Benign Prostatic Hyperplasia (BPH)

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. http://accesspharmacy.com/content.aspx?aid=7994823. 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

Imaging

• 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

• Prostate cancer
• Bladder cancer
• Neurogenic bladder
• Urinary tract infection

• 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