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Benign prostatic hyperplasia - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of benign prostatic hyperplasia (BPH).

Alternative Names

Enlarged prostate; BPH

Highlights:

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is a condition in which the prostate gland becomes enlarged. However, the actual size of the gland does not always predict symptom severity. Some men with minimally enlarged prostate glands may experience symptoms while other men with much larger glands may have few symptoms. BPH is very common among older men, affecting about 60% of men over age 60 and 80% of men over age 80.

BPH Symptoms

The symptoms associated with BPH are collectively called lower urinary tract symptoms (LUTS). These are generally classified as either voiding (obstructive) symptoms or storage (irritative) symptoms.

Common symptoms of BPH include:

An urgent need to urinate and difficulty postponing urination
A hesitation before urine flow starts despite the urgency to urinate
Straining when urinating
Weak or intermittent urinary stream
A sense that the bladder has not emptied completely
Dribbling at the end of urination or leakage afterward
An increased frequency of urination (every few hours), particularly at night

Urinary retention (inability to void) is a serious symptom of severe BPH that requires immediate medical attention

Treatment

BPH is not a cancerous or precancerous condition. It rarely causes serious complications, and men usually have a choice whether to treat it immediately or delay treatment. Treatment options include medications and surgery.

Drug Warning

Tamsulosin (Flomax), a drug used to treat BPH, has been associated with an eye condition called intraoperative floppy iris syndrome (IFIS). Men who take tamsulosin should inform their doctors before having cataract or other eye surgery. Tamsulosin and other alpha-blocker drugs can cause difficulty with these surgeries. The risks appear highest with selective alpha-blockers, which also include alfusozin (Uroxatral) and silodosin (Rapaflo). Silodosin is a new selective alpha-blocker, approved in 2008.

Resources

www.niddk.nih.gov -- National Institute of Diabetes and Digestive and Kidney Diseases
www.urologyhealth.org -- American Urological Association

References

Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J; International Scientific Committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2009 Apr;181(4):1779-87. Epub 2009 Feb 23.

Bell CM, Hatch WV, Fischer HD, Cernat G, Paterson JM, Gruneir A, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009 May 20;301(19):1991-6.

Bravi F, Bosetti C, Dal Maso L, Talamini R, Montella M, Negri E, et al. Food groups and risk of benign prostatic hyperplasia. Urology. 2006 Jan;67(1):73-9.

Davidson JH, Chutka DS. Benign prostatic hyperplasia: treat or wait? J Fam Pract. 2008 Jul;57(7):454-63.

Emberton M, Fitzpatrick JM, Garcia-Losa M, Qizilbash N, Djavan B. Progression of benign prostatic hyperplasia: systematic review of the placebo arms of clinical trials. BJU Int. 2008 Sep;102(8):981-6. Epub 2008 Jun 28.

Fitzpatrick JM. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 88.

Friedman AH. Tamsulosin and the intraoperative floppy iris syndrome. JAMA. 2009 May 20;301(19):2044-5.

Johnson AR, Munoz A, Gottlieb JL, Jarrard DF. High dose zinc increases hospital admissions due to genitourinary complications. J Urol. 2007 Feb;177(2):639-43.

Johnson TM 2nd, Burrows PK, Kusek JW, Nyberg LM, Tenover JL, Lepor H, et al. The effect of doxazosin, finasteride and combination therapy on nocturia in men with benign prostatic hyperplasia. J Urol. 2007 Nov;178(5):2045-50; discussion 2050-1. Epub 2007 Sep 17.

Kirby R and Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. St. Louis, Mo: WB Saunders; 2007:chap 87.

Kramer BS, Hagerty KL, Justman S, Somerfield MR, Albertsen PC, Blot WJ,et al. Use of 5-alpha-reductase inhibitors for prostate cancer chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline. J Clin Oncol. 2009 Mar 20;27(9):1502-16. Epub 2009 Feb 24.

Lourenco T, Armstrong N, N'Dow J, Nabi G, Deverill M, Pickard R, et al. Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement. Health Technol Assess. 2008 Nov;12(35):iii, ix-x, 1-146, 169-515.

Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G, et al. Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomised controlled trials. BMJ. 2008 Jun 30;337:a449. doi: 10.1136/bmj.39575.517674.BE.

Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G, et al. Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised controlled trials. BMJ. 2008 Oct 9;337:a1662. doi: 10.1136/bmj.a1662.

Mattiasson A, Wagrell L, Schelin S, Nordling J, Richthoff J, Magnusson B, et al. Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study. Urology. 2007 Jan;69(1):91-6.

Moyad MA, Lowe FC. Educating patients about lifestyle modifications for prostate health. Am J Med. 2008 Aug;121(8 Suppl 2):S34-42.

Neal RH, Keister D. What's best for your patient with BPH? J Fam Pract. 2009 May;58(5):241-7.

Rich KT, Safranek S. FPIN's clinical inquiries. Medical treatment of benign prostatic hyperplasia. Am Fam Physician. 2008 Mar 1;77(5):665-6.

Roehrborn CG and McConnell JD. Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. St. Louis, Mo: WB Saunders; 2007:chap 86.

Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Morrill B, et al. The effects of 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. J Urol. 2008 Feb;179(2):616-21; discussion 621. Epub 2007 Dec 21.

Rohrmann S, Giovannucci E, Willett WC, Platz EA. Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men. Am. J. Clin. Nutr. 2007 Feb;85(2):523-9.

Spatafora S, Conti G, Perachino M, Casarico A, Mazzi G, Pappagallo GL; AURO.it BPH Guidelines Committee. Evidence-based guidelines for the management of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy: updated summary. Curr Med Res Opin. 2007 Jul;23(7):1715-32.

van der Meulen J, Brown CT, Yap T, Cromwell DA, Rixon L, Steed L, et al. Self management for men with lower urinary tract symptoms: randomised controlled trial. BMJ. 2007 Jan 6;334(7583):25. Epub 2006 Nov 21.

Reviewed last on: 7/8/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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