Benign Prostatic

Hypertrophy:
Comprehensive
Management Guide
Benign Prostatic Hypertrophy (BPH) is a common condition affecting
aging men. This guide covers the pathophysiology, diagnosis,
pharmacological and surgical options, and long-term management of this
condition. Follow evidence-based practices for optimal patient care.

by Thanakorn Wongsombut
Pathophysiology of BPH
DHT Metabolism
BPH is linked to the accumulation of DHT, a
testosterone byproduct. This leads to prostatic
cell proliferation, glandular enlargement, and
urethral compression, leading to lower urinary
symptoms and obstruction.
Stromal-Epithelial Composition
Cellular Growth
Growth factors like IGF-1 and EGF, acting on
prostate stromal-epithelial cells, promote cellular
growth that leads to glandular enlargement and
urinary symptoms.
Clinical Assessment and Diagnosis
LUTS Assessment Digital Rectal Examination

Use standardized questionnaires like IPSS to Comprehensive DRE should evaluate prostate
assess lower urinary tract symptoms (LUTS) size, consistency, and identify any nodules or
in patients with BPH. asymmetries in the gland.

PSA Reference Ranges Diagnostic Algorithms

PSA levels should be interpreted considering Guidelines like AUA or EAU offer diagnostic
age-specific values, as well as symptom algorithms that help in decision-making,
severity, prostate size, and other clinical factoring in serum PSA levels, prostate
factors. volume, and symptom severity.
Imaging Modalities

1 TRUS

Transrectal ultrasound (TRUS) measures prostate volume and identifies the transitional
zones, which are associated with BPH.

2 Uroflowmetry and PVR Measurements

Uroflowmetry and post-void residual (PVR) measurements help quantify urinary flow rates
and residual urine volumes, respectively.

3 RSNA Guidelines

Follow the Radiological Society of North America (RSNA) guidelines for standardized
interpretation of imaging findings in patients with BPH.
Medical Management
1 Alpha-Blockers
Tamsulosin (0.4
mg/day) and doxazosin
(1-8 mg/day) are alpha-
blockers that relieve
obstructive symptoms in
BPH.
2 5-Alpha Reductase 3 Combination Therapy
Inhibitors
Finasteride (5 mg/day) Combining alpha-
and dutasteride (0.5 blockers and 5-alpha
mg/day) reduce prostate reductase inhibitors
size in BPH treatment. offers symptom relief
and further reduction in
prostate size.

4 Recent Studies and Guidelines 5 Pharmaceutical Chapters

The latest studies and guidelines from Pharmacological chapters in medical

credible sources recommend alpha- textbooks provide insights into medical
blockers as first-line therapy and BPH management.
combination therapy for moderate to
severe BPH cases.
Minimally Invasive Therapies
Thermodilation
(TUMT)
Transurethral microwave
thermotherapy (TUMT)
delivers microwave energy to
the prostate to induce thermal
necrosis and shrinkage,
offering symptom relief.
Water Vapor Therapy
(Rezūm)
Water vapor therapy (Rezūm)
injects steam into the
prostate, leading to cellular
death and subsequent
reduction in glandular size
and obstruction.
Prostate Arterial
Embolization (PAE)
PAE is a selective
embolization of arteries
feeding the prostate, inducing
tissue shrinkage from
ischemia and reducing
obstructive symptoms.
Surgical Interventions
TURP
Transurethral resection of
the prostate (TURP)
removes obstructive
prostatic tissue using an
electrified wire loop via the
urethra.
Holmium Laser
Enucleation of the
Prostate (HoLEP)
Holmium laser enucleation
of the prostate (HoLEP) is a
safe and effective
alternative to TURP in the
treatment of large
prostates.
Robotic-Assisted
Surgeries
Robotic-assisted surgeries
like robot-assisted simple
prostatectomy are less
invasive and offer better
outcomes for large
prostate glands, especially
in experienced hands.
Follow-up and Long-term Management
Guidelines for Long-term
Monitoring Management

Monitor changes in PSA levels, BPH guidelines provide evidence-

prostate size, urinary symptoms, based recommendations for long-
medication side effects, or term management and follow-up
procedure complications. of patients with BPH.

1 2 3 4

Follow-up Intervals Complications and Side

Effects
Follow-up visits may occur every 3-
6 months post-initiation of therapy Prostate-related complications
then move to yearly thereafter. and medication side effects are
important considerations for long-
term management.
Conclusion

Comprehensive Management Evidence-Based Practices

A comprehensive approach to BPH management Optimal treatment for BPH is guided by evidence-
includes addressing pathophysiology, diagnosis, based practices derived from current guidelines
pharmacological and surgical options, and long- and standard urological surgery textbooks.
term follow-up.