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Management of Benign Prostatic Hyperplasia.

Eric H Kim1, Jeffrey A Larson1, Gerald L Andriole1

  • 1Washington University School of Medicine, St. Louis, Missouri 63110; email: kime@wudosis.wustl.edu , larsonj@wudosis.wustl.edu , andrioleg@wudosis.wustl.edu.

Annual Review of Medicine
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PubMed
Summary

Benign prostatic hyperplasia (BPH), causing lower urinary tract symptoms (LUTS) in older men, is diagnosed through medical history, physical exam, and tests. Treatment ranges from medication to surgery for severe cases.

Keywords:
5-alpha reductase inhibitorsadrenergic alpha-antagonistslower urinary tract symptomsphosphodiesterase type 5 inhibitorstransurethral resection of prostate

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Area of Science:

  • Urology
  • Geriatrics
  • Men's Health

Background:

  • Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) are prevalent in aging men.
  • Pathogenesis may involve age-related metabolic, hormonal, and inflammatory changes.
  • Accurate diagnosis is crucial to differentiate BPH from other LUTS causes.

Purpose of the Study:

  • To outline the diagnostic approach for BPH and LUTS.
  • To review the spectrum of available medical and surgical treatment options.
  • To establish criteria for surgical intervention in BPH management.

Main Methods:

  • Comprehensive medical history and focused physical examination.
  • Digital rectal examination and urinalysis as baseline assessments.
  • Consideration of further investigations: PSA, creatinine, urine cytology, imaging, cystourethroscopy, PVR, and pressure-flow studies based on clinical presentation.

Main Results:

  • Diagnosis relies on integrating clinical findings with diagnostic tests.
  • A range of medical therapies and surgical procedures are available for BPH.
  • Surgical intervention is indicated for refractory symptoms or BPH-related complications.

Conclusions:

  • Effective management of BPH and LUTS requires a systematic diagnostic process.
  • Treatment selection should be individualized based on symptom severity and patient factors.
  • Surgery is reserved for patients with treatment failure or significant complications.