eMedicine Specialties > Urology > Benign Prostatic Hypertrophy

Prostate Hyperplasia, Benign: Follow-up

Author: Raymond J Leveillee, MD, FRCS(Glasg), Professor of Clinical Urology, Radiology and Biomedical Engineering, Department of Urology, University of Miami Miller School of Medicine; Chief, Division of Endourology/Laparoscopy and Minimally Invasive Surgery, Department of Urology, Jackson Memorial Hospital
Coauthor(s): Vipul R Patel, MD, Consulting Surgeon, Global Robotics Institute, Florida Hospital Celebration Health; Vincent G Bird, MD, Assistant Professor of Clinical Urology, University of Miami, Miller School of Medicine; Consulting Staff, Department of Urology, Division of Endourology/Laparoscopy and Minimally Invasive Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital; Charles R Moore, MD, Fellow, Department of Urology, University of Miami
Contributor Information and Disclosures

Updated: Jun 8, 2009

Follow-up

Further Outpatient Care

  • Patients with benign prostatic hyperplasia (BPH) who have symptoms significant enough to be placed on medication should be evaluated during biannual (at least) office visits to discuss the efficacy of the medication and potential dose adjustment.
  • Patients should undergo DRE and PSA screening at least annually.

Complications

  • Complications related to bladder outlet obstruction (BOO) secondary to BPH
    • Urinary retention
    • Renal insufficiency
    • Recurrent urinary tract infections
    • Gross hematuria
    • Bladder calculi
    • Renal failure or uremia (rare in current practice)

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to pay special attention to the onset and duration of symptoms, general health issues (including sexual history), fitness for any possible surgical intervention, severity of symptoms and how they are affecting QOL, medications, and previously attempted treatments could lead to medicolegal liability.
  • Symptoms often attributed to benign prostatic hyperplasia (BPH) can be caused by neurogenic bladder, carcinoma in situ of the bladder, urethral stricture due to trauma or a sexually transmitted disease, cystitis, and prostatitis. Failure to exclude these entities based on findings from a thorough history and appropriately directed diagnostic studies could lead to medicolegal liability.
 


More on Prostate Hyperplasia, Benign

Overview: Prostate Hyperplasia, Benign
Differential Diagnoses & Workup: Prostate Hyperplasia, Benign
Treatment & Medication: Prostate Hyperplasia, Benign
Follow-up: Prostate Hyperplasia, Benign
Multimedia: Prostate Hyperplasia, Benign
References
Further Reading
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References

  1. Seftel AD, Rosen RC, Rosenberg MT, Sadovsky R. Benign prostatic hyperplasia evaluation, treatment and association with sexual dysfunction: practice patterns according to physician specialty. Int J Clin Pract. Apr 2008;62(4):614-22. [Medline].

  2. American Cancer Society. 2009. American Cancer Society - Learn About Prostate Cancer. Available at http://www.cancer.org/docroot/lrn/lrn_0.asp. Accessed 1/29/2009.

  3. McConnell JD, Barry MJ, Bruskewitz RC, et al. Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guideline. No. 8, AHCPR Publication No. 94-0582. Rockville, Md: Agency for Healthcare Policy and Research,. Public Health Service, US Department of Health and Human Services, 1994.

  4. AUA Clinical Guidelines - Management of BPH ('03/Updated '06). Available at http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=bph. Accessed 1/29/2009.

  5. Emberton M, Cornel EB, Bassi PF, Fourcade RO, Gómez JM, Castro R. Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. Int J Clin Pract. Jul 2008;62(7):1076-86. [Medline].

  6. Cantrell MA, Bream-Rouwenhorst HR, Steffensmeier A, Hemerson P, Rogers M, Stamper B. Intraoperative floppy iris syndrome associated with alpha1-adrenergic receptor antagonists. Ann Pharmacother. Apr 2008;42(4):558-63. [Medline].

  7. Bell CM, Hatch WV, Fischer HD, Cernat G, Paterson JM, Gruneir A, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. May 20 2009;301(19):1991-6. [Medline]. [Full Text].

  8. Madersbacher S, Marszalek M, Lackner J, Berger P, Schatzl G. The long-term outcome of medical therapy for BPH. Eur Urol. Jun 2007;51(6):1522-33. [Medline].

  9. McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med. Feb 26 1998;338(9):557-63. [Medline].

  10. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. Dec 18 2003;349(25):2387-98. [Medline].

  11. Roehrborn CG. Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. BJU Int. Apr 2006;97(4):734-41. [Medline].

  12. Vallancien G, Emberton M, Alcaraz A, Matzkin H, van Moorselaar RJ, Hartung R. Alfuzosin 10 mg once daily for treating benign prostatic hyperplasia: a 3-year experience in real-life practice. BJU Int. Apr 2008;101(7):847-52. [Medline].

  13. Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Morrill B. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol. Feb 2008;179(2):616-21; discussion 621. [Medline].

  14. Gallegos PJ, Frazee LA. Anticholinergic therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia. Pharmacotherapy. Mar 2008;28(3):356-65. [Medline].

  15. Sildenafil [package insert]. New York, NY: Pfizer Inc.; 2002.

  16. Vardenafil [package insert]. Pittsburgh, Pa: Bayer Pharmaceuticals Corporation/GlaxoSmithKline; 2003.

  17. Tadalafil [package insert]. Indianapolis, IN: Lilly ICOS LLC; 2005.

  18. Mulhall JP, Guhring P, Parker M, Hopps C. Assessment of the impact of sildenafil citrate on lower urinary tract symptoms in men with erectile dysfunction. J Sex Med. Jul 2006;3(4):662-7. [Medline].

  19. Sotelo R, Spaliviero M, Garcia-Segui A, et al. Laparoscopic retropubic simple prostatectomy. J Urol. Mar 2005;173(3):757-60. [Medline].

  20. Malek RS, Kuntzman RS, Barrett DM. Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol. Oct 2005;174(4 Pt 1):1344-8. [Medline].

  21. Kuntz RM. Laser treatment of benign prostatic hyperplasia. World J Urol. Jun 2007;25(3):241-7. [Medline].

  22. Elzayat EA, Habib EI, Elhilali MM. Holmium laser enucleation of the prostate: a size-independent new "gold standard". Urology. Nov 2005;66(5 Suppl):108-13. [Medline].

  23. Kristal AR, Arnold KB, Schenk JM, Neuhouser ML, Goodman P, Penson DF. Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol. Apr 15 2008;167(8):925-34. [Medline].

  24. Arai Y, Fukuzawa S, Terai A, Yoshida O. Transurethral microwave thermotherapy for benign prostatic hyperplasia: relation between clinical response and prostate histology. Prostate. Feb 1996;28(2):84-8. [Medline].

  25. Barry MJ, Cockett AT, Holtgrewe HL, et al. Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia. J Urol. Aug 1993;150(2 Pt 1):351-8. [Medline].

  26. Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. Nov 1992;148(5):1549-57; discussion 1564. [Medline].

  27. Barry MJ, O'Leary MP. Advances in benign prostatic hyperplasia. The developmental and clinical utility of symptom scores. Urol Clin North Am. May 1995;22(2):299-307. [Medline].

  28. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. Sep 1984;132(3):474-9. [Medline].

  29. Bihrle R, Foster RS, Sanghvi NT, et al. High intensity focused ultrasound for the treatment of benign prostatic hyperplasia: early United States clinical experience. J Urol. May 1994;151(5):1271-5. [Medline].

  30. Bolmsjo M, Wagrell L, Hallin A, et al. The heat is on--but how? A comparison of TUMT devices. Br J Urol. Oct 1996;78(4):564-72. [Medline].

  31. Bruskewitz R, Girman CJ, Fowler J, Rigby OF, Sullivan M, Bracken RB. Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. PLESS Study Group. Proscar Long-term Efficacy and Safety Study. Urology. Oct 1999;54(4):670-8. [Medline].

  32. Cohen MS, Steiner MS. Interstitial laser coagulation techniques: local anesthesia techniques. World J Urol. Apr 2000;18 Suppl 1:S18-21. [Medline].

  33. Danielli L, Kaver I, Fintsi Y, et al. Water induced thermotherapy (WIT) for benign prostatic hypertrophy (BPH), one year clinical experience and histopathological studies. Eur Urol. 1996;30(S2):222.

  34. Girman CJ, Epstein RS, Jacobsen SJ, et al. Natural history of prostatism: impact of urinary symptoms on quality of life in 2115 randomly selected community men. Urology. Dec 1994;44(6):825-31. [Medline].

  35. Girman CJ, Jacobsen SJ, Guess HA, et al. Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol. May 1995;153(5):1510-5. [Medline].

  36. International Scientific Committee. The evaluation and treatment of lower urinary tract symptoms (LUTS) in older men. Proceedings of the 5th International Consultation on BPH; Paris, France;. 2000;519-32.

  37. Issa MM. Transurethral needle ablation of the prostate: report of initial United States clinical trial. J Urol. Aug 1996;156(2 Pt 1):413-9. [Medline].

  38. Jacobsen SJ, Jacobson DJ, Girman CJ, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. Aug 1997;158(2):481-7. [Medline].

  39. Kaplan SA, Chiou RK, Morton WJ, Katz PG. Long-term experience utilizing a new balloon expandable prostatic endoprosthesis: the Titan stent. North American Titan Stent Study Group. Urology. Feb 1995;45(2):234-40. [Medline].

  40. Kirby R, Lepor H. Evaluation and Non-surgical Management of Benign Prostatic Hyperplasia. In: Wein A, Kavoussi L, Novick A, Partin A, and Peters C, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: WB Saunders Co; 2007:2766-2802.

  41. Le Duc A, Gilling PJ. Holmium laser resection of the prostate. Eur Urol. Feb 1999;35(2):155-60. [Medline].

  42. Lepor H, Sypherd D, Machi G, Derus J. Randomized double-blind study comparing the effectiveness of balloon dilation of the prostate and cystoscopy for the treatment of symptomatic benign prostatic hyperplasia. J Urol. Mar 1992;147(3):639-42; discussion 642-4. [Medline].

  43. Lepor H, Williford WO, Barry MJ, Haakenson C, Jones K. The impact of medical therapy on bother due to symptoms, quality of life and global outcome, and factors predicting response. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. J Urol. Oct 1998;160(4):1358-67. [Medline].

  44. McCullough DL. Minimally invasive treatment of benign prostatic hyperplasia. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1479-1509.

  45. McNeal JE. Origin and evolution of benign prostatic enlargement. Invest Urol. Jan 1978;15(4):340-5. [Medline].

  46. McNeal JE. The prostate gland: Morphology and pathobiology. Monogr Urol. 1983;4:3-33.

  47. Mebust WK. Transurethral Surgery. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1511-28.

  48. Muschter R, Hofstetter A. Interstitial laser therapy outcomes in benign prostatic hyperplasia. J Endourol. Apr 1995;9(2):129-35. [Medline].

  49. Narayan P, Starling J. Minimally invasive therapies for the treatment of symptomatic benign prostatic hyperplasia: the University of Florida experience. J Clin Laser Med Surg. Feb 1998;16(1):29-32. [Medline].

  50. Narayan P, Tewari A, Aboseif S, Evans C. A randomized study comparing visual laser ablation and transurethral evaporation of prostate in the management of benign prostatic hyperplasia. J Urol. Dec 1995;154(6):2083-8. [Medline].

  51. [Best Evidence] Nickel JC, Sander S, Moon TD. A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia. Int J Clin Pract. Oct 2008;62(10):1547-59. [Medline].

  52. Oesterling JE. Retropubic and Suprapubic Prostatectomy. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:1529-41.

  53. Oesterling JE, Kaplan SA, Epstein HB. The North American experience with the UroLume endoprosthesis as a treatment for benign prostatic hyperplasia: long-term results. The North American UroLume Study Group. Urology. Sep 1994;44(3):353-62. [Medline].

  54. Reich O, Bachmann A, Siebels M, et al. High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients. J Urol. Jan 2005;173(1):158-60. [Medline].

  55. Roehrborn C, McConnell JD. Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology and Natural History. In: Wein A, Kavoussi L, Novick A, Partin A, and Peters C, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: WB Saunders; 2007:2727-2765.

  56. Schulman CC. Lower urinary tract symptoms/benign prostatic hyperplasia: minimizing morbidity caused by treatment. Urology. Sep 2003;62(3 Suppl 1):24-33. [Medline].

  57. Steele GS, Sleep DJ. Transurethral needle ablation of the prostate: a urodynamic based study with 2-year followup. J Urol. Nov 1997;158(5):1834-8. [Medline].

  58. Stein BS, Bihrle RB, Issa M, et al. Minimally Invasive Surgeries for BPH. 009826 PG. Presented at AUA 93rd Annual Meeting; San Diego, California, USA. Baltimore, Md: AUA Office of Education; 1998.

  59. Steiner MS, Cohen MS, Conn RL, et al. The armamentarium for BPH. Physicians Dialogue. 1998;1:5-11.

  60. Tewari A, Oleksa J, Johnson C, et al. Minimally invasive therapy of benign prostatic hypertrophy. Hospital Physician. 1999;May:29-68.

  61. [Best Evidence] U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. Aug 5 2008;149(3):185-91. [Medline].

  62. Watson G, Anson K, Janetschek G, et al. An in-depth evaluation of contact laser vaporization of prostate. J Urol. 1994;151:231A.

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Further Reading

Additional resources on benign prostatic hyperplasia (BPH) are available at Medscape's Benign Prostatic Hyperplasia Resource Center.

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Keywords

benign prostatic hyperplasia, BPH, benign prostatic hypertrophy, benign prostate hyperplasia, benign prostate hypertrophy, prostatism, prostatic hypertrophy, enlarged prostate, bladder outlet obstruction, BOO, testosterone, dihydrotestosterone, DHT, obstruction-induced bladder dysfunction, acute urinary retention, AUR, frequent urination, nocturia, lower urinary tract symptoms, LUTS, prostatectomy, transurethral resection of the prostate, TURP, transurethral incision of the prostate, TUIP, transurethral microwave therapy, TUMT, transurethral needle ablation of the prostate, TUNA, water-induced thermotherapy, WIT, digital rectal examination, DRE, prostate-specific antigen, PSA

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Contributor Information and Disclosures

Author

Raymond J Leveillee, MD, FRCS(Glasg), Professor of Clinical Urology, Radiology and Biomedical Engineering, Department of Urology, University of Miami Miller School of Medicine; Chief, Division of Endourology/Laparoscopy and Minimally Invasive Surgery, Department of Urology, Jackson Memorial Hospital
Raymond J Leveillee, MD, FRCS(Glasg) is a member of the following medical societies: American Urological Association, Endourological Society, Sigma Xi, and Society of Laparoendoscopic Surgeons
Disclosure: ACMI/Gyrus Honoraria Speaking and teaching; Boston Scientific Honoraria Speaking and teaching; Applied Medical Honoraria Speaking and teaching; Intuitive Surgical  Honoraria Speaking and teaching; LMA suisse Grant/research funds Consulting; Pluromed Grant/research funds Consulting

Coauthor(s)

Vipul R Patel, MD, Consulting Surgeon, Global Robotics Institute, Florida Hospital Celebration Health
Vipul R Patel, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, Endourological Society, Ohio State Medical Association, and Society of Laparoendoscopic Surgeons
Disclosure: Intuitive Surgical Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Vincent G Bird, MD, Assistant Professor of Clinical Urology, University of Miami, Miller School of Medicine; Consulting Staff, Department of Urology, Division of Endourology/Laparoscopy and Minimally Invasive Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital
Vincent G Bird, MD is a member of the following medical societies: American Urological Association, Endourological Society, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Charles R Moore, MD, Fellow, Department of Urology, University of Miami
Charles R Moore, MD is a member of the following medical societies: Alpha Omega Alpha and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Martin I Resnick, MD †, Former Lester Persky Professor and Chair, Department of Urology, Former Professor, Department of Oncology, Case Western Reserve University School of Medicine
Martin I Resnick, MD † is a member of the following medical societies: American College of Surgeons, American Federation for Medical Research, American Institute of Ultrasound in Medicine, American Medical Association, American Society for Bone and Mineral Research, American Society for Reproductive Medicine, American Society of Andrology, American Surgical Association, American Urological Association, Association for Academic Surgery, Endocrine Society, National Kidney Foundation, Ohio Urological Society, and Pan American Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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