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Urology

Benign Prostatic Hyperplasia (BPH)

Age-related non-cancerous transitional-zone prostate growth causing bladder-outlet obstruction and lower urinary tract symptoms (LUTS) in men over 50.

Last reviewed 25 Jun 2026 - MedicoMedics editorial team

Urinary obstruction from enlarged prostate in BPH

Pathophysiology

Dihydrotestosterone-driven proliferation of prostatic stromal and epithelial cells enlarges the transitional zone, compressing the urethra. Dynamic component from alpha-1 adrenergic tone at bladder neck and prostatic capsule.

Sources: AUA Guideline: Management of BPH (2023 amendment); EAU Guidelines on Non-neurogenic Male LUTS (2024)

Clinical presentation

Storage LUTS: frequency, urgency, nocturia. Voiding LUTS: hesitancy, weak stream, straining, intermittency, incomplete emptying. Complications: recurrent UTI, bladder stones, haematuria, acute urinary retention, hydronephrosis.

Sources: AUA Guideline: Management of BPH (2023 amendment); EAU Guidelines on Non-neurogenic Male LUTS (2024)

Diagnosis

IPSS score quantifies symptoms. Digital rectal exam: smooth, enlarged prostate. PSA and urinalysis. Ultrasound: prostate volume, post-void residual, upper-tract dilatation. Uroflowmetry (Qmax <10 mL/s suggests obstruction).

Sources: AUA Guideline: Management of BPH (2023 amendment); EAU Guidelines on Non-neurogenic Male LUTS (2024)

Management

Mild - lifestyle (fluid timing, avoid caffeine/alcohol). Moderate - alpha-1 blockers (tamsulosin) for symptom relief; 5-alpha reductase inhibitors (finasteride, dutasteride) for large glands (>40 mL); combination for both. PDE5 inhibitors (tadalafil) if concurrent ED. Surgical: TURP, laser enucleation (HoLEP), UroLift, aquablation, or simple prostatectomy for very large glands.

Sources: AUA Guideline: Management of BPH (2023 amendment); EAU Guidelines on Non-neurogenic Male LUTS (2024)

Sample USMLE-style MCQs

Try 5 questions on this topic. Practice hundreds more free with a trial.

Question 1

Which prostate zone is enlarged in BPH?

Related topics:prostate cancer

Question 2

First-line pharmacologic treatment for symptomatic BPH?

Question 3

Which drug shrinks the gland over months?

Question 4

Effect of finasteride on PSA?

Question 5

Which is an indication for surgery in BPH?

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 25 Jun 2026 by MedicoMedics editorial team.

  1. AUA Guideline: Management of BPH (2023 amendment)
  2. EAU Guidelines on Non-neurogenic Male LUTS (2024)

Frequently asked

Do 5-alpha reductase inhibitors affect PSA?

Yes - they roughly halve serum PSA; double the measured value when interpreting for cancer screening.

When is urgent intervention required?

Acute urinary retention, refractory retention, recurrent UTIs, bladder stones, gross haematuria, or renal insufficiency from obstruction.

Which drug can precipitate retention?

Anticholinergics, alpha-agonist decongestants and opioids.

What is the mechanism of tamsulosin?

Selective alpha-1A adrenergic antagonist relaxes prostatic smooth muscle and bladder neck, improving flow.

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