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Hiperplasia prostática benigna

Last reviewed: 16 Aug 2025
Last updated: 06 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • sintomas de armazenamento
  • sintomas de micção
Full details

Other diagnostic factors

  • febre com disúria
  • retenção urinária
Full details

Risk factors

  • idade superior a 50 anos
  • história familiar de HPB
  • raça não asiática
  • tabagismo
  • alopécia androgênica
  • síndrome metabólica
Full details

Diagnostic investigations

1st investigations to order

  • urinálise
  • antígeno prostático específico (PSA)
  • questionário de escore de sintomas
  • quadro de frequência/volume e diário de micção
Full details

Investigations to consider

  • ultrassonografia
  • TC ou RNM do abdome/pelve
  • cistoscopia
  • Avaliação do resíduo pós-miccional (RPM)
  • urofluxometria
  • estudos urodinâmicos de pressão de fluxo
  • avaliação da função renal
Full details

Treatment algorithm

ACUTE

sintomas não incômodos

sintomas incômodos sem indicação de cirurgia

sintomas incômodos com indicação de cirurgia: volume da próstata ≤30 g

sintomas incômodos com indicação de cirurgia: volume da próstata 30-80 g

sintomas incômodos com indicação de cirurgia: volume da próstata ≤80 g

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.

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.

References

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.

Key articles

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.Full text  Abstract

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

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.Full text  Abstract

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.Full text  Abstract

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. Abstract

Reference articles

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

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