Benign prostatic hyperplasia. Its natural history, epidemiologic characteristics, and surgical treatment
J. E. Oesterling
Department of Urology, Mayo Clinic, Rochester, Minn.
Benign prostatic hyperplasia is a nonmalignant enlargement of the prostate
that is due to both epithelial and stromal hyperplasia. Although the exact
origin of this condition is not well defined, it is thought to arise as
microscopic nodules in the periurethral tissue of the prostate gland as
early as the late '20s. With advancing age and the presence of androgens,
this histologically identifiable hyperplastic tissue progresses to a
macroscopic state, which is a palpably enlarged prostate. This enlarged
prostate causes clinically significant obstruction of the bladder outlet in
many men, necessitating therapeutic intervention. Currently, prostatectomy
is the standard treatment with successful long-term results. Nevertheless,
much information has become available recently on its indications,
outcomes, associated morbidity and mortality, and effect on quality of
life. Because of these findings as well as the rising healthcare costs and
the desire among patients to avoid surgery if possible, there is much
enthusiasm for developing less expensive, less invasive, but effective
treatments for symptomatic benign prostatic hyperplasia. To appreciate the
tremendous advances being made with regard to the treatment of benign
prostatic hyperplasia, it is necessary to have a complete understanding of
the disease process itself and its traditional therapies. This clinical
report provides a comprehensive review of the natural history,
epidemiologic characteristics, and outcomes of both open and transurethral
surgery for benign prostatic hyperplasia.
