Some degree of BPH is present in 50% of men over 50 years old and 90% of men over 90 years old. BPH is not cancerous and there is no conclusive evidence that it can lead to cancer. [famplan.org.hk]

BPH Case Report Chief Complaint: LF is a 64-year-old white male presenting with fatigue and sleep pattern changes that have lasted over the past several years. [uspharmacist.com]

Patients present with symptoms of bladder irritation ( urinary frequency, urgency, urge incontinence ), bladder outlet obstruction (urinary hesitancy, straining to urinate, sensation of incomplete voiding), and/or hematuria. [amboss.com]

The prostate is a gland about the size of a walnut that is only present in men. It is located just below the bladder and surrounds the urethra, the tube through which urine flows from the bladder and out through the penis. [mayo.edu]

Dysuria and hematuria are not commonly associated with BPH and may be an indication that another disease process is present. [accessmedicine.mhmedical.com]

• Surgical Procedure

  Surgical procedures, some of which may be minimally invasive, will usually improve urine flow rates and other symptoms. [drugs.com]

  Open prostatectomy requires general anesthesia, a longer hospital stay than other surgical procedures for benign prostatic hyperplasia, and a longer rehabilitation period. [niddk.nih.gov]

  Other, more involved surgical procedures include: Laser therapy to remove part of your prostate Transurethral resection of the prostate, or TURP, in which the doctor uses a scope and cuts out pieces of the gland with a wire loop Transurethral incision [webmd.com]

  Simple prostatectomy : It is a procedure to remove the inside part of the prostate gland. It is done through a surgical cut in your lower belly. This treatment is most often done on men who have very large prostate glands. [medlineplus.gov]

  There are different types of surgical procedures that can help treat BPH when medications are not effective. [healthline.com]

• Fever

  Signs of infection, including fever or chills. [vikaspedia.in]

  Call your provider right away if you have: Less urine than usual Fever or chills Back, side, or abdominal pain Blood or pus in your urine Also call if: Your bladder does not feel completely empty after you urinate. [medlineplus.gov]

  When to Contact a Medical Professional Call your provider right away if you have: Less urine than usual Fever or chills Back, side, or abdominal pain Blood or pus in your urine Also call if: Your bladder does not feel completely empty after you urinate [pennstatehershey.adam.com]

  Contrast imaging studies (eg, CT, intravenous urography [IVU]) are rarely necessary unless the patient has had a urinary tract infection (UTI) with fever or obstructive symptoms have been severe and prolonged. [msdmanuals.com]

  […] about any worsening of urinary symptoms when taking cold or sinus drugs, and previous urinary tract infections or prostatitis (inflammation of the prostate, which may cause pain in the lower back and the area between the scrotum and rectum, and chills, fever [hopkinsmedicine.org]

• Anemia

  With more severe, chronic BPH symptoms, blood creatinine of blood urea nitrogen (BUN) and hemoglobin are measured to rule out kidney damage and anemia. [hopkinsmedicine.org]

• Abdominal Pain

  Call your provider right away if you have: Less urine than usual Fever or chills Back, side, or abdominal pain Blood or pus in your urine Also call if: Your bladder does not feel completely empty after you urinate. [medlineplus.gov]

  When to Contact a Medical Professional Call your provider right away if you have: Less urine than usual Fever or chills Back, side, or abdominal pain Blood or pus in your urine Also call if: Your bladder does not feel completely empty after you urinate [pennstatehershey.adam.com]

  […] or pain while urinating, called dysuria. [12] Bladder outlet obstruction (BOO) can be caused by BPH. [13] Symptoms are abdominal pain, a continuous feeling of a full bladder, frequent urination, acute urinary retention (inability to urinate), pain during [en.wikipedia.org]

• Hypotension

  Finasteride increased sexual dysfunction; alpha blockers increased dizziness, postural hypotension and asthenia. [ti.ubc.ca]

  It is available in a slow-release formulation, which reduces the systemic adverse effects such as postural hypotension and the need for dose titration. 12 Tamsulosin is a commonly prescribed drug in Australia but reimbursement is only covered by the Repatriation [nps.org.au]

  Possible side effects of alpha-adrenergic blockers are orthostatic hypotension (dizziness upon standing, due to a fall in blood pressure), fatigue and headaches. [hopkinsmedicine.org]

  Examples of alpha-blockers used in the treatment of BPH include: Terazosin ( Hytrin ) Doxazosin ( Cardura, Cardura XL ) Alfuzosin ( Uroxatral ) Tamsulosin ( Flomax ) Silodosin ( Rapaflo ) Side effects that may occur with alpha-blockers include: hypotension [drugs.com]

  Tamsulosin treatment for benign prostatic hyperplasia and risk of severe hypotension in men aged 40-85 years in the United States: risk window analyses using between and within patient methodology. BMJ. 2013 Nov 5. 347:f6320. [Medline]. [Full Text]. [medscape.com]

• Hypertension

  Risk factors increasing age family history race: blacks > whites > asians cardiovascular disease use of beta-blockers metabolic syndrome: diabetes, hypertension, obesity 8 Markers prostate specific antigen (PSA) : elevated but non-specific Ultrasound [radiopaedia.org]

  Among men treated for hypertension, the doses of anti-hypertension drugs may need to be adjusted due to the blood-pressure-lowering effects of an alpha-adrenergic blocker. [hopkinsmedicine.org]

  Diet-Induced Hyperinsulinemia as a Key Factor in the Etiology of Both Benign Prostatic Hyperplasia and Essential Hypertension?. Nutr Metab Insights. 2018. 11:1178638818773072. [Medline]. [Full Text]. Egan KB. [medscape.com]

  A 2-year trial of alfuzosin vs. placebo (n=1506) also found no difference in AUR or surgery. 3 Only one trial longer than a year reports on serious adverse events (SAEs): alfuzosin 12%, placebo 11%. 3 In the ALLHAT hypertension trial (no placebo arm), [ti.ubc.ca]

  Over the ensuing 10 weeks, the patient, distrustful of the clinician he encountered, canceled his follow-up with subsequent progressive chronic urinary retention, obstructive uropathy with renal failure, and life-threatening hypertension. [psnet.ahrq.gov]

• Heart Disease

  Diabetes and heart disease. Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH. Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk. [mayoclinic.org]

  National Institute of Diabetes and Digestive and Kidney Diseases website. [medlineplus.gov]

  Symptoms Less than half of all men with BPH have symptoms of the disease. [pennstatehershey.adam.com]

  […] in the Asian Journal of Urology, on the other hand, notes that 8 to 60 percent of men have BPH at age 90. ( 8 ) Aside from increased age, risk factors for BPH include: Family history of BPH Obesity Lack of physical activity Erectile dysfunction (2) Heart [everydayhealth.com]

  They should be avoided in patients receiving nitrates for ischaemic heart disease or those with poor cardiac function. Referral Urological referral is indicated for patients who have ongoing symptoms despite medical therapy. [nps.org.au]

• Suggestibility

  Hormonal changes Research suggests that hormonal changes that occur as a man ages play an important role in the development of an enlarged prostate. [news-medical.net]

  Abnormal gait may suggest a neurologic condition such as Parkinson disease or stroke that can also affect lower urinary tract function. Lower abdomen. A palpable bladder suggests urinary retention. External genitalia. [mdedge.com]

  UroLift system is a permanently placed device used to lift and hold the enlarged prostate tissue out of the way, so it no longer blocks the urethra In some cases, your doctor may also suggest a traditional, open surgery or a robotic procedure to remove [webmd.com]

  This fact suggests a possible link between high DHT levels and BPH. Several risk factors appear to increase a person's likelihood of developing BPH. [medicalnewstoday.com]

  Flow rate 15 mL/sec suggests obstruction, and postvoid residual volume > 100 mL suggests retention. Interpreting prostate-specific antigen (PSA) levels can be complex. [msdmanuals.com]

• Asthenia

  Finasteride increased sexual dysfunction; alpha blockers increased dizziness, postural hypotension and asthenia. [ti.ubc.ca]

• Enlargement of the Prostate

  Benign prostate hypertrophy, also called prostate enlargement or BPH, is a non-cancerous enlargement of the prostate gland. The prostate enlarges slowly, and over time puts increasing pressure on the urethra and the base of the bladder. [healthdirect.gov.au]

  Prostatic, Benign fibroma of prostate, Benign enlargement of prostate, Enlarged prostate - benign, benign hypertrophy of prostate NOS, BPH, Prostatic Hypertrophy, Benign, Glandular, stromal and muscular hyperplasia of prostate gland, BEP - Benign enlargement [ebi.ac.uk]

  However, TURPs can only be used if the prostate is not too enlarged. Open surgery is used when the prostate is very enlarged. [healthengine.com.au]

  Prostatic hypertrophy, benign: A common, noncancerous enlargement of the prostate gland. [medicinenet.com]

• Incomplete Bladder Emptying

  This can cause a variety of symptoms (see below), ranging from obstructive (slow stream, incomplete bladder emptying) to irritative (urgency to void, voiding multiple times at night). [healthcare.utah.edu]

  By Andrew Husband, MSc, and Adam Todd, PhD, MRPharmS For older men, benign prostatic hyperplasia is a common cause of lower urinary tract symptoms such as polyuria, incomplete bladder emptying, urinary urgency and, in severe cases, urinary retention Summary [pharmaceutical-journal.com]

  When patients develop clinically significant BPH, they complain to clinicians of lower urinary tract symptoms (LUTS) such as increased urinary frequency, nocturia, urinary hesitancy, urine stream weakness, postvoid dribbling, and incomplete bladder emptying [accessmedicine.mhmedical.com]

  Symptoms usually increase in severity over time and may include: Difficulty starting to urinate Weak urination stream Dribbling at the end of urination Sensation of incomplete bladder emptying Urge to urinate frequently, especially at night Deep discomfort [winchesterhospital.org]

  Common symptoms include: incomplete bladder emptying nocturia, which is the need to urinate two or more times per night dribbling at the end of your urinary stream incontinence, or leakage of urine the need to strain when urinating a weak urinary stream [healthline.com]

• Urinary Hesitancy

  Symptoms can be associated with difficulties storing urine (eg, urinary urgency and polyuria) or voiding the bladder (eg, urinary hesitancy and poor urinary flow). [pharmaceutical-journal.com]

  When patients develop clinically significant BPH, they complain to clinicians of lower urinary tract symptoms (LUTS) such as increased urinary frequency, nocturia, urinary hesitancy, urine stream weakness, postvoid dribbling, and incomplete bladder emptying [accessmedicine.mhmedical.com]

  Urinary hesitancy (difficulty initiating the urination) or straining to urinate Incomplete bladder emptying: this may be just a feeling or it may be the case that the bladder is retaining too much urine Weak or “stuttering” urinary stream Diagnosis There [healthcare.utah.edu]

  References: [1] [3] [7] Clinical features Lower urinary tract symptoms ( LUTS ) Irritative symptoms of BPH Urinary frequency Urinary urgency and urge incontinence Nocturia Dysuria Obstructive symptoms of BPH Hesitancy Straining to urinate Poor and/or [amboss.com]

  Chronic bladder outlet obstruction can lead to bladder decompensation and detrusor underactivity, manifesting as incomplete emptying, urinary hesitancy, intermittency (starting and stopping while voiding), a weakened urinary stream, and urinary retention [mdedge.com]

• Uremia

  The consequences of untreated postrenal kidney failure are uremia and death. The relief of the urinary tract often leads to massive polyuria. Polyuria is caused by the excretion of accumulated osmotically active substances. [urology-textbook.com]

Primary care physicians are uniquely positioned to screen for BPH, conduct a timely diagnostic workup, and if indicated, initiate medical therapy. [mdedge.com]

Drug treatment combinations may also be more effective for some patients than use of a single drug. Common medications used for treatment of BPH Alpha-blockers : Alpha-blockers are a class of drugs considered to be first-line treatment for BPH. [drugs.com]

Treatment Conservative treatment for prostate gland hypertrophy includes making changes to your lifestyle, such as reducing stress and avoiding drinking fluids in the evening. [cirse.org]

BPH treatment BPH treatment usually depends on your symptoms. [healthdirect.gov.au]

These are still indications for aggressive treatment but are less frequently encountered. In modern practice the level of bother from the symptoms most often drives treatment decision-making. [healthcare.utah.edu]

The treatment depends on the severity of symptoms. [nps.org.au]

MRI enlarged transition zone heterogeneous signal with an intact low signal pseudocapsule in the periphery Treatment and prognosis Medical management for early disease typically commences with an alpha blocker such as tamsulosin given in combination with [radiopaedia.org]

[…] developed breast cancer (~ 200 times expected rate). 2, 24 In a 7-year prostate cancer prevention trial (n=18,882) fewer men on finasteride vs. placebo developed tumours, 18.4% vs. 24.4%, but more men on finasteride had high-grade tumours with a worse prognosis [ti.ubc.ca]

Due to the more progressive nature of the disease in men with larger glands and/or higher PSA values, conservatively treated patients (watchful waiting or placebo groups) face an increasingly worse prognosis, enhancing the difference over time in outcomes [auanet.org]

Etiology The etiology is not fully understood The following factors play a role in prostatic hyperplasia and growth Hormonal factors Androgens : Dihydrotestosterone ( DHT ) is a potent prostatic growth factor Gene amplification of androgen receptors : [amboss.com]

You are here: Urology Textbook > Prostate > BPH > Definition, epidemiology, etiology Benign prostatic hyperplasia (1/6): definitions, epidemiology and etiology Benign prostatic hyperplasia (2/6): signs and symptoms Benign prostatic hyperplasia (3/6): [urology-textbook.com]

Roehrborn CG, McConnell JD: Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. Campbell-Walsh Urology. [springermedizin.de]

The etiology is unknown but probably involves hormonal changes associated with aging. [msdmanuals.com]

Diet-Induced Hyperinsulinemia as a Key Factor in the Etiology of Both Benign Prostatic Hyperplasia and Essential Hypertension?. Nutr Metab Insights. 2018. 11:1178638818773072. [Medline]. [Full Text]. Egan KB. [medscape.com]

Epidemiologic Risk Factors for Benign Prostatic Hyperplasia (BPH): The epidemiology of BPH is fairly constant, some genetic factors or environmental influences may modestly increase the risk for BPH. [urology-textbook.com]

In parallel, epidemiological studies demonstrated that diet may play an important role on incidence and development of prostatic diseases. [urotoday.com]

References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Roehrborn CG, McConnell JD: Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. Campbell-Walsh Urology. [springermedizin.de]

Epidemiology of clinical benign prostatic hyperplasia. Asian Journal of Urology. July 2017. Benign Prostatic Hyperplasia. Mayo Clinic. Benign Prostatic Hyperplasia (BPH). Johns Hopkins Medicine. [everydayhealth.com]

Roehrborn CG, McConnell JD: Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. Campbell-Walsh Urology. [springermedizin.de]

References: [2] [3] [4] [5] [6] Pathophysiology The prostate consists of three distinct histologic zones The inner central zone The middle transition zone: BPH develops in this zone. The outer peripheral zone: Prostate cancer develops in this zone. [amboss.com]

Pathophysiology, epidemiology, and natural history of benign prostatic hyperplasia. Rev Urol. 2004;6(suppl 9):S3-S10. 4. Abrams P, Chapple C, Khoury S, et al. Evaluation and treatment of lower urinary tract symptoms in older men. [uspharmacist.com]

Pathology and Pathophysiology of Benign Prostatic Hyperplasia Macroscopic Anatomy of BPH: The enlargement of the periurethral prostate [fig. prostate zones in BPH ] can affect the so-called middle lobe, the lateral lobes or a combination of both. [urology-textbook.com]

BPH involves the stromal and epithelial elements of the prostate arising in the periurethral and transition zones of the gland (see Pathophysiology ). [medscape.com]

The goals of drug therapy are symptom relief and prevention of complications. [ti.ubc.ca]

Surgical procedures for BPH include: Transurethral resection of the prostate (TURP) Laser surgery Open prostatectomy Transurethral incision of the prostate (TUIP) (2,6,10,12) Benign Prostatic Hyperplasia Prevention There is no definitive way to prevent [everydayhealth.com]

Prevention BPH affects many males as they get older, and it may not be possible to prevent it. [medicalnewstoday.com]

These classes of medications will often be used in combination to prevent urinary obstruction and ease symptoms. Medication doesn’t help everyone. [pcf.org]

How can benign prostatic hyperplasia be prevented? Researchers have not found a way to prevent benign prostatic hyperplasia. [niddk.nih.gov]