BackTable / Urology / Topic / Condition
Benign Prostate Hyperplasia (BPH)
Benign Prostate Hyperplasia (BPH) is the benign proliferation of tissue, specifically glandular epithelial tissue, smooth muscle, and connective tissue within the transition zone of the prostate. It occurs almost ubiquitously with aging in individuals with prostates, with an occurance of 60% by age 60, and 80% by age 80.
The causes of BPH are multifactorial, and may be related to changes in sex hormone balance. Other risk factors for BPH include a family history of BPH, a family history of bladder cancer, obesity, a lack of physical activity, and diabetes.
BPH is by definition benign, and is not a risk factor for prostate cancer. BPH may lead to an enlarged prostate, which then obstructs urine flow at the level of the bladder neck, and causes lower urinary tract symptoms (LUTS), such as increased urinary frequency, urgency, and nocturia.
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Benign Prostate Hyperplasia Diagnosis
BPH is diagnosed by establishing the presence of storage voiding, and irritative symptoms in the absence of findings suggesting non-BPH LUTS causes. The diagnosis involves a thorough history, physical examination, and imaging to rule out other possible causes. The history evaluates both storage (frequency, urgency, nocturia) and voiding symptoms (weak urinary stream, hesitancy, intermittency, post-void dribbling). Presence of hematuria, incontinence, or urinary retention should prompt further urology work up. It is also important to elicit any history of neurological disease, cigarette smoking, urethral trauma, or certain medications. A digital rectal exam (DRE) should be performed as a part of the physical examination. A urinalysis should be ordered to identify pyuria, glucosuria, proteinuria, ketonuria, or bacteriuria, which may suggest alternative diagnoses. A PSA is also useful to evaluate prostate volume when considering certain treatments. A cystoscopy is not needed, unless planning surgical treatment or evaluating urethral strictures.
Differential Diagnosis: Urethral strictures, bladder neck contracture, bladder cancer, cardiovascular disease, neurologic disease, endocrine disease, polydipsia.
Benign Prostate Hyperplasia (BPH) Podcasts
Listen to leading physicians discuss benign prostate hyperplasia (bph) on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
En el primer episodio en español de BackTable Urology, yo y Dr. Francisco Gelpi discutimos los tratamientos mínimamente invasivos para HPB, específicamente Urolift, Rezum, y GreenLight. Escucha el episodio completo para aprender más sobre la transición de Dr. Gelpi desde práctica oncológica académica a práctica privada enfocada en HPB, evaluación inicial de los HPB pacientes, factores importantes en la toma de decisión de un tratamiento de HPB, y beneficios y complicaciones de cada tratamiento.
Urologist Dr. Claus Roehrborn and Interventional Radiologist Dr. Sandeep Bagla discuss the pros and cons of Prostate Artery Embolization (PAE) compared to other Minimally Invasive Surgical Treatments (MISTS) for Benign Prostate Hyperplasia (BPH). They also discuss the importance of a collaborative, multidisciplinary approach when offering these treatment options, including agreeing on the best treatment for the patient.
Urologist Dr. Francisco Gelpi discusses surgical treatments for BPH with a special focus on the minimally-invasive GreenLight Laser prostatectomy. Listen to hear more about Dr. Gelpi’s transition from an oncology-focused practice to a BPH-focused practice, initial BPH patient workup , using prostate anatomy to choose a BPH surgical treatment, GreenLight Laser postoperative care, and the importance of BPH patient involvement and expectations.
In Part II, Dr. Aditya Bagrodia talks with Dr. Claus Roehrborn of UT Southwestern Medical Center about the surgical management of benign prostatic hyperplasia (BPH).
In Part I, Dr. Aditya Bagrodia talks with Dr. Claus Roehrborn of UT Southwestern Medical Center about the medical management of benign prostatic hyperplasia (BPH).
Benign Prostate Hyperplasia Treatment
Medical treatment for BPH may include alpha-adrenergic receptor blockers, PDE5 inhibitors, 5-alpha reductase inhibitors, and in patients with overactive bladder symptoms, beta-3 adrenergic agonists and anticholinergics. In patients that fail medical therapy, surgical intervention may be indicated, especially if patient suffers from refractory urinary retention, recurrent UTIs, recurrent gross hematuria, and recurrent bladder stones.
Benign Prostate Hyperplasia (BPH) Articles
Read our exclusive BackTable Urology Articles for quick insights on benign prostate hyperplasia (bph), provided by physicians for physicians.
The HoLEP procedure, or holmium laser enucleation of the prostate, is a new BPH treatment that is widely used because of its minimal invasiveness and quicker recovery times. However, urologists should evaluate the limitations of the HoLEP procedure before they decide on the surgery.
The bipolar TURP procedure involves the use of a bipolar current to resect excess prostate tissue, alleviating symptoms in patients with benign prostate hyperplasia (BPH). Learn about Bipolar TURP procedure steps, advantages of the procedure, and complications.
The International Prostate Symptom Score (IPSS) is a universal assessment endorsed by the AUA. The IPSS questionnaire consists of 7 questions and evaluates BPH patients from a score of 0 to 35.
 Platz EA, Joshu CE, Mondul AM, et al. Incidence and progression of lower urinary tract symptoms in a large prospective cohort of United States men. J Urol 2012; 188:496.
 Marshall LM, Holton KF, Parsons JK, et al. Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men. Prostate Cancer Prostatic Dis 2014; 17:265.
 Foster HE, Barry MJ, Dahm P, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. J Urol 2018; 200:612.
 McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185:1793.
 Foster HE, Dahm P, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019. J Urol 2019; 202:592.
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