Review Article
Volume 4 Issue 2 - 2021
Benign Prostatic Hyperplasia (BPH): Perennial Plague of the Prostate
Nicholas A Kerna1,2*, Uzoamaka Nwokorie3, John V Flores4,5, Hilary M Holets4,5, Lawrence U Akabike6, Mark H Chen7, Emmaneulla Olubumni Solomon8, Kevin D Pruitt9 and Shain Waugh10
1SMC–Medical Research, Thailand
2First InterHealth Group, Thailand
3University of Washington, USA
4Beverly Hills Wellness Surgical Institute, USA
5Orange Partners Surgicenter, USA
6Larrico Enterprises, LLC, USA
7For Your Health, LLC, USA
8Obafemi Awolowo University, Nigeria
9Kemet Medical Consultants, USA
*Corresponding Author: Nicholas A Kerna, (mailing address) POB47 Phatphong, Suriwongse Road, Bangkok, Thailand 10500.
Received: December 28, 2020; Published: January 30, 2021


Benign prostatic hyperplasia (BPH) is a common condition with lower urinary tract symptoms (LUTS) in middle-aged and older men. BPH is the most prevalent non-malignant urological disorder. Nearly three hundred years ago, an enlarged prostate was recognized to cause urinary retention. LUTS include inconsistent urine flow, partial or complete urine retention, increased urinary frequency, difficulty emptying the bladder, nocturia, and dysuria. BPH is not a life-threatening condition; however, increased severity can cause urinary tract infections, bleeding, bladder stones, and kidney damage. BPH diagnosis is made by symptom score, quality-oflife (QoL) score, physical examination, and diagnostic imaging, such as ultrasonography, cystoscopy, and uroflowmetry. Age, genetics, and other factors, including lifestyle, affect BPH development and progression. Conservative treatment for BPH includes watchful waiting, pharmacological intervention, and specific lifestyle changes. There are a variety of surgical interventions available, the choice of which is based upon several factors. However, surgical intervention is a last resort for BPH treatment and is used primarily refractory from medications or in severe symptoms and complications. Invasive techniques include minimally invasive therapy and novel treatment modalities, as described in this paper.

Keywords: Ablation; Prostate Enlargement; Saw Palmetto; Urinary Tract Infection; Watchful Waiting


  1. CG Roehrborn. “Pathology of benign prostatic hyperplasia”. International Journal of Impotence Research 3 (2008): 11-18.
  2. JN Hellwege., et al. “Heritability and genome-wide association study of benign prostatic hyperplasia (BPH) in the eMERGE network”. Scientific Reports 1 (2019): 1-10.
  3. B Fibbi., et al. “Chronic inflammation in the pathogenesis of benign prostatic hyperplasia”. International Journal of Andrology 3 (2010): 475-488.
  4. JK Parsons. “Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors”. Current Bladder Dysfunction Reports 4 (2010): 212-218.
  5. M Altok., et al. “Chromosomal aberrations in benign prostatic hyperplasia patients”. Korean Journal of Urology 571 (2016): 45-49.
  6. G Untergasser., et al. “Benign prostatic hyperplasia: Age-related tissue-remodeling”. Experimental Gerontology 3 (2005): 121-128.
  7. M Hennenberg., et al. “Cooperative effects of EGF, FGF, and TGF-β1 in prostate stromal cells are different from responses to single growth factors”. Life Sciences 123 (2015): 18-24.
  8. S Wen., et al. “Stromal androgen receptor roles in the development of normal prostate, benign prostate hyperplasia, and prostate cancer”. American Journal of Pathology 2 (2015): 293-301.
  9. TM Nicholson and WA Ricke. “Androgens and estrogens in benign prostatic hyperplasia: Past, present and future”. Differentiation4-5 (2011): 184-199.
  10. X Shi., et al. “Estradiol promotes epithelial-to-mesenchymal transition in human benign prostatic epithelial cells”. Prostate 14 (2017): 1424-1437.
  11. P Alonso-Magdalena., et al. “A role for epithelial-mesenchymal transition in the etiology of benign prostatic hyperplasia”. Proceedings of the National Academy of Sciences of the United States of America8 (2009): 2859-2863.
  12. Y Bostanci., et al. “Correlation between benign prostatic hyperplasia and inflammation”. Current Opinion in Urology 1 (2013): 5-10.
  13. G Gandaglia., et al. “The role of chronic prostatic inflammation in the pathogenesis and progression of benign prostatic hyperplasia (BPH)”. BJU International4 (2013): 432-441.
  14. D Parikesit., et al. “The impact of obesity towards prostate diseases”. Prostate International1 (2016): 1-6.
  15. GW Cannon., et al. “A Preliminary Study of JM-27: A Serum Marker That Can Specifically Identify Men With Symptomatic Benign Prostatic Hyperplasia”. Journal of Urology2 (2007): 610-614.
  16. SD Lokeshwar., et al. “Epidemiology and treatment modalities for the management of benign prostatic hyperplasia”. Translational Andrology and Urology 5 (2019): 529-539.
  17. MS Choo., et al. “Alcohol, smoking, physical activity, protein, and lower urinary tract symptoms: Prospective longitudinal cohort”. International Neurourology Journal 3 (2015): 197-206.
  18. CL Lee and HC Kuo. “Pathophysiology of benign prostate enlargement and lower urinary tract symptoms: Current concepts”. Tzu Chi Medical Journal2 (2017): 79-83.
  19. G Bartsch., et al. “Consensus statement: The role of prostate-specific antigen in managing the patient with benign prostatic hyperplasia”. BJU International1 (2004): 27-29.
  20. US Shah., et al. “Androgen regulation of JM-27 is associated with the diseased prostate”. Journal of Urology4 (2006): 1437.
  21. GC Luo., et al. “Diagnosis of prostate adenoma and the relationship between the site of prostate adenoma and bladder outlet obstruction”. Singapore Medical Journal9 (2013): 482-486.
  22. , et al. “Singapore urological association clinical guidelines for male lower urinary tract symptoms/benign prostatic hyperplasia”. Singapore Medical Journal 58.8 (2017): 473-480.
  23. H Lepor. “Alpha-blockers for the Treatment of Benign Prostatic Hyperplasia”. Urologic Clinics of North America3 (2016): 311-323.
  24. JH Jung., et al. “Silodosin for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia”. Cochrane Database of Systematic Reviews 11 (2017).
  25. RS Rittmaster., et al. “for Atrophy Men Given Finasteride * of”. (1996): 814-819.
  26. V Mysore and BM Shashikumar. “Guidelines on the use of finasteride in androgenetic alopecia”. Indian Journal of Dermatology, Venereology and Leprology2 (2016): 128-134.
  27. RS Rittmaster. “5Α-Reductase Inhibitors in Benign Prostatic Hyperplasia and Prostate Cancer Risk Reduction”. Best Practice and Research: Clinical Endocrinology and Metabolism2 (2008): 389-402.
  28. JD McConnell., et al. “The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia”. New England Journal of Medicine25 (2003): 2387-2398.
  29. C Konstantinidis., et al. “Lower urinary tract symptoms associated with benign prostatic hyperplasia: Combined treatment with fesoterodine fumarate extended-release and tamsulosin - A prospective study”. Urologia Internationalis2 (2013):156-160.
  30. B S., et al. “Saw palmetto for benign prostatic hyperplasia”. Medical Letter on Drugs and Therapeutics”. The New England Journal of Medicine 1046 (1999): 18.
  31. MS Karadeniz., et al. “Bipolar versus monopolar resection of benign prostate hyperplasia: a comparison of plasma electrolytes, hemoglobin and TUR syndrome”. Springer Plus1 ( 2016).
  32. CE Méndez-Probst., et al. “A multicentre single-blind randomized controlled trial comparing bipolar and monopolar transurethral resection of the prostate”. Journal of the Canadian Urological Association6 (2011): 385-389.
  33. M Marszalek., et al. “Transurethral Resection of the Prostate”. European Urology, Supplements6 (2009): 504-512.
  34. PJ Gilling., et al. “The use of the holmium laser in the treatment of benign prostatic hyperplasia”. Journal of Endourology5 (1996): 459-461.
  35. A Srinivasan and R Wang. “An update on minimally invasive surgery for benign prostatic hyperplasia: Techniques, risks, and efficacy”. World Journal of Men’s Health4 (2019): 402-411.
  36. JM Kuebker and NL Miller. “Holmium Laser Enucleation of the Prostate: Patient Selection and Outcomes”. Current Urology Reports12 (2017).
  37. Y Zhu., et al. “Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: a systematic review and meta-analysis”. World Journal of Urology4 (2015): 509-515.
  38. AM Elshal., et al. “GreenLightTM laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: A randomized controlled study”. Journal of Urology3 (2015): 927-934.
  39. P Jones., et al. “UroLift: A new minimally-invasive treatment for benign prostatic hyperplasia”. Therapeutic Advances in Urology6 (2016): 372-376.
  40. N Shore., et al. “Efficacy and safety of fexapotide triflutate in outpatient medical treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia”. Therapeutic Advances in Urology 11 (2019): 175628721882080.
  41. U Teichgräber., et al. “Prostate Artery Embolization: Indication, Technique and Clinical Results”. RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren (2018).
  42. J Westwood., et al. “Rezum: a new transurethral water vapour therapy for benign prostatic hyperplasia”. Therapeutic Advances in Urology11 (2018): 327-333.
  43. S Taktak., et al. “Aquablation: a novel and minimally invasive surgery for benign prostate enlargement”. Therapeutic Advances in Urology6 (2018): 183-188.
Citation: Kerna NA, Nwokorie U, Flores JV, Holets HM, Akabike LU, Chen MH, Solomon EO, Pruitt KD, Waugh S. “Benign Prostatic Hyperplasia (BPH): Perennial Plague of the Prostate”. EC Clinical and Medical Case Reports 4.2 (2021): 53-61.

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