Feature Article

Assessing and managing benign prostatic hyperplasia

Feature Article

Assessing and managing benign prostatic hyperplasia

Petr Macek, Dinesh Patel, Phillip D Stricker AO

Abstract

The prevalence of benign prostatic hyperplasia is increasing, and, although rarely life threatening, this condition can have a significant impact on a patient’s quality of life and morbidity.

Key Points

  • The aetiology of benign prostatic hypertrophy (BPH) is not yet known, but heredity, increasing age and the presence of testosterone appear to play a part.
  • Most patients with BPH present with a mixture of lower urinary tract symptoms.
  • The most useful initial investigation for patients with BPH is an ultrasound of the urinary tract, with determination of postvoid residual bladder volume.
  • Observation is appropriate for patients with mild to moderate symptoms but no complications related to the BPH.
  • Patients with mild to moderate symptoms that significantly impact on their quality of life are candidates for medical therapy, usually with an alpha blocker or finasteride.
  • Surgical treatment is reserved for patients with more severe symptoms or who fail initial medical therapy; transurethral resection of the prostate is considered the gold standard of treatment of symptomatic BPH.