Management of benign prostatic hyperplasia: practice variation and appropriateness of care

Many elderly men will wistfully remember the days that their voiding pattern was like that of the boy on the cover. As age increases, many physical changes take place, often resulting in the appearance of more or less significant health problems or 'inconveniences of old age'. Voiding dysfunction is a typical problem of elderly men. In many cases, this has its cause in a small but sometimes very troublesome organ: the prostate. The prostate gland is situated under the bladder, surrounding the proximal part of the urethra. A normal adult prostate is about the size and shape of a chestnut, and weighs about twenty grammes. Its exact function is unclear. Although the prostatic secretion, discharged into the urethra during ejaculation, has been thought to have some role in sustaining the sperm and to facilitate its passage into the uterus, it has been proven not to be essential for the fertilization process. The majority of the voiding problems in elderly men is due to benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the central part of the prostate. Basically, BPH refers to a histological change of prostatic tissue, consisting of the proliferation of small nodules. As was demonstrated in various autopsy studies, this histopathological (microscopic) condition is very common in elderly males, varying from 32·52% in the age group of 51-60 years to 77-99% in men of 81 years and older.