Introduction

Definition Benign prostatic hyperplasia (BPH) is a nonmalignant proliferation of the glandular and stromal components of the prostate, mainly in the transition zone.

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Put what you learned about BPH into practice in a simulated, AI-powered consultation: talk with Carlos, a 68-year-old patient with urinary symptoms, by typing or speaking. Request the physical exam and tests, propose a diagnosis and a treatment, and get an evaluation at the end. It is a complementary practice tool, free to use.

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Video lesson

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Video pending upload (embedded YouTube)

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Summary

What is BPH?

It is important to distinguish three concepts:

BPH: histologic diagnosis.
Benign prostatic enlargement: increase in prostate volume.
LUTS: lower urinary tract symptoms.

A patient can have an enlarged prostate without symptoms and can also have LUTS without BPH necessarily being the cause.

Key concept

BPH is not prostate cancer or a premalignant lesion, although both conditions can coexist.

Where does it originate?

BPH develops mainly in the transition zone, around the prostatic urethra.

In contrast, most prostate cancers originate in the peripheral zone, which is the region most accessible to the digital rectal exam.

Why does it cause obstruction?

There are two components:

Static component: growth of prostate tissue that compresses the urethra.
Dynamic component: increased tone of prostatic and urethral smooth muscle, mediated mainly by alpha-1 receptors.

This helps in understanding the treatment:

Dynamic component → alpha-blockers.
Static component and progression → 5-alpha-reductase inhibitors.

Complications

Progression can be associated with:

Urinary retention.
Recurrent urinary tract infections.
Bladder stones.
Recurrent hematuria.
Hydronephrosis.
Deterioration of renal function.
Bladder dysfunction.

To remember

BPH → transition zone.
Cancer → predominantly peripheral zone.
Urinary symptoms ≠ prostate size.

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PDF

⬇ Download lesson guide (PDF)

Prostate Adenoma (BPH) — Guide for Medicine: definition, epidemiology, pathophysiology, clinical presentation (LUTS), diagnostic tests, differential diagnoses, pharmacologic and surgical treatment, diagnostic-therapeutic algorithm, and exam pearls.

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Practical algorithm

Content pending upload The static/dynamic component → treatment mapping is developed in the Summary (block 3); it will be added here as a visual diagram.

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Clinical case

Integrative case

Man with lower urinary tract symptoms

Step-by-step case presentation — you make decisions as it unfolds, with a score and feedback at the end.

Solve the case →

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Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

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References

European Association of Urology (EAU) — Guidelines on Management of Non-Neurogenic Male LUTS incl. Benign Prostatic Obstruction, 2025.
American Urological Association (AUA) — Guideline on Benign Prostatic Hyperplasia (BPH), 2026.

Sources cited in the PDF study guide (block 4).

Benign prostatic hyperplasia