Benign Prostatic Hyperplasia
Age-related non-cancerous prostate enlargement causing urinary obstruction and LUTS.
Emergency Management: Acute urinary retention requires immediate decompression with urethral or suprapubic catheter.
Non-malignant adenomatous overgrowth of the periurethral transition zone of the prostate gland, leading to bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS).
Detailed Overview
BPH affects most aging men, causing static obstruction from prostatic tissue and dynamic obstruction from increased alpha-1 adrenergic tone. Prolonged obstruction induces detrusor hypertrophy, bladder instability, and eventually urinary retention or renal injury.
Epidemiology & Demographics
Prevalence is ~50% by age 60 and >90% by age 85. Symptomatic in 25% of men at age 55.
Etiological Mechanism
Driven by aging and the action of dihydrotestosterone (DHT) on prostatic tissue.
Primary Causes
Testosterone conversion to DHT via 5-alpha-reductase stimulates stromal and epithelial hyperplasia.
DHT binds androgen receptors, triggering growth factors (FGF, EGF) that promote transition zone proliferation. The hyperplastic tissue compresses the urethra (static BOO). Concurrently, alpha-1 receptors in the prostate stroma increase smooth muscle tone (dynamic BOO).
Diagnostic Criteria & Guidelines
Clinical diagnosis via IPSS >7, DRE findings, uroflowmetry (Qmax < 10 mL/s), and post-void residual (PVR) > 100 mL.
Tamsulosin 0.4 mg PO daily (alpha-1 blocker). For prostates >40g or PSA >1.5 ng/mL, add Finasteride 5 mg PO daily (5-ARI).
Second-Line & Adjunctive Therapy
Tadalafil 5 mg PO daily if concurrent erectile dysfunction. Tolterodine 2 mg BID for overactive bladder symptoms if PVR <150 mL.
Surgical & Procedural Management
Transurethral Resection of the Prostate (TURP) for prostates <80g. Holmium Laser Enucleation (HoLEP) or simple prostatectomy for >80g.
Patient Counseling & Advice
Warn that Finasteride halves PSA values (must double when screening for cancer) and can cause decreased libido/ED. Tamsulosin can cause orthostatic hypotension.
Follow-Up & Monitoring Schedule
Yearly IPSS, DRE, PSA, and PVR check.
Preventive Strategies
Maintain healthy weight, routine physical activity.
Progressive disease; 1-2% risk per year of acute urinary retention if untreated.