Snapshot A 70-year-old man presents to his physician with difficulty initiating a stream and post-void dribbling. He also reports having increased urinary urgency and a weak urinary stream. Medical history is significant for hypertension and is not on medication. On digital rectal exam, his prostate is enlarged, non-tender, firm, and smooth. Urinalysis is unremarkable and prostate-specific antigen is elevated. He is started on tamsulosin to improve his lower urinary tract symptoms. Introduction Clinical definition benign hyperplasia of the stromal and epithelial cells of the prostate that results in lower urinary tract symptoms (LUTS) such as post-void dribbling increased urinary frequency and urgency nocturia weak urinary stream Epidemiology Demographics men > 45 years of age Etiology Pathogenesis unclear; however, chronic inflammation and hormonal and vascular mechanisms may play a role Associated conditions obesity and metabolic syndromes hypertension type 2 diabetes mellitus Presentation Symptoms issues with urinary storage e.g., nocturia, increased urinary frequency, urinary incontinence, and urgency issues with voiding e.g., weak urinary stream, hesistancy, straining to void, and post-void dribbling exacerbated by alpha-1 agonists irritative issues e.g., urgency and increased urinary frequency Physical exam digital rectal exam a non-tender, smooth, elastic, and firm enlarged prostate Studies Labs urinalysis to detect the presence of a urinary tract infection or blood prostate-specific antigen non-specific Diagnostic criteria this is a clinical diagnosis based on history (e.g., storage, voiding, and/or irritating urinary symptoms) and physical exam (e.g., a non-tender, smooth, elastic, and firm enlarged prostate) Differential Prostate cancer Prostatitis Urinary tract infection Bladder cancer Treatment Medical α1-blockers (e.g., terazosin and tamsulosin) indication login to view 3 more bullets 5-α reductase inhibitors (e.g., finasteride) indication login to view 2 more bullets phosphodiesterase-5 inhibitors (e.g., sildenafil) indication login to view 1 more bullet Surgical transurethral resection of the prostate indication login to view 2 more bullets complication login to view 3 more bullets Complications UTI Nephrolithiasis Bladder stones Chronic kidney disease Hydronephrosis Prognosis Symptoms slowly and progressively worsen