Editing Benign prostatic hyperplasia

{{short description|Noncancerous increase in size of the prostate gland}}
[[File:Benign hyperplasia prostate; evidence or bladder neck obstruction.jpg|thumb|Benign hyperplasia prostate, evidence of bladder neck obstruction.]]
{{Use dmy dates|date=January 2021}}
{{Use American English|date=November 2017}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox medical condition (new)
| name = Benign prostatic hyperplasia
| synonyms = Benign enlargement of the prostate (BEP, BPE), adenofibromyomatous hyperplasia, benign prostatic hypertrophy,<ref name=NIH2014 /> benign prostatic obstruction<ref name=NIH2014 />
| image = Benign Prostatic Hyperplasia nci-vol-7137-300.jpg
| caption = Diagram of a normal [[prostate]] ''(left)'' and benign prostatic hyperplasia ''(right)''
| field = [[Urology]]
| symptoms = [[Frequent urination]], trouble starting to urinate, weak stream, [[urinary retention|inability to urinate]], [[urinary incontinence|loss of bladder control]]<ref name=NIH2014 />
| complications = [[Urinary tract infection]]s, [[bladder stone]]s, [[kidney failure]]<ref name=Kim2016 />
| onset = Age over 40<ref name=NIH2014 />
| duration =
| causes = Unclear<ref name=NIH2014 />
| risks = Family history, [[obesity]], [[type 2 diabetes]], not enough exercise, [[erectile dysfunction]]<ref name=NIH2014 />
| diagnosis = Based on symptoms and [[Physical examination|examination]] after ruling out other possible causes<ref name=Kim2016 />
| differential = [[Heart failure]], [[diabetes]], [[prostate cancer]]<ref name=Kim2016 />
| prevention =
| treatment = Lifestyle changes, medications, several procedures, surgery<ref name=NIH2014 /><ref name=Kim2016 />
| medication = [[Alpha blocker]]s such as [[terazosin]], [[5α-reductase inhibitor]]s such as [[finasteride]]<ref name=NIH2014 />
| prognosis =
| frequency = 94 million men affected globally (2019)<ref name=Awedew2022/>
| deaths =
}}
<!-- Definition and symptoms -->

'''Benign prostatic hyperplasia''' ('''BPH'''), also called '''prostate enlargement''', is a noncancerous increase in size of the [[prostate gland]].<ref name=NIH2014 /> Symptoms may include [[frequent urination]], trouble starting to urinate, weak stream, [[urinary retention|inability to urinate]], or [[urinary incontinence|loss of bladder control]].<ref name=NIH2014 /> Complications can include [[urinary tract infection]]s, [[bladder stone]]s, and [[chronic kidney problems]].<ref name=Kim2016>{{cite journal | vauthors = Kim EH, Larson JA, Andriole GL | title = Management of Benign Prostatic Hyperplasia | journal = Annual Review of Medicine | volume = 67 | pages = 137–151 | date = 2016 | pmid = 26331999 | doi = 10.1146/annurev-med-063014-123902 | doi-access = free | type = Review }}</ref>

<!-- Cause and pathophysiology -->
The cause is unclear.<ref name=NIH2014 /> Risk factors include a family history, [[obesity]], [[type 2 diabetes]], not enough exercise, and [[erectile dysfunction]].<ref name=NIH2014 /> Medications like [[pseudoephedrine]], [[anticholinergic]]s, and [[calcium channel blocker]]s may worsen symptoms.<ref name=Kim2016 /> The underlying mechanism involves the prostate pressing on the [[urethra]] thereby making it difficult to pass urine out of the [[bladder]].<ref name=NIH2014 /> Diagnosis is typically based on symptoms and [[Physical examination|examination]] after ruling out other possible causes.<ref name=Kim2016 />

<!-- Prevention and treatment -->
Treatment options include lifestyle changes, medications, a number of procedures, and surgery.<ref name=NIH2014/><ref name=Kim2016/> In those with mild symptoms, weight loss, decreasing [[caffeine]] intake, and exercise are recommended, although the quality of the evidence for exercise is low.<ref name=Kim2016/><ref>{{cite journal | vauthors = Silva V, Grande AJ, Peccin MS | title = Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 4 | pages = CD012044 | date = April 2019 | pmid = 30953341 | pmc = 6450803 | doi = 10.1002/14651858.CD012044.pub2 }}</ref> In those with more significant symptoms, medications may include [[alpha blocker]]s such as [[terazosin]] or [[5α-reductase inhibitor]]s such as [[finasteride]].<ref name=NIH2014>{{cite web |title = Prostate Enlargement (Benign Prostatic Hyperplasia) |url = https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia |website = NIDDK |access-date = 19 October 2017 |date = September 2014 |url-status = live |archive-url = https://web.archive.org/web/20171004190055/https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia |archive-date = 4 October 2017}}</ref> Surgical removal of part of the prostate may be carried out in those who do not improve with other measures.<ref name=Kim2016 /> Some [[herbal medicine]]s that have been studied, such as [[saw palmetto]], have not been shown to help.<ref name=Kim2016 /> Other herbal medicines somewhat effective at improving urine flow include [[beta-sitosterol]]<ref name="Wilt1999">{{cite journal | vauthors = Wilt T, Ishani A, MacDonald R, Stark G, Mulrow C, Lau J | title = Beta-sitosterols for benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 1999 | issue = 2 | pages = CD001043 | year = 1999 | pmid = 10796740 | pmc = 8407049 | doi = 10.1002/14651858.CD001043 | veditors = Wilt TJ }}</ref> from ''[[Hypoxis rooperi]]'' (African star grass), [[pygeum (herbal remedy)|pygeum]] (extracted from the bark of ''[[Prunus africana]]''),<ref name="Wilt1998">{{cite journal | vauthors = Wilt T, Ishani A, Mac Donald R, Rutks I, Stark G | title = Pygeum africanum for benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 1998 | issue = 1 | pages = CD001044 | year = 1998 | pmid = 11869585 | pmc = 7032619 | doi = 10.1002/14651858.CD001044 | veditors = Wilt TJ }}</ref> pumpkin seeds (''[[Cucurbita pepo]]''), and [[stinging nettle]] (''[[Urtica dioica]]'') root.<ref name="pmid11276294">{{cite journal | vauthors = Wilt TJ, Ishani A, Rutks I, MacDonald R | title = Phytotherapy for benign prostatic hyperplasia | journal = Public Health Nutrition | volume = 3 | issue = 4A | pages = 459–472 | date = December 2000 | pmid = 11276294 | doi = 10.1017/S1368980000000549 | doi-access = free }}</ref>

<!-- Epidemiology and prognosis -->
{{as of|lc=no|2019}}, about 94 million men aged 40 years and older are affected globally.<ref name=Awedew2022>{{cite journal | title = The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019 | journal = The Lancet. Healthy Longevity | volume = 3 | issue = 11 | pages = e754–e776 | date = November 2022 | pmid = 36273485 | pmc = 9640930 | doi = 10.1016/S2666-7568(22)00213-6 | vauthors = Awedew AF, Han H, Abbasi B, Abbasi-Kangevari M, Ahmed MB, Almidani O, Amini E, Arabloo J, Argaw AM, Athari SS, Atlaw D, Banach M, Barrow A, Bhagavathula AS, Bhojaraja VS, Bikbov B, Bodicha BB, Butt NS, Caetano Dos Santos FL, Dadras O, Dai X, Doan LP, Eftekharzadeh S, Fatehizadeh A, Garg T, Gebremeskel TG, Getachew ME, Ghamari S, Gilani SA, Golechha M | collaboration = GBD 2019 Benign Prostatic Hyperplasia Collaborators }}</ref> BPH typically begins after the age of 40.<ref name=NIH2014 /> The [[prevalence]] of clinically diagnosed BPH peaks at 24% in men aged 75–79 years.<ref name=Awedew2022/> Based on [[autopsy]] studies, half of males aged 50 and over are affected, and this figure climbs to 80% after the age of 80.<ref name=Awedew2022/> Although [[prostate specific antigen]] levels may be elevated in males with BPH, the condition does not increase the risk of [[prostate cancer]].<ref>{{cite journal | vauthors = Chang RT, Kirby R, Challacombe BJ | title = Is there a link between BPH and prostate cancer? | journal = The Practitioner | volume = 256 | issue = 1750 | pages = 13–6, 2 | date = April 2012 | pmid = 22792684 }}</ref>
[[File:NHS-prevalence.png|none|thumb|400x400px|The prevalence of enlarged prostate, and symptoms of an enlarged prostate, in men of different ages.<ref>{{cite journal | vauthors = Berry SJ, Coffey DS, Walsh PC, Ewing LL | title = The development of human benign prostatic hyperplasia with age | journal = The Journal of Urology | volume = 132 | issue = 3 | pages = 474–479 | date = September 1984 | pmid = 6206240 | doi = 10.1016/S0022-5347(17)49698-4 }}</ref><ref>{{cite journal | vauthors = Chute CG, Panser LA, Girman CJ, Oesterling JE, Guess HA, Jacobsen SJ, Lieber MM | title = The prevalence of prostatism: a population-based survey of urinary symptoms | journal = The Journal of Urology | volume = 150 | issue = 1 | pages = 85–89 | date = July 1993 | pmid = 7685427 | doi = 10.1016/S0022-5347(17)35405-8 }}</ref>

Graphic from NHS England.<ref name="www.england.nhs.uk">{{Cite web |title=NHS England » Decision support tool: making a decision about enlarged prostate (BPE) |url=https://www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-enlarged-prostate-bpe/ |access-date=2024-09-08 |website=www.england.nhs.uk}}</ref>]]
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== Signs and symptoms ==
[[File:Benign Prostatic Hyperplasia (BPH).png|thumb|upright=1.36]]
BPH is the most common cause of [[lower urinary tract symptoms]] (LUTS), which are divided into storage, [[voiding]], and symptoms which occur after urination.<ref>{{citation |title = Lower urinary tract symptoms in men: management |publisher = NICE (National Institute for Health and Care Excellence) }}</ref> Storage symptoms include the need to urinate frequently, [[nocturia|waking at night to urinate]], [[urinary urgency|urgency]] (compelling need to void that cannot be deferred), [[Urinary incontinence|involuntary urination]], including involuntary urination at night, or [[urge incontinence]] (urine leak following a strong sudden need to urinate).<ref>{{cite web |title = Urge incontinence |url = https://www.nlm.nih.gov/medlineplus/ency/article/001270.htm |website = MedlinePlus |publisher = US National Library of Medicine |access-date = 26 October 2015 |url-status = live |archive-url = https://web.archive.org/web/20151006031743/https://www.nlm.nih.gov/medlineplus/ency/article/001270.htm |archive-date = 6 October 2015}}</ref> Voiding symptoms include [[urinary hesitancy]] (a delay between trying to urinate and the flow actually beginning), intermittency (not continuous),<ref>{{cite book | chapter = Incontinence and Stream Abnormalities | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK295/ | title = Clinical Methods: The History, Physical, and Laboratory Examinations | edition = 3rd | location = Boston | publisher = Butterworths | date = 1990 | pmid = 21250138 | vauthors = White JR, O'Brien III DP, Walker HK, Hall WD, Hurst JW | isbn = 9780409900774 }}</ref> involuntary interruption of voiding, weak urinary stream, straining to void, a sensation of incomplete emptying, and uncontrollable leaking after the end of urination.<ref>{{cite journal | vauthors = Robinson J | title = Post-micturition dribble in men: causes and treatment | journal = Nursing Standard | volume = 22 | issue = 30 | pages = 43–46 | date = 11 February 2008 | pmid = 18459613 | doi = 10.7748/ns2008.04.22.30.43.c6440 }}</ref><ref>{{cite journal | vauthors = Sarma AV, Wei JT | title = Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms | journal = The New England Journal of Medicine | volume = 367 | issue = 3 | pages = 248–257 | date = July 2012 | pmid = 22808960 | doi = 10.1056/nejmcp1106637 }}</ref><ref>{{cite web |title = Urination – difficulty with flow |url = https://www.nlm.nih.gov/medlineplus/ency/article/003143.htm |website = MedlinePlus |publisher = US National Library of Medicine |access-date = 26 October 2015 |url-status = live |archive-url = https://web.archive.org/web/20151006115737/https://www.nlm.nih.gov/medlineplus/ency/article/003143.htm |archive-date = 6 October 2015}}</ref> These symptoms may be accompanied by bladder pain or pain while urinating, called [[dysuria]].<ref>{{cite web |title = Urination – painful |url = https://www.nlm.nih.gov/medlineplus/ency/article/003145.htm |website = MedlinePlus |publisher = US National Library of Medicine |access-date = 26 October 2015 |url-status = live |archive-url = https://web.archive.org/web/20151006110537/https://www.nlm.nih.gov/medlineplus/ency/article/003145.htm |archive-date = 6 October 2015}}</ref>

[[Bladder outlet obstruction]] (BOO) can be caused by BPH.<ref>{{cite web |title = Bladder outlet obstruction |url = https://www.nlm.nih.gov/medlineplus/ency/article/002238.htm |website = MedlinePlus |publisher = US National Library of Medicine |access-date = 26 October 2015 |url-status = live |archive-url = https://web.archive.org/web/20151006110511/https://www.nlm.nih.gov/medlineplus/ency/article/002238.htm |archive-date = 6 October 2015}}</ref> Symptoms are abdominal pain, a continuous feeling of a full bladder, frequent urination, acute urinary retention (inability to urinate), pain during urination (dysuria), problems starting urination (urinary hesitancy), slow urine flow, starting and stopping (urinary intermittency), and nocturia.<ref>{{cite web |url= https://www.lecturio.com/concepts/benign-prostatic-hyperplasia/ | title= Benign Prostatic Hyperplasia
| website= The Lecturio Medical Concept Library |access-date= 5 July 2021}}</ref>

BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in residual urine or urinary stasis, which can lead to an increased risk of [[urinary tract infection]].<ref>{{cite journal | vauthors = Truzzi JC, Almeida FM, Nunes EC, Sadi MV | title = Residual urinary volume and urinary tract infection--when are they linked? | journal = The Journal of Urology | volume = 180 | issue = 1 | pages = 182–185 | date = July 2008 | pmid = 18499191 | doi = 10.1016/j.juro.2008.03.044 }}</ref>

== Causes ==
=== Hormones ===
Most experts consider [[androgen]]s ([[testosterone]] and related [[hormone]]s) to play a permissive role in the development of BPH. This means that androgens must be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by evidence suggesting that [[castration|castrated]] boys do not develop BPH when they age. In a study of 26 [[eunuch]]s from the palace of the [[Qing dynasty]] still living in [[Beijing]] in 1960, the prostate could not be felt in 81% of the studied eunuchs.<ref>{{cite journal | vauthors = Wu CP, Gu FL | title = The prostate in eunuchs | journal = Progress in Clinical and Biological Research | volume = 370 | pages = 249–255 | date = 1991 | pmid = 1924456 }}</ref> The average time since castration was 54 years (range, 41–65 years). On the other hand, some studies suggest that administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms, so the role of testosterone in prostate cancer and BPH is still unclear. Further randomized controlled trials with more participants are needed to quantify any risk of giving exogenous testosterone.<ref>{{cite web |title = Testosterone and Aging: Clinical Research Directions. |url = https://www.ncbi.nlm.nih.gov/books/NBK216175/ |publisher = NCBI Bookshelf |access-date = 2 February 2015 |url-status = live |archive-url = https://web.archive.org/web/20171105194336/https://www.ncbi.nlm.nih.gov/books/NBK216175/ |archive-date = 5 November 2017}}</ref>

[[Dihydrotestosterone]] (DHT), a [[metabolite]] of testosterone, is a critical mediator of prostatic growth. DHT is synthesized in the prostate from circulating testosterone by the action of the [[enzyme]] [[5α-reductase]], type 2. DHT can act in an [[autocrine]] fashion on the stromal cells or in [[paracrine]] fashion by diffusing into nearby [[epithelium|epithelial cells]]. In both of these cell types, DHT binds to nuclear [[androgen receptor]]s and signals the [[Transcription (genetics)|transcription]] of [[growth factor]]s that are mitogenic to the epithelial and stromal cells. DHT is ten times more potent than testosterone because it dissociates from the androgen receptor more slowly. The importance of DHT in causing [[nodule (medicine)|nodular]] hyperplasia is supported by clinical observations in which an [[Enzyme inhibitor|inhibitor]] of 5α-reductase such as [[finasteride]] is given to men with this condition. Therapy with a 5α-reductase inhibitor markedly reduces the DHT content of the prostate and, in turn, reduces prostate volume and BPH symptoms.<ref>{{cite web |title = Proscar (finasteride) Prescribing Information |url = http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020180s037lbl.pdf |website = FDA – Drug Documents |publisher = Merck and Company |access-date = 2 March 2015 |url-status = live |archive-url = https://web.archive.org/web/20160303231752/http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020180s037lbl.pdf |archive-date = 3 March 2016}}</ref><ref>{{cite journal | vauthors = Bartsch G, Rittmaster RS, Klocker H | title = Dihydrotestosterone and the concept of 5alpha-reductase inhibition in human benign prostatic hyperplasia | journal = World Journal of Urology | volume = 19 | issue = 6 | pages = 413–425 | date = April 2002 | pmid = 12022710 | doi = 10.1007/s00345-002-0248-5 | s2cid = 3257666 }}</ref>

Testosterone promotes prostate cell proliferation,<ref name="Feldman2001">{{cite journal | vauthors = Feldman BJ, Feldman D | title = The development of androgen-independent prostate cancer | journal = Nature Reviews. Cancer | volume = 1 | issue = 1 | pages = 34–45 | date = October 2001 | pmid = 11900250 | doi = 10.1038/35094009 | s2cid = 205020623 }}</ref> but relatively low levels of serum testosterone are found in patients with BPH.<ref name="Lagiou1997">{{cite journal | vauthors = Lagiou P, Mantzoros CS, Tzonou A, Signorello LB, Lipworth L, Trichopoulos D | title = Serum steroids in relation to benign prostatic hyperplasia | journal = Oncology | volume = 54 | issue = 6 | pages = 497–501 | year = 1997 | pmid = 9394847 | doi = 10.1159/000227609 }}</ref><ref name="Roberts2004">{{cite journal | vauthors = Roberts RO, Jacobson DJ, Rhodes T, Klee GG, Leiber MM, Jacobsen SJ | title = Serum sex hormones and measures of benign prostatic hyperplasia | journal = The Prostate | volume = 61 | issue = 2 | pages = 124–131 | date = October 2004 | pmid = 15305335 | doi = 10.1002/pros.20080 | s2cid = 24288565 }}</ref> One small study has shown that medical castration lowers the serum and prostate hormone levels unevenly, having less effect on testosterone and dihydrotestosterone levels in the prostate.<ref name="Page2006">{{cite journal | vauthors = Page ST, Lin DW, Mostaghel EA, Hess DL, True LD, Amory JK, Nelson PS, Matsumoto AM, Bremner WJ | title = Persistent intraprostatic androgen concentrations after medical castration in healthy men | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 91 | issue = 10 | pages = 3850–3856 | date = October 2006 | pmid = 16882745 | doi = 10.1210/jc.2006-0968 | doi-access = free }}</ref>

Besides testosterone and DHT, other androgens are also known to play a crucial role in BPH development. {{chem|C|21}} 11-oxygenated steroids (pregnanes) have been identified are precursors to 11-oxygenated androgens which are also potent agonists for the androgen receptor.<ref name="pmid18308097">{{cite journal | vauthors = Dimitrakov J, Joffe HV, Soldin SJ, Bolus R, Buffington CA, Nickel JC | title = Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome | journal = Urology | volume = 71 | issue = 2 | pages = 261–266 | date = February 2008 | pmid = 18308097 | pmc = 2390769 | doi = 10.1016/j.urology.2007.09.025 }}</ref> Specifically, steroids like [[11β-hydroxyprogesterone]] and [[11-ketoprogesterone]] can be converted to [[11-ketodihydrotestosterone]], an 11-oxo form of DHT with the same potency. These precursors have also been detected in tissue [[biopsy]] samples from patients with BPH, as well as in their serum levels.<ref name="pmid31626910">{{cite journal | vauthors = du Toit T, Swart AC | title = The 11β-hydroxyandrostenedione pathway and C11-oxy C<sub>21</sub> backdoor pathway are active in benign prostatic hyperplasia yielding 11keto-testosterone and 11keto-progesterone | journal = The Journal of Steroid Biochemistry and Molecular Biology | volume = 196 | pages = 105497 | date = February 2020 | pmid = 31626910 | doi = 10.1016/j.jsbmb.2019.105497 | s2cid = 204734045 }}</ref><ref name="pmid35987379">{{cite journal | vauthors = Masiutin MG, Yadav MK | title = "Re: Adrenocortical Hormone Abnormalities in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome" | language = English | journal = Urology | volume = 169 | pages = 273 | date = November 2022 | pmid = 35987379 | doi = 10.1016/j.urology.2022.07.051 | s2cid = 251657694 }}</ref><ref name="pmid35985522">{{cite journal | vauthors = Dimitrakoff J, Nickel JC | title = Author Reply | language = English | journal = Urology | volume = 169 | pages = 273–274 | date = November 2022 | pmid = 35985522 | doi = 10.1016/j.urology.2022.07.049 | s2cid = 251658492 }}</ref> Besides that, androgens biosynthesized via a [[androgen backdoor pathway|backdoor pathway]] can contribute to the development of BPH.<ref name="pmid31626910"/>

While there is some evidence that estrogen may play a role in the cause of BPH, this effect appears to be mediated mainly through local conversion of androgens to estrogen in the prostate tissue rather than a direct effect of estrogen itself.<ref name="Ho2008">{{cite journal | vauthors = Ho CK, Nanda J, Chapman KE, Habib FK | title = Oestrogen and benign prostatic hyperplasia: effects on stromal cell proliferation and local formation from androgen | journal = The Journal of Endocrinology | volume = 197 | issue = 3 | pages = 483–491 | date = June 2008 | pmid = 18492814 | doi = 10.1677/JOE-07-0470 | doi-access = free }}</ref> In canine ''in vivo'' studies castration, which significantly reduced androgen levels but left estrogen levels unchanged, caused significant atrophy of the prostate.<ref name="Niu2003">{{cite journal | vauthors = Niu YJ, Ma TX, Zhang J, Xu Y, Han RF, Sun G | title = Androgen and prostatic stroma | journal = Asian Journal of Andrology | volume = 5 | issue = 1 | pages = 19–26 | date = March 2003 | pmid = 12646998 }}</ref> Studies looking for a correlation between prostatic hyperplasia and serum estrogen levels in humans have generally shown none.<ref name="Roberts2004" /><ref name="Ansari2008">{{cite journal | vauthors = Ansari MA, Begum D, Islam F | title = Serum sex steroids, gonadotrophins and sex hormone-binding globulin in prostatic hyperplasia | journal = Annals of Saudi Medicine | volume = 28 | issue = 3 | pages = 174–178 | year = 2008 | pmid = 18500180 | pmc = 6074428 | doi = 10.4103/0256-4947.51727 | doi-access = free }}</ref>

In 2008, Gat et al. published evidence that BPH is caused by failure in the spermatic venous drainage system resulting in increased hydrostatic pressure and local testosterone levels elevated more than 100-fold above serum levels.<ref name="pmid18811916">{{cite journal | vauthors = Gat Y, Gornish M, Heiblum M, Joshua S | title = Reversal of benign prostate hyperplasia by selective occlusion of impaired venous drainage in the male reproductive system: novel mechanism, new treatment | journal = Andrologia | volume = 40 | issue = 5 | pages = 273–281 | date = October 2008 | pmid = 18811916 | doi = 10.1111/j.1439-0272.2008.00883.x | s2cid = 205442245 | doi-access = free }}</ref> If confirmed, this mechanism explains why serum androgen levels do not seem to correlate with BPH and why giving exogenous testosterone would not make much difference.

=== Diet ===
Studies indicate that dietary patterns may affect the development of BPH, but further research is needed to clarify any important relationship.<ref>{{cite journal | vauthors = Heber D | title = Prostate enlargement: the canary in the coal mine? | journal = The American Journal of Clinical Nutrition | volume = 75 | issue = 4 | pages = 605–606 | date = April 2002 | pmid = 11916745 | doi = 10.1093/ajcn/75.4.605 | doi-access = free }}<!--|access-date=1 March 2015--></ref> Studies from China suggest that greater protein intake may be a factor in the development of BPH. Men older than 60 in rural areas had very low rates of clinical BPH, while men living in cities and consuming more animal protein had a higher incidence.<ref>{{cite journal | vauthors = Zhang SX, Yu B, Guo SL, Wang YW, Yin CK | title = [Comparison of incidence of BPH and related factors between urban and rural inhabitants in district of Wannan] | journal = Zhonghua Nan Ke Xue = National Journal of Andrology | volume = 9 | issue = 1 | pages = 45–47 | date = February 2003 | pmid = 12680332 }}</ref><ref>{{cite journal | vauthors = Gu F | title = Changes in the prevalence of benign prostatic hyperplasia in China | journal = Chinese Medical Journal | volume = 110 | issue = 3 | pages = 163–166 | date = March 1997 | pmid = 9594331 }}</ref> On the other hand, a study in Japanese-American men in Hawaii found a strong negative association with alcohol intake, but a weak positive association with beef intake.<ref>{{cite journal | vauthors = Chyou PH, Nomura AM, Stemmermann GN, Hankin JH | title = A prospective study of alcohol, diet, and other lifestyle factors in relation to obstructive uropathy | journal = The Prostate | volume = 22 | issue = 3 | pages = 253–264 | date = 1993 | pmid = 7683816 | doi = 10.1002/pros.2990220308 | s2cid = 32639108 }}</ref> In a large prospective cohort study in the US (the Health Professionals Follow-up Study), investigators reported modest associations between BPH (men with strong symptoms of BPH or surgically confirmed BPH) and total energy and protein, but not fat intake.<ref>{{cite journal | vauthors = Suzuki S, Platz EA, Kawachi I, Willett WC, Giovannucci E | title = Intakes of energy and macronutrients and the risk of benign prostatic hyperplasia | journal = The American Journal of Clinical Nutrition | volume = 75 | issue = 4 | pages = 689–697 | date = April 2002 | pmid = 11916755 | doi = 10.1093/ajcn/75.4.689 | doi-access = free }}</ref> There is also epidemiological evidence linking BPH with [[metabolic syndrome]] (concurrent [[obesity]], impaired glucose metabolism and [[diabetes]], [[hypertriglyceridemia|high triglyceride levels]], high levels of low-density cholesterol, and [[hypertension]]).<ref>{{cite journal | vauthors = Gacci M, Corona G, Vignozzi L, Salvi M, Serni S, De Nunzio C, Tubaro A, Oelke M, Carini M, Maggi M | title = Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis | journal = BJU International | volume = 115 | issue = 1 | pages = 24–31 | date = January 2015 | pmid = 24602293 | doi = 10.1111/bju.12728 | hdl-access = free | s2cid = 22937831 | doi-access = free | hdl = 2158/953282 }}</ref>

=== Degeneration ===
Benign prostatic hyperplasia is an age-related disease. Misrepair-accumulation aging theory<ref>{{cite journal | vauthors = Wang J, Michelitsch T, Wunderlin A, Mahadeva R | title = Aging as a consequence of misrepair--A novel theory of aging. | journal = Nature Precedings | date = March 2009 | doi = 10.1038/npre.2009.2988.1 | doi-access = free | arxiv = 0904.0575 }}</ref> suggests that the development of benign prostatic hyperplasia is a consequence of [[fibrosis]] and weakening of the muscular tissue in the prostate.<ref>{{cite arXiv |title = Tissue fibrosis: a principal evidence for the central role of Misrepairs in aging | vauthors = Wang-Michelitsch J, Michelitsch T |year = 2015 |class = cs.DM |eprint = 1503.01376 }}</ref> The muscular tissue is important in the functionality of the prostate, and provides the force for excreting the fluid produced by prostatic glands. However, repeated contractions and dilations of myofibers will unavoidably cause injuries and broken myofibers. Myofibers have a low potential for regeneration; therefore, collagen fibers need to be used to replace the broken myofibers. Such misrepairs make the muscular tissue weak in functioning, and the fluid secreted by glands cannot be excreted completely. Then, the accumulation of fluid in glands increases the resistance of muscular tissue during the movements of contractions and dilations, and more and more myofibers will be broken and replaced by collagen fibers.<ref>{{cite journal | vauthors = Roehrborn CG | title = Benign prostatic hyperplasia: an overview | journal = Reviews in Urology | volume = 7 | issue = Suppl 9 | pages = S3–S14 | date = 2005 | pmid = 16985902 | pmc = 1477638 }}</ref>

== Pathophysiology ==
[[File:Benign prostate hyperplasia.jpg|thumb|right|Benign prostate hyperplasia]]
As men age, the enzymes [[aromatase]] and [[5-alpha reductase]] increase in activity. These enzymes are responsible for converting androgen hormones into [[estrogen]] and [[dihydrotestosterone]], respectively. This metabolism of androgen hormones leads to a decrease in testosterone but increased levels of DHT and estrogen.

Both the glandular epithelial cells and the stromal cells (including muscular fibers) undergo hyperplasia in BPH.<ref name="Kim2016" /> Most sources agree that of the two tissues, stromal hyperplasia predominates, but the exact ratio of the two is unclear.<ref name=Wasserman>{{cite journal | vauthors = Wasserman NF | title = Benign prostatic hyperplasia: a review and ultrasound classification | journal = Radiologic Clinics of North America | volume = 44 | issue = 5 | pages = 689–710, viii | date = September 2006 | pmid = 17030221 | doi = 10.1016/j.rcl.2006.07.005 }}</ref>{{rp|694}}

Anatomically the median and lateral lobes are usually enlarged, due to their highly glandular composition. The anterior lobe has little in the way of glandular tissue and is seldom enlarged. (Carcinoma of the prostate typically occurs in the posterior lobe – hence the ability to discern an irregular outline per rectal examination). The earliest microscopic signs of BPH usually begin between the age of 30 and 50 years old in the PUG, which is posterior to the proximal urethra.<ref name=Wasserman />{{rp|694}} In BPH, the majority of growth occurs in the transition zone (TZ) of the prostate.<ref name=Wasserman />{{rp|694}} In addition to these two classic areas, the peripheral zone (PZ) is also involved to a lesser extent.<ref name=Wasserman />{{rp|695}} Prostatic cancer typically occurs in the PZ. However, BPH nodules, usually from the TZ are often biopsied anyway to rule out cancer in the TZ.<ref name=Wasserman />{{rp|695}} BPH can be a progressive growth that in rare instances leads to exceptional enlargement.<ref name=Sch2011/> In some males, the prostate enlargement exceeds 200 to 500 grams.<ref name=Sch2011>{{cite journal | vauthors = Ojewola RW, Tijani KH, Fatuga AL, Onyeze CI, Okeke CJ | title = Management of a giant prostatic enlargement: Case report and review of the literature | journal = The Nigerian Postgraduate Medical Journal | volume = 27 | issue = 3 | pages = 242–247 | year = 2020 | pmid = 32687126 | doi = 10.4103/npmj.npmj_69_20 | publisher = Medknow | s2cid = 220652018 | doi-access = free }}</ref> This condition has been defined as giant prostatic hyperplasia (GPH).<ref name=Sch2011/>

== Diagnosis ==
The clinical diagnosis of BPH is based on a history of LUTS (lower urinary tract symptoms), a digital rectal exam, and the exclusion of other causes of similar signs and symptoms. The degree of LUTS does not necessarily correspond to the size of the prostate. An enlarged prostate gland on [[rectal examination]] that is symmetric and smooth supports a diagnosis of BPH.<ref name="Kim2016" /> However, if the prostate gland feels asymmetrical, firm, or nodular, this raises concern for prostate cancer.<ref name="Kim2016" />

Validated questionnaires such as the American Urological Association Symptom Index (AUA-SI), the [[International Prostate Symptom Score]] (I-PSS), and more recently the UWIN score (urgency, weak stream, incomplete emptying, and nocturia) are useful aids to making the diagnosis of BPH and quantifying the severity of symptoms.<ref name="Kim2016" /><ref>{{cite journal | vauthors = Parsons JK | title = Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors | journal = Current Bladder Dysfunction Reports | volume = 5 | issue = 4 | pages = 212–218 | date = December 2010 | pmid = 21475707 | pmc = 3061630 | doi = 10.1007/s11884-010-0067-2 }}</ref><ref>{{cite journal | vauthors = Eid K, Krughoff K, Stoimenova D, Smith D, Phillips J, O'Donnell C, Barqawi A | title = Validation of the Urgency, Weak stream, Incomplete emptying, and Nocturia (UWIN) score compared with the American Urological Association Symptoms Score in assessing lower urinary tract symptoms in the clinical setting | journal = Urology | volume = 83 | issue = 1 | pages = 181–185 | date = January 2014 | pmid = 24139351 | doi = 10.1016/j.urology.2013.08.039 }}</ref>

===Laboratory investigations===
[[Urinalysis]] is typically performed when LUTS are present and BPH is suspected to evaluate for signs of a urinary tract infection, [[glycosuria|glucose in the urine]] (suggestive of diabetes), or [[proteinuria|protein in the urine]] (suggestive of kidney disease).<ref name="Kim2016" /> Bloodwork including [[Renal function|kidney function tests]] and [[prostate specific antigen]] (PSA) are often ordered to evaluate for kidney damage and prostate cancer, respectively.<ref name="Kim2016" /> However, checking blood PSA levels for [[prostate cancer screening]] is controversial and not necessarily indicated in every evaluation for BPH.<ref name="Kim2016" /> Benign prostatic hyperplasia and prostate cancer are both capable of increasing blood PSA levels and PSA elevation is unable to differentiate these two conditions well.<ref name="Kim2016" /> If PSA levels are checked and are high, then further investigation is warranted. Measures including PSA density, free PSA, rectal examination, and transrectal [[medical ultrasonography|ultrasonography]] may help determine whether a PSA increase is due to BPH or prostate cancer.<ref name="Kim2016" />

===Imaging and other investigations===
Uroflowmetry is done to measure the rate of urine flow and total volume of urine voided when the subject is urinating.<ref name="pmid30614059">{{cite journal | vauthors = Gammie A, Drake MJ | title = The fundamentals of uroflowmetry practice, based on International Continence Society good urodynamic practices recommendations | journal = Neurourology and Urodynamics | volume = 37 | issue = S6 | pages = S44–S49 | date = August 2018 | pmid = 30614059 | doi = 10.1002/nau.23777 | s2cid = 58586667 | doi-access = free }}</ref>

Abdominal ultrasound examination of the prostate and [[kidney]]s is often performed to rule out [[hydronephrosis]] and hydroureter. Incidentally, cysts, tumours, and stones may be found on ultrasound. [[Urinary retention#Diagnosis|Post-void residual volume]] of more than 100 ml may indicate significant obstruction.<ref>{{Cite journal | vauthors = Foo KT |date=June 2013 |title=The Role of Transabdominal Ultrasound in Office Urology |journal=Proceedings of Singapore Healthcare |language=en |volume=22 |issue=2 |pages=125–130 |doi=10.1177/201010581302200208 |s2cid=74205747 |issn=2010-1058|doi-access=free }}</ref> Prostate size of 30 cc or more indicates enlargement of the prostate.<ref name="pmid31340802">{{cite journal | vauthors = Aprikian S, Luz M, Brimo F, Scarlata E, Hamel L, Cury FL, Tanguay S, Aprikian AG, Kassouf W, Chevalier S | title = Improving ultrasound-based prostate volume estimation | journal = BMC Urology | volume = 19 | issue = 1 | pages = 68 | date = July 2019 | pmid = 31340802 | pmc = 6657110 | doi = 10.1186/s12894-019-0492-2 | doi-access = free }}</ref>

[[Prostatic calculi|Prostatic calcification]] can be detected through transrectal ultrasound (TRUS). Calcification is due to solidification of prostatic secretions or calcified [[corpora amylacea]] ([[hyaline]] masses on the prostate gland). Calcification is also found in a variety of other conditions such as prostatitis, [[Chronic prostatitis/chronic pelvic pain syndrome|chronic pelvic pain syndrome]], and prostate cancer.<ref>{{cite journal | vauthors = Kitzing YX, Prando A, Varol C, Karczmar GS, Maclean F, Oto A | title = Benign Conditions That Mimic Prostate Carcinoma: MR Imaging Features with Histopathologic Correlation | journal = Radiographics | volume = 36 | issue = 1 | pages = 162–175 | date = January 2016 | pmid = 26587887 | pmc = 5496681 | doi = 10.1148/rg.2016150030 }}</ref><ref>{{cite journal | vauthors = Singh S, Martin E, Tregidgo HF, Treeby B, Bandula S | title = Prostatic calcifications: Quantifying occurrence, radiodensity, and spatial distribution in prostate cancer patients | journal = Urologic Oncology | volume = 39 | issue = 10 | pages = 728.e1–728.e6 | date = October 2021 | pmid = 33485763 | pmc = 8492071 | doi = 10.1016/j.urolonc.2020.12.028 }}</ref> For those with elevated levels of PSA, TRUS guided biopsy is performed to take a sample of the prostate for investigation.<ref name="pmid20199941">{{cite journal | vauthors = Mitterberger M, Horninger W, Aigner F, Pinggera GM, Steppan I, Rehder P, Frauscher F | title = Ultrasound of the prostate | journal = Cancer Imaging | volume = 10 | issue = 1 | pages = 40–48 | date = March 2010 | pmid = 20199941 | pmc = 2842183 | doi = 10.1102/1470-7330.2010.0004 }}</ref> Although MRI is more accurate than TRUS in determining prostate volume, TRUS is less expensive and almost as accurate as MRI. Therefore, TRUS is still preferred to measure prostate volume.<ref name="pmid17495490">{{cite journal | vauthors = Lee JS, Chung BH | title = Transrectal ultrasound versus magnetic resonance imaging in the estimation of prostate volume as compared with radical prostatectomy specimens | journal = Urologia Internationalis | volume = 78 | issue = 4 | pages = 323–327 | date = 2007 | pmid = 17495490 | doi = 10.1159/000100836 | s2cid = 10731245 }}</ref>

=== Differential diagnosis ===
==== Medical conditions ====
The differential diagnosis for LUTS is broad and includes various medical conditions, neurologic disorders, and other diseases of the bladder, urethra, and prostate such as [[bladder cancer]], urinary tract infection, [[urethral stricture]], [[Ureterolithiasis|urethral calculi (stones)]], [[chronic prostatitis/chronic pelvic pain syndrome|chronic prostatitis]], and prostate cancer.<ref name="Kim2016" /> [[Neurogenic bladder]] can cause urinary retention and cause symptoms similar to those of BPH. This may occur as a result of uncoordinated contraction of the bladder muscle or impairment in the timing of bladder muscle contraction and urethral sphincter relaxation.<ref name="Kim2016" /> Notable causes of neurogenic bladder include disorders of the [[central nervous system]] such as [[Parkinson's disease]], [[multiple sclerosis]], and [[spinal cord injury|spinal cord injuries]] as well as disorders of the peripheral nervous system such as [[diabetes mellitus]], [[vitamin B12 deficiency]], and [[alcoholic neuropathy|alcohol-induced nerve damage]].<ref name="Kim2016" /> Individuals affected by [[heart failure]] often experience nighttime awakenings to urinate due to redistribution of fluid accumulated in swollen legs.<ref name="Kim2016" />

==== Medications ====
Certain medications can increase urination difficulties by increasing bladder outlet resistance due to increased [[smooth muscle]] tone at the prostate or bladder neck and contribute to LUTS.<ref name="Kim2016" /> [[Alpha-adrenergic agonist]] medications, such as [[decongestant]]s with [[pseudoephedrine]] can increase bladder outlet resistance.<ref name="Kim2016" /> In contrast, [[calcium channel blocker]]s and [[anticholinergic]] medications can worsen urinary retention by promoting bladder muscle relaxation.<ref name="Kim2016" /> Diuretic medications such as [[loop diuretic]]s (e.g., [[furosemide]]) or [[thiazide]]s (e.g., [[chlorthalidone]]) can cause or worsen urinary frequency and nighttime awakenings to urinate.<ref name="Kim2016" />

<gallery class="center">
File:Nodular hyperplasia of the prostate.jpg|[[Micrograph]] showing nodular hyperplasia (left off center) of the prostate from a [[transurethral resection of the prostate]] (TURP). [[H&E stain]].
File:Prostate histology.jpg|Microscopic examination of different types of prostate tissues (stained with [[immunohistochemistry|immuno{{shy}}histochemical]] techniques): A. Normal (non-neoplastic) prostatic tissue (NNT). B. Benign prostatic hyperplasia. C. [[High-grade prostatic intraepithelial neoplasia]]. D. [[Prostatic adenocarcinoma]] (PCA).
</gallery>

== Management ==
When treating and managing benign prostatic hyperplasia, the aim is to prevent complications related to the disease and improve or relieve symptoms.<ref name="Hwang_2018">{{cite journal | vauthors = Hwang EC, Gandhi S, Jung JH, Imamura M, Kim MH, Pang R, Dahm P | title = Naftopidil for the treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 10 | pages = CD007360 | date = October 2018 | pmid = 30306544 | pmc = 6516835 | doi = 10.1002/14651858.CD007360.pub3 }}</ref> Approaches used include lifestyle modifications, medications, catheterization, and surgery.

=== Lifestyle ===
[[File:NHS-thingstotry.png|alt=If you suffer symptoms, gradually train your bladder. Hold on when you need to pee and delay for longer each time. Do this slowly over several weeks. Try to pee in succession. This is where you wait a few moments after you have finished peeing and try again. It can help you empty your bladder properly. Use pads or a sheath to absorb leaks or dribbles. Pads can be worn inside underwear or replace underwear. Try to maintain a healthy weight. Being overweight can make your symptoms worse. If you have dribbling after peeing. Pelvic floor exercises can help. Manually push out the last few drops of urine (pee). After peeing, wait a few seconds, place your fingertips behind your scrotum, and gently massage forwards and upwards. Repeat twice.|thumb|Things that you can try if you have symptoms of an enlarged prostate, according to the NHS in England<ref name="www.england.nhs.uk" />.]]
[[File:NHS-thingstoavoid.png|alt=Drink fewer drinks with artificial sweeteners, and drink less alcohol. These can affect the bladder. Avoid caffeine completely. Caffeine can irritate the bladder lining which can make you want to pee urgently and cause leakage. It can take 4 – 6 weeks of completely avoiding caffeine to see a difference in symptoms. Fruit juices can sometimes make symptoms worse. This is because they are acidic and can irritate the bladder, especially if you have had prostate surgery. Avoid being constipated. It can put pressure on your bladder. Include fibre in your diet such as fruit, vegetables, beans, and whole grains. Avoid medicines with decongestants or antihistamines. These can make symptoms worse.|thumb|400x400px|Things to avoid if you have symptoms of an enlarged prostate, according to the NHS in England<ref name="www.england.nhs.uk" />.]]
Lifestyle alterations to address the symptoms of BPH include physical activity,<ref>{{cite journal | vauthors = Silva V, Grande AJ, Peccin MS | title = Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 4 | pages = CD012044 | date = April 2019 | pmid = 30953341 | pmc = 6450803 | doi = 10.1002/14651858.CD012044.pub2 }}</ref> decreasing fluid intake before bedtime, moderating the consumption of alcohol and caffeine-containing products, and following a timed voiding schedule.

Patients can also attempt to avoid products and medications with [[anticholinergic]] properties that may exacerbate urinary retention symptoms of BPH, including [[antihistamine]]s, [[decongestant]]s, [[opioid]]s, and [[tricyclic antidepressant]]s; however, changes in medications should be done with input from a medical professional.<ref>{{cite web |title = Benign prostatic hyperplasia |url = http://umm.edu/health/medical/reports/articles/benign-prostatic-hyperplasia |publisher = University of Maryland Medical Center |archive-url = https://web.archive.org/web/20170425092640/http://umm.edu/health/medical/reports/articles/benign-prostatic-hyperplasia |archive-date = 25 April 2017 }}</ref>

==== Physical activity ====
Physical activity has been recommended as a treatment for urinary tract symptoms. A 2019 Cochrane review of six studies involving 652 men assessing the effects of physical activity alone, and physical activity as a part of a self-management program, among others.  However, the quality of evidence was very low and therefore it remains uncertain whether physical activity is helpful in men experiencing urinary symptoms caused by benign prostatic hyperplasia.<ref>{{cite journal | vauthors = Silva V, Grande AJ, Peccin MS | title = Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 4 | pages = CD012044 | date = April 2019 | pmid = 30953341 | pmc = 6450803 | doi = 10.1002/14651858.CD012044.pub2 | collaboration = Cochrane Urology Group }}</ref>

==== Voiding position ====
Voiding position when urinating may influence urodynamic parameters (urinary flow rate, voiding time, and post-void residual volume).<ref>{{cite web |url = http://www.mednet.nl/wosmedia/1718/mictiehouding_tvu.pdf |title = Influence of voiding posture on urodynamic parameters in men: a literature review | vauthors = De Jong Y, Pinckaers JH, Ten Brinck RM, Lycklama à Nijeholt AA  |publisher = Nederlands Tijdschrift voor urologie |access-date = 2 July 2014 |url-status = live |archive-url = https://web.archive.org/web/20140714200739/http://www.mednet.nl/wosmedia/1718/mictiehouding_tvu.pdf |archive-date = 14 July 2014}}</ref> A [[meta-analysis]] found no differences between the standing and sitting positions for healthy males, but that, for elderly males with lower urinary tract symptoms, voiding in the sitting position-- <ref>{{cite journal | vauthors = de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM | title = Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e101320 | date = 2014 | pmid = 25051345 | pmc = 4106761 | doi = 10.1371/journal.pone.0101320 | doi-access = free | bibcode = 2014PLoSO...9j1320D }}</ref>
* decreased the post-void residual volume;
* increased the maximum urinary flow, comparable with pharmacological intervention; and
* decreased the voiding time.

This [[Urodynamic testing|urodynamic]] profile is associated with a lower risk of urologic complications, such as [[cystitis]] and [[bladder stones]].

=== Medications ===
The two main medication classes for BPH management are [[alpha blocker]]s and [[5α-reductase inhibitor]]s.<ref>{{cite journal | vauthors = Silva J, Silva CM, Cruz F | title = Current medical treatment of lower urinary tract symptoms/BPH: do we have a standard? | journal = Current Opinion in Urology | volume = 24 | issue = 1 | pages = 21–28 | date = January 2014 | pmid = 24231531 | doi = 10.1097/mou.0000000000000007 | s2cid = 40954757 }}</ref>

==== Alpha-blockers ====
[[Alpha-1 blocker|Selective α<sub>1</sub>-blockers]] are the most common choice for initial therapy.<ref name="Roehrborn2007">{{cite journal | vauthors = Roehrborn CG, Nuckolls JG, Wei JT, Steers W | title = The benign prostatic hyperplasia registry and patient survey: study design, methods, and patient baseline characteristics | journal = BJU International | volume = 100 | issue = 4 | pages = 813–819 | date = October 2007 | pmid = 17822462 | doi = 10.1111/j.1464-410X.2007.07061.x | hdl-access = free | s2cid = 21001077 | collaboration = BPH Registry and Patient Survey Steering Committee | hdl = 2027.42/73286 }}</ref><ref name="Black2006">{{cite journal | vauthors = Black L, Naslund MJ, Gilbert TD, Davis EA, Ollendorf DA | title = An examination of treatment patterns and costs of care among patients with benign prostatic hyperplasia | journal = The American Journal of Managed Care | volume = 12 | issue = 4 Suppl | pages = S99–S110 | date = March 2006 | pmid = 16551208 | url = http://www.ajmc.com/pubMed.php?pii=3096 }}</ref><ref name="Hutchison2007">{{cite journal | vauthors = Hutchison A, Farmer R, Verhamme K, Berges R, Navarrete RV | title = The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries | journal = European Urology | volume = 51 | issue = 1 | pages = 207–15; discussion 215–6 | date = January 2007 | pmid = 16846678 | doi = 10.1016/j.eururo.2006.06.012 }}</ref> They include [[alfuzosin]],<ref name="MacDonald2005">{{cite journal | vauthors = MacDonald R, Wilt TJ | title = Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: a systematic review of efficacy and adverse effects | journal = Urology | volume = 66 | issue = 4 | pages = 780–788 | date = October 2005 | pmid = 16230138 | doi = 10.1016/j.urology.2005.05.001 }}</ref><ref name="Roehrborn2001">{{cite journal | vauthors = Roehrborn CG | title = Efficacy and safety of once-daily alfuzosin in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a randomized, placebo-controlled trial | journal = Urology | volume = 58 | issue = 6 | pages = 953–959 | date = December 2001 | pmid = 11744466 | doi = 10.1016/S0090-4295(01)01448-0 }}</ref> [[doxazosin]],<ref name="MacDonald2004">{{cite journal | vauthors = MacDonald R, Wilt TJ, Howe RW | title = Doxazosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects | journal = BJU International | volume = 94 | issue = 9 | pages = 1263–1270 | date = December 2004 | pmid = 15610102 | doi = 10.1111/j.1464-410X.2004.05154.x | s2cid = 6640867 | doi-access = free }}</ref> [[silodosin]], [[tamsulosin]], [[terazosin]], and [[naftopidil]].<ref name="Hwang_2018" /> They have a small to moderate benefit at improving symptoms.<ref name="Wilt_2003" /><ref name="Hwang_2018" /><ref name="Djavan1999">{{cite journal | vauthors = Djavan B, Marberger M | title = A meta-analysis on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction | journal = European Urology | volume = 36 | issue = 1 | pages = 1–13 | year = 1999 | pmid = 10364649 | doi = 10.1159/000019919 | s2cid = 73366414 }}</ref> Selective alpha-1 blockers are similar in effectiveness but have slightly different side effect profiles.<ref name="Wilt_2003">{{cite journal | vauthors = Wilt TJ, Mac Donald R, Rutks I | title = Tamsulosin for benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD002081 | date = 2003 | pmid = 12535426 | doi = 10.1002/14651858.CD002081 | veditors = Wilt T }}</ref><ref name="Hwang_2018" /><ref name="Djavan1999" /> Alpha blockers relax smooth muscle in the prostate and the bladder neck, thus decreasing the blockage of urine flow. Common side effects of alpha-blockers include [[orthostatic hypotension]] (a head rush or dizzy spell when standing up or stretching), [[ejaculation]] changes, [[erectile dysfunction]],<ref>{{cite journal | vauthors = Santillo VM, Lowe FC | title = Treatment of benign prostatic hyperplasia in patients with cardiovascular disease | journal = Drugs & Aging | volume = 23 | issue = 10 | pages = 795–805 | year = 2006 | pmid = 17067183 | doi = 10.2165/00002512-200623100-00003 | s2cid = 24428368 }}</ref> headaches, nasal congestion, and weakness. For men with [[Lower urinary tract symptoms|LUTS]] due to an enlarged prostate, the effects of naftopidil, tamsulosin, and silodosin on urinary symptoms and quality of life may be similar.<ref name="Hwang_2018" /> Naftopidil and tamsulosin may have similar levels of unwanted sexual side effects but fewer unwanted side effects than silodosin.<ref name="Hwang_2018" />

Tamsulosin and silodosin are selective α1 receptor blockers that preferentially bind to the α1A receptor in the prostate instead of the α1B receptor in the blood vessels. Less-selective α1 receptor blockers such as terazosin and doxazosin may lower blood pressure. The older, less selective α1-adrenergic blocker prazosin is not a first-line choice for either [[hypertension|high blood pressure]] or prostatic hyperplasia; it is a choice for patients who present with both problems at the same time. The older, broadly non-selective alpha-blocker medications such as [[phenoxybenzamine]] are not recommended for control of BPH.<ref name="pmid12853821">{{cite journal | title = AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations | journal = The Journal of Urology | volume = 170 | issue = 2 Pt 1 | pages = 530–547 | date = August 2003 | pmid = 12853821 | doi = 10.1097/01.ju.0000078083.38675.79 | author1 = AUA Practice Guidelines Committee }}</ref> Non-selective alpha-blockers such as terazosin and doxazosin may also require slow dose adjustments as they can lower blood pressure and cause [[syncope (medicine)|syncope]] (fainting) if the response to the medication is too strong.

==== 5α-reductase inhibitors ====

The 5α-reductase inhibitors [[finasteride]] and [[dutasteride]] may also be used in people with BPH.<ref name="Blankstein2016">{{cite journal | vauthors = Blankstein U, Van Asseldonk B, Elterman DS | title = BPH update: medical versus interventional management | journal = The Canadian Journal of Urology | volume = 23 | issue = Suppl 1 | pages = 10–15 | date = February 2016 | pmid = 26924590 | url = http://www.canjurol.com/html/free-articles/V23I1S1F-07_DrElterman.pdf | url-status = live | archive-url = https://web.archive.org/web/20160807134146/http://www.canjurol.com/html/free-articles/V23I1S1F-07_DrElterman.pdf | archive-date = 7 August 2016 }}</ref> These medications inhibit the [[5α-reductase]] enzyme, which, in turn, inhibits the production of [[Dihydrotestosterone|DHT]], a hormone responsible for enlarging the prostate. Effects may take longer to appear than alpha blockers, but they persist for many years.<ref name="Roehrborn2004">{{cite journal | vauthors = Roehrborn CG, Bruskewitz R, Nickel JC, McConnell JD, Saltzman B, Gittelman MC, Malek GH, Gottesman JE, Suryawanshi S, Drisko J, Meehan A, Waldstreicher J | title = Sustained decrease in incidence of acute urinary retention and surgery with finasteride for 6 years in men with benign prostatic hyperplasia | journal = The Journal of Urology | volume = 171 | issue = 3 | pages = 1194–1198 | date = March 2004 | pmid = 14767299 | doi = 10.1097/01.ju.0000112918.74410.94 | collaboration = Proscar Long-Term Efficacy Safety Study Group }}</ref> When used together with alpha-blockers, no benefit was reported in short-term trials, but in a longer-term study (3–4 years) there was a greater reduction in BPH progression to acute urinary retention and surgery than with either agent alone, especially in people with more severe symptoms and larger prostates.<ref>{{cite journal | vauthors = Roehrborn CG, Barkin J, Tubaro A, Emberton M, Wilson TH, Brotherton BJ, Castro R | title = Influence of baseline variables on changes in International Prostate Symptom Score after combined therapy with dutasteride plus tamsulosin or either monotherapy in patients with benign prostatic hyperplasia and lower urinary tract symptoms: 4-year results of the CombAT study | journal = BJU International | volume = 113 | issue = 4 | pages = 623–635 | date = April 2014 | pmid = 24127818 | doi = 10.1111/bju.12500 | s2cid = 38243275 }}</ref><ref name="ReferenceB">{{cite journal | vauthors = Greco KA, McVary KT | title = The role of combination medical therapy in benign prostatic hyperplasia | journal = International Journal of Impotence Research | volume = 20  | issue = Suppl 3 | pages = S33–S43 | date = December 2008 | pmid = 19002123 | doi = 10.1038/ijir.2008.51 | doi-access = free }}</ref><ref name="pmid16406915">{{cite journal | vauthors = Kaplan SA, McConnell JD, Roehrborn CG, Meehan AG, Lee MW, Noble WR, Kusek JW, Nyberg LM | title = Combination therapy with doxazosin and finasteride for benign prostatic hyperplasia in patients with lower urinary tract symptoms and a baseline total prostate volume of 25 ml or greater | journal = The Journal of Urology | volume = 175 | issue = 1 | pages = 217–20; discussion 220–1 | date = January 2006 | pmid = 16406915 | doi = 10.1016/S0022-5347(05)00041-8 | collaboration = Medical Therapy of Prostatic Symptoms (MTOPS) Research Group }}</ref> Other trials have confirmed reductions in symptoms, within 6 months in one trial, an effect that was maintained after withdrawal of the alpha blocker.<ref name="ReferenceB" /><ref>{{cite journal | vauthors = Barkin J, Guimarães M, Jacobi G, Pushkar D, Taylor S, van Vierssen Trip OB | title = Alpha-blocker therapy can be withdrawn in the majority of men following initial combination therapy with the dual 5alpha-reductase inhibitor dutasteride | journal = European Urology | volume = 44 | issue = 4 | pages = 461–466 | date = October 2003 | pmid = 14499682 | doi = 10.1016/s0302-2838(03)00367-1 }}</ref> Side effects include decreased [[libido]] and ejaculatory or erectile dysfunction.<ref name = Gormley>{{cite journal | vauthors = Gormley GJ, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD, Andriole GL, Geller J, Bracken BR, Tenover JS | title = The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group | journal = The New England Journal of Medicine | volume = 327 | issue = 17 | pages = 1185–1191 | date = October 1992 | pmid = 1383816 | doi = 10.1056/NEJM199210223271701 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Gacci M, Ficarra V, Sebastianelli A, Corona G, Serni S, Shariat SF, Maggi M, Zattoni F, Carini M, Novara G | title = Impact of medical treatments for male lower urinary tract symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review and meta-analysis | journal = The Journal of Sexual Medicine | volume = 11 | issue = 6 | pages = 1554–1566 | date = June 2014 | pmid = 24708055 | doi = 10.1111/jsm.12525 }}</ref> The 5α-reductase inhibitors are contraindicated in pregnant women because of their [[teratogenicity]] due to interference with fetal testosterone metabolism, and as a precaution, pregnant women should not handle crushed or broken tablets.<ref>{{cite web | vauthors = Deters L |title = Benign Prostatic Hypertrophy Treatment & Management |url = http://emedicine.medscape.com/article/437359-treatment |website = Medscape |access-date = 14 November 2015 |url-status = live |archive-url = https://web.archive.org/web/20151030062812/http://emedicine.medscape.com/article/437359-treatment |archive-date = 30 October 2015}}</ref>
[[File:NHS-medicines-effectiveness.png|none|thumb|650x650px|The effectiveness of alpha-blockers and 5-ARIs, and a combination of the two, versus placebo pills, in improving symptoms of an enlarged prostate.<ref name="McConnell_2003">{{cite journal | vauthors = McConnell JD, Roehrborn CG, Bautista OM, Andriole GL, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA | title = The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia | journal = The New England Journal of Medicine | volume = 349 | issue = 25 | pages = 2387–2398 | date = December 2003 | pmid = 14681504 | doi = 10.1056/NEJMoa030656 }}</ref><ref name="Roehrborn_2010">{{cite journal | vauthors = Roehrborn CG, Siami P, Barkin J, Damião R, Major-Walker K, Nandy I, Morrill BB, Gagnier RP, Montorsi F | title = The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study | journal = European Urology | volume = 57 | issue = 1 | pages = 123–131 | date = January 2010 | pmid = 19825505 | doi = 10.1016/j.eururo.2009.09.035 }}</ref><ref name="Kaplan_2006">{{cite journal | vauthors = Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z | title = Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial | journal = JAMA | volume = 296 | issue = 19 | pages = 2319–2328 | date = November 2006 | pmid = 17105794 | doi = 10.1001/jama.296.19.2319 }}</ref>

Graphic from NHS England.<ref name="www.england.nhs.uk" />]]
[[File:NHS-medicines-sideeffects.png|none|thumb|676x676px|The frequency of side effects from alpha-blockers and 5-ARIs.<ref name="McConnell_2003" /><ref name="Roehrborn_2010" /><ref name="Kaplan_2006" /><ref>{{cite journal | vauthors = van Dijk MM, de la Rosette JJ, Michel MC | title = Effects of alpha(1)-adrenoceptor antagonists on male sexual function | journal = Drugs | volume = 66 | issue = 3 | pages = 287–301 | date = 2006-02-01 | pmid = 16526818 | doi = 10.2165/00003495-200666030-00002 }}</ref><ref>{{cite journal | vauthors = Descazeaud A, de La Taille A, Giuliano F, Desgrandchamps F, Doridot G | title = [Negative effects on sexual function of medications for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia] | journal = Progres en Urologie | volume = 25 | issue = 3 | pages = 115–127 | date = March 2015 | pmid = 25605342 | doi = 10.1016/j.purol.2014.12.003 }}</ref><ref>{{Cite web |date=2010-05-23 |title=Evidence {{!}} Lower urinary tract symptoms in men: management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/cg97/evidence |access-date=2024-09-08 |website=www.nice.org.uk}}</ref>

Graphic from NHS England.<ref name="www.england.nhs.uk" />]]

====Phosphodiesterase inhibitors (PDE)====

A 2018 Cochrane review of studies on men over 60 with moderate to severe [[lower urinary tract symptoms]] analyzed the impacts of [[phosphodiesterase inhibitor]]s (PDE) in comparison to other drugs.<ref>{{cite journal | vauthors = Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK | title = Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD010060 | date = November 2018 | pmid = 30480763 | pmc = 6517182 | doi = 10.1002/14651858.CD010060.pub2 | collaboration = Cochrane Urology Group }}</ref> These drugs may improve urinary symptoms slightly and reduce urinary bother but may also cause more side effects than placebo. The evidence in this review found that there is probably no difference between PDE and [[alpha blocker]]s, however when used in combination they may provide a greater improvement in symptoms (with more side effects). PDE also likely improves symptoms when used with [[5-alpha reductase inhibitors]].

Several phosphodiesterase-5 inhibitors are also effective but may require multiple doses daily to maintain adequate urine flow.<ref>{{cite journal | vauthors = Wang Y, Bao Y, Liu J, Duan L, Cui Y | title = Tadalafil 5 mg Once Daily Improves Lower Urinary Tract Symptoms and Erectile Dysfunction: A Systematic Review and Meta-analysis | journal = Lower Urinary Tract Symptoms | volume = 10 | issue = 1 | pages = 84–92 | date = January 2018 | pmid = 29341503 | doi = 10.1111/luts.12144 | s2cid = 23929021 }}</ref><ref name="Pattanaik CD010060">{{cite journal | vauthors = Pattanaik S, Mavuduru RS, Panda A, Mathew JL, Agarwal MM, Hwang EC, Lyon JA, Singh SK, Mandal AK | title = Phosphodiesterase inhibitors for lower urinary tract symptoms consistent with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD010060 | date = November 2018 | pmid = 30480763 | pmc = 6517182 | doi = 10.1002/14651858.CD010060.pub2 }}</ref> [[Tadalafil]], a phosphodiesterase-5 inhibitor, was considered then rejected by NICE in the UK for the treatment of symptoms associated with BPH.<ref name="guidance.nice.org.uk">{{cite web |title = Hyperplasia (benign prostatic) – tadalafil (terminated appraisal) (TA273) |url = http://guidance.nice.org.uk/TA273 |work = National Institute for Health and Clinical Excellence (NICE) |date = 23 January 2013 |access-date = 27 January 2013 |url-status = live |archive-url = https://web.archive.org/web/20130224050938/http://guidance.nice.org.uk/TA273 |archive-date = 24 February 2013}}</ref> In 2011, the U.S. Food and Drug Administration approved tadalafil to treat the signs and symptoms of benign prostatic hyperplasia, and for the treatment of BPH and erectile dysfunction (ED), when the conditions occur simultaneously.<ref name="fda.gov">{{cite web |title = FDA approves Cialis to treat benign prostatic hyperplasia |url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm |work = U.S. Food and Drug Administration (FDA) |access-date = 7 May 2013 |url-status = dead |archive-url = https://web.archive.org/web/20170118091151/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm274642.htm |archive-date = 18 January 2017}}</ref>

==== Others ====

[[Antimuscarinic]]s such as [[tolterodine]] may also be used, especially in combination with alpha-blockers.<ref name="Kaplan2006">{{cite journal | vauthors = Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z | title = Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial | journal = JAMA | volume = 296 | issue = 19 | pages = 2319–2328 | date = November 2006 | pmid = 17105794 | doi = 10.1001/jama.296.19.2319 | doi-access = free }}</ref> They act by decreasing [[acetylcholine]] effects on the smooth muscle of the [[bladder]], thus helping control symptoms of an [[overactive bladder]].<ref>{{cite journal | vauthors = Abrams P, Andersson KE | title = Muscarinic receptor antagonists for overactive bladder | journal = BJU International | volume = 100 | issue = 5 | pages = 987–1006 | date = November 2007 | pmid = 17922784 | doi = 10.1111/j.1464-410x.2007.07205.x | s2cid = 30983780 | doi-access = free }}</ref>

=== Self-catheterization ===

Intermittent [[urinary catheterization]] is used to relieve the bladder in people with [[urinary retention]]. Self-catheterization is an option in BPH when it is difficult or impossible to empty the bladder.<ref>{{cite web|url=http://www.harvardhealthcontent.com/SpecialHealthReports/70,PA0212?Page=Section9|title=Prostate enlargement (benign prostatic hyperplasia)|website=Harvard Health Content|publisher=Harvard Health Publications|url-status=dead|archive-url=https://web.archive.org/web/20150403012629/http://www.harvardhealthcontent.com/SpecialHealthReports/70%2CPA0212?Page=Section9|archive-date=3 April 2015|access-date=2 February 2015}}</ref> [[Urinary tract infection]] is the most common complication of intermittent catheterization.<ref>{{cite journal | vauthors = Wyndaele JJ | title = Complications of intermittent catheterization: their prevention and treatment | journal = Spinal Cord | volume = 40 | issue = 10 | pages = 536–541 | date = October 2002 | pmid = 12235537 | doi = 10.1038/sj.sc.3101348 | doi-access = free }}<!--|access-date=2 February 2015--></ref> Several techniques and types of catheter are available, including sterile (single-use) and clean (multiple use) catheters, but, based on current information, none is superior to others in reducing the incidence of urinary tract infection.<ref>{{cite journal | vauthors = Prieto JA, Murphy CL, Stewart F, Fader M | title = Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD006008 | date = October 2021 | pmid = 34699062 | pmc = 8547544 | doi = 10.1002/14651858.CD006008.pub5 }}</ref>

=== Surgery ===
{{Main|Surgery for benign prostatic hyperplasia}}

[[File:Rtu.jpg|thumb|right|Transurethral resection of the prostate (TURP)]]

If medical treatment is not effective, surgery may be performed. Surgical techniques used include the following:
* [[Transurethral resection of the prostate]] (TURP): the gold standard.<ref name="Franco_2021">{{cite journal | vauthors = Franco JV, Garegnani L, Escobar Liquitay CM, Borofsky M, Dahm P | title = Transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 6 | pages = CD004135 | date = June 2021 | pmid = 34180047 | pmc = 8236484 | doi = 10.1002/14651858.CD004135.pub4 }}</ref> TURP is thought to be the most effective approach for improving urinary symptoms and urinary flow, however, this surgical procedure may be associated with complications in up to 20% of men.<ref name="Franco_2021" /> Surgery carries some risk of complications, such as [[retrograde ejaculation]] (most commonly), [[erectile dysfunction]], [[urinary incontinence]], [[urethral stricture]]s.<ref>{{Cite web|url=https://www.nhs.uk/conditions/transurethral-resection-of-the-prostate-turp/risks/|title=Transurethral resection of the prostate (TURP) - Risks|date=2017-10-24|website=nhs.uk|language=en|access-date=2020-03-08}}</ref>
* [[Transurethral incision of the prostate]] (TUIP): rarely performed; the technique is similar to TURP but less definitive.
* Open [[prostatectomy]]: not usually performed nowadays due to its high morbidity, even if the results are excellent.
Other less invasive surgical approaches (requiring [[Spinal anaesthesia|spinal anesthesia]]) include:
* [[Holmium laser ablation of the prostate]] (HoLAP)
* [[Holmium laser enucleation of the prostate]] (HoLeP)
* Thulium laser transurethral vaporesection of the prostate (ThuVARP)
* Photoselective vaporization of the prostate (PVP)
* [[Aquablation therapy]]: a type of surgery using a water jet to remove prostatic tissue.

=== Minimally invasive procedures ===
Some less invasive procedures are available according to patients' preferences and co-morbidities. These are performed as [[outpatient procedure]]s with [[local anesthesia]].
* [[Prostatic artery embolization]]: an endovascular procedure performed in [[interventional radiology]].<ref name="pmid28032133">{{cite journal | vauthors = Kuang M, Vu A, Athreya S | title = A Systematic Review of Prostatic Artery Embolization in the Treatment of Symptomatic Benign Prostatic Hyperplasia | journal = CardioVascular and Interventional Radiology | volume = 40 | issue = 5 | pages = 655–663 | date = May 2017 | pmid = 28032133 | doi = 10.1007/s00270-016-1539-3 | s2cid = 12154537 }}</ref> Through [[catheter]]s, embolic agents are released in the main branches of the prostatic artery, in order to induce a decrease in the size of the prostate gland, thus reducing the urinary symptoms.<ref name="pmid27019980">{{cite journal | vauthors = Pisco J, Bilhim T, Pinheiro LC, Fernandes L, Pereira J, Costa NV, Duarte M, Oliveira AG | title = Prostate Embolization as an Alternative to Open Surgery in Patients with Large Prostate and Moderate to Severe Lower Urinary Tract Symptoms | journal = Journal of Vascular and Interventional Radiology | volume = 27 | issue = 5 | pages = 700–708 | date = May 2016 | pmid = 27019980 | doi = 10.1016/j.jvir.2016.01.138 }}</ref>
* [[Prostate steam treatment|Water vapor thermal therapy]] (marketed as Rezum): This is a newer office procedure for removing prostate tissue using steam aimed at preserving sexual function.
* [[Prostatic urethral lift]] (marketed as UroLift): This intervention consists of a system of a device and an implant designed to pull the prostatic lobe away from the urethra.<ref>{{cite journal | vauthors = McNicholas TA | title = Benign prostatic hyperplasia and new treatment options - a critical appraisal of the UroLift system | journal =Medical Devices: Evidence and Research   | volume = 9 | pages = 115–123 | date = May 2016 | pmid = 27274321 | pmc = 4876946 | doi = 10.2147/MDER.S60780 | doi-access = free }}</ref>
* [[Transurethral microwave thermotherapy]] (TUMT) is an outpatient procedure that is less invasive compared to surgery and involves using microwaves (heat) to shrink prostate tissue that is enlarged.<ref name="Franco_2021" />
* [[Temporary implantable nitinol device]] (TIND and {{Proper name|iTIND}}): is a device that is placed in the urethra that, when released, is expanded, reshaping the urethra and the bladder neck.<ref>{{cite journal | vauthors = Porpiglia F, Fiori C, Bertolo R, Garrou D, Cattaneo G, Amparore D | title = Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up | journal = BJU International | volume = 116 | issue = 2 | pages = 278–287 | date = August 2015 | pmid = 25382816 | doi = 10.1111/bju.12982 | hdl-access = free | s2cid = 5712711 | hdl = 2318/1623503 }}</ref>
[[File:NHS-surgeries-effectiveness.png|none|thumb|700x700px|The effectiveness of different surgeries and minimally-invasive procedures for enlarged prostate.<ref>{{cite journal | vauthors = Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Patterson JM, Fahrenkrug L, Schoenthaler M, Sonksen J | title = Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study | journal = BJU International | volume = 119 | issue = 5 | pages = 767–775 | date = May 2017 | pmid = 27862831 | doi = 10.1111/bju.13714 }}</ref><ref>{{cite journal | vauthors = Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terrens W, Kohan A, Gonzalez RR, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu LM, Alshak MN, Kaminetzky J | title = The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial | journal = Urology | volume = 153 | pages = 270–276 | date = July 2021 | pmid = 33373708 | doi = 10.1016/j.urology.2020.12.022 }}</ref><ref name="Gilling_2019">{{cite journal | vauthors = Gilling PJ, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Roehrborn C | title = Randomized Controlled Trial of Aquablation versus Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia: One-year Outcomes | journal = Urology | volume = 125 | pages = 169–173 | date = March 2019 | pmid = 30552937 | doi = 10.1016/j.urology.2018.12.002 }}</ref><ref>{{Cite journal |date=September 2021 |title=Benign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09) |url=http://www.auajournals.org/doi/10.1097/JU.0000000000001982 |journal=Journal of Urology |language=en |volume=206 |issue=Supplement 3 |doi=10.1097/JU.0000000000001982 |issn=0022-5347}}</ref><ref>{{cite journal | vauthors = Cho SY, Park S, Jeong MY, Ro YK, Son H | title = 120W GreenLight High Performance System laser for benign prostate hyperplasia: 68 patients with 3-year follow-up and analysis of predictors of response | journal = Urology | volume = 80 | issue = 2 | pages = 396–401 | date = August 2012 | pmid = 22857762 | doi = 10.1016/j.urology.2012.01.063 }}</ref><ref name="Sievert_2019">{{cite journal | vauthors = Sievert KD, Schonthaler M, Berges R, Toomey P, Drager D, Herlemann A, Miller F, Wetterauer U, Volkmer B, Gratzke C, Amend B | title = Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2 years | journal = World Journal of Urology | volume = 37 | issue = 7 | pages = 1353–1360 | date = July 2019 | pmid = 30283994 | pmc = 6620255 | doi = 10.1007/s00345-018-2494-1 }}</ref><ref name="Sønksen_2015">{{cite journal | vauthors = Sønksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Montorsi F, Patterson JM, Fahrenkrug L, Schoenthaler M, Gratzke C | title = Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study | journal = European Urology | volume = 68 | issue = 4 | pages = 643–652 | date = October 2015 | pmid = 25937539 | doi = 10.1016/j.eururo.2015.04.024 | doi-access = free }}</ref><ref name="McVary_2016">{{cite journal | vauthors = McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM, Rousseau M, Beahrs JR, Kaminetsky J, Cowan BE, Cantrill CH, Mynderse LA, Ulchaker JC, Larson TR, Dixon CM, Roehrborn CG | title = Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia | journal = The Journal of Urology | volume = 195 | issue = 5 | pages = 1529–1538 | date = May 2016 | pmid = 26614889 | doi = 10.1016/j.juro.2015.10.181 }}</ref><ref>{{cite journal | vauthors = Darson MF, Alexander EE, Schiffman ZJ, Lewitton M, Light RA, Sutton MA, Delgado-Rodriguez C, Gonzalez RR | title = Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezūm system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia | language = English | journal = Research and Reports in Urology | volume = 9 | pages = 159–168 | date = 2017-08-21 | pmid = 28861405 | pmc = 5572953 | doi = 10.2147/RRU.S143679 | doi-access = free }}</ref><ref>{{Cite journal |date=September 2021 |title=Benign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09) |url=http://www.auajournals.org/doi/10.1097/JU.0000000000001982 |journal=Journal of Urology |language=en |volume=206 |issue=Supplement 3 |doi=10.1097/JU.0000000000001982 |issn=0022-5347}}</ref><ref name="Campobasso_2023">{{cite journal | vauthors = Campobasso D, Siena G, Chiodini P, Conti E, Franzoso F, Maruzzi D, Martinelli E, Varvello F, De Nunzio C, Autorino R, Somani BK, Ferrari G, Cindolo L | title = Composite urinary and sexual outcomes after Rezum: an analysis of predictive factors from an Italian multi-centric study | journal = Prostate Cancer and Prostatic Diseases | volume = 26 | issue = 2 | pages = 410–414 | date = June 2023 | pmid = 36042295 | doi = 10.1038/s41391-022-00587-6 }}</ref><ref name="Bilhim_2022">{{cite journal | vauthors = Bilhim T, Costa NV, Torres D, Pinheiro LC, Spaepen E | title = Long-Term Outcome of Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia: Single-Centre Retrospective Study in 1072 Patients Over a 10-Year Period | journal = CardioVascular and Interventional Radiology | volume = 45 | issue = 9 | pages = 1324–1336 | date = September 2022 | pmid = 35778579 | doi = 10.1007/s00270-022-03199-8 }}</ref><ref>{{cite journal | vauthors = Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, Pereira J, Oliveira AG | title = Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up | journal = European Radiology | volume = 23 | issue = 9 | pages = 2561–2572 | date = September 2013 | pmid = 23370938 | doi = 10.1007/s00330-012-2714-9 | hdl = 10400.17/1192 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M | title = Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis | journal = CardioVascular and Interventional Radiology | volume = 39 | issue = 1 | pages = 44–52 | date = January 2016 | pmid = 26506952 | doi = 10.1007/s00270-015-1202-4 }}</ref><ref name="Chughtai_2021">{{cite journal | vauthors = Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terrens W, Kohan A, Gonzalez RR, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu LM, Alshak MN, Kaminetzky J | title = The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial | journal = Urology | volume = 153 | pages = 270–276 | date = July 2021 | pmid = 33373708 | doi = 10.1016/j.urology.2020.12.022 }}</ref><ref name="Rieken_2010">{{cite journal | vauthors = Rieken M, Ebinger Mundorff N, Bonkat G, Wyler S, Bachmann A | title = Complications of laser prostatectomy: a review of recent data | journal = World Journal of Urology | volume = 28 | issue = 1 | pages = 53–62 | date = February 2010 | pmid = 20052586 | doi = 10.1007/s00345-009-0504-z }}</ref><ref>{{cite journal | vauthors = Kim A, Hak AJ, Choi WS, Paick SH, Kim HG, Park H | title = Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study | journal = Urology | volume = 154 | pages = 300–307 | date = August 2021 | pmid = 33933503 | doi = 10.1016/j.urology.2021.04.019 }}</ref><ref name="Gilling_2019" /><ref>{{cite journal | vauthors = Al-Ansari A, Younes N, Sampige VP, Al-Rumaihi K, Ghafouri A, Gul T, Shokeir AA | title = GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up | journal = European Urology | volume = 58 | issue = 3 | pages = 349–355 | date = September 2010 | pmid = 20605316 | doi = 10.1016/j.eururo.2010.05.026 }}</ref><ref name="Thomas_2016">{{cite journal | vauthors = Thomas JA, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Bachmann A | title = A Multicenter Randomized Noninferiority Trial Comparing GreenLight-XPS Laser Vaporization of the Prostate and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: Two-yr Outcomes of the GOLIATH Study | journal = European Urology | volume = 69 | issue = 1 | pages = 94–102 | date = January 2016 | pmid = 26283011 | doi = 10.1016/j.eururo.2015.07.054 }}</ref><ref>{{cite journal | vauthors = Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC | title = Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety | journal = World Journal of Urology | volume = 39 | issue = 12 | pages = 4389–4395 | date = December 2021 | pmid = 33837819 | doi = 10.1007/s00345-021-03688-4 }}</ref><ref>{{cite journal | vauthors = Cindolo L, Ruggera L, Destefanis P, Dadone C, Ferrari G | title = Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser | journal = International Urology and Nephrology | volume = 49 | issue = 3 | pages = 405–411 | date = March 2017 | pmid = 28044238 | doi = 10.1007/s11255-016-1494-6 }}</ref><ref>{{cite journal | vauthors = Calves J, Thoulouzan M, Perrouin-Verbe MA, Joulin V, Valeri A, Fournier G | title = Long-term Patient-reported Clinical Outcomes and Reoperation Rate after Photovaporization with the XPS-180W GreenLight Laser | journal = European Urology Focus | volume = 5 | issue = 4 | pages = 676–680 | date = July 2019 | pmid = 29102672 | doi = 10.1016/j.euf.2017.10.006 | url = https://hal.archives-ouvertes.fr/hal-03488114/file/S2405456917302432.pdf }}</ref><ref>{{cite journal | vauthors = Ajib K, Mansour M, Zanaty M, Alnazari M, Hueber PA, Meskawi M, Valdivieso R, Tholomier C, Pradere B, Misrai V, Elterman D, Zorn KC | title = Photoselective vaporization of the prostate with the 180-W XPS-Greenlight laser: Five-year experience of safety, efficiency, and functional outcomes | journal = Canadian Urological Association Journal | volume = 12 | issue = 7 | pages = E318–E324 | date = July 2018 | pmid = 29603912 | pmc = 6118054 | doi = 10.5489/cuaj.4895 }}</ref><ref>{{Cite journal | vauthors = Babar M, Azhar U, Loloi J, Sayed R, Labagnara K, Zhu M, Tang K, Salami A, Singh S, Ines M, Iqbal N, Ciatto M |date=April 2023 |title=MP51-13 Four-Year Rezum Outcomes in Relationship to the Number of Injections: Is the "Less Is More" Treatment Approach Durable? |url=http://www.auajournals.org/doi/10.1097/JU.0000000000003299.13 |journal=Journal of Urology |language=en |volume=209 |issue=Supplement 4 |doi=10.1097/JU.0000000000003299.13 |issn=0022-5347}}</ref><ref name="Sievert_2019" /><ref name="Roehrborn_2016">{{cite journal | vauthors = Roehrborn CG | title = Prostatic Urethral Lift: A Unique Minimally Invasive Surgical Treatment of Male Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia | journal = The Urologic Clinics of North America | volume = 43 | issue = 3 | pages = 357–369 | date = August 2016 | pmid = 27476128 | doi = 10.1016/j.ucl.2016.04.008 | series = Treatment of Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia }}</ref><ref name="Sønksen_2015" /><ref>{{cite journal | vauthors = McNicholas TA, Woo HH, Chin PT, Bolton D, Fernández Arjona M, Sievert KD, Schoenthaler M, Wetterauer U, Vrijhof EJ, Gange S, Montorsi F | title = Minimally invasive prostatic urethral lift: surgical technique and multinational experience | journal = European Urology | volume = 64 | issue = 2 | pages = 292–299 | date = August 2013 | pmid = 23357348 | doi = 10.1016/j.eururo.2013.01.008 }}</ref><ref>{{Cite journal | vauthors = Loloi J, Wang S, Labagnara K, Plummer M, Douglass L, Watts K, Abraham N, Ohmann E |date=May 2024 |title=Predictors of reoperation after transurethral resection of the prostate in a diverse, urban academic centre |url=https://journals.sagepub.com/doi/10.1177/20514158221132102 |journal=Journal of Clinical Urology |language=en |volume=17 |issue=3 |pages=238–245 |doi=10.1177/20514158221132102 |issn=2051-4158}}</ref><ref>{{cite journal | vauthors = Guo S, Müller G, Lehmann K, Talimi S, Bonkat G, Püschel H, Gasser T, Bachmann A, Rieken M | title = The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective non-randomized bi-center study | journal = Lasers in Medical Science | volume = 30 | issue = 3 | pages = 1147–1151 | date = April 2015 | pmid = 25698433 | doi = 10.1007/s10103-015-1721-x }}</ref><ref>{{cite journal | vauthors = Kim A, Hak AJ, Choi WS, Paick SH, Kim HG, Park H | title = Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study | journal = Urology | volume = 154 | pages = 300–307 | date = August 2021 | pmid = 33933503 | doi = 10.1016/j.urology.2021.04.019 }}</ref><ref name="Bilhim_2022" /><ref name="Ray_2018">{{cite journal | vauthors = Ray AF, Powell J, Speakman MJ, Longford NT, DasGupta R, Bryant T, Modi S, Dyer J, Harris M, Carolan-Rees G, Hacking N | title = Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study) | journal = BJU International | volume = 122 | issue = 2 | pages = 270–282 | date = August 2018 | pmid = 29645352 | doi = 10.1111/bju.14249 | doi-access = free }}</ref><ref name="Pisco_2013">{{cite journal | vauthors = Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, Pereira J, Oliveira AG | title = Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up | journal = European Radiology | volume = 23 | issue = 9 | pages = 2561–2572 | date = September 2013 | pmid = 23370938 | doi = 10.1007/s00330-012-2714-9 | hdl = 10400.17/1192 | hdl-access = free }}</ref> Graphic from NHS England.<ref name="www.england.nhs.uk" />]]
[[File:NHS-surgeries-effectiveness2.png|none|thumb|700x700px|The outcomes from different surgeries and minimally-invasive procedures for enlarged prostate.Graphic from NHS England.<ref name="www.england.nhs.uk" />]]
[[File:NHS-surgeries-sideeffects.png|none|thumb|800x800px|Frequencies of side-effects from different surgeries and minimally-invasive procedures for enlarged prostate.<ref>{{cite journal | vauthors = Knight L, Dale M, Cleves A, Pelekanou C, Morris R | title = UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update | journal = Applied Health Economics and Health Policy | volume = 20 | issue = 5 | pages = 669–680 | date = September 2022 | pmid = 35843995 | pmc = 9385790 | doi = 10.1007/s40258-022-00735-y }}</ref><ref>{{Cite web |date=2010-05-23 |title=Evidence {{!}} Lower urinary tract symptoms in men: management {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/cg97/evidence |access-date=2024-09-08 |website=www.nice.org.uk}}</ref><ref>{{cite journal | vauthors = Cacciamani GE, Cuhna F, Tafuri A, Shakir A, Cocci A, Gill K, Gómez Rivas J, Dourado A, Veneziano D, Okhunov Z, Capogrosso P, Hueber PA, Alberseen M, Abreu A, Migliorini F, Fiori C, Porcaro AB, Porpiglia F, Desai M, Russo GI | title = Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials | journal = Minerva Urologica e Nefrologica = the Italian Journal of Urology and Nephrology | volume = 71 | issue = 5 | pages = 427–434 | date = October 2019 | pmid = 31487977 | doi = 10.23736/s0393-2249.19.03588-4 }}</ref><ref>{{cite journal | vauthors = Lokeshwar SD, Valancy D, Lima TF, Blachman-Braun R, Ramasamy R | title = A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH | journal = Current Urology Reports | volume = 21 | issue = 12 | pages = 54 | date = October 2020 | pmid = 33104947 | doi = 10.1007/s11934-020-01012-y }}</ref><ref>{{cite journal | vauthors = Calik G, Laguna MP, Gravas S, Albayrak S, de la Rosette J | title = Preservation of antegrade ejaculation after surgical relief of benign prostatic obstruction is a valid endpoint | journal = World Journal of Urology | volume = 39 | issue = 7 | pages = 2277–2289 | date = July 2021 | pmid = 33796882 | doi = 10.1007/s00345-021-03682-w }}</ref><ref name="Gilling_2019" /><ref name="Thomas_2016" /><ref>{{cite journal | vauthors = Kuntz RM, Ahyai S, Lehrich K, Fayad A | title = Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients | journal = The Journal of Urology | volume = 172 | issue = 3 | pages = 1012–1016 | date = September 2004 | pmid = 15311026 | doi = 10.1097/01.ju.0000136218.11998.9e }}</ref><ref name="Sønksen_2015" /><ref>{{cite journal | vauthors = Capitán C, Blázquez C, Martin MD, Hernández V, de la Peña E, Llorente C | title = GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up | journal = European Urology | volume = 60 | issue = 4 | pages = 734–739 | date = October 2011 | pmid = 21658839 | doi = 10.1016/j.eururo.2011.05.043 }}</ref><ref>{{cite journal | vauthors = Ghobrial FK, Shoma A, Elshal AM, Laymon M, El-Tabey N, Nabeeh A, Shokeir AA | title = A randomized trial comparing bipolar transurethral vaporization of the prostate with GreenLight laser (xps-180watt) photoselective vaporization of the prostate for treatment of small to moderate benign prostatic obstruction: outcomes after 2 years | journal = BJU International | volume = 125 | issue = 1 | pages = 144–152 | date = January 2020 | pmid = 31621175 | doi = 10.1111/bju.14926 }}</ref><ref>{{cite journal | vauthors = Krambeck AE, Handa SE, Lingeman JE | title = Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia | journal = The Journal of Urology | volume = 183 | issue = 3 | pages = 1105–1109 | date = March 2010 | pmid = 20092844 | doi = 10.1016/j.juro.2009.11.034 }}</ref><ref name="Rieken_2010" /><ref>{{cite journal | vauthors = Elshal AM, Soltan M, El-Tabey NA, Laymon M, Nabeeh A | title = Randomised trial of bipolar resection vs holmium laser enucleation vs Greenlight laser vapo-enucleation of the prostate for treatment of large benign prostate obstruction: 3-years outcomes | journal = BJU International | volume = 126 | issue = 6 | pages = 731–738 | date = December 2020 | pmid = 32633020 | doi = 10.1111/bju.15161 }}</ref><ref>{{cite journal | vauthors = Geavlete B, Georgescu D, Multescu R, Stanescu F, Jecu M, Geavlete P | title = Bipolar plasma vaporization vs monopolar and bipolar TURP-A prospective, randomized, long-term comparison | journal = Urology | volume = 78 | issue = 4 | pages = 930–935 | date = October 2011 | pmid = 21802121 | doi = 10.1016/j.urology.2011.03.072 }}</ref><ref>{{cite journal | vauthors = Rai P, Srivastava A, Dhayal IR, Singh S | title = Comparison of Safety, Efficacy and Cost Effectiveness of Photoselective Vaporization with Bipolar Vaporization of Prostate in Benign Prostatic Hyperplasia | language = en-US | journal = Current Urology | volume = 11 | issue = 2 | pages = 103–109 | date = February 2018 | pmid = 29593470 | pmc = 5836246 | doi = 10.1159/000447202 }}</ref><ref>{{cite journal | vauthors = Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC | title = Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety | journal = World Journal of Urology | volume = 39 | issue = 12 | pages = 4389–4395 | date = December 2021 | pmid = 33837819 | doi = 10.1007/s00345-021-03688-4 }}</ref><ref>{{cite journal | vauthors = Bachmann A, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Thomas JA | title = 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial--the GOLIATH study | journal = European Urology | volume = 65 | issue = 5 | pages = 931–942 | date = May 2014 | pmid = 24331152 | doi = 10.1016/j.eururo.2013.10.040 }}</ref><ref name="Roehrborn_2016" /><ref>{{cite journal | vauthors = Gratzke C, Barber N, Speakman MJ, Berges R, Wetterauer U, Greene D, Sievert KD, Chapple CR, Patterson JM, Fahrenkrug L, Schoenthaler M, Sonksen J | title = Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study | journal = BJU International | volume = 119 | issue = 5 | pages = 767–775 | date = May 2017 | pmid = 27862831 | doi = 10.1111/bju.13714 }}</ref><ref>{{cite journal | vauthors = Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M, Wang Y | title = Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial | journal = Radiology | volume = 270 | issue = 3 | pages = 920–928 | date = March 2014 | pmid = 24475799 | doi = 10.1148/radiol.13122803 }}</ref><ref name="Campobasso_2023" /><ref>{{cite journal | vauthors = Dixon C, Cedano ER, Pacik D, Vit V, Varga G, Wagrell L, Tornblom M, Mynderse L, Larson T | title = Efficacy and Safety of Rezūm System Water Vapor Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia | journal = Urology | volume = 86 | issue = 5 | pages = 1042–1047 | date = November 2015 | pmid = 26216644 | doi = 10.1016/j.urology.2015.05.046 }}</ref><ref name="McVary_2016" /><ref>{{Cite journal | vauthors = Kaplan-Marans E, Cochran J, Wood A, Dubowitch E, Lee M, Schulman A |date=September 2021 |title=PD18-04 Urolife and Rezum: A Comparison of Device Related Adverse Events in a National Registry |url=http://www.auajournals.org/doi/10.1097/JU.0000000000002007.04 |journal=Journal of Urology |language=en |volume=206 |issue=Supplement 3 |doi=10.1097/JU.0000000000002007.04 |issn=0022-5347}}</ref><ref name="Pisco_2013" /><ref>{{cite journal | vauthors = Pisco JM, Bilhim T, Costa NV, Torres D, Pisco J, Pinheiro LC, Oliveira AG | title = Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia | journal = European Urology | volume = 77 | issue = 3 | pages = 354–362 | date = March 2020 | pmid = 31831295 | doi = 10.1016/j.eururo.2019.11.010 | hdl = 10400.17/3575 | hdl-access = free }}</ref><ref name="Ray_2018" /><ref>{{cite journal | vauthors = Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M | title = Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis | journal = CardioVascular and Interventional Radiology | volume = 39 | issue = 1 | pages = 44–52 | date = January 2016 | pmid = 26506952 | doi = 10.1007/s00270-015-1202-4 }}</ref><ref name="Bilhim_2022" /><ref>{{cite journal | vauthors = Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Kaufman RP, Trainer A, Arther A, Badlani G, Plante M, Desai M, Doumanian L, Te AE, DeGuenther M, Roehrborn C | title = Three-year outcomes after Aquablation therapy compared to TURP: results from a blinded randomized trial | journal = The Canadian Journal of Urology | volume = 27 | issue = 1 | pages = 10072–10079 | date = February 2020 | pmid = 32065861 | url = https://www.canjurol.com/html/free-articles/Cdn_JU27_I1_05_FREE_DrGilling.pdf | publication-date = 2020 }}</ref><ref>{{cite journal | vauthors = Desai M, Bidair M, Bhojani N, Trainer A, Arther A, Kramolowsky E, Doumanian L, Elterman D, Kaufman RP, Lingeman J, Krambeck A, Eure G, Badlani G, Plante M, Uchio E, Gin G, Goldenberg L, Paterson R, So A, Humphreys M, Roehrborn C, Kaplan S, Motola J, Zorn KC | title = WATER II (80-150 mL) procedural outcomes | journal = BJU International | volume = 123 | issue = 1 | pages = 106–112 | date = January 2019 | pmid = 29694702 | doi = 10.1111/bju.14360 }}</ref><ref>{{Cite journal | vauthors = De Los Reyes TJ, Bhojani N, Zorn KC, Elterman DS |date=2020-09-01 |title=WATER II Trial (Aquablation) |url=https://link.springer.com/article/10.1007/s11884-020-00596-y |journal=Current Bladder Dysfunction Reports |language=en |volume=15 |issue=3 |pages=225–228 |doi=10.1007/s11884-020-00596-y |issn=1931-7220}}</ref><ref>{{cite journal | vauthors = Porpiglia F, Fiori C, Bertolo R, Garrou D, Cattaneo G, Amparore D | title = Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up | journal = BJU International | volume = 116 | issue = 2 | pages = 278–287 | date = August 2015 | pmid = 25382816 | doi = 10.1111/bju.12982 | hdl = 2318/1623503 | hdl-access = free }}</ref><ref name="Chughtai_2021" /><ref>{{cite journal | vauthors = Elterman D, Alshak MN, Martinez Diaz S, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terens W, Kohan A, Gonzalez R, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu L, Kaminetsky J, Chughtai B | title = An Evaluation of Sexual Function in the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia in Men Treated with the Temporarily Implanted Nitinol Device | journal = Journal of Endourology | volume = 37 | issue = 1 | pages = 74–79 | date = January 2023 | pmid = 36070450 | pmc = 9810348 | doi = 10.1089/end.2022.0226 }}</ref><ref>{{cite journal | vauthors = Kadner G, Valerio M, Giannakis I, Manit A, Lumen N, Ho BS, Alonso S, Schulman C, Barber N, Amparore D, Porpiglia F | title = Second generation of temporary implantable nitinol device (iTind) in men with LUTS: 2 year results of the MT-02-study | journal = World Journal of Urology | volume = 38 | issue = 12 | pages = 3235–3244 | date = December 2020 | pmid = 32124019 | doi = 10.1007/s00345-020-03140-z }}</ref>

Graphic from NHS England.<ref>{{Cite web |title=NHS England » Decision support tool: making a decision about enlarged prostate (BPE) |url=https://www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-enlarged-prostate-bpe/ |access-date=2024-09-08 |website=www.england.nhs.uk}}</ref>]]

=== Alternative medicine ===
While [[herbal remedies]] are commonly used, a 2016 review found the herbs studied to be no better than [[placebo]]s.<ref>{{cite journal | vauthors = Keehn A, Taylor J, Lowe FC | title = Phytotherapy for Benign Prostatic Hyperplasia | journal = Current Urology Reports | volume = 17 | issue = 7 | pages = 53 | date = July 2016 | pmid = 27180172 | doi = 10.1007/s11934-016-0609-z | s2cid = 25609876 }}</ref> Particularly, several reviews found that [[saw palmetto extract]], while one of the most commonly used, is no better than a placebo both in symptom relief and in decreasing prostate size.<ref name="pmid16467543">{{cite journal | vauthors = Bent S, Kane C, Shinohara K, Neuhaus J, Hudes ES, Goldberg H, Avins AL | title = Saw palmetto for benign prostatic hyperplasia | journal = The New England Journal of Medicine | volume = 354 | issue = 6 | pages = 557–566 | date = February 2006 | pmid = 16467543 | doi = 10.1056/NEJMoa053085 | s2cid = 13815057 | doi-access = free }}</ref><ref name="pmid18423748">{{cite journal | vauthors = Dedhia RC, McVary KT | title = Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia | journal = The Journal of Urology | volume = 179 | issue = 6 | pages = 2119–2125 | date = June 2008 | pmid = 18423748 | doi = 10.1016/j.juro.2008.01.094 }}</ref><ref>{{cite journal | vauthors = Franco JV, Trivisonno L, Sgarbossa NJ, Alvez GA, Fieiras C, Escobar Liquitay CM, Jung JH | title = Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 6 | pages = CD001423 | date = June 2023 | pmid = 37345871 | pmc = 10286776 | doi = 10.1002/14651858.CD001423.pub4 }}</ref>

== Epidemiology ==
[[File:Benign prostatic hypertrophy world map - DALY - WHO2004.svg|thumb|left|upright=1.36|[[Disability-adjusted life year]] for benign prostatic hyperplasia per 100,000&nbsp;inhabitants in 2004<ref>{{cite web|year=2009|title=WHO Disease and injury country estimates|url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|url-status=live|archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|archive-date=11 November 2009|access-date=11 November 2009|work=World Health Organization}}</ref>{{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|less than 20}}
{{legend|#fff200|20–28}}
{{legend|#ffdc00|28–36}}
{{legend|#ffc600|36–44}}
{{legend|#ffb000|44–52}}
{{legend|#ff9a00|52–60}}
{{legend|#ff8400|60–68}}
{{legend|#ff6e00|68–76}}
{{legend|#ff5800|76–84}}
{{legend|#ff4200|84–92}}
{{legend|#ff2c00|92–100}}
{{legend|#cb0000|more than 100}}
{{div col end}}]]

Globally, benign prostatic hyperplasia affects about 94&nbsp;million males {{as of|lc=yes|2019}}.<ref name=Awedew2022/>

The prostate gets larger in most men as they get older. For a symptom-free man of 46 years, the risk of developing BPH over the next 30 years is 45%. [[Incidence (epidemiology)|Incidence]] rates increase from 3 cases per 1000 man-years at age 45–49 years, to 38 cases per 1000 man-years by the age of 75–79 years. While the [[prevalence]] rate is 2.7% for men aged 45–49, it increases to 24% by the age of 80 years.<ref name="pmid12361895">{{cite journal | vauthors = Verhamme KM, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MC, Artibani W, Begaud B, Berges R, Borkowski A, Chappel CR, Costello A, Dobronski P, Farmer RD, Jiménez Cruz F, Jonas U, MacRae K, Pientka L, Rutten FF, van Schayck CP, Speakman MJ, Sturkenboom MC, Tiellac P, Tubaro A, Vallencien G, Vela Navarrete R | title = Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care--the Triumph project | journal = European Urology | volume = 42 | issue = 4 | pages = 323–328 | date = October 2002 | pmid = 12361895 | doi = 10.1016/S0302-2838(02)00354-8 | collaboration = Triumph Pan European Expert Panel }}</ref>
{{clear}}

== References ==

{{Reflist}}

== External links ==

{{Portal|Medicine}}
{{Commons category|Benign prostatic hyperplasia}}
* [https://web.archive.org/web/20140708202105/http://www.endoatlas.com/co_ge_18.html Extrinsic Compression by Prostate]
{{Medical condition classification and resources
| DiseasesDB     = 10797
| ICD10          = {{ICD10|N|40||n|40}}
| ICD9           = {{ICD9|600}}
| ICDO           =
| OMIM           = 600082
| MedlinePlus    = 000381
| eMedicineSubj  = med
| eMedicineTopic = 1919
| MeshID         = D011470
}}

{{Male diseases of the pelvis and genitals}}

{{Authority control}}

[[Category:Andrology]]
[[Category:Men's health]]
[[Category:Neoplastic and hyperplastic prostate disorders]]
[[Category:Wikipedia medicine articles ready to translate]]