Summary

• Multi-factorial involving smooth muscle hyperplasia, prostatic enlargement, and bladder dysfunction, as well as input from the CNS.
• Presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).
• Physical examination may demonstrate prostate volume ≥30 g, nodules or tenderness suspicious of prostate cancer or prostatitis.
• Evaluation includes history and examination including an abdominal exam for a palpable bladder, a digital rectal exam, and a neurological assessment.
• Urinalysis, PSA level, and International Prostate Symptom Score (IPSS) are first-line tests of powerful diagnostic impact in the appropriate patient groups. Given the debate regarding the morbidity and mortality reduction of prostate cancer with PSA testing, the implications of such testing should be discussed with the patient prior to testing.
• If symptoms or disease severity warrant, therapy can be initiated with an alpha-blocker and 5-alpha-reductase inhibitors.
• Common complications are disease progression and urinary retention, which may require invasive therapy.