Urinary Function

Benign prostatic hyperplasia (BPH) is a common problem among older men and can have a significant impact on quality of life. BPH is a histologically diagnosed disease and is present in 8% of men aged 41 to 50, 40 to 50% of men aged 51 to 60, 70% of men aged 61 to 70, and more than 80% of men older than 80 years. The pathogenesis of BPH remains incompletely understood, but there are many known risk factors for developing this disease. These include race, family history of cancer, higher serum levels of testosterone and estradiol, alcohol consumption, prostatitis, and nonsteroidal anti-inflammatory drug use.1 2 3 4 5 The classic clinical presentation of BPH is the experience of lower urinary tract symptoms (LUTS). These symptoms include frequency, nocturia, urgency, incontinence, slow or intermittent stream, straining, and terminal dribbling (Table 1). These symptoms are experienced moderately to severely in 25% of men in their 50s, 33% of men in their 60s, and approximately 50% of men in their 80s. Like any other disease, the clinical evaluation for a man with suspected BPH begins with a thorough history and physical exam. The International Prostate Symptom Score (IPSS) index can be used to classify the severity of LUTS in patients. This consists of seven questions that assess the severity and frequency of different symptoms of BPH as well as a question asking the patient to rate how their quality of life is affected by these symptoms.