Continuing Education Column Benign Prostatic Hyperplasia Choung Soo Kim, MD. Department of Urology, Ulsan University College of Medicine E mail : cskim@amc.seoul.kr J Korean Med Assoc 2007; 50(7): 626-636 Abstract Benign prostatic hyperplasia (BPH), a pathological terminology that means benign proliferation of prostatic tissue, is commonly used as a clinical terminology indicating low urinary tract symptoms (LUTS) resulting from prostate enlargement. It mainly arises from the transition zone of the prostate by stimulation of dihydrotestosterone (DHT), and its incidence is about 21~28% in men with age over fifty. LUTS related to BPH consist of frequency, residual urine sense, nocturia, interruption, urgency, weak stream, and hesitancy. The International Prostate Symptom Score (IPSS) is currently being used for the evaluation of the patient in the clinical setting. The size of the prostate (>30 g), an elevated serum prostate specific antigen level (PSA: >1.5ng/mL), high IPSS ( 20), and a large amount of post void residual urine (>100ml) are considered as risk factors of BPH aggravation. Physical examination including digital rectal examination, urinalysis, serum PSA, and uroflowmetry with residual urine measurement are performed as basic test items for BPH. Standard initial treatment of BPH is medical therapy: mainly alpha adrenergic blockers and 5 alpha reductase inhibitors, and optionally anticholinergics, desmopressin, and phytotherapy. The standard surgical treatment of BPH nowadays is transurethral resection of prostate (TURP) but open prostatectomy or minimally invasive treatment such as transurethral incision of prostate (TUI), thermal therapy, and photoselective vaporization of prostate (PVP) can be applied in selected cases. Keywords : Benign prostatic hyperplasia; Low urinary tract symptoms; Alpha adrenergic blockers; Transurethral resection of prostate 626
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Kim CS Table 1. Absolute indication Recurrent acute urinary retention Bladder stone related to BPH Deterioration of renal function Recurrent hematuria Recurrent UTI Relative indication Low urinary symptoms worsening quality of life Large amount of post void residual volume 634
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Kim CS ment of benign prostatic hyperplasia. Kirby R, Lepor H. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell Walsh urology. 9th ed. China: Elsevier Inc, 2007: 2803-2844. Peer Reviewer Commentary 636