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Source: Lee M. Benign Prostatic Hyperplasia. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. Accessed July 3, 2012.

  • Benign neoplasm of the male prostate gland

  • Benign prostatic hypertrophy (BPH) caused by androgen-driven growth in size of prostate.

  • Precise pathophysiologic mechanisms that cause BPH are not clear. Intraprostatic dihydrotestosterone (DHT) and type II 5α-reductase are thought to be involved.
  • BPH commonly results from both static (gradual enlargement of prostate) and dynamic (agents or situations that increase α-adrenergic tone and constrict gland’s smooth muscle) factors.
  • Drugs can exacerbate symptoms:
    • Testosterone
    • α-adrenergic agonists (e.g., decongestants)
    • Anticholinergics (e.g., antihistamines, phenothiazines, tricyclic antidepressants, antispasmodics, antiparkinsonian agents)

  • Common in men >60 years old, with peak incidence at 63–65 years of age.

  • Male gender
  • Age >60

  • Presents as obstructive or irritative signs and symptoms that vary over time
    • Mild disease may stabilize, whereas others experience progressive disease

Signs and Symptoms

  • Obstructive
    • Results when dynamic and/or static factors reduce bladder emptying:
      • Urinary hesitancy
      • Dribbling
      • Bladder feels full even after voiding
  • Irritative
    • Results from long-standing obstruction at the bladder neck
      • Urinary frequency
      • Urinary urgency
      • Nocturia

Means of Confirmation and Diagnosis

  • Diagnosis requires careful medical history, including medication history and physical examination

Laboratory Tests

  • Urinalysis
  • Prostate-specific antigen (PSA)
  • Objective measures of bladder emptying:
    • Peak and average urinary flow rate
    • Postvoid residual urine volume


  • Transabdominal ultrasound to determine postvoid residual urine volume

Diagnostic Procedures

  • Digital rectal examination: Prostate is usually but not always enlarged (>20 g), soft, smooth, and symmetric

Differential Diagnosis

  • Relieve bothersome manifestations of the disease.
  • Prevent serious complications that can be life threatening.
  • Restore adequate urinary flow without causing adverse effects.

  • Management options depend on severity of signs and symptoms (Table 1).
    • Watchful waiting
      • Appropriate with mild disease and uncomplicated moderate disease with mildly bothersome symptoms (Figure 1).
      • Reassess annually.
    • Drug therapy
    • Surgical intervention

Table 1. Categories of BPH Disease Severity Based on Symptoms and Signs

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