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OCCUPYING 1/5 OF UROLOGICAL CASES: WHAT IS BENIGN PROSTATIC HYPERPLASIA (BPH)?

OCCUPYING 1/5 OF UROLOGICAL CASES: WHAT IS BENIGN PROSTATIC HYPERPLASIA (BPH)?

04/09/2025

Benign Prostatic Hyperplasia (BPH) is the most common benign condition in older men. When the prostate gland enlarges, it can compress the urethra, leading to lower urinary tract symptoms (LUTS). By age 55, approximately 25% of men experience symptoms; the frequency increases to about 50% in men aged 75, and 20–30% of them develop symptoms severe enough to require treatment.

Classification / Pathophysiology

Benign Prostatic Hyperplasia (BPH) is not merely cellular hyperplasia. It is a complex histological process involving the proliferation of both glandular and stromal components, sometimes accompanied by small foci of atrophy. This enlargement is primarily due to a decrease in cell death rather than a rapid increase in cell proliferation. It is associated with increased sensitivity to androgens (such as dihydrotestosterone) and estrogens, as well as the promotion of stromal and collagen development.

Causes and risk factors

  • Age is the primary risk factor; the incidence of BPH significantly increases after the age of 40, with rates of 8%, 50%, 80% at ages 40, 60, and 90, respectively.

  • Factors: metabolic syndrome, chronic inflammation, family history, obesity, type 2 diabetes, physical inactivity, and erectile dysfunction are all identified as being associated with an increased risk of BPH.

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Symptoms

Common symptoms include frequent urination, nocturia, incomplete bladder emptying, weak or interrupted urine stream, difficulty initiating urination, or urinary urgency. In severe cases, recurrent urinary tract infections, acute urinary retention, bladder stones, and secondary kidney failure due to collection of urine may occur.

Diagnosis

Diagnosis of BPH is based on:

  • Medical history and thorough clinical examination, focusing on urinary symptoms and identifying other causes.

  • Digital Rectal Examination (DRE) to assess the size and texture of the prostate gland.

  • Urinalysis and additional tests if necessary: PSA, creatinine, ultrasound, measurement of post-void residual urine, cystoscopy, and urodynamic studies…

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Treatment

a) Monitoring and Observation 

For cases with mild symptoms, only watchful waiting. Treatment only begins if symptoms worsen.

b) Medical Treatment 

  • Alpha-blockers: help relax smooth muscles in the bladder neck and gland, improving urine flow (e.g., tamsulosin). 

  • 5-alpha-reductase inhibitors (5-ARIs): limit DHT conversion, helping to reduce prostate volume over time.

  • Combining medications (e.g., tamsulosin + dutasteride) is more effective than monotherapy.

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c) Surgical and minimally invasive procedures

  • TURP (Transurethral resection of the prostate): Transurethral endoscopic surgery is considered the gold standard.

  • HoLEP (Holmium Laser Enucleation of the Prostate): uses a Holmium laser to remove internal glandular tissue, reducing obstruction.

  • Aquablation, Prostatic Urethral Lift (PUL): minimally invasive endoscopic procedure to lift the urethra or reduce obstructive lesions.

  • PAE (Prostatic Artery Embolization): endovascular intervention that blocks blood flow to the gland to shrink its size and reduce symptoms; it is a new method with potential short-term equivalence to TURP.

  • WVTT (Water Vapor Thermal Therapy / Prostate Steam Treatment – Rezum): uses water vapor to destroy glandular tissue, is minimally invasive, and offers rapid recovery.

Benign Prostatic Hyperplasia (BPH) is a common condition in middle-aged and older men, causing urinary disorders and significantly impacting quality of life. Accurate diagnosis relies on symptoms, clinical examination, and supportive laboratory tests. Treatment must be personalized: from watchful waiting, medication to minimally invasive procedures or surgery. Advances such as HoLEP, PAE, and Rezum offer new prospects in optimizing treatment, reducing side effects, and enhancing efficacy.

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At the Department of Nephrourology - Andrology, AIH, patients will receive comprehensive and personalized care for each case from highly experienced urologists. Along with the support of modern diagnostic facilities, doctors can accurately diagnose complex diseases right from the first examination, leading to the highest possibility of successful treatment.

AIH is currently applying various treatment methods, from medication to minimally invasive surgeries such as endourology, keyhole surgery, etc., with the goal of bringing comfort and the fastest recovery to patients. 

To receive consultation and schedule an appointment with specialists in Nephrourology - Andrology, please contact Hotline (028) 3910 9999 or INBOX Fanpage  https://m.me/aih.com.vn.

References:

Singapore Urological Association

Johns Hopkins Medicine

Johns Hopkins University

Wikipedia

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