Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Timeline
  • Published:

Landmarks in BPH—from aetiology to medical and surgical management

Abstract

Clinicians treat the symptoms associated with BPH on a daily basis. Although BPH is nearly universal with age, not all men develop lower urinary tract symptoms. Over the past 100 years, several notable advances in the field of urology have not only improved our understanding of the aetiology and natural history of this common disease, but have also facilitated the development of therapeutics to effectively manage BPH-related symptoms. The high quality of modern-day diagnosis, as well as medical and surgical treatment for BPH, is a testimony to centuries of observation and decades of scientific research.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 4
Figure 1: During prostate development, testosterone diffuses into prostatic cells and is converted to DHT by 5αR.
Figure 2: The partial overlap between the different disease definitions.
Figure 3

References

  1. Groves, H. K., Chang, D., Palazzi, K., Cohen, S. & Parsons, J. K. The incidence of acute urinary retention secondary to BPH is increasing among California men. Prostate Cancer Prostatic Dis. 16, 260–265 (2013).

    Article  CAS  Google Scholar 

  2. Walsh, P. C. Benign prostatic hyperplasia: etiological considerations. Prog. Clin. Biol. Res. 6, 1–8 (1976).

    CAS  PubMed  Google Scholar 

  3. Steadman, F. H. & Krichesky, B. Prostate and seminal vesicle response to testosterone propionate in intact and castrate rats. Endocrinology 37, 89–95 (1945).

    Article  CAS  Google Scholar 

  4. Siiteri, P. K. & Wilson, J. D. Dihydrotestosterone in prostatic hypertrophy. I. The formation and content of dihydrotestosterone in the hypertrophic prostate of man. J. Clin. Invest. 49, 1737–1745 (1970).

    Article  CAS  Google Scholar 

  5. Horton, R., Hsieh, P., Barberia, J., Pages, L. & Cosgrove, M. Altered blood androgens in elderly men with prostate hyperplasia. J. Clin. Endocrinol. Metab. 41, 793–796 (1975).

    Article  CAS  Google Scholar 

  6. Theyer, G. et al. Phenotypic characterization of infiltrating leukocytes in benign prostatic hyperplasia. Lab. Invest. 66, 96–107 (1992).

    CAS  PubMed  Google Scholar 

  7. Story, M. T. et al. Cultured human prostate-derived fibroblasts produce a factor that stimulates their growth with properties indistinguishable from basic fibroblast growth factor. Prostate 15, 355–365 (1989).

    Article  CAS  Google Scholar 

  8. Klein, L. A. & Stoff, J. S. Prostaglandins and the prostate: an hypothesis on the etiology of benign prostatic hyperplasia. Prostate 4, 247–251 (1983).

    Article  CAS  Google Scholar 

  9. Kahokehr, A., Vather, R., Nixon, A. & Hill, A. G. Non-steroidal anti-inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta-analysis of randomized controlled trials. BJU Int. 111, 304–311 (2013).

    Article  CAS  Google Scholar 

  10. Berry, S. J., Coffey, D. S., Walsh, P. C. & Ewing, L. L. The development of human benign prostatic hyperplasia with age. J. Urol. 132, 474–479 (1984).

    Article  CAS  Google Scholar 

  11. Nielsen, K. K., Nordling, J. & Hald, T. Critical review of the diagnosis of prostatic obstruction. Neurourol. Urodyn. 13, 201–217 (1994).

    Article  CAS  Google Scholar 

  12. Abrams, P. Managing lower urinary tract symptoms in older men. BMJ 310, 1113–1117 (1995).

    Article  CAS  Google Scholar 

  13. Abrams, P. et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 61, 37–49 (2003).

    Article  Google Scholar 

  14. Abrams, P. Objective evaluation of bladder outlet obstruction. Br. J. Urol. 76 (Suppl. 1), 11–15 (1995).

    PubMed  Google Scholar 

  15. Abrams, P. H., Farrar, D. J., Turner-Warwick, R. T., Whiteside, C. G. & Feneley, R. C. The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J. Urol. 121, 640–642 (1979).

    Article  CAS  Google Scholar 

  16. Abrams, P. H. & Griffiths, D. J. The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br. J. Urol. 51, 129–134 (1979).

    Article  CAS  Google Scholar 

  17. Griffiths, D. et al. Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol. Urodyn. 16, 1–18 (1997).

    Article  CAS  Google Scholar 

  18. Barry, M. J. et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J. Urol. 148, 1549–1557 (1992).

    Article  CAS  Google Scholar 

  19. Haltbakk, J., Hanestad, B. R. & Hunskaar, S. How important are men's lower urinary tract symptoms (LUTS) and their impact on the quality of life (QOL)? Qual. Life Res. 14, 1733–1741 (2005).

    Article  CAS  Google Scholar 

  20. McConnell, J. D. et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N. Engl. J. Med. 338, 557–563 (1998).

    Article  CAS  Google Scholar 

  21. Bruskewitz, R. et al. Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. PLESS Study Group. Proscar Long-term Efficacy and Safety Study. Urology 54, 670–678 (1999).

    Article  CAS  Google Scholar 

  22. Flanigan, R. C. et al. 5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study. J. Urol. 160, 12–16 (1998).

    Article  CAS  Google Scholar 

  23. McConnell, J. D. et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N. Engl. J. Med. 349, 2387–2398 (2003).

    Article  CAS  Google Scholar 

  24. Lieber, M. M. et al. Natural history of benign prostatic enlargement: long-term longitudinal population-based study of prostate volume doubling times. BJU Int. 105, 214–219 (2010).

    Article  Google Scholar 

  25. Caine, M., Perlberg, S. & Meretyk, S. A placebo-controlled double-blind study of the effect of phenoxybenzamine in benign prostatic obstruction. Br. J. Urol. 50, 551–554 (1978).

    Article  CAS  Google Scholar 

  26. Lepor, H. et al. A randomized, placebo-controlled multicenter study of the efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia. J. Urol. 148, 1467–1474 (1992).

    Article  CAS  Google Scholar 

  27. Lukacs, B., Grange, J. C., Comet, D. & McCarthy, C. History of 7,093 patients with lower urinary tract symptoms related to benign prostatic hyperplasia treated with alfuzosin in general practice up to 3 years. Eur. Urol. 37, 183–190 (2000).

    Article  CAS  Google Scholar 

  28. Gormley, G. J. et al. The effect of finasteride in men with benign prostatic hyperplasia. The Finasteride Study Group. N. Engl. J. Med. 327, 1185–1191 (1992).

    Article  CAS  Google Scholar 

  29. Hudson, P. B. et al. Efficacy of finasteride is maintained in patients with benign prostatic hyperplasia treated for 5 years. The North American Finasteride Study Group. Urology 53, 690–695 (1999).

    Article  CAS  Google Scholar 

  30. Lepor, H. et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Veterans Affairs Cooperative Studies Benign Prostatic Hyperplasia Study Group. N. Engl. J. Med. 335, 533–539 (1996).

    Article  CAS  Google Scholar 

  31. Kirby, R. S. et al. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial. Urology 61, 119–126 (2003).

    Article  Google Scholar 

  32. Roehrborn, C. G. et al. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J. Urol. 179, 616–621 (2008).

    Article  CAS  Google Scholar 

  33. Sairam, K., Kulinskaya, E., McNicholas, T. A., Boustead, G. B. & Hanbury, D. C. Sildenafil influences lower urinary tract symptoms. BJU Int. 90, 836–839 (2002).

    Article  CAS  Google Scholar 

  34. McVary, K. T. et al. Sildenafil citrate improves erectile function and urinary symptoms in men with erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized, double-blind trial. J. Urol. 177, 1071–1077 (2007).

    Article  CAS  Google Scholar 

  35. Andersson, K. E. et al. Tadalafil for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: pathophysiology and mechanism(s) of action. Neurourol. Urodyn. 30, 292–301 (2011).

    Article  CAS  Google Scholar 

  36. Giuliano, F. et al. The mechanism of action of phosphodiesterase type 5 inhibitors in the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. Eur. Urol. 63, 506–516 (2013).

    Article  CAS  Google Scholar 

  37. Novara, G., Galfano, A., Ficarra, V. & Artibani, W. Anticholinergic drugs in patients with bladder outlet obstruction and lower urinary tract symptoms: a systematic review. Eur. Urol. 50, 675–683 (2006).

    Article  CAS  Google Scholar 

  38. Filson, C. P., Hollingsworth, J. M., Clemens, J. Q. & Wei, J. T. The efficacy and safety of combined therapy with alpha-blockers and anticholinergics for men with benign prostatic hyperplasia: a meta-analysis. J. Urol. 190, 2153–2160 (2013).

    Article  CAS  Google Scholar 

  39. Weissbart, S. J. et al. Acetylcholine for male LUTS. Curr. Urol. Rep. 13, 413–419 (2012).

    Article  Google Scholar 

  40. Blandy, J. P., Notley, R. G. & Reynard, J. M. Transurethral resection, 5th edn (Taylor & Francis, 2005).

    Google Scholar 

  41. Bottini, E. Die galvanocaustische Diaerese zur Radical-Behandlung der Ischurie bei Hypertrophie der Prostata [German]. Arch. Klin. Chir. 54, 96 (1896).

    Google Scholar 

  42. McGill, A. F. Suprapubic prostatectomy. BMJ 2, 1104 (1887).

    Google Scholar 

  43. Wilson, H. H. Asepsis in prostatectomy. Br. J. Surg. 33, 41–46 (1945).

    Article  Google Scholar 

  44. Beer, E. Removal of neoplasms of the urinary bladder. A new method employing high frequency (Oudin) currents through a catheterising cystoscope. JAMA 45, 1768 (1910).

    Article  Google Scholar 

  45. Bugbee, H. G. The relief of vesical obstruction in selected cases: preliminary report. NY State Med. J. 13, 410 (1913).

    Google Scholar 

  46. Luys, G. T. Raitement de l'hypertrophie de la prostate par la voie endourétrale [French]. Clinique 44, 693 (1913).

    Google Scholar 

  47. Stern, M. Resections of obstructions at the vesical orifice. JAMA 87, 1726–1730 (1926).

    Article  Google Scholar 

  48. Iglesias, J. J. & Stams, U. K. How to prevent the TUR syndrome [German]. Urologe 14, 287–291 (1975).

    CAS  PubMed  Google Scholar 

  49. Botto, H. et al. Electrovaporization of the prostate with the Gyrus device. J. Endourol. 15, 313–316 (2001).

    Article  CAS  Google Scholar 

  50. Omar, M. I. et al. Systematic review and meta-analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP). BJU Int. 113, 24–35 (2014).

    Article  Google Scholar 

  51. Kaplan, S. A. & Te, A. E. Transurethral electrovaporization of the prostate: a novel method for treating men with benign prostatic hyperplasia. Urology 45, 566–572 (1995).

    Article  CAS  Google Scholar 

  52. Schulman, C. C. et al. Transurethral needle ablation (TUNA): safety, feasibility, and tolerance of a new office procedure for treatment of benign prostatic hyperplasia. Eur. Urol. 24, 415–423 (1993).

    Article  CAS  Google Scholar 

  53. Yerushalmi, A. et al. Localized deep microwave hyperthermia in the treatment of poor operative risk patients with benign prostatic hyperplasia. J. Urol. 133, 873–876 (1985).

    Article  CAS  Google Scholar 

  54. Costello, A. J., Bowsher, W. G., Bolton, D. M., Braslis, K. G. & Burt, J. Laser ablation of the prostate in patients with benign prostatic hypertrophy. Br. J. Urol. 69, 603–608 (1992).

    Article  CAS  Google Scholar 

  55. Kaplan, S. A. & Te, A. E. A comparative study of transurethral resection of the prostate using a modified electro-vaporizing loop and transurethral laser vaporization of the prostate. J. Urol. 154, 1785–1790 (1995).

    Article  CAS  Google Scholar 

  56. Gilling, P. J., Cass, C. B., Malcolm, A. R. & Fraundorfer, M. R. Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J. Endourol. 9, 151–153 (1995).

    Article  CAS  Google Scholar 

  57. Gilling, P. J., Kennett, K., Das, A. K., Thompson, D. & Fraundorfer, M. R. Holmium laser enucleation of the prostate (HoLEP) combined with transurethral tissue morcellation: an update on the early clinical experience. J. Endourol. 12, 457–459 (1998).

    Article  CAS  Google Scholar 

  58. Gilling, P. J. et al. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 109, 408–411 (2012).

    Article  Google Scholar 

  59. Kuntz, R. M., Lehrich, K. & Ahyai, S. A. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur. Urol. 53, 160–166 (2008).

    Article  Google Scholar 

  60. Naspro, R. et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur. Urol. 50, 563–568 (2006).

    Article  Google Scholar 

  61. Bouchier-Hayes, D. M., Anderson, P., Van Appledorn, S., Bugeja, P. & Costello, A. J. KTP laser versus transurethral resection: early results of a randomized trial. J. Endourol. 20, 580–585 (2006).

    Article  Google Scholar 

  62. Maria, G. et al. Relief by botulinum toxin of voiding dysfunction due to benign prostatic hyperplasia: results of a randomized, placebo-controlled study. Urology 62, 259–264 (2003).

    Article  Google Scholar 

  63. Denmeade, S. R. et al. Phase 1 and 2 studies demonstrate the safety and efficacy of intraprostatic injection of PRX302 for the targeted treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur. Urol. 59, 747–754 (2011).

    Article  CAS  Google Scholar 

  64. McNicholas, T. A. et al. Minimally invasive prostatic urethral lift: surgical technique and multinational experience. Eur. Urol. 64, 292–299 (2013).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

Both authors researched data for the article, contributed to the discussion of content and wrote the article. P. J. Gilling reviewed the manuscript before submission.

Corresponding author

Correspondence to Peter J. Gilling.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kahokehr, A., Gilling, P. Landmarks in BPH—from aetiology to medical and surgical management. Nat Rev Urol 11, 118–122 (2014). https://doi.org/10.1038/nrurol.2013.318

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2013.318

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing