Benign prostatic hyperplasia: a review

To provide a review of the natural history, evaluation and management of men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Current literature and guidelines related to BPH were reviewed.

The natural history of symptomatic BPH is variable and unpredictable. Initial symptom severity relates to the need for treatment while severity of symptoms, increased age, prostate size and decreased peak flow rate predict an increased incidence of urinary retention. Guidelines for the evaluation of men with LUTS have been developed but there is considerable variation in the extent of investigation among urologists. Complications secondary to BPH are uncommon and treatment decisions relate to improvement in quality of life. Drug therapy usually with an alpha blocker is generally the first treatment choice but for many men with minimal symptoms watchful waiting is an appropriate option. While a number of "less invasive" therapies have been extensively investigated and reported, they have not been widely adopted. Contemporary TURP has become a safer procedure with minimal hospital stay and remains, for many urologists, the interventional treatment of choice.

BPH is a disease which impacts mainly on quality of life. Patients need to consider the benefits and harms of the treatment options. Treatment will depend on the availability of these treatments and on patient and physician preference.