Benign prostatic hyperplasia (BPH) is a noncancerous enlargement, or hypertrophy, of the prostate gland. It is one of the most common diseases in aging men. BPH typically occurs in men older than 40 years. By the time they reach 60 years, 50% of men have BPH. It affects as many as 90% of men by 85 years of age. BPH is the second most common cause of surgical intervention in men older than 60 years.

Smoking, heavy alcohol consumption, obesity, reduced activity level, hypertension, heart disease, diabetes, and a Western diet (high in animal fat and protein and refined carbohydrates, low in fiber) are risk factors for BPH.

The cause of BPH is not well understood, but testicular androgens have been implicated. Dihydrotestosterone (DHT), a metabolite of testosterone, is a critical mediator of prostatic growth. Estrogens may also play a role in the cause of BPH; BPH generally occurs when men have elevated estrogen levels and when prostate tissue becomes more sensitive to estrogens and less responsive to DHT. The prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine. Incomplete emptying of the bladder and urinary retention leading to urinary stasis may result in hydronephrosis, hydroureter, and urinary tract infections (UTIs). BPH develops over a prolonged period; changes in the urinary tract are slow and insidious. The cause is not well understood, but evidence suggests hormonal involvement.

• Symptoms vary, ranging from mild to severe; severity tends to increase with age.
• The prostate is large, rubbery, and nontender on digital rectal exam (DRE). Prostatism (obstructive and irritative symptom complex) is noted.
• Hesitancy in starting urination, increased frequency of urination, nocturia, urgency, and abdominal straining are seen.
• Decrease in volume and force of the urinary stream, interruption of the urinary stream, and dribbling may be present.
• Sensation of incomplete emptying of the bladder, acute urinary retention (more than 50 mL in middle-aged adults, more than 100 mL in older adults), and recurrent UTIs occur; ultimately, azotemia and kidney disease result, with chronic urinary retention and large residual volumes.
• Fatigue, anorexia, nausea and vomiting, and pelvic discomfort are also reported.

• Health history should focus on urinary tract, including previous surgical procedures, family history of prostate disease, and general health issues. Voiding diary may be helpful to assess frequency and related symptoms.
• Physical examination, including DRE, is performed.
• Urinalysis is used to screen for hematuria and UTI.
• Prostate-specific antigen (PSA) level is obtained if the patient has at least a 10-year life expectancy and knowledge of the presence of prostate cancer would change management.
• Urinary flow rate recording and the measurement of postvoid residual (PVR) urine are assessed.
• Urodynamic studies, urethrocystoscopy, and ultrasound may be performed.
• Complete blood studies, including clotting studies, are obtained.
• Cardiac status and respiratory function are assessed because of age group.

The treatment plan depends on the cause, severity of symptoms and obstruction, and condition of the patient. Treatment measures include the following:

• Immediate catheterization if patient cannot void (with consultation of a urologist if an ordinary catheter cannot be inserted); suprapubic cystostomy sometimes necessary
• “Watchful waiting” to monitor disease progression

See “Nursing Process: The Patient Undergoing Prostatectomy” under Cancer of the Prostate in Section C additional information.

For more information, see Chapter 59 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.