Benign prostatic hyperplasia

Last reviewed: 6 Sep 2022
Last updated: 27 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • storage symptoms
  • voiding symptoms
More key diagnostic factors

Other diagnostic factors

  • fever with dysuria
  • urinary retention
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • urinalysis
  • prostate-specific antigen (PSA)
  • International Prostate Symptom Score
  • volume charting
More 1st investigations to order

Investigations to consider

  • ultrasound
  • CT abdomen/pelvis
  • MRI abdomen/pelvis
  • cystoscopy
  • uroflowmetry
  • urodynamic study
More investigations to consider

Treatment algorithm

ACUTE

non-bothersome symptoms

bothersome symptoms with no indications for surgery

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

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

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

Contributors

Authors

Claus Roehrborn, MD

Professor

Urology

University of Texas Southwestern Medical Center

Dallas

TX

Disclosures

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

TX

Disclosures

RG declares that he has no competing interests.

Acknowledgements

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.

Disclosures

EA declares that she has no competing interests.

Peer reviewers

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

UK

Disclosures

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

UK

Disclosures

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

FL

Disclosures

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.

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