Benign prostatic hyperplasia. Part 1—Diagnosis

doi:10.1136/bmj.39421.685023.AE

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Timothy J Wilt, professor of medicine1,
James N’Dow, professor of urology2

¹Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417, USA
²Academic Urology Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD

Correspondence to: T J Wilt tim.wilt{at}med.va.gov

Summary points

Lower urinary tract symptoms are bothersome yet often under-reported by older men
Symptom severity generally progresses over time but is rarely life threatening
Many clinical and lifestyle factors can cause or worsen the symptoms but can be modified by simple interventions
Asking about how bothersome the symptoms are and how they affect the patient’s quality of life is useful for considering whether to suggest additional treatment
Benign prostatic hyperplasia does not increase risk of prostate cancer but is associated with higher levels of prostate specific antigen
These levels are associated with prostate volume and may be useful when combined with symptom and health status measures for assessing potential effectiveness of treatment options
Most men can be assessed and treated by primary care clinicians on the basis of the severity of their symptoms and how bothersome they are
Additional diagnostic evaluations include diaries, uroflowmetry, bladder pressure studies, urinary tract imaging, and urethrocystoscopy

Lower urinary tract symptoms in older men are common and bothersome, leading to considerable use of healthcare services.1 2 Symptoms may reflect obstructive voiding (weak urine flow, hesitancy, straining, and incomplete emptying) or bladder storage problems (frequency, urgency, and nocturia). Lower urinary tract symptoms are often considered to be due to benign prostatic hyperplasia (BPH) or benign prostatic enlargement. However, such symptoms are common in women, as well as in men with prostate glands that are not enlarged.3 4 The symptoms can be caused by overactivity of the bladder’s detrusor muscle, non-urological conditions, medications, or lifestyle factors. This article provides evidence to guide primary care doctors in the diagnosis of men with lower urinary tract symptoms, with an emphasis on BPH. A second article, to be published soon, will focus on management.