Prostatic Hyperplasia, Benign (BPH)

Basics

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

Epidemiology

Age related with nearly universal development in men

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

Etiology and Pathophysiology

  • Unknown etiology
  • Develops in prostatic periurethral or transition zone
  • Hyperplastic nodules of stromal and epithelial components increase glandular components.

Risk Factors

  • Increasing age
  • Higher free prostate-specific antigen (PSA) levels, heart disease, and use of β-blockers
  • Low androgen levels from cirrhosis/chronic alcoholism reduce the risk of BPH.
  • Obesity and sedentary lifestyle can worsen LUTS.
  • No evidence of increased or decreased risk with smoking, alcohol, or any dietary factors

General Prevention

Symptoms can be managed through weight loss, regulation of fluid intake (especially in the evening), decreased intake of caffeine, and increased physical activity.

Commonly Associated Conditions

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

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