Latest Trends and Recommendations on Epidemiology, Diagnosis, and Treatment of Benign Prostatic Hyperplasia (BPH)

Background: A re-evaluation of established tests and treatments has become necessary after publication of several new guidelines on BPH during the past two years. This article describes the latest developments concerning epidemiology, diagnosis, and treatment of BPH. Material and Methods: Diagnostic and treatment guidelines on BPH of the German, European, or North American urologists as well as UK doctors were reviewed according to key articles and latest modifications. Results: The only German epidemiological trial on BPH demonstrated that all components of the BPH disease (symptoms prostate enlargement bladder outlet obstruction) increase with ageing. 27% of German men will have disease progression within the next 5 years. Risk factors for disease progression are: age, symptoms, prostate size, PSA, urinary flow rate, and postvoiding residual urine. Diagnosis aims to distinguish BPH from other diseases with similar symptoms, quantify the BPH components, and estimate the individual risk of disease progression. BPH is an exclusion diagnosis. Ultrasonic measurement of detrusor wall thickness at the anterior wall of bladders filled with >= 250 mL can securely detect bladder outlet obstruction if the value is >= 2 mm. Watchful waiting and lifestyle modifications are suitable for men with mild symptoms and low disease progression risk. All drugs used in BPH treatment reduce symptoms but have no influence on bladder outlet obstruction. alpha-blockers are firstline drugs and may be combined with muscarinic receptor antagonists or 5 alpha-reductase inhibitors to further increase efficacy. Prostate surgery is indicated when drug treatment is insufficient, the patient develops complications in the upper or lower urinary tract (absolute indications), or has severe bladder outlet obstruction. Standard operations are TURP in small (<= 80 mL) or open prostatectomy in large prostates (>80 mL). Minimally invasive, alternative surgeries may be considered in selected men and offer advantages with regard to the risk of bleeding, duration of catheterisation, or maintenance of sexual function. Conclusions: Current guidelines have integrated the latest knowledge and developments on BPH and are likely to improve assessment and treatment.