J Korean Med Assoc.  2007 Jul;50(7):626-636. 10.5124/jkma.2007.50.7.626.

Benign Prostatic Hyperplasia

• Kim CS

• KMID: 2184873
• DOI: http://doi.org/10.5124/jkma.2007.50.7.626

Abstract

Benign prostatic hyperplasia (BPH), a pathological terminology that means benign proliferation of prostatic tissue, is commonly used as a clinical terminology indicating low urinary tract symptoms (LUTS) resulting from prostate enlargement. It mainly arises from the transition zone of the prostate by stimulation of dihydrotestosterone (DHT), and its incidence is about 21~28% in men with age over fifty. LUTS related to BPH consist of frequency, residual urine sense, nocturia, interruption, urgency, weak stream, and hesitancy. The International Prostate Symptom Score (IPSS) is currently being used for the evaluation of the patient in the clinical setting. The size of the prostate (>30 g), an elevated serum prostate-specific antigen level (PSA: >1.5ng/mL), high IPSS ( 20), and a large amount of post-void residual urine (>100ml) are considered as risk factors of BPH aggravation. Physical examination including digital rectal examination, urinalysis, serum PSA, and uroflowmetry with residual urine measurement are performed as basic test items for BPH. Standard initial treatment of BPH is medical therapy: mainly alpha adrenergic blockers and 5-alpha reductase inhibitors, and optionally anticholinergics, desmopressin, and phytotherapy. The standard surgical treatment of BPH nowadays is transurethral resection of prostate (TURP) but open prostatectomy or minimally invasive treatment such as transurethral incision of prostate (TUI), thermal therapy, and photoselective vaporization of prostate (PVP) can be applied in selected cases.

Keyword

Benign prostatic hyperplasia; Low urinary tract symptoms; Alpha-adrenergic blockers; Transurethral resection of prostate

MeSH Terms

5-alpha Reductase Inhibitors
Adrenergic alpha-Antagonists
Cholinergic Antagonists
Deamino Arginine Vasopressin
Digital Rectal Examination
Dihydrotestosterone
Humans
Incidence
Male
Nocturia
Physical Examination
Phytotherapy
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Hyperplasia*
Risk Factors
Rivers
Transurethral Resection of Prostate
Urinalysis
Urinary Tract
Volatilization
5-alpha Reductase Inhibitors
Adrenergic alpha-Antagonists
Cholinergic Antagonists
Deamino Arginine Vasopressin
Dihydrotestosterone
Prostate-Specific Antigen

Reference

1. Stolzenburg J, Schwalenberg T, Horn L, Neuhaus J, Constantinides C, Liatsikos E. Anatomical Landmarks of Radical Prostatecomy. Eur Urol. 2003. 21:629–639.

2. Baisch H, Otto U, Fack H. Growth of human prostate carcinomas with and without hormone alpha-dehydrotestosterone. Eur Urol. 1998. 34:505–511.

3. Roehborn CG, McConneli JD. Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history. Campbell-Walsh urology. 2007. 9th ed. China: Elsevier Inc;2727–2765.

4. Gerber GS, Brendler CB. Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Evaluation of the urologic patient: History, physical examination, and urinalysis. Campbell-Walsh urology. 2007. 9th ed. China: Elsevier Inc;81–110.

5. O'Leary M. The importance of standardisation and validation of symptom scores and quality of life: the urologist's point of view. Eur Urol. 1997. 32:S2. 48–49.

6. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA. Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003. 349:2387–2398.

7. Ranjan P, Dalela D, Sankhwar S. Diet and benign prostatic hyperplasia: Implications for prevention. Urology. 2006. 68:470–476.

8. Kirby R, Lepor H. Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Evaluation and nonsurgical management of benign prostatic hyperplasia. Campbell-Walsh urology. 2007. 9th ed. China: Elsevier Inc;2766–2802.

9. Gretzer MB, Partin AW. Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Prostate cancer tumor markers. Campbell-Walsh urolog. 2007. 9th ed. China: Elsevier Inc;2896–2911.

10. Pannek J, Brands FH. Additional aids in detection of prostate carcinomas? PSA-prostatic volume quotient, PSA-doubling time, age-dependent PSA reference values and PSA in urine. Urologe A. 2000. 39:324–329.

11. Lee T. Kim JC, Kim HJ, Park CH, Oh SJ, Lee KS, Lee JZ, Chung BS, Choo MS, editors. Urodynamic study. Textbook of voiding dysfunction and female urology. 2003. 1st ed. Korea: Ilchokak;136–156.

12. Kirby RS, Coppinger SWC, Corcoran MO, Chapple CR, Flanniqan M, Milrov EJ. Prazosin in the treatment of prostatic obstruction: A placebo-controlled study. Br J Urol. 1987. 60:136–142.

13. Kirby RS, O'Leary MP, Carson C. Efficacy of extended-release doxazosin and doxazosin standard in patients with concomitant benign prostatic hyperplasia and sexual dysfunction. BJU Int. 2005. 95:103–109.

14. Wilt TJ, MacDonald R, Nelson D. Tamsulosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: A systematic review of efficacy and adverse effects. J Urol. 2002. 167:177–183.

15. Lukacs B, Grange JC, Comet D, McCarthy C. History of 7,093 patients with lower urinary tract symptoms related to benign prostatic hyperplasia treated with alfuzosin in general practice up to 3 years. Eur Urol. 2000. 37:183–190.

16. Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G. ARIA3001 ARIA3002 and ARIA3003 Study Investigators. Efficacy and safety of a dual inhibitor of 5 alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology. 2002. 60:434–441.

17. Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia (BPH). UCNA. 2002. 29:23–30.

18. Fitzpatrick JM; Minimally invasive and endoscopic management of benign prostatic hyperplasia, Kirby R, Lepor H. Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Evaluation and nonsurgical management of benign prostatic hyperplasia. Campbell-Walsh urology. 2007. 9th ed. China: Elsevier Inc;2803–2844.