Bladder Outlet Obstruction in Elderly Males

Common Causes and Pathophysiology

Benign prostatic hyperplasia (BPH) is the most common cause of bladder outlet obstruction in elderly males, affecting approximately 60% of men by age 60 and 80% by age 80, according to the American Urological Association 1
The static component of BPH, which is the direct physical obstruction from enlarged prostatic tissue, contributes to urinary obstruction 1
The dynamic component of BPH, which is the increased smooth muscle tone and resistance within the enlarged gland, also contributes to urinary obstruction 1
BPH develops due to an imbalance between growth and apoptosis (cellular death) in favor of growth, subsequently causing an increase in cellular mass, as stated by the European Association of Urology 1

Storage symptoms of BPH include urgency, frequency, and nocturia, as reported by the American Urological Association 1
Voiding symptoms of BPH include weak stream, hesitancy, intermittency, straining, and sensation of incomplete emptying, according to the European Association of Urology 1
A required initial assessment for BPH includes relevant medical history, physical examination including digital rectal examination (DRE), assessment of symptom severity and bother, and urinalysis, as recommended by the American Urological Association 1, 3, 4, 5
Additional evaluations for BPH may include serum PSA, frequency-volume chart, and post-void residual measurement, as suggested by the European Association of Urology 2, 3, 5

Alpha-adrenergic antagonists (Alpha Blockers) are a first-line therapy for most men with moderate symptoms of BPH, as recommended by the American Urological Association 1
5-alpha reductase inhibitors (5ARIs) are effective for men with larger prostates (>30cc) and can reduce prostate size over time, according to the European Association of Urology 2
Transurethral resection of the prostate (TURP) is the gold standard surgical approach for BPH and is most effective for relieving symptoms and improving urinary flow, as stated by the American Urological Association 1, 2
Minimally invasive procedures, such as laser procedures (HoLEP, GreenLight), may be considered for patients with BPH, as reported by the European Association of Urology 2

BPH is rarely life-threatening, but its impact on quality of life can be significant, as noted by the American Urological Association 1
Treatment decisions for BPH should consider symptom severity, degree of bother, comorbidities, and potential drug interactions, as recommended by the European Association of Urology 3