BENIGN PROSTATIC HYPERPLASIA - FOREWORD

Benign prostatic hyperplasia (BPH) is a pathologic disorder that devel ops in response to the action of dihydrotestosterone on the aging pros tate and to changes in stromal and epithelial cells in this exocrine g land. The current therapies for this disorder are chosen after other c auses for irritative and obstructive symptoms have been excluded and t he status of the urinary tract has been assessed. This evaluation incl udes a detailed medical history, a thorough genito-urinary and neurolo gical examination, assessment of serum prostate specific antigen and c reatinine levels, as well as a urinalysis. A urodynamic evaluation con sisting of a combined pressure-flow study is required if the diagnosis of obstruction is to be made. Patients with minimal symptoms and norm al test results require no therapy. Mild to moderate symptoms can be c ontrolled, at least temporarily, with alpha-adrenergic blockers such a s terazosin or doxazosin. A subset of BPH patients with obstructive sy mptoms respond to the 5 alpha-reductase inhibitor finasteride. Early r esults with minimally invasive treatments such as laser prostatectomie s, hyperthermia, and ultrasonic and radio-frequency ablation appear en couraging for those with moderate symptoms of prostatism. Severe sympt oms, urinary retention, gross hematuria, recurrent urinary bt act infe ctions, bladder calculi, and hydronephrosis or renal insufficiency war rant transurethral incision, resection, vaporization, or open prostate ctomy (for very large neoplasms). Although the morbidities of these la tter surgical therapies are not insignificant, these treatments offer the best and most durable results for relief of obstruction and amelio ration of symptoms.