1932

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.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-med-063014-123902
2016-01-14
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/med/67/1/annurev-med-063014-123902.html?itemId=/content/journals/10.1146/annurev-med-063014-123902&mimeType=html&fmt=ahah

Literature Cited

  1. Berry SJ, Coffey DS, Walsh PC, Ewing LL. 1.  1984. The development of human benign prostatic hyperplasia with age. J. Urol. 132:474–79 [Google Scholar]
  2. Verhamme KMC, Dieleman JP, Bleumink GS. 2.  et al. 2002. Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care—the Triumph Project. Eur. Urol. 42:323–28 [Google Scholar]
  3. Barry MJ, Fowler FJ, O'Leary MP. 3.  et al. 1992. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J. Urol. 148:1549–57 [Google Scholar]
  4. Wei JT, Calhoun E, Jacobsen SJ. 4.  2005. Urologic Diseases in America Project: benign prostatic hyperplasia. J. Urol. 173:1256–61 [Google Scholar]
  5. Ozden C, Ozdal OL, Urgancioglu G. 5.  et al. 2007. The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia. Eur. Urol. 51:199–206 [Google Scholar]
  6. Moul S, McVary KT. 6.  2010. Lower urinary tract symptoms, obesity and the metabolic syndrome. Curr. Opin. Urol. 20:7–12 [Google Scholar]
  7. McNeal JE. 7.  1968. Regional morphology and pathology of the prostate. Am. J. Clin. Pathol. 49:347–57 [Google Scholar]
  8. McNeal JE. 8.  1988. Normal histology of the prostate. Am. J. Surg. Pathol. 12:619–33 [Google Scholar]
  9. Berger AP, Deibl M, Leonhartsberger N. 9.  et al. 2005. Vascular damage as a risk factor for benign prostatic hyperplasia and erectile dysfunction. BJU Int. 96:1073–78 [Google Scholar]
  10. Chen IH, Tsai YS, Tong YC. 10.  2012. Correlations among cardiovascular risk factors, prostate blood flow, and prostate volume in patients with clinical benign prostatic hyperplasia. Urology 79:409–14 [Google Scholar]
  11. Vignozzi L, Rastrelli G, Cornoa G. 11.  et al. 2014. Benign prostatic hyperplasia: a new metabolic disease?. J. Endocrinol. Invest. 37:313–22 [Google Scholar]
  12. Berger AP, Kofler K, Bektic J. 12.  et al. 2003. Increased growth factor production in a human prostatic stromal cell culture model caused by hypoxia. Prostate 57:57–65 [Google Scholar]
  13. Tinel H, Stelte-Ludwig B, Hutter J, Sandner P. 13.  2006. Pre-clinical evidence for the use of phosphodiesterase-5 inhibitors for treating benign prostatic hyperplasia and lower urinary tract symptoms. BJU Int. 98:1259–63 [Google Scholar]
  14. Fibbi B, Morelli A, Vignozzi L. 14.  et al. 2010. Characterization of phosphodiesterase type 5 expression and functional activity in the human male lower urinary tract. J. Sex. Med. 7:59–69 [Google Scholar]
  15. Roehrborn CG, Schwinn DA. 15.  2004. Alpha 1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J. Urol. 171:1029–35 [Google Scholar]
  16. McVary KT, Razzaq A, Lee C. 16.  et al. 1994. Growth of the rat prostate gland is facilitated by the autonomic nervous system. Biol. Reprod. 51:99–107 [Google Scholar]
  17. Montie JE, Pienta KJ. 17.  1994. Review of the role of androgenic hormones in the epidemiology of benign prostatic hyperplasia and prostate cancer. Urology 43:892–99 [Google Scholar]
  18. Ho CKM, Habib FK. 18.  2011. Estrogen and androgen signaling in the pathogenesis of BPH. Nat. Rev. Urol. 8:29–41 [Google Scholar]
  19. Kessler OJ, Keisari Y, Servadio C, Abramovici A. 19.  1998. Role of chronic inflammation in the promotion of prostatic hyperplasia in rats. J. Urol. 159:1049–53 [Google Scholar]
  20. Di Silverio F, Gentile V, De Matteis A. 20.  et al. 2003. Distribution of inflammation, pre-malignant lesions, incidental carcinoma in histologically confirmed benign prostatic hyperplasia: a retrospective analysis. Eur. Urol. 43:164–75 [Google Scholar]
  21. Nickel JC, Roehrborn CG, O'Leary MP. 21.  et al. 2008. The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial. Eur. Urol. 54:1379–84 [Google Scholar]
  22. Mishra VC, Allen DJ, Nicolaou C. 22.  et al. 2007. Does intraprostatic inflammation have a role in the pathogenesis and progression of benign prostatic hyperplasia. BJU Int. 100:327–31 [Google Scholar]
  23. Kramer G, Mitteregger D, Marberger M. 23.  2007. Is benign prostatic hyperplasia (BPH) an immune inflammatory disease?. Eur. Urol. 51:1202–16 [Google Scholar]
  24. Sarma AV, Purke JP, Jacobson DJ. 24.  et al. 2008. Associations between diabetes and clinical markers of benign prostatic hyperplasia among community-dwelling black and white men. Diabetes Care 31:476–82 [Google Scholar]
  25. Parsons JK. 25.  2007. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J. Urol. 178:395–401 [Google Scholar]
  26. Roehrborn CG, Girman CJ, Rhodes T. 26.  et al. 1997. Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound. Urology 49:548–57 [Google Scholar]
  27. Thompson IM. 27.  1987. The evaluation of microscopic hematuria: a population-based study. J. Urol. 138:1189–90 [Google Scholar]
  28. Bostwick DG, Cooner WH, Denis L. 28.  et al. 1991. The association of benign prostatic hyperplasia and cancer of the prostate. Cancer 70:291–301 [Google Scholar]
  29. Sershon PD, Barry MJ, Oesterling JE. 29.  1994. Serum prostate-specific antigen weakly discriminates between men with benign prostatic hyperplasia and patients with organ-confined prostate cancer. Eur. Urol. 25:281–87 [Google Scholar]
  30. Kim EH, Andriole GL. 30.  2015. Prostate-specific antigen-based screening: controversy and guidelines. BMC Med. 13:61 [Google Scholar]
  31. McConnell JD, Bruskewitz R, Walsh P. 31.  et al. 1998. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N. Engl. J. Med. 338:557–63 [Google Scholar]
  32. McConnell JD, Roehrborn CG, Bautista OM. 32.  et al. 2003. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N. Engl. J. Med. 349:2387–98 [Google Scholar]
  33. Roehrborn CG, McConnell JD, Lieber M. 33.  et al. 1999. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. Urology 53:473–80 [Google Scholar]
  34. Benson MC, Whang IS, Pantuck A. 34.  et al. 1992. The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J. Urol. 147:817–21 [Google Scholar]
  35. Fang J, Metter EJ, Landis P, Carter HB. 35.  2002. PSA velocity for assessing prostate cancer risk in men with PSA between 2.0 and 4.0 ng/ml. Urology 59:889–93 [Google Scholar]
  36. Partin AW, Catalona WJ, Southwick PC. 36.  et al. 1996. Analysis of percent free prostate-specific antigen (PSA) for prostate cancer detection: influence of total PSA, prostate volume, and age. Urology 48:55–61 [Google Scholar]
  37. Loeb S, Sanda MG, Broyles DL. 37.  et al. 2015. The prostate health index selectively identifies clinically significant prostate cancer. J. Urol. 193:41163–69 [Google Scholar]
  38. Carlsson S, Maschino A, Schroder F. 38.  et al. 2013. Predictive value of four kallikrein markers for pathologically insignificant compared with aggressive prostate cancer in radical prostatectomy specimens: results from the European Randomized Study of Screening for Prostate Cancer section Rotterdam. Eur. Urol. 64:693–99 [Google Scholar]
  39. Birch NC, Hurst G, Doyle PT. 39.  1988. Serial residual volumes in men with prostatic hypertrophy. Br. J. Urol. 62:571–75 [Google Scholar]
  40. Barry MJ, Cockett AT, Holtgrewe HL. 40.  et al. 1993. Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia. J. Urol. 150:351–58 [Google Scholar]
  41. Mochtar CA, Kiemeney LALM, van Riemsdijk MM. 41.  et al. 2006. Post-void residual urine volume is not a good predictor of the need for invasive therapy among patients with benign prostatic hyperplasia. J. Urol. 175:213–16 [Google Scholar]
  42. El Din KE, De Wildt M, Rosier P. 42.  et al. 1996. The correlation between urodynamic and cystoscopic findings in elderly men with voiding complaints. J. Urol. 155:1018–22 [Google Scholar]
  43. Abrams P, Chapple C, Khoury S. 43.  et al. 2009. Evaluation and treatment of lower urinary tract symptoms in older men. J. Urol. 181:1779–87 [Google Scholar]
  44. Lepor H, Williford WO, Barry MJ. 44.  et al. 1998. The impact of medical therapy on bother due to symptoms, quality of life and global outcome, and factors predicting response. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group.. J. Urol. 160:1358–67 [Google Scholar]
  45. Abrams PH, Griffiths DJ. 45.  1979. The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br. J. Urol. 51:129–34 [Google Scholar]
  46. Ko DSC, Fenster HN, Chambers K. 46.  et al. 1995. The correlation of multichannel urodynamic pressure-flow studies and American Urological Association symptom index in the evaluation of benign prostatic hyperplasia. J. Urol. 154:396–98 [Google Scholar]
  47. McVary KT, Roehrborn CG, Avins AL. 47.  et al. 2011. Update on AUA guideline on the management of benign prostatic hyperplasia. J. Urol. 185:1793–803 [Google Scholar]
  48. Madersbacher S, Alivizatos G, Nordling J. 48.  et al. 2004. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur. Urol. 46:547–54 [Google Scholar]
  49. Jacobsen SJ, Jacobson DJ, Girman CJ. 49.  et al. 1997. Natural history of prostatism: risk factors for acute urinary retention. J. Urol. 158:481–87 [Google Scholar]
  50. Meigs JB, Barry MJ, Giovannucci E. 50.  et al. 1999. Incidence rates and risk factors for acute urinary retention: the Health Professionals Followup Study. J. Urol. 162:376–82 [Google Scholar]
  51. Chapple CR, Wyndaele JJ, Nordling J. 51.  et al. 1996. Tamsulosin, the first prostate-selective alpha 1A-adrenoceptor antagonist. A meta-analysis of two randomized, placebo-controlled, multicentre studies in patients with benign prostate obstruction (symptomatic BPH). Eur. Urol. 29:155–67 [Google Scholar]
  52. Roehrborn CG. 52.  2006. Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. BJU Int. 97:734–41 [Google Scholar]
  53. Roehrborn CG, Bruskewitz R, Nickel JC. 53.  et al. 2004. Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia. J. Urol. 171:1194–98 [Google Scholar]
  54. Nickel JC, Gilling P, Tammela TL. 54.  et al. 2011. Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS). BJU Int. 108:388–94 [Google Scholar]
  55. McVary KT, Monnig W, Camps JL. 55.  et al. 2007. Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J. Urol. 177:1071–77 [Google Scholar]
  56. McVary KT, Roehrborn CG, Kaminetsky JC. 56.  et al. 2007. Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J. Urol. 177:1401–7 [Google Scholar]
  57. Stief CG, Porst H, Neuser D. 57.  et al. 2008. A randomized, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur. Urol. 53:1236–44 [Google Scholar]
  58. Roehrborn CG, McVary KT, Elion-Mboussa A, Viktrup L. 58.  2008. Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. J. Urol. 180:1228–34 [Google Scholar]
  59. Porst H, Kim ED, Casabe AR. 59.  et al. 2011. Efficacy and safety of tadalafil once daily in the treatment of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results of an international randomized, double-blind, placebo-controlled trial. Eur. Urol. 60:1105–13 [Google Scholar]
  60. Roehrborn CG, Siami P, Barkin J. 60.  et al. 2010. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur. Urol. 57:123–31 [Google Scholar]
  61. Lepor H, Williford WO, Barry MJ. 61.  et al. 1996. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group.. N. Engl. J. Med. 335:533–39 [Google Scholar]
  62. Liguori G, Trombetta C. Giorgi G. 62. , De et al. 2009. Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction. J. Sex. Med. 6:544–52 [Google Scholar]
  63. Tuncel A, Nalcacioglu V, Ener K. 63.  et al. 2010. Sildenafil citrate and tamsulosin combination is not superior to monotherapy in treating lower urinary tract symptoms and erectile dysfunction. World J. Urol. 28:17–22 [Google Scholar]
  64. Gacci M, Vittori G, Tosi N. 64.  et al. 2012. A randomized, placebo-controlled study to assess safety and efficacy of vardenafil 10 mg and tamsulosin 0.4 mg vs. tamsulosin 0.4 mg alone in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J. Sex. Med. 9:1624–33 [Google Scholar]
  65. Bent S, Kane C, Shinohara K. 65.  et al. 2006. Saw palmetto for benign prostatic hyperplasia. N. Engl. J. Med. 354:557–66 [Google Scholar]
  66. Barry MJ, Meleth S, Lee JY. 66.  et al. 2011. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 306:1344–51 [Google Scholar]
  67. Fowler FJ, Wennberg JE, Timothy RP. 67.  et al. 1988. Symptom status and quality of life following prostatectomy. JAMA 259:3018–22 [Google Scholar]
  68. Neal DE, Ramsden PD, Sharples L. 68.  et al. 1989. Outcome of elective prostatectomy. BMJ 299:762–67 [Google Scholar]
  69. Wasson JH, Reda DJ, Bruskewitz RC. 69.  et al. 1995. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. N. Engl. J. Med. 332:75–79 [Google Scholar]
  70. Yang Q, Peters TJ, Donovan JL. 70.  et al. 2001. Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials. J. Urol. 165:1526–32 [Google Scholar]
  71. Madersbacher S, Marberger M. 71.  1999. Is transurethral resection of the prostate still justified?. BJU Int. 83:227–37 [Google Scholar]
  72. Gratzke C, Schlenker B, Seitz M. 72.  et al. 2007. Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J. Urol. 177:1419–22 [Google Scholar]
  73. Baumert H, Ballaro A, Dugardin F, Kaisary AV. 73.  2006. Laparoscopic versus open simple prostatectomy: a comparative study. J. Urol. 175:1691–94 [Google Scholar]
  74. Kuntz RM. 74.  2006. Current role of lasers in the treatment of benign prostatic hyperplasia (BPH). Eur. Urol. 49:961–69 [Google Scholar]
  75. Bachmann A, Tubaro A, Barber N. 75.  et al. 2015. A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study. J. Urol. 193:570–78 [Google Scholar]
  76. Ahyai SA, Lehrich K, Kuntz RM. 76.  2007. Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur. Urol. 52:1456–64 [Google Scholar]
  77. Dahlstrand C, Walden M, Geirsson G, Pettersson S. 77.  1995. Transurethral microwave thermotherapy versus transurethral resection for symptomatic benign prostatic obstruction: a prospective randomized study with a 2-year follow-up. Br. J. Urol. 76:614–18 [Google Scholar]
  78. Mattiasson A, Wagrell L, Schelin S. 78.  et al. 2007. Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study. Urology 69:91–96 [Google Scholar]
  79. Zlotta AR, Giannakopoulos X, Maehlum O. 79.  et al. 2003. Long-term evaluation of transurethral needle ablation of the prostate (TUNA) for treatment of symptomatic benign prostatic hyperplasia: clinical outcome up to five years from three centers. Eur. Urol. 44:89–93 [Google Scholar]
  80. Madersbacher S, Schatzl G, Djavan B. 80.  et al. 2000. Long-term outcome of transrectal high-intensity focused ultrasound therapy for benign prostatic hyperplasia. Eur. Urol. 37:687–94 [Google Scholar]
  81. Oesterling JE, Defalco AJ, Kaplan SA. 81.  et al. 1994. The North American experience with the UroLume endoprosthesis as a treatment for benign prostatic hyperplasia: long-term results. The North American UroLume Study Group.. Urology 44:353–62 [Google Scholar]
  82. Roehrborn CG, Gange SN, Shore ND. 82.  et al. 2013. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: The L.I.F.T. Study.. J. Urol. 190:2161–67 [Google Scholar]
/content/journals/10.1146/annurev-med-063014-123902
Loading
/content/journals/10.1146/annurev-med-063014-123902
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error