Management of Benign Prostatic Hyperplasia

Annu Rev Med. 2016;67:137-51. doi: 10.1146/annurev-med-063014-123902. Epub 2015 Sep 2.

Abstract

Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) commonly affect older men. Age-related changes associated with metabolic disturbances, changes in hormone balance, and chronic inflammation may cause BPH development. The diagnosis of BPH hinges on a thorough medical history and focused physical examination, with attention to other conditions that may be causing LUTS. Digital rectal examination and urinalysis should be performed. Other testing may be considered depending on presentation of symptoms, including prostate-specific antigen, serum creatinine, urine cytology, imaging, cystourethroscopy, post-void residual, and pressure-flow studies. Many medical and surgical treatment options exist. Surgery should be reserved for patients who either have failed medical management or have complications from BPH, such as recurrent urinary tract infections, refractory urinary retention, bladder stones, or renal insufficiency as a result of obstructive uropathy.

Keywords: 5-alpha reductase inhibitors; adrenergic alpha-antagonists; lower urinary tract symptoms; phosphodiesterase type 5 inhibitors; transurethral resection of prostate.

Publication types

  • Review

MeSH terms

  • 5-alpha Reductase Inhibitors / therapeutic use
  • Ablation Techniques
  • Adrenergic alpha-Antagonists / therapeutic use
  • Digital Rectal Examination
  • Humans
  • Laser Therapy
  • Lower Urinary Tract Symptoms / etiology*
  • Male
  • Phosphodiesterase 5 Inhibitors / therapeutic use
  • Prostatic Hyperplasia / complications
  • Prostatic Hyperplasia / diagnosis*
  • Prostatic Hyperplasia / metabolism
  • Prostatic Hyperplasia / pathology
  • Prostatic Hyperplasia / therapy*
  • Transurethral Resection of Prostate
  • Watchful Waiting

Substances

  • 5-alpha Reductase Inhibitors
  • Adrenergic alpha-Antagonists
  • Phosphodiesterase 5 Inhibitors