Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) refers to the nonmalignant growth or hyperplasia of prostate tissue and is a common cause of lower urinary tract symptoms in men. Disease prevalence has been shown to increase with advancing age. Indeed the histological prevalence of BPH at autopsy is as high as 50% to 60% for males in their 60's, increasing to 80% to 90% of those over 70 years of age. Several definitions exist in the literature when describing BPH. These include bladder outlet obstruction (BOO), lower urinary tract symptoms (LUTS), and benign prostatic enlargement (BPE). BPH describes the histological changes, benign prostatic enlargement (BPE) describes the increased size of the gland (usually secondary to BPH) and bladder outlet obstruction (BOO) describes the obstruction to flow. Those with BPE who present with BOO are termed benign prostatic obstruction. Lower urinary tract symptoms (LUTS) simply describe urinary symptoms shared by disorders affecting the bladder and prostate (when in reference to men). LUTS can be subdivided into storage and voiding symptoms. These terms have largely replaced those historically termed "prostatism." The development of benign prostatic hyperplasia is characterized by stromal and epithelial cell proliferation in the prostate transition zone (surrounding the urethra), this leads to compression of the urethra and development of bladder outflow obstruction (BOO) which can result in clinical manifestations of lower urinary tract symptoms (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 emergency) and long-term changes to the bladder detrusor (both overactivity and reduced contractility). Treatment options for BPH range from watchful waiting, to medical and surgical intervention. Risk factors may be divided into non-modifiable and modifiable, with factors such as age, genetics, geographical location, and obesity, all shown to influence the development of BPH. It is, therefore, important to be able to identify those at risk of disease progression and those who can be managed more conservatively to reduce associated morbidity and health care burden. This review provides an overview of the etiology, pathophysiology, recognition, and management of benign prostatic hyperplasia as well as interprofessional aspects that may enhance patient care.