Benign Prostatic Hyperplasia (BPH): Urinary & Sexual Impact

BPH = non-cancerous prostate enlargement (transition zone). Prevalence: 50% at 60, 80% at 80. Compresses prostatic urethra → bladder outlet obstruction (BOO).

Urinary Symptoms (LUTS)

Storage	Voiding	Post-Micturition
Frequency (>8/day)	Hesitancy	Feeling incomplete
Nocturia (≥2/night)	Weak stream	Post-void dribbling
Urgency ± incontinence	Intermittency
	Straining

Pathophysiology

• Static: Adenomatous nodules compress urethra.
• Dynamic: α1-adrenergic tone in prostate/stromal smooth muscle ↑urethral resistance.
• Bladder compensation: Hypertrophy → trabeculation → decompensation (↓compliance, ↑residual urine).

Sexual Function Impact

• Erectile dysfunction (ED): Shared risk factors (age, vascular disease, metabolic syndrome); not directly caused by BPH. However, BPH surgery (TURP, HoLEP) carries 5–15% risk of ED (cavernous nerve injury).
• Retrograde ejaculation: 65–90% post-TURP; 10–40% on α-blockers (tamsulosin, silodosin). Bladder neck fails to close → semen enters bladder. Harmless but causes infertility.
• Libido: 5-ARIs (finasteride, dutasteride) → ↓DHT → ↓libido (3–5%), ED (5–10%), gynecomastia.

Management

• Watchful waiting (mild LUTS, no complications)
• α-blockers (tamsulosin): rapid symptom relief
• 5-ARIs (finasteride): ↓prostate volume 20–30% over 6–12 mo; best for >30g
• Combination: maximal benefit for moderate-severe
• Surgery (TURP, HoLEP, Rezūm, UroLift): refractory, retention, stones, recurrent UTI, hydronephrosis