Professor Iqbal Shergill
Consultant Urological Surgeon and Treasurer Elect, BAUS, Wrexham Maelor Hospital, North Wales
There are a few key terms within benign prostate disease which need to be understood carefully, as the terminology can be potentially confusing.
Benign prostatic enlargement (BPE) refers to the clinical finding of physical enlargement of the prostate, which is benign and not cancerous. Benign prostate obstruction (BPO) is bladder outlet obstruction caused by benign prostatic enlargement.
Benign prostate hyperplasia/hypertrophy (BPH) refers to a histological diagnosis – and hence can only be theoretically made after operation. Lower urinary tract symptoms (LUTS) is a non-specific term for symptoms which may be attributable to lower urinary tract dysfunction.
In contemporary clinical practice, we use the term LUTS/BPH to refer LUTS caused by BPE resulting in BPO.
Studies show that the prevalence of LUTS/BPH is around 13% in men aged 40-49, rising to a third of men over the age of 70.
Identifying key symptoms
Symptoms from LUTS/BPH may be primarily due to physical blockage to the bladder/urethra, or due to secondary changes resulting in bladder overactivity. Symptoms due to the physical blockage from the prostate are termed obstructive/voiding symptoms. Typically, they would be poor flow, straining, incomplete emptying, hesitancy and intermittency. Overactive bladder symptoms include frequency, urgency (with or without leakage) and nocturia.
Urologists will commonly use the International Prostate Symptom Score (IPSS.pdf (baus.org.uk)) to objectively quantify the severity of symptoms and its effect on quality of life. The IPSS is very advantageous in that it is valid, reliable and reproducible. Importantly, for clinical follow up, it can also be subsequently used to objectively establish response to surgical treatments.
High risk groups
We do not fully understand the exact cause of LUTS/BPH, but age is the biggest risk factor. Studies show that the prevalence of LUTS/BPH is around 13% in men aged 40-49, rising to a third of men over the age of 70.
Furthermore, the prevalence increases to 88% in 80-year-old men. The natural history of LUTS/BPH is that it is a slowly progressive condition with an inevitable deterioration of symptoms as men get older.
It is vitally important that men with symptoms seek help. Primarily, a clinical assessment is needed to exclude or diagnose prostate cancer, symptoms of LUTS/BPH can be non-specific and as such, do overlap with some prostate cancer symptoms.
Secondly, when a firm diagnosis of LUTS/BPH has been made, there is a significant risk of developing complications, also called “clinical progression” of symptoms. This refers to the future risk of developing acute urinary retention, need for operation, risk of kidney failure and risk of developing urine infections.
All these complications can be potentially life threatening and may require emergency hospital admission and treatment. Importantly, the complications may be avoided if men seek help early.