Benign prostatic hyperplasia

doi:10.1136/bmj.323.7320.1042

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Michael J Barry, associate professor of medicine (mbarry@partners.org)a,
Claus G Roehrborn, associate professorb

^a General Medicine Unit, Medical Practices Evaluation Center, Massachusetts General Hospital, Boston, MA 02114-2698, USA
^b Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX 75235-9031, USA

Correspondence to:

Background

Definition Benign prostatic hyperplasia (BPH) is defined histologically. Clinically, it is characterised by lower urinary tract symptoms (urinary frequency, urgency, a weak and intermittent stream, needing to strain, a sense of incomplete emptying, and nocturia), and can lead to complications, including acute urinary retention.

Interventions

Beneficial:

α Blockers

5α Reductase inhibitors

Transurethral resection (TURP)

Transurethral microwave thermotherapy (TUMT)

Transurethral needle ablation (TUNA)

Likely to be beneficial:

Saw palmetto plant extracts

β Sitosterol plant extracts

Rye grass pollen extract

Unknown effectiveness:

TURP versus less invasive surgical techniques

Incidence/prevalence Estimates of the prevalence of symptomatic BPH range from 10-30% for men in their early 70s, depending on how BPH is defined.1

Aetiology/risk factors The mechanisms by which BPH causes symptoms and complications are unclear, although obstruction of the bladder outlet is an important factor.2 The best documented risk factors are increasing age and functioning testes.3

Prognosis Community and practice based studies suggest that men with lower urinary tract symptoms can expect slow progression of the symptoms. 4 5 However, symptoms can wax and wane without treatment. In men with symptoms of BPH, rates of acute urinary retention range from 1-2% a year.5–7

Aims To reduce or alleviate lower urinary tract symptoms; to prevent complications; and to minimise adverse effects of treatment.

Outcomes Burden of lower urinary tract symptoms; rates of acute urinary retention and prostatectomy; rates of adverse effects of treatment. Symptoms are measured using the validated international prostate symptom score, which includes seven questions quantifying symptoms on an overall scale from 0-35, with higher scores representing more frequent symptoms

Methods

Clinical Evidence update search and appraisal August 2000. This review is currently being updated and will be available on the Clinical Evidence website in December 2001.

Question What are the effects of medical treatments?

Option α Blockers

Summary Two systematic reviews have found that …