Benign prostatic hyperplasia: an overview

Abstract

Despite the deceptively simple description of benign prostatic hyperplasia (BPH), the actual relationship between BPH, lower urinary tract symptoms (LUTS), benign prostatic enlargement, and bladder outlet obstruction is complex and requires a solid understanding of the definitional issues involved. The etiology of BPH and LUTS is still poorly understood, but the hormonal hypothesis has many arguments in its favor. There are many medical and minimally invasive treatment options available for affected patients. In the intermediate and long term, minimally invasive treatment options are superior to medical therapy in terms of symptom and flow rate improvement; tissue ablative surgical treatment options are superior to both minimally invasive and medical therapy.

Figures

Figure 1

Complex relationship between benign prostatic hyperplasia (BPH), lower urinary tract symptoms (LUTS), benign prostatic enlargement (BPE), and bladder outlet obstruction (BOO).

Figure 2

Trends in aging and life expectancy. (A) Percentage of population aged 65 years and older, by world region. (B) Trends in life expectancy at birth (in years), by world region. Data from United Nations.

Figure 3

Guidelines for the evaluation of men with lower urinary tract symptoms and benign prostatic hyperplasia. H&P, history and physical examination; DRE, digital rectal examination; PSA, prostate-specific antigen; IPSS, International Prostate Symptom Score; AUR, acute urinary retention; UTI, urinary tract infection. Adapted from the American Urological Association Practice Guidelines Committee.

Figure 4

Comparison of the improvement in International Prostate Symptom Score by various α-blockers. Effect of α1-adrenergic receptor antagonists on total symptom score in placebo-controlled studies. Total number of patients: alfuzosin (ALF), n = 2208; terazosin (TER), n = 3229; doxazosin (DOX), n = 3947; and tamsulosin (TAM), n = 1331. IR, immediate release; SR, sustained release; S, standard; GITS, gastrointestinal. Additional benefit with α-blockers over placebo is approximately 10% to 15%. Reproduced with permission from Djavan et al.

Figure 5

Cumulative incidence of overall progression of benign prostatic hyperplasia in the Medical Therapy of Prostatic Symptoms trial by treatment group. Reproduced with permission from McConnell et al.

Figure 6

Comparisons of (A) symptom score and (B) flow rate improvement by treatment modality and follow-up. Data from the American Urological Association Practice Guidelines Committee.

Figure 7

Improvement in (A) International Prostate Symptom Score (IPSS) and (B) peak urinary flow rate (Qmax) over time with terazosin versus transurethral microwave thermotherapy. Updated from Djavan et al.

Figure 8

Improvements in mean International Prostate Symptom Score (IPSS) in a randomized trial of tamsulosin versus interstitial laser coagulation (ILC) with the Indigo Optima laser. Presented by Roehrborn and associates at the American Urological Association Annual Meeting, May 25, 2005, San Antonio, TX.