BPH and Male Lower Urinary Tract Symptoms

Benign prostatic hyperplasia (BPH) is a histological diagnosis indicating an increase in the cell number and size of non-cancerous stromal and glandular tissue that is common in older men. BPH contributes to lower urinary tract symptoms that can be bothersome and that potentially could result in significant bladder outlet obstruction that could require surgery or urgent bladder catheterization. Epidemiological studies have shown that clinically significant BPH is related to obesity and metabolic syndrome. The diagnostic evaluation of BPH requires a history of the onset, duration, and severity of symptoms, and a targeted physical examination. Needed testing includes a urinalysis and perhaps a measure of prostate size or post-void residual. Functional limitations and cognitive impairment have a meaningful impact on the evaluation and management of BPH. Men with moderate to severe BPH symptoms who desire treatment can be managed by behavioral, medication, or surgical treatments. The choice of specific interventions will be influenced by prostate size, but also by the degree of bother, presence of comorbidities, use of concomitant medications, and frailty.