Benign prostatic hyperplasia (BPH) is a common condition seen in older men.

Risk factors

• age
  • around 50% of 50-year-old men will have evidence of BPH and 30% will have symptoms
  • around 80% of 80-year-old men have evidence of BPH
• ethnicity: black > white > Asian

BPH typically presents with lower urinary tract symptoms (LUTS), which may be categorised into:

• voiding symptoms (obstructive):
  • weak or intermittent urinary flow
  • straining
  • hesitancy
  • terminal dribbling
  • incomplete emptying
• storage symptoms (irritative)
  • urgency
  • frequency
  • urgency incontinence
  • nocturia
• post-micturition
  • dribbling
• complications
  • urinary tract infection
  • retention
  • obstructive uropathy

Assessment

• dipstick urine
• U&Es: particularly if chronic retention is suspected
• PSA: should be done if there are any obstructive symptoms, of if the patient is worried about prostate cancer
• urinary frequency-volume chart
  • should be done for at least 3 days
• International Prostate Symptom Score (IPSS)
  • tool for classifying the severity of lower urinary tract symptoms (LUTS) and assessing the impact of LUTS on quality of life
  • Score 20-35: severely symptomatic
  • Score 8-19: moderately symptomatic
  • Score 0-7: mildly symptomatic

Management options

• watchful waiting
• alpha-1 antagonists e.g. tamsulosin, alfuzosin
  • decrease smooth muscle tone of the prostate and bladder
  • considered first-line: NICE recommend if moderate-to-severe voiding symptoms (IPSS ≥ 8)
  • improve symptoms in around 70% of men
  • adverse effects: dizziness, postural hypotension, dry mouth, depression