BAUS Medical Student Essay Competition: Medical management of symptomatic benign prostatic enlargement

摘要

Benign prostatic enlargement (BPE) and the development of lower urinary tract symptoms (LUTS) are often related events. LUTS are not classified as a disease, but has a symptom complex characterized by storage and voiding problems [1]. Although the aetiology of LUTS can be multifactorial - including idiopathic detrusor overactivity, age-related smooth muscle dysfunction, neurological disorders (e.g. dementia), longstanding diabetes, etc., it is understood that in many elderly men, LUTS are due1 to bladder outlet obstruction secondary to BPE [1,2]. This notion is supported by the well-documented findings that the incidence of LUTS and BPE (which is often defined histologically as benign prostatic hyperplasia) both increase with age [3]. Histological disease is present in more than 60% of men above the age of 60 with more than 40% of them becoming symptomatic (Fig. 1) [3]. Therefore, during the greater part of the 20th century, the most common treatment for LUTS arising from BPE was resection or enucleation of the prostate adenoma [2]; surgical approaches that were highly effective for treating symptomatic BPE.