Benign Prostatic Hyperplasia

Excerpt

Benign prostatic hyperplasia (BPH) refers to the nonmalignant growth or hyperplasia of prostate tissue and is a common cause of lower urinary tract symptoms (LUTS) in older men. Disease prevalence has been shown to increase with advancing age. The histological prevalence of BPH at autopsy is as high as 50% to 60% for males in their 60s, increasing to 80% to 90% of those older than 70 years of age.

Several definitions exist in the literature when describing BPH. These include bladder outlet obstruction, LUTS, and benign prostatic enlargement (BPE). BPH describes the histological changes, BPE refers to the increased size of the gland (usually secondary to BPH), and bladder outlet obstruction is defined as the blockage to urinary flow. Those with BPE who present with bladder outlet obstruction are also termed benign prostatic obstruction.

Lower urinary tract symptoms (LUTS) describe the urinary abnormalities shared by disorders affecting the bladder and prostate, typically caused by BPH. These terms have largely replaced those historically termed "prostatism."

The development of BPH is characterized by stromal and epithelial cell proliferation in the prostate transition zone, which surrounds the urethra. This leads to urethral compression and bladder outflow obstruction, which can result in clinical manifestations of LUTS, urinary retention, or infections due to incomplete bladder emptying. Long-term, untreated disease can lead to the development of chronic high-pressure retention (a potentially life-threatening condition) and long-term or permanent changes to the bladder detrusor muscle.

BPH treatment options range from watchful waiting to various medical and surgical interventions. Risk factors may be divided into non-modifiable and modifiable. Other factors such as age, genetics, geographical location, and obesity have all been shown to influence the development of BPH.