Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) – colloquially called benign enlargement of the prostate (prostate gland) – (synonyms: Adenoma of the prostate; BOO (bladder outlet obstruction); BPE; BPH; BPO (benign prostate obstruction); BPS (benign prostatic syndrome); Benign prostatic hyperplasia; Prostate adenoma; Prostate hyperplasia; Prostate hypertrophy; benign prostatic enlargement (BPE); Prostate enlargement, benign; ICD-10-GM N40: Prostatic hyperplasia) was formerly called prostatic adenoma (PA).

Benign prostatic hyperplasia (BPH), which in itself does not require treatment, should be distinguished from benign prostatic enlargement (BPE).

BPH can also be the cause of obstructive and irritative micturition symptoms, the so-called lower urinary tract symptoms (LUTS). These include both bladder voiding dysfunction and bladder storage dysfunction.

When benign prostatic hyperplasia (BPH) leads to an increase in bladder outlet resistance, this is called benign prostatic obstruction (BPO).

BPH is found in almost all (older) men, with LUTS often associated with BPE and/or BPO. In such cases, it is referred to as: LUTS/BPS, where “BPS” stands for “benign prostatic syndrome.”

Benign prostatic syndrome (BPS) thus comprises three variable components:

  • Lower urinary tract symptoms (LUTS).
  • Prostatic hyperplasia (BPE, E for enlargement).
  • Bladder outlet obstruction (BPO; Engl.: Bladder outlet obstruction, BOO).

The term “benign prostatic hyperplasia (BPH)” in a worldwide change in terminology refers only to the histological (fine tissue) underlying tissue change, ie, the increase in the number of connective tissue and muscle cells and glandular tissue.

Benign prostatic hyperplasia (BPH) is histologically classified as follows:

  1. Benign nodular hyperplasia
  2. Atrophy-associated hyperplasia
  3. Atypical adenomatous hyperplasia

Frequency peak: the maximum incidence of the disease is after the age of 60.

The prevalence (disease incidence) increases with age and is 10-20% in men aged 50-59 years in Germany and 25-35% in men aged 60-79 years. In the 9th decade of life, the prevalence is more than 90%.

Course and prognosis: In patients with benign prostatic syndrome (BPS), progression of the disease occurs in approximately one-fifth to one-third of cases within 3 to 5 years after diagnosis. This is reflected in Lower Urinary Tract Symptoms (LUTS) – see “Symptoms – Complaints”.As a result of prostatic hyperplasia (BPH), the urethra (urinary tract) can become narrowed to the point where symptoms such as bladder emptying problems can occur. BPH is the most common cause of bladder emptying disorders in men. This causes residual urine formation, which in turn can lead to cystitis (bladder inflammation) and urolithiasis (urinary stones). Another possible consequence of prostatic hyperplasia is urinary retention (inability to empty the bladder). Note: Clinically relevant is residual urine formation from 50-100 ml. The most effective therapy for benign prostatic hyperplasia is surgery. In this way, the symptoms described above can usually be treated effectively.

Comorbidity (concomitant disease): with alopecia androgenetica, the risk of men developing benign prostatic hyperplasia (OR 1.26, 95% CI 1.05-1.51) increases.