Clinical Review Extracts from “Clinical Evidence”

Benign prostatic hyperplasia

BMJ 2001; 323 doi: (Published 03 November 2001) Cite this as: BMJ 2001;323:1042
  1. Michael J Barry, associate professor of medicine (,
  2. Claus G Roehrborn, associate professorb
  1. a General Medicine Unit, Medical Practices Evaluation Center, Massachusetts General Hospital, Boston, MA 02114-2698, USA
  2. b Department of Urology, University of Texas, Southwestern Medical Center, Dallas, TX 75235-9031, USA
  1. Correspondence to:


    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.



    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.57

    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


    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 …

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