Benign prostatic hyperplasia

Histological evidence of benign prostatic hyperplasia (BPH) develops in most Western men with increasing age, due to a complex interplay of hormonal and dietary influences. Urinary symptoms, in association with prostatic enlargement, affect 25% of the male population, increasing to 43% of the male population aged > 60 years. About 50% of symptomatic men have measurable BPH/enlargement. Dietary, hormonal, cardiac, renal and habitual factors contribute to urinary symptoms in both sexes, particularly as they age. A focused history and examination, simple tests (prostate-specific antigen, creatinine) and assessment of voiding function (flow rate, ultrasound) help make the diagnosis. Many can be stratified according to the severity of their symptoms by scoring systems. Lifestyle advice can lessen mild symptoms, medical therapy is most appropriate for mild or moderate symptoms and may help severe symptoms. Severely symptomatic or obstructed men do best with a surgical or high energy technique chosen according to prostate size. Pressure-flow studies can improve the accuracy of diagnosis and the selection of candidates for surgery. Outcomes for obstructed or moderate to severely symptomatic men are good. 5-alpha reductase inhibitor therapy offers the opportunity to prevent the development of further BPH instead of, or after, surgical treatment.