Benign prostatic hyperplasia (BPH)
Benign prostatic hyperplasia is age-related epithelial and stromal growth of the prostate transition zone causing bladder outlet obstruction and lower urinary tract symptoms in older men. Diagnosis rests on history, the AUA/IPSS symptom score, and a symmetrically enlarged, smooth prostate on digital rectal exam; management is staged from observation to alpha-1-blockers, 5-alpha-reductase inhibitors, and surgery.
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What this article covers
- Overview
Age-related bladder outlet obstruction from prostate growth: benign prostatic hyperplasia (BPH) is urinary outflow resistance from epithelial and stromal cell growth in the prostate transition zone, which surrounds the urethra.
- Epidemiology
Age is the dominant driver: LUTS are most likely caused by BPH in men older than 50 and most likely caused by another condition in men younger than 40, since prostate size increases with age.
- Risk factors
Advancing age: the single strongest risk factor; LUTS attributable to BPH are rare before age 40 and increasingly likely each subsequent decade.
- Pathophysiology
Hyperplasia of the transition zone: BPH arises from epithelial and stromal cell proliferation in the periurethral transition zone, the zone that directly surrounds the urethra, in contrast to…
- Clinical features
Voiding (obstructive) symptoms: weak or slow stream, splitting/spraying, intermittency, hesitancy, straining, and terminal dribbling; these reflect mechanical obstruction and are usually earliest.
- Differential diagnosis
Prostate cancer (adenocarcinoma): asymmetric, nodular, indurated prostate on DRE (versus smooth, symmetric BPH); usually peripheral-zone and less likely to obstruct early; evaluated with…
- Diagnosis
BPH is established clinically by history, the AUA/IPSS symptom score, and a symmetrically enlarged, firm, nontender prostate on DRE; there is no single confirmatory test.
- Management
First, stratify by symptom severity and bother using the AUA/IPSS.
- Complications
Acute urinary retention: sudden inability to void requiring emergency catheter decompression, with risk higher at higher symptom scores and with precipitating sympathomimetics, anticholinergics, or alcohol.
- Prognosis
Chronic and progressive untreated: declining flow rates and rising retention risk over years.
- Prevention
No proven primary prevention exists for BPH itself; prevention instead targets progression and complications once LUTS are present.
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