BPH
Formal Definition
Benign Prostatic Hyperplasia; non-malignant enlargement of the prostate gland causing lower urinary tract symptoms (LUTS) including hesitancy, weak stream, incomplete emptying, frequency, urgency, and nocturia; affects >50% of men by age 60 and >80% by age 80; treated medically with alpha-blockers and 5-alpha-reductase inhibitors, or surgically (TURP).
How It's Used on the Ward
"Enlarged prostate" or "BPH symptoms" — the urological diagnosis underlying most urinary retention in older men.
Example
""68-year-old male presenting unable to void, post-void residual 800mL on bladder scan: acute urinary retention secondary to BPH. Foley catheter placed, urology consulted, starting tamsulosin. Trial of void in 24–48 hours after alpha-blocker takes effect.""
Clinical Context
LUTS assessment: AUA Symptom Score (AUASS) quantifies severity. Mild (0–7): watchful waiting. Moderate (8–19): medical therapy. Severe (20–35): consider surgery. Medical treatment: alpha-blockers (tamsulosin, alfuzosin) — relax smooth muscle, rapid onset (days); 5-ARIs (finasteride, dutasteride) — reduce prostate size, slow onset (3–6 months). Combination therapy for large glands. Surgery: TURP (transurethral resection of the prostate) is gold standard. Complication of untreated retention: hydronephrosis, CKD, recurrent UTIs. Rule out malignancy: PSA, digital rectal exam. Red flags: hematuria, rapid symptom progression, pelvic mass → investigate further.