 participants (4.0%) were categorized as having "Poor" knowledge, scoring less than 40%. These results indicate that while the majority of the population has a decent level of awareness regarding BPH and its treatment options, a targeted focus on those with fair or poor understanding is needed to close remaining gaps in public knowledge—particularly in rural and less formally educated segments of the population.

This cross-sectional study offers critical insights into the level of public knowledge and awareness regarding Benign Prostatic Hyperplasia (BPH) and its surgical treatment options among residents of Kangra district, Himachal Pradesh. The findings reveal a moderately high level of awareness among participants, especially regarding core concepts of prostate function, common symptoms of BPH and the role of surgery in its management.

Table 2: Public Knowledge and Awareness of Benign Prostatic Hyperplasia (BPH) and Surgical Treatment Options

However, the study also identifies several key areas where public knowledge remains incomplete or inconsistent, indicating the need for more comprehensive and targeted health education efforts.

The majority of participants fell within the younger to middle-aged adult category (26–45 years), which may partly explain the relatively high awareness levels, as this demographic is generally more tech-savvy and likely to access online health information. Interestingly, while the focus of the study was on male health awareness, 45% of the respondents were female. This reflects the broader community’s interest and involvement in men’s health, especially among spouses or caregivers and underlines the role of family awareness in influencing health-seeking behavior. The participation of both urban and rural populations—with rural residents forming the majority (57%)—adds depth to the findings, showcasing the diversity of perspectives in health knowledge.

Knowledge scores indicated that 40% of respondents had very good awareness and 42% demonstrated good understanding, together comprising over four-fifths of the total sample. This is encouraging and suggests that the general population, particularly in this region, possesses a foundational awareness of BPH. Most participants were able to identify the prostate’s role in reproductive health, recognize urinary difficulty as a common symptom and acknowledge the existence of surgical options such as 

Table 3: Knowledge Score Classification on Benign Prostatic Hyperplasia (BPH) and Surgical Treatment Options

TURP (transurethral resection of the prostate). These findings are consistent with recent studies in India and globally, which have shown increasing public awareness about non-communicable diseases, including urological conditions, due to improved internet access and digital health campaigns [1,2].

However, certain gaps in knowledge were clearly evident. For instance, only 67% of respondents were aware that BPH can recur even after surgery. This suggests a lack of understanding of the chronic and sometimes progressive nature of the condition. Similarly, awareness of early-stage asymptomatic cases (70%) and BPH-associated complications such as urinary tract infections (68%) and post-surgical bleeding (72%) was lower than expected. These findings are particularly relevant because misperceptions about symptom onset and treatment efficacy can lead to delays in diagnosis or unrealistic expectations about surgical outcomes. The relatively limited understanding of lifestyle modifications (71%) and the role of obesity as a risk factor (75%) further emphasizes the need for public health messages that integrate preventive strategies alongside treatment information.

Awareness about the importance of pre-surgical preparation was moderately high, with 79% recognizing the need to disclose medication use and 76% correctly identifying fasting as a requirement before surgery. Encouragingly, 83% of participants correctly identified urologists as the appropriate specialists for BPH surgery, reflecting a growing familiarity with specialized medical fields. Still, the 17% who were unaware may reflect a lack of direct interaction with specialized healthcare or misconceptions common in rural communities, where general physicians are often the first and only point of contact.

The gender composition of the participants, with a significant female representation, also offers an interesting lens. While BPH is a male-specific condition, female caregivers often play a central role in facilitating healthcare decisions in Indian households. Their involvement in this study highlights the potential value of involving both genders in awareness initiatives, especially in family-based or community-level interventions [9-10].

One of the strengths of this study is its digital approach to data collection, which enabled a wide reach across diverse age groups and locations. However, this also introduces a potential limitation, as it may have excluded individuals without internet access or digital literacy—groups that may be at even greater risk of poor awareness. As a result, the findings may slightly overestimate the actual level of knowledge in more marginalized or elderly populations. Future studies may consider a hybrid approach, incorporating in-person interviews or paper-based surveys to ensure inclusivity.

From a public health perspective, the implications of these findings are significant. There is a clear need for structured awareness campaigns tailored specifically to men aged 40 and above, focusing not only on symptom recognition but also on the importance of timely consultation and available surgical interventions. Incorporating BPH education into routine primary care visits, health camps and community outreach programs can make a tangible difference. Additionally, leveraging social media, community radio and local influencers may help overcome cultural taboos and stimulate more open discussions around men’s urological health [11,12].

The findings of this study suggest that while many individuals in Kangra have a fair understanding of Benign Prostatic Hyperplasia (BPH) and its surgical treatments, there are still noticeable gaps in public knowledge particularly regarding early signs, long-term outcomes and the importance of lifestyle factors. Though the overall awareness levels are promising, certain misconceptions and a lack of depth in understanding persist, especially in rural and less formally educated populations. This highlights the importance of designing locally relevant and easy-to-understand awareness campaigns that not only explain what BPH is, but also guide individuals on when to seek help and what treatment options are available. Engaging both men and their families in these educational efforts and delivering information through trusted community channels, could significantly improve early diagnosis and encourage more informed health decisions among aging men in the region.

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