Benign prostatic hyperplasia

Обзор 
Теория 
Диагноз 
Лечение 
Последующее наблюдение 
Источники 

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Последний просмотренный: 14 Aug 2025

Last updated: 03 Oct 2024

Benign prostatic hyperplasia (BPH) presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).

Physical examination may demonstrate prostate size/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 neurologic assessment.

Urinalysis, prostate-specific antigen (PSA) level, and International Prostate Symptom Score 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, discuss the implications with the patient before testing.

Use shared decision-making based on understanding the patient’s desires and risks associated with specific therapies to guide treatment strategies.

If symptoms or disease severity warrant, initiate therapy with an alpha-blocker, 5-alpha-reductase inhibitor, combination therapy, or other agents depending on symptom profile.

Common complications are disease progression and urinary retention, which may require invasive therapy.

Failure or intolerance of medical management or renal complications are indications for surgical intervention. There are a host of procedural treatments, which have unique risk/benefit profiles for consideration.

Определение

Lower urinary tract symptoms (LUTS) caused by bladder outlet obstruction due to BPH, also known as benign prostatic enlargement, are predominantly due to 2 components: a static component related to an increase in benign prostatic tissue narrowing the urethral lumen and a dynamic component related to an increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors. Symptoms related to bladder outlet obstruction may also be contributed by bladder overactivity. LUTS are further defined as storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).[1]

Анамнез и осмотр

Ключевые диагностические факторы

storage symptoms
voiding symptoms

Полная информация

Другие диагностические факторы

fever with dysuria
urinary retention

Полная информация

Факторы риска

age over 50 years
family history of BPH
non-Asian race
cigarette smoking
male pattern baldness
metabolic syndrome

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

urinalysis
prostate-specific antigen (PSA)
symptom score questionnaire
frequency/volume chart and voiding diary

Полная информация

Исследования, проведение которых нужно рассмотреть

ultrasound
CT or MRI abdomen/pelvis
cystoscopy
Postvoid residual (PVR) assessment
uroflowmetry
pressure flow urodynamic studies
assessment of renal function

Полная информация

Алгоритм лечения

Острый

non-bothersome symptoms

bothersome symptoms with no indications for surgery

bothersome symptoms with indication for surgery: prostate volume ≤30 g

bothersome symptoms with indication for surgery: prostate volume 30-80 g

bothersome symptoms with indication for surgery: prostate volume ≥80 g

Составители

Авторы

Claus Roehrborn, MD

Professor

Urology

University of Texas Southwestern Medical Center

Dallas

Раскрытие информации

CR is on an ad board for Teleflex; consults for Teleflex, Zenflow, and Medeon; and has done research with Zenflow and Teleflex. CR is an author of several references cited in this topic.

Ramy Goueli, MD

Assistant Professor

Urology

University of Texas Southwestern Medical Center

Dallas

利益声明

RG declares that he has no competing interests.

鸣谢

Professor Claus Roehrborn and Dr Ramy Goueli would like to gratefully acknowledge Professor Michael T. Flannery and Dr Erika Abel, the previous contributors to this topic. Regretfully, Professor Flannery died in December 2020.

利益声明

EA declares that she has no competing interests.

同行评议者

Christopher R. Chapple, BSc, MD, FRCS (Urol), FEBU

Consultant Urological Surgeon

Royal Hallamshire Hospital

Honorary Senior Lecturer of Urology

University of Sheffield

Newcastle University

Visiting Professor of Urology

Sheffield Hallam University

Adjunct Secretary responsible for Education

European Association of Urology

Sheffield

利益声明

CRC is Chairman of NICE Male LUTS Guidelines Development Group.

Robert Pickard, MD, FRCS (Urol)

Professor of Urology

Institute of Cellular Medicine

Newcastle University

Newcastle upon Tyne

利益声明

RP has received funding from the UK NHS (NIHR) to undertake commissioned reviews of treatment for benign prostatic enlargement.

Steven K. Brooks, MD

Chief

Department of Surgery

South Seminole Hospital

Longwood

利益声明

SKB is a member of the National Speakers Bureau for Boehringer Ingelheim, Astellas Pharmaceuticals, and Glaxo Pharmaceuticals and has served as a consultant for these companies.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. J Urol. 2024 Jan;211(1):11-9.全文摘要

European Association of Urology. Management of non-neurogenic male LUTS. 2024 [internet publication].全文

Elterman D, Aubé-Peterkin M, Evans H, et al. Update - Canadian Urological Association guideline: male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J. 2022 Aug;16(8):245-56.全文摘要

Expert Panel on Urological Imaging; Alexander LF, Oto A, Allen BC, et al. ACR Appropriateness Criteria® lower urinary tract symptoms - suspicion of benign prostatic hyperplasia. J Am Coll Radiol. 2019 Nov;16(11s):S378-83.全文摘要

McConnell JD, Roehrborn CG, Bautista O, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003 Dec 18;349(25):2387-98. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Overactive bladder
- Acute prostatitis
- Chronic prostatitis
更多鉴别诊断
指南
- Management of non-neurogenic male LUTS
- Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia
更多指南
患者教育信息
Enlarged prostate: what is it?
Enlarged prostate: what treatments are there?
更多患者教育信息
医学计算器
International Prostatism Symptom Score (IPSS)
更多医学计算器
Videos
Male urethral catheterization: animated demonstration
更多操作视频
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Benign prostatic hyperplasia

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

non-bothersome symptoms

bothersome symptoms with no indications for surgery

bothersome symptoms with indication for surgery: prostate volume ≤30 g

bothersome symptoms with indication for surgery: prostate volume 30-80 g

bothersome symptoms with indication for surgery: prostate volume ≥80 g

Составители

Авторы

Claus Roehrborn, MD

Раскрытие информации

Ramy Goueli, MD

利益声明

鸣谢

利益声明

同行评议者

Christopher R. Chapple, BSc, MD, FRCS (Urol), FEBU

利益声明

Robert Pickard, MD, FRCS (Urol)

利益声明

Steven K. Brooks, MD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

患者教育信息

医学计算器

Videos

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

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