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© The Canadian Journal of Urology™; 23(Supplement 1); February 2016
BPH update: medical versus interventional
management
Udi Blankstein, MD,
1
Brandon Van Asseldonk, BASc,
2
Dean S. Elterman, MD
2
1
Department of Urology, McMaster University, Hamilton, Ontario, Canada
2
Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
BLANKSTEINU, VANASSELDONKB, ELTERMAN
DS. BPH update: medical versus interventional
management.
Can J Urol
2016;23(Suppl 1):10-15.
Benign prostatic hyperplasia (BPH) is a common
condition that afflicts a large proportion of aging men.
The primary care physician has an important role with the
identification and early treatment of bothersome urinary
symptoms caused by BPH. This includes a detailed history
and physical exam, as well as initiation of a number of
medications such as alpha-blockers, 5-alpha reductase
inhibitors and phosphodiesterase-5 inhibitors. It is also
very important for the primary care giver to determine
when additional evaluation and referral to a urologist
needs to occur, specifically when surgical intervention is
needed. This reviewwill summarize themanagement of this
common disorder and is designed to aid the generalist with
the pertinent information needed to provide excellent care.
Key Words:
BPH, benign prostatic hyperplasia
referred to as BPH-LUTS. Common LUTS can be
subdivided into storage andvoiding symptoms. Storage
LUTS includes frequency, urgencyandnocturia. Voiding
LUTS includes weak stream, hesitancy, intermittent
stream, straining and incomplete emptying. Progression
of BPH can lead to a significant reduction in quality of
life (QoL), and is associatedwithdepression and anxiety
amongst elderly men.
3
Furthermore, if left untreated,
there may be eventual development of urinary
retention, recurrent urinary tract infections (UTIs), and
hydronephrosis. Thus, as common as this condition
is, it is in fact an important issue to recognize, monitor
and treat appropriately. Moreover, as the population
ages, primary care physicians will be encounteringmen
with this problemwith increasing frequency.
4
As such,
the purpose of this article is to familiarize the general
practitioner with the work up and current recognized
treatment options available for BPH.
10
Background
Benignprostatic hyperplasia (BPH) is a commondisease
in men with incidence that increases with age. It is
estimated that 50% of men age 60 or older, and 80%
of men aged 80 or older, suffer from some form of the
disease.
1
BPH involves the growth of the prostate to
a point where the flow of urine is obstructed, causing
bladder outlet obstruction (BOO) and resulting in lower
urinary tract symptoms (LUTS). BPH can physically
obstruct the urethra in addition to causing increased
smooth muscle tone, both of which result in BOO.
2
The combination of benign prostatic hyperplasia and
resulting lower urinary tract symptoms is commonly
Address correspondence to Dr. Dean S. Elterman, Toronto
Western Hospital, Main Pavilion, 8
th
Floor, Room 317, 399
Bathurst Street, Toronto, ON M5T 2S8 Canada