1Attending Urologic Surgeon, Toronto Western Hospital, University Health Network, Assistant Professor, Division of Urology, Department of Surgery, University of Toronto, Toronto, ON. 2Department of Urology, McMaster University, Hamilton, ON.
Abstract: Benign prostatic hyperplasia (BPH) affects the aging male. Treatment options vary widely. Some men will elect to conservatively monitor their symptoms and make alterations to their lifestyle choices. Pharmacotherapy options exist as well, and include alpha-blockers, 5-alpha reductase inhibitors and phosphodiesterase-5 inhibitors. Lastly, surgical options are also a viable treatment option, with many types at the disposal of the caregiver. Technological advancements have changed, and will continue to change the field in the near future. This review outlines the important aspects of this common affliction.
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There is a spectrum of bother ranging from mild nuisance to significant decrease in quality of life – this is largely associated with how the patient perceives the problem.
Physical exam and medical history are imperative in the initial assessment of BPH.
Conservative measures and lifestyle changes should be the first line treatment choice.
Surgical intervention should be attempted after failure of medical therapy to alleviate symptoms and prevent kidney injury or infection.
Ensure that there are no other causes that may cause LUTS such as various medications, and other comorbidities.
When considering more invasive intervention, ensure that the surgical team knows the patient's anticoagulation status.
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Life After Age 85 will Likely Include Benign Prostatic Hyperplasia
Teaser:
Joyce So, BSc
Benign prostatic hyperplasia (BPH) is a non-malignant condition of nodular but symmetrical enlargement of the prostate in the peri-urethral region, likely due to androgen imbalances associated with aging. It is common in men over the age of 40, regardless of ethnic background. The incidence of BPH can be as high as 50% by the age of 60, and 90% by age 85.1 This makes BPH a condition of increasing importance as the population ages.
Because of its proximity to the urogenital tract, prostatic enlargement most commonly presents as obstructive lower urinary tract symptoms, although some are asymptomatic (see Figure 1). Bladder outlet obstruction, causing incomplete emptying and subsequent rapid filling, results in urgency, frequency, and nocturia as the primary presenting complaints. The weak and reduced urinary stream in BPH produces hesitancy, intermittency and post-void dribbling. Urinary retention and stasis predispose BPH patients to infection, which can cause bladder and upper urinary tract inflammation, as well as calculus formation. In severe, prolonged obstruction, there is a risk of hydronephrosis and progressive renal failure and azotemia.
Figure 1. Location of the prostate gland in relations to the urogenital tract
