Urology
Benign Prostatic Hyperplasia
전립선비대
Benign nodular hyperplasia of the transition zone of prostate
- How common
- 50s 50%, 80s 90%
- Typical age
- Men >50
What is it?
DHT-dependent nodular hyperplasia of transition zone compresses urethra causing obstruction.
Commonly affected: Prostate transition zone, bladder neck, detrusor
How it develops
- DHT stimulation5α-reductase produces DHT
- Nodular hyperplasiaBenign nodules in transition zone
- Urethral compressionDynamic + static obstruction
- Bladder remodelingDetrusor hypertrophy → instability → residual urine
Symptoms
- Acute retentionSudden inability to urinate; emergency
- Voiding symptomsWeak stream, hesitancy, intermittency
- Storage symptomsFrequency, nocturia, urgency
- Post-void symptomsSensation of incomplete emptying, dribbling
How it is examined
- Digital rectal examSmooth, symmetrical enlargement
- IPSS scoreInternational Prostate Symptom Score
- PSA + uroflowmetryCancer screen, peak flow + PVR
Imaging
Transrectal US (TRUS) measures prostate size.
- Transition zone enlargement
- Volume 30–150 mL
Multiparametric MRI to rule out cancer when indicated.
- Nodular enlargement
- PI-RADS score
Non-surgical care
- Alpha-blocker (tamsulosin)Relieves dynamic obstruction (2–4 wk)
- 5α-reductase inhibitor (finasteride)Shrinks prostate over 6–12 months
- Combination therapyBest for large prostates >30 mL
- Antimuscarinic/mirabegronAdd for storage-predominant LUTS
- LifestyleEvening fluid restriction, less caffeine/alcohol
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Medical failure, recurrent retention, stones, renal insufficiency
Procedures that may be discussed
- TURP
- HoLEP (holmium enucleation)
- UroLift, REZUM, simple prostatectomy
Outlook
Most controlled medically; 80% symptom relief with surgery.