Prostatic Hyperplasia, Benign (BPH)

Prostatic Hyperplasia, Benign (BPH) is a topic covered in the 5-Minute Clinical Consult.

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  • Benign prostatic hyperplasia (BPH) is due to proliferation of both the smooth muscle and epithelial cell lines of the prostate which causes increased volume and may cause compression of the urethra and obstructive symptoms.
  • Clinically presents with storage and/or voiding symptoms collectively referred to as lower urinary tract symptoms (LUTS). These include difficulty initiating stream, frequency, or dysuria.
  • Symptoms do not directly correlate to prostate volume. It is estimated that half of all men with histologic evidence of BPH experience moderate to severe LUTS.
  • Progression may result in upper and lower tract infections and may progress to direct bladder outlet obstruction and acute renal failure (ARF).


Age related, nearly universal development in men

Incidence increases with age; estimates of prevalence vary from 70% to 90% by the age of 80 years (estimated at 8–20% by age 40 years).

Etiology and Pathophysiology

  • Develops in prostatic periurethral or transition zone
  • Hyperplastic nodules of stromal and epithelial components increase glandular components.
  • Etiology is unknown.

Risk Factors

  • Most significant risk factor is age.
  • Increased risk with higher free prostate-specific antigen (PSA) levels, heart disease, and use of β-blockers
  • Low androgen levels from cirrhosis/chronic alcoholism can reduce the risk of BPH.
  • Obesity and lack of exercise can cause LUTS to be more significant.
  • No evidence of increased or decreased risk with smoking, alcohol, or any dietary factors

General Prevention

  • The disease appears to be part of the aging process.
  • Symptoms can be managed through weight loss, regulation of fluid intake, decreased intake of caffeine, and increased physical activity.

Commonly Associated Conditions

  • LUTS
    • LUTS can be divided into two groups: filling/storage symptoms and voiding symptoms.
      • Filling/storage symptoms include frequency, nocturia, urgency, and urge incontinence.
      • Voiding symptoms include difficulty initiating stream, incomplete voiding, or weak stream.
      • Can lead to acute or chronic obstructive symptoms
  • Sexual dysfunction, including erectile dysfunction and ejaculatory disorders
  • LUTS can also be secondary to cardiovascular, respiratory, or renal disease (1).

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