The Definition of Benign Prostatic Hyperplasia

Abstract

Benign prostatic hyperplasia (BPH) is the most common neoplasm in men and is a significant cause of urinary symptoms in the aging male (1). Although much is unknown about the pathophysiology of BPH, the condition results in a diminished quality of life for many patients. The symptoms of BPH can be broadly divided into obstructive and irritative components. The former symptoms include a weakened urinary stream, hesitancy, and the need to push or strain to initiate micturition. Irritative symptoms can be much more bothersome for many men and include frequency, nocturia, and urgency (2). When assessing the importance and magnitude of BPH, one must consider several factors. First, the typical symptoms of BPH are nonspecific (3). There are many other potential causes of urinary symptoms in aging men, including diabetes mellitus, Parkinson’ s disease, and stroke, which can lead to the same urinary problems seen in men with prostatic enlargement. Second, unlike most other common, chronic medical disorders such as diabetes, hypertension, or hypercholesterolemia, there is no standardized medical test or measurement that can be used to quantify the problem or assess the response to treatment for men with BPH. Rather than lowering blood pressure or maintaining blood glucose levels in the desired range, the primary goal in the management of BPH for most patients is a subjective improvement in urinary symptoms and quality of life. Although objective measurements such as urinary flow rate and postvoid residual urine volume can be used to evaluate BPH, the reproducibility and correlation of these measures with urinary symptoms is often limited (4,5). Finally, much is unknown about the natural history of BPH, and this may dramatically impact our understanding of the magnitude and prevalence of the problem (6).