Intended for healthcare professionals

Clinical Review

Benign prostatic hyperplasia. Part 1—Diagnosis

BMJ 2008; 336 doi: (Published 17 January 2008) Cite this as: BMJ 2008;336:146
  1. Timothy J Wilt, professor of medicine1,
  2. James N’Dow, professor of urology2
  1. 1Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417, USA
  2. 2Academic Urology Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD
  1. Correspondence to: T J Wilt tim.wilt{at}

    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.

    What causes lower urinary tract symptoms due to BPH?

    The pathophysiology of benign prostatic enlargement involves hyperplasia of the epithelial and stromal components of …

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