BackTable / Urology / Topic / Condition

Benign Prostate Hyperplasia (BPH)

Benign Prostate Hyperplasia (BPH) is the benign proliferation of tissue, specifically glandular epithelial tissue, smooth muscle, and connective tissue within the transition zone of the prostate. It occurs almost ubiquitously with aging in individuals with prostates, with an occurance of 60% by age 60, and 80% by age 80.

The causes of BPH are multifactorial, and may be related to changes in sex hormone balance. Other risk factors for BPH include a family history of BPH, a family history of bladder cancer, obesity, a lack of physical activity, and diabetes.

BPH is by definition benign, and is not a risk factor for prostate cancer. BPH may lead to an enlarged prostate, which then obstructs urine flow at the level of the bladder neck, and causes lower urinary tract symptoms (LUTS), such as increased urinary frequency, urgency, and nocturia.

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Ep 22 Collaborative Approach to Prostate Artery Embolization (PAE) for BPH with Dr. Claus Roehrborn and Dr. Sandeep Bagla

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Benign Prostate Hyperplasia Diagnosis

BPH is diagnosed by establishing the presence of storage voiding, and irritative symptoms in the absence of findings suggesting non-BPH LUTS causes. The diagnosis involves a thorough history, physical examination, and imaging to rule out other possible causes. The history evaluates both storage (frequency, urgency, nocturia) and voiding symptoms (weak urinary stream, hesitancy, intermittency, post-void dribbling). Presence of hematuria, incontinence, or urinary retention should prompt further urology work up. It is also important to elicit any history of neurological disease, cigarette smoking, urethral trauma, or certain medications. A digital rectal exam (DRE) should be performed as a part of the physical examination. A urinalysis should be ordered to identify pyuria, glucosuria, proteinuria, ketonuria, or bacteriuria, which may suggest alternative diagnoses. A PSA is also useful to evaluate prostate volume when considering certain treatments. A cystoscopy is not needed, unless planning surgical treatment or evaluating urethral strictures.

Differential Diagnosis: Urethral strictures, bladder neck contracture, bladder cancer, cardiovascular disease, neurologic disease, endocrine disease, polydipsia.

Benign Prostate Hyperplasia (BPH) Podcasts

Listen to leading physicians discuss benign prostate hyperplasia (bph) on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #148

Defending the Detrusor: A Clinician’s Perspective

In this episode, Dr. Wayne Kuang (MD for Men LLC in Albuquerque, NM) discusses his initiative to redefine the benign prostatic hyperplasia (BPH) care pathway for patients, doctors, and the healthcare industry.

Episode #142

Aquablation: Expanding BPH Management Options

In this episode of the Backtable Urology Podcast, Dr. Jose Silva invites Dr. Ali Kasraeian, urologic oncologist in Jacksonville, Florida, to discuss his experiences with the Aquablation technique for treating benign prostatic hyperplasia (BPH).

Episode #138

Hood-Sparing & Greenlight Laser Therapy in BPH Management

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Bilal Chughtai discuss their workup for benign prostate hyperplasia (BPH) and how they use GreenLight Laser therapy and pharmacologic interventions to treat this common condition.

Episode #101

Treating BPH with Rezum

This week on the BackTable Urology Podcast, Dr. Jose Silva invites Dr. Seth Bechis onto the show to discuss the diagnosis and treatment of BPH with Rezum, a minimally invasive surgical that uses water vapor to dissolve prostate tissue.

Episode #edición-esp-01

Tratamientos Mínimamente Invasivos para HPB

En el primer episodio en español de BackTable Urology, yo y Dr. Francisco Gelpi discutimos los tratamientos mínimamente invasivos para HPB, específicamente Urolift, Rezum, y GreenLight. Escucha el episodio completo para aprender más sobre la transición de Dr. Gelpi desde práctica oncológica académica a práctica privada enfocada en HPB, evaluación inicial de los HPB pacientes, factores importantes en la toma de decisión de un tratamiento de HPB, y beneficios y complicaciones de cada tratamiento.

Episode #22

Collaborative Approach to Prostate Artery Embolization (PAE) for BPH

Urologist Dr. Claus Roehrborn and Interventional Radiologist Dr. Sandeep Bagla discuss the pros and cons of Prostate Artery Embolization (PAE) compared to other Minimally Invasive Surgical Treatments (MISTS) for Benign Prostate Hyperplasia (BPH). They also discuss the importance of a collaborative, multidisciplinary approach when offering these treatment options, including agreeing on the best treatment for the patient.

Episode #14

Patient Selection for GreenLight & Other BPH Treatments

Urologist Dr. Francisco Gelpi discusses surgical treatments for BPH with a special focus on the minimally-invasive GreenLight Laser prostatectomy. Listen to hear more about Dr. Gelpi’s transition from an oncology-focused practice to a BPH-focused practice, initial BPH patient workup , using prostate anatomy to choose a BPH surgical treatment, GreenLight Laser postoperative care, and the importance of BPH patient involvement and expectations.

Episode #6

Contemporary Surgical Management of BPH

In Part II, Dr. Aditya Bagrodia talks with Dr. Claus Roehrborn of UT Southwestern Medical Center about the surgical management of benign prostatic hyperplasia (BPH).

Episode #5

Contemporary Medical Management of BPH

In Part I, Dr. Aditya Bagrodia talks with Dr. Claus Roehrborn of UT Southwestern Medical Center about the medical management of benign prostatic hyperplasia (BPH).

Benign Prostate Hyperplasia Treatment

Medical treatment for BPH may include alpha-adrenergic receptor blockers, PDE5 inhibitors, 5-alpha reductase inhibitors, and in patients with overactive bladder symptoms, beta-3 adrenergic agonists and anticholinergics. In patients that fail medical therapy, surgical intervention may be indicated, especially if patient suffers from refractory urinary retention, recurrent UTIs, recurrent gross hematuria, and recurrent bladder stones.

Benign Prostate Hyperplasia (BPH) Articles

Read our exclusive BackTable Urology Articles for quick insights on benign prostate hyperplasia (bph), provided by physicians for physicians.

Aquablation Essentials: Patient Candidacy & Procedure Protocols

Aquablation is a relatively new benign prostatic hyperplasia (BPH) treatment that is growing in popularity. Offering a unique mechanism of action for prostate treatment, aquablation is a minimally invasive, ultrasound-guided procedure that uses high-pressure water jet technology to remove prostate tissue.

Aquablation of the Prostate: A Practical Procedure Guide

Aquablation is an emerging treatment for patients with BPH (benign prostatic hyperplasia). Dr. Ali Kasraeian, a pioneer in the development of aquablation, provides a step-by-step surgical guide with Dr. Jose Silva on how to successfully carry out the aquablation procedure.

Rezum Post-Procedure: Symptoms, Recovery, & Medications

Rezum post-procedure practices consist of catheterization, antibiotics such as Bactrim and Celebrex, anti-inflammatory drugs including steroids, and patient counseling. Learn more about Rezum recovery timelines.

Rezum Prostate Procedure Technique: ‘Less is More’

The Rezum procedure uses steam that is injected into the prostate to relieve benign prostate hyperplasia (BPH) symptoms. Urologist Dr. Seth Bechis describes his experience with Rezum treatment techniques.

Rezum Treatment for BPH: Who Is The Ideal Patient?

When is Rezum treatment appropriate, where does it sit within the BPH treatment algorithm, and who is the ideal candidate? To answer these questions, Urologist Dr. Seth Bechis describes his approach to Rezum workup, including his process of initial treatment for BPH, and identifying ideal Rezum patients.

Bipolar TURP Procedure Advantages & Complications

The bipolar TURP procedure involves the use of a bipolar current to resect excess prostate tissue, alleviating symptoms in patients with benign prostate hyperplasia (BPH). Learn about Bipolar TURP surgery, advantages of bipolar TURP, and potential complications.

UroLift Pros and Cons

Learn about the UroLift procedure pros and cons. It is a minimally invasive, non-ablative BPH treatment that places permanent implants to pull the prostate lobes away from the urethra.

HoLEP Procedure Pros & Cons

The HoLEP procedure, or holmium laser enucleation of the prostate, is a new BPH treatment that is widely used because of its minimal invasiveness and quicker recovery times. However, urologists should evaluate the HoLEP procedure pros and cons before they decide on the surgery.

Using 5-Alpha Reductase Inhibitors for BPH

5-alpha reductase inhibitors are a class of medications commonly used to treat BPH. They are most effective in BPH patients with large prostates. Learn more about using 5-alpha reductase inhibitors for BPH.

Using the IPSS to Evaluate BPH Symptoms

The International Prostate Symptom Score (IPSS) is a universal assessment endorsed by the AUA. The IPSS questionnaire consists of 7 questions and evaluates BPH patients from a score of 0 to 35.

Benign Prostate Hyperplasia (BPH) Tools

Check out benign prostate hyperplasia (bph) apps, calculators, and decision aids to assist you in your day to day practice.

Prostate Volume Calculator

BackTable's prostate volume calculator is an essential tool for doctors and patients alike. Accurate, fast, and easy-to-use. Try it today!

Ellipsoid Volume Calculator

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References

[1] Platz EA, Joshu CE, Mondul AM, et al. Incidence and progression of lower urinary tract symptoms in a large prospective cohort of United States men. J Urol 2012; 188:496.
[2] Marshall LM, Holton KF, Parsons JK, et al. Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men. Prostate Cancer Prostatic Dis 2014; 17:265.
[3] Foster HE, Barry MJ, Dahm P, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. J Urol 2018; 200:612.
[4] McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185:1793.
[5] Foster HE, Dahm P, Kohler TS, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019. J Urol 2019; 202:592.

Disclaimer: The Materials available on https://www.BackTable.com/ are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.