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Prostatic Hyperplasia
Katherine To'o, MD; Richard E. Fan, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          TERMINOLOGY

          • Synonyms

            • Prostatism; glandular and stromal hyperplasia
            • Hyperplasia is correct term since BPH is characterized by increased number of stromal and glandular cells (not hypertrophy, which means increase in size)
          • Definitions

            • BPH reserved for histopathologic pattern of smooth muscle and epithelial cell proliferation in transition zone (TZ) and periurethral glands [not in peripheral zone (PZ) where most cancers form]
            • Prostatism historically applied to almost all symptoms of micturition disorder in older men
              • Term implies prostate as cause of problem, which may not be case (e.g., neurologic abnormalities)
            • Lower urinary tract symptoms (LUTS) applies to any patient with urinary symptoms, regardless of age or sex; does not specify underlying etiology
              • Storage LUTS: Frequency, urgency, nocturia
              • Voiding LUTS: Hesitancy, straining, slow stream, intermittent or interrupted flow, terminal dribbling, sensation of incomplete emptying
            • Benign prostate enlargement (BPE): Usually presumptive diagnosis based on prostate size
            • Benign prostate obstruction (BPO): Enlarged gland with obstruction that has been proven by urodynamics
            • Bladder outlet obstruction (BOO): Generic term for any cause of subvesical obstruction, including BPO

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Roehrborn C et al: Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. In Partin A et al: Urology. 12th ed. Elsevier. 3305-42, 2021
                                          2. Mock S et al: Benign prostatic hyperplasia and related entities. In Hanno P et al: PENN Clinical Manual of Urology. 2nd ed. Saunders. 462-504, 2014
                                          3. Wasserman NF: Benign prostatic hyperplasia: a review and ultrasound classification. Radiol Clin North Am. 44(5):689-710, viii, 2006
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Prostatism; glandular and stromal hyperplasia
                                                    • Hyperplasia is correct term since BPH is characterized by increased number of stromal and glandular cells (not hypertrophy, which means increase in size)
                                                  • Definitions

                                                    • BPH reserved for histopathologic pattern of smooth muscle and epithelial cell proliferation in transition zone (TZ) and periurethral glands [not in peripheral zone (PZ) where most cancers form]
                                                    • Prostatism historically applied to almost all symptoms of micturition disorder in older men
                                                      • Term implies prostate as cause of problem, which may not be case (e.g., neurologic abnormalities)
                                                    • Lower urinary tract symptoms (LUTS) applies to any patient with urinary symptoms, regardless of age or sex; does not specify underlying etiology
                                                      • Storage LUTS: Frequency, urgency, nocturia
                                                      • Voiding LUTS: Hesitancy, straining, slow stream, intermittent or interrupted flow, terminal dribbling, sensation of incomplete emptying
                                                    • Benign prostate enlargement (BPE): Usually presumptive diagnosis based on prostate size
                                                    • Benign prostate obstruction (BPO): Enlarged gland with obstruction that has been proven by urodynamics
                                                    • Bladder outlet obstruction (BOO): Generic term for any cause of subvesical obstruction, including BPO

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Roehrborn C et al: Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. In Partin A et al: Urology. 12th ed. Elsevier. 3305-42, 2021
                                                                                  2. Mock S et al: Benign prostatic hyperplasia and related entities. In Hanno P et al: PENN Clinical Manual of Urology. 2nd ed. Saunders. 462-504, 2014
                                                                                  3. Wasserman NF: Benign prostatic hyperplasia: a review and ultrasound classification. Radiol Clin North Am. 44(5):689-710, viii, 2006