Extracts from "Clinical Evidence": Benign prostatic hyperplasia

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Abstract
Background Definition Benign prostatic hyperplasia (BPH) is defined histologically. Clinically, it is characterised by lower urinary tract symptoms (urinary frequency, urgency, a weak and intermittent stream, needing to strain, a sense of incomplete emptying, and nocturia), and can lead to complications, including acute urinary retention. Interventions Beneficial: α Blockers 5α Reductase inhibitors Transurethral resection (TURP) Transurethral microwave thermotherapy (TUMT) Transurethral needle ablation (TUNA) Likely to be beneficial: Saw palmetto plant extracts β Sitosterol plant extracts Rye grass pollen extract Unknown effectiveness: TURP versus less invasive surgical techniques Incidence/prevalence Estimates of the prevalence of symptomatic BPH range from 10-30% for men in their early 70s, depending on how BPH is defined.1 Aetiology/risk factors The mechanisms by which BPH causes symptoms and complications are unclear, although obstruction of the bladder outlet is an important factor.2 The best documented risk factors are increasing age and functioning testes.3 Prognosis Community and practice based studies suggest that men with lower urinary tract symptoms can expect slow progression of the symptoms. 4 5 However, symptoms can wax and wane without treatment. In men with symptoms of BPH, rates of acute urinary retention range from 1-2% a year.5–7 Aims To reduce or alleviate lower urinary tract symptoms; to prevent complications; and to minimise adverse effects of treatment. Outcomes Burden of lower urinary tract symptoms; rates of acute urinary retention and prostatectomy; rates of adverse effects of treatment. Symptoms are measured using the validated international prostate symptom score, which includes seven questions quantifying symptoms on an overall scale from 0-35, with higher scores representing more frequent symptoms

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