Overview Snapshot A 52-year-old man presents to his primary care physician with nocturia and increased day-time urinary frequency. He notices that he needs to strain when beginning to void and tends to dribble after he finishes urinating. Medical history is significant for hypertension treated with hydrochlorothiazide and type 2 diabetes mellitus treated with metformin. On digital rectal exam, there is a non-tender, smooth, elastic, and firm enlarged prostate. A urinalysis and prostate-specific antigen level is ordered. Introduction Clinical definition benign hyperplasia of the stromal and epithelial cells of the prostate that results in lower urinary tract symptoms (LUTS) such as post-void dribbling increased urinary frequency and urgency nocturia weak urinary stream Epidemiology demographics men > 45 years of age Pathogenesis unclear; however, chronic inflammation and hormonal and vascular mechanisms may play a role Associated conditions obesity and metabolic syndromes hypertension type 2 diabetes mellitus Prognosis symptoms slowly and progressively worsen Presentation Symptoms issues with urinary storage e.g., nocturia, increased urinary frequency, urinary incontinence, and urgency issues with voiding e.g., weak urinary stream, hesistancy, straining to void, and post-void dribbling irritative issues e.g., urgency and increased urinary frequency Physical exam digital rectal exam a non-tender, smooth, elastic, and firm enlarged prostate Studies Labs urinalysis to detect the presence of a urinary tract infection or blood prostate-specific antigen non-specific Diagnostic criteria this is a clinical diagnosis based on history (e.g., storage, voiding, and/or irritating urinary symptoms) and physical exam (e.g., a non-tender, smooth, elastic, and firm enlarged prostate) Differential Prostate cancer Prostatitis Urinary tract infection Bladder cancer Treatment Medical α1-blockers (e.g., terazosin and tamsulosin) indication login to view 6 more bullets 5α-reductase inhibitors (e.g., finasteride) indication login to view 2 more bullets phosphodiesterase-5 inhibitors (e.g., sildenafil) indication login to view 1 more bullet Surgical transurethral resection of the prostate indication login to view 2 more bullets Complications UTI Nephrolithiasis Bladder stones Chronic kidney disease