Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) commonly affect older men. Age-related changes associated with metabolic disturbances, changes in hormone balance, and chronic inflammation may cause of BPH development.
The diagnosis of BPH hinges on a thorough medical history and focused physical examination, with attention to other conditions that may be causing LUTS. Digital rectal examination and urinalysis should be performed. Other testing may be considered depending on presentation of symptoms, including prostate-specific antigen, serum creatinine, urine cytology, imaging, cystourethroscopy, post-void residual, and pressure-flow studies. Many medical and surgical treatment options exist. Surgery should be reserved for patients who either have failed medical management or have complications from BPH, such as recurrent urinary tract infections, refractory urinary retention, bladder stones, or renal insufficiency as a result of obstructive uropathy. Expected final online publication date for the Annual Review of Medicine Volume 67 is January 14, 2016. Please see http://www. annualreviews. org/catalog/pubdates. aspx for revised estimates.
Annual review of medicine. 2015 Sep 02 [Epub ahead of print]
Eric H Kim, Jeffrey A Larson, Gerald L Andriole
Washington University School of Medicine, St. Louis, MO