Benign prostatic hyperplasia (BPH) is a common disorder of the aging male that is a benign enlargement of the prostate gland. Histologic evidence of BPH is rare under the age of 30, but by the eighth decade of life the disease can be found in nearly all men.1,2 An abnormal proliferation of both stromal and glandular elements in an area of the prostate known as the transition zone is responsible for the disease. The etiology of this proliferation is unknown at the present time.3 A genetic predisposition to the proliferation appears to exist, as a family history of BPH is a significant risk factor for the development of BPH. An endocrine basis for the disease also exists. Men who have been castrated do not develop BPH. Furthermore, as is discussed later, endocrine manipulation can cause involution of BPH.

BPH produces symptoms, which are classified as either obstructive or irritative. The obstructive symptoms include urinary hesitancy, a weak stream, double voiding, and an inability to empty the bladder. The irritative symptoms, which consist of frequency, urgency, and dysuria, are the most bothersome and are the reason most men seek treatment. A poor correlation is found between prostate size and the magnitude of voiding symptoms, although larger glands in general do produce more prostatic symptoms.

In men with mild to moderate voiding symptoms, observation is a reasonable option.4,5 Results of a multicenter randomized trial show that most men do not develop serious complications such as retention or urinary tract infections if such an approach is followed.6 Growth of the prostate is relatively slow, averaging 1.6% per year in a prospective population-based trial.7 In larger prostates, the growth rate is higher.

Surgical resection or enucleation of the prostatic adenoma has been the mainstay of treatment for BPH until the past decade. Transurethral resection of the prostate (TURP) remains the gold standard of treatment for BPH, as it produces the greatest improvements in urinary flow rate and symptom improvement. TURP is an invasive procedure, however, requiring a 1- to 3-day hospital stay, and is associated with a 70% to 75% incidence of retrograde ejaculation, a 5% to 10% incidence of impotence, and a 2% to 4% risk of urinary incontinence.8,9,10 and 11 In addition, the reoperation rate is estimated at 15% to 10%.12 For smaller prostates, transurethral incision of the prostate is an effective procedure.13