Figure 1. Gross specimen of prostate gland.

Figure 2. Microscopic effects of BPH.

Figure 3. Prevalence by Age of Moderate to Severe LUTS and LUTS Combined With Qmax <15 Ml/s.

Age (years)

0

10

20

30

40

50

40–49 50–59 60–69 70–79

Men

(%

)

AUA >7 AUA >7 and Qmax <15 mL/s

Qmax=peak urinary flow rate.

Figure 4. Decision-making algorithm for the diagnosis and treatment

of BPH.

TUVP

Initial evaluation• History• Physical examination

(DRE)• Urinalysis• Assess renal function

(measure serum creatinine)

Optional tests• PSA• Uroflowmetry• Postvoid residual

urine• Pressure-flow

studies

Consider referral to a urologist, patients with complicated BPH:

• Refractory urinary retention

• Urinary tract infection• Hematuria (blood in urine)• Bladder stones• Renal insufficiency

Quantitative symptom reassessment

(AUA Symptom Index)

Bothersome, Moderate to Severe (8-35 points)

Watchful waiting

-Blocker therapy orfinasteride

Refer to a urologist for

consideration of other treatment

options

Openprostatectomy

TURP TUIP Minimally invasivesurgical options

Laser therapy

Thermotherapy Stent

TUNA Microwave

Mild (0-7 points)

Complicated BPH or failed medical

therapy

Worsening of BPH

symptoms at annual

evaluation

Medical therapy

Figure 5. Digital rectal examination.

Figure 6.Example of equipment foruroflowmetry.

Kirby RS, McConnell JD. Benign Prostatic Hyperplasia, 1996.

Time (s)

Urin

ary

flow

rat

e (m

L/s)

Figure 7. Typical Urinary Flow Rate Curves As Measured by Uroflowmetry: Normal and BPH.