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:
- 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.
- Presents as obstructive or irritative signs and symptoms
that vary over time
- Mild disease may stabilize,
whereas others experience progressive disease
- Results when dynamic and/or
static factors reduce bladder emptying:
- Bladder feels full even after voiding
- Results from long-standing obstruction
at the bladder neck
- Urinary frequency
- Urinary urgency
Means of Confirmation
- Diagnosis requires careful medical history, including
medication history and physical examination
- Prostate-specific antigen (PSA)
- Objective measures of bladder emptying:
and average urinary flow rate
- Postvoid residual urine volume
- Transabdominal ultrasound to determine postvoid residual
- Digital rectal examination: Prostate is usually but not
always enlarged (>20 g), soft, smooth, and symmetric
- 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
- Watchful waiting
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 ||Download (.pdf)
Table 1. Categories of BPH Disease Severity Based on Symptoms and Signs
AUA Symptom Score
Typical Symptoms and Signs
Peak urinary flow rate <10 mL/s
Postvoid residual urine volume >25–50 mL
All of the above signs plus obstructive voiding symptoms
and irritative voiding symptoms (signs of detrusor instability)
All of the above plus one or more complications of BPH