Main Article Content

Pablo Andrés Alvarez Barros
Franklin Fernando Cisneros Espín


Prostatic hyperplasia, pharmacological treatment, adrenergic alpha-Antagonists


Benign Prostatic Hyperplasia (BPH) stands as the most prevalent noncancerous growth in the prostate gland in elderly men, characterized by the enlargement of the prostate gland. A subtype of BPH that has garnered the interest in the medical community is one in which a significant increase in the middle lobe is evident, which can lead to various complications and challenges in clinical management. Methodology: The study adopts a systematic approach to review the literature on treatment response in patients with benign prostatic hyperplasia and a notably affected middle lobe. A comprehensive search was conducted in medical and scientific databases using relevant keywords and temporal filters. Clinical studies that met specific inclusion criteria were selected, and bibliometric analysis was performed to identify prominent journals in this field and their impact. This provides a comprehensive view of research in this domain and its influence on the scientific community.

Result: Various non-invasive therapies, such as psychosexual therapy and phosphodiesterase 5 inhibitors (PDE5), have shown significant improvements in the symptoms of benign prostatic hyperplasia (BPH) without negatively affecting sexual function. Multiple surgical procedures, such as open prostatectomy, transurethral resection of the prostate (TURP), and arterial embolization of the prostate (AEP), are used in the treatment of BPH, each with different success rates and risks. GreenLight laser photoselective vaporization is an effective and safe option.

Conclusion: Risk factors, treatment selection, and the importance of early diagnosis are emphasized, along with the ongoing need to research and improve therapies for this common condition in older men.

Abstract 182 | pdf Downloads 67


1. Langan RC. Benign Prostatic Hyperplasia. Primary Care: Clinics in Office Practice. 2019; 46(2).
2. Sandoval E, Fonseca J, Bautista J, Mora C. Benign prostatic hyperplasia: Review article. Latin Science. 2022.
3. Brenes F. Diagnosis of benign prostatic hyperplasia. Spanish Association of Urology. 2020.
4. Lokeshwar SD, Harper BT, Webb E, Jordan A, TA, Neal DE, et al. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Translational Andrology and Urology. 2019; (529-539).
5. McVary KT. Epidemiology and pathophysiology of benign prostatic hyperplasia. UpToDate. 2023.
6. Madersbacher S, Sampson N, Culig Z. Pathophysiology of Benign Prostatic Hyperplasia and Benign Prostatic Enlargement: A Mini-Review. Gerontology. 2019;: p. 458-464.
7. Ng M, Baradhi KM. Benign Prostatic Hyperplasia. StatPearls. 2022.
8. Lerner LB, McVary KT, Barry MJ, Rixler BR, Dahm P, Das AK, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA GUIDELINE PART I-Initial Work-up and Medical Management. The Journal of Urology. 2021;: p. 806-817.
9. GBD 2019 Benign Prostatic Hyperplasia Collaborators. The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancent. 2022; 3(11).
10. Delgado-Quiñones EG, Pulido-Guerrero C, Navarro-Sandoval C, Rivera-Valdivia WG, Sahagún-Cuevas MN. Prevalence of prostate symptoms in patients over 60 years of age in a family medicine unit. Medical Journal MD. 2015.
11. Untergasser G, Madersbacher S, Berger P. Benign prostatic hyperplasia: age-related tissue-remodeling. Experimental Gerontology. 2005.
12. Soler R, Andersson KE, Chancellor MB, Chapple CR, de Groat C, Drake MJ, et al. Future Direction in Pharmacotherapy for Non-neurogenic Male Lower Urinary Tract Symptoms. European Urology. 2013.
13. Tyloch JF, Wieczorek AP. The standards of an ultrasound examination of the prostate gland. Part 2. Journal of Ultrasonography. 2017;: p. 43-58.
14. Vignozzi L, Gacci M, Maggi M. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nature reviews. Urology. 2016.
15. Romero F, Romero AW, Filhno TB, Kulysz D, Oliveira FC, Filho RT. The prostate exam. Health Education Journal. 2012.
16. Kang D, Andriole GL, Van De Vooren RC, Crawford D, Chia D, Urban DA, et al. Risk behaviours and benign prostatic hyperplasia. BJU International. 2004; 93(9).
17. Dai X, Fang X, Ma Y, Xianyu J. Benign Prostatic Hyperplasia and the Risk of Prostate Cancer and Bladder Cancer. Medicine. 2016; 95(18).
18. Asiedu B, Anang Y, Nyarko A, Doku DA, Amoah BY, Santa S, et al. The role of sex hormones in benign prostatic hyperplasia. The Aging Male. 2017; 20(1).
19. Wang YB, Yang L, Deng YQ, Yan SY, Luo LS, Chen P, et al. Causal relationship between obesity, lifestyle factors and risk of benign prostatic hyperplasia: a univariable and multivariable Mendelian randomization study. Journal of Translational Medicine. 2022.
20. Zhang AY, Xu X. Prevalence, Burden, and Treatment of Lower Urinary Tract Symptoms in Men Aged 50 and Older: A Systematic Review of the Literature. SAGE Open Nursing. 2018.
21. Arana-Carrera dL, Morales-Ramos VM. Review of the application of photoselective vaporization in benign prostatic hyperplasia. Mexican Journal of Urology. 2021; 81(3).
22. Miernik A, Gratzke C. Current Treatment for Benign Prostatic Hyperplasia. Deutsches Arzteblatt International. 2020;: p. 843-854.
23. Sandoval Gutierrez JÁE, Fonseca Andrade JE, Bautista Frausto JH, Mora Vazquez CA. Benign prostatic hyperplasia: Review article. Latin Science. Multidisciplinary Journal. 2022; 6(2).
24. Jia L, Strand DW, Goueli RS, Gahan JC, Roehrborn CG, Mauck RJ. PSA density is associated with BPH cellular composition. Prostate. 2022.
25. Descazeaud A, Robert G, de La Taille A. How to evaluate BPH-related SBAUs in clinical practice and research? Progres in urologie. 2018.
26. McVary K. Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia. UpToDate. 2023.
27. Plochocki A, King B. Medical Treatment of Benign Prostatic Hyperplasia. Urologic Clinics of North America. 2022; 49(2).
28. Narayan P, Tununguntla HS. Long-Term Efficacy and Safety of Tamsulosin for Benign Prostatic Hyperplasia. Reviews in urology. 2005.
29. Traish AM. Health Risks Associated with Long-Term Finasteride and Dutasteride Use: It's Time to Sound the Alarm. The World Journa of Men's Health. 2020; 38(3).
30. Montiel Jarquín ÁJ, Gutiérrez Quiroz T, Pérez Vázquez AL, Ortiz Agustín JJ, García Galicia A, Loría Castellanos J. Quality of life and erectile dysfunction in patients with benign prostatic hyperplasia. Surgery and surgeons. 2021.
31. Quimis A, Vargas L, Izquierdo J. Predominant factors of benign prostatic hyperplasia. Scientific Journal of Research. 2019.
32. Well, Ortiz. Clinical and epidemiological characteristics of patients with symptomatic benign prostatic hyperplasia at the Regional Teaching Hospital of Cajamarca, 2018. Revista Medica de Trujillo. 2022.
33. Ramos F. Prevalence and epidemiological characteristics of benign prostatic hyperplasia in patients attended at the Regional Hospital of Ica during the year 2021 - 2022. Mexican Journal of Urology. 2023.
34. Delgado-Quiñones G, Pulido-Guerrero C, Navarro-Sandoval C, Rivera-Valdivia WG, Sahagún-Cuevas MN. Prevalence of prostate symptoms in patients over 60 years of age in a family medicine unit. Medical Journal MD. 2015.
35. Pinilla Conil M, Betés Pola P, Blasco Borao S, Rodríguez Hernández P, Molero Conde B, Loraque Alonso M. Benign prostatic hyperplasia: clinical case. Revista Sanitaria de Investigación. 2022.
36. Farfan I. Prevalence and epidemiological characteristics of benign prostatic hyperplasia in patients attended at the Regional Hospital of Ica during the year 2021 - 2022. Mexican Journal of Urology. 2023.
37. Vargas M. Benign prostatic hyperplasia: epidemiology, etiology, pathophysiology, evaluation and diagnosis. Systematic review. Electronic Journal of PortalesMedicos. 2023.
38. Hernández Galván F, García Torres F, Suarez Fernández de Lara OA, López Sánchez E, Vidaña Amaro JA, Pineda Rodríguez ME, et al. Correlation of intravesical prostatic protrusion and lower urinary symptomatology. Imbiomed. 2019; 30(3).
39. Barreto Pincay GM, Barreto Loor F, Cevallos Villamar JD, Giler Saltos LA, Vinces Zambrano MI. Preventive considerations in patients undergoing prostate surgery. Pol. Con. 2019; 4(3): p. 18-349.
40. Alcántara Montero A, López de Alda González A. Can measurement of intravesical protrusion predict response to medical treatment in patients with benign prostatic hyperplasia? Lights and shadows. Spanish Urological Acts. 2019; 42(8): p. 542-543.
42. Maldonado Ávila M, Sierra Ramirez JA, Carrillo Ruiz JD, Manzanilla García HA, Guzman Esquivel J, González Valle C, et al. Intravesical prostatic middle lobe size as a predictor of the outcome of attempted transurethral catheter removal in patients with acute urine retention. Mexican Journal of Urology. 2019; 74(1): p. 30-34.
43. Tjie Wijaya A, Srie Laksminingsih N, Made Dwijaputra I, Widiana R, Kusuma Duarsa GW, Widhi Asih M, et al. Correlation of Prostate Volume and Intravesical Prostatic Protrusion with Detrusor Wall Thickness using Transabdominal Ultrasonography in Benign Prostate Enlargement: A Preliminary Study. Jurnal Bedah Nasional. 22; 6(2): p. 50.
44. Olufikayo Oshagbemi A, Gideon Ofoha C, C. Akpayak I, Ibrahim Shuaibu S, Kutan Dakum N, Mamzhi Ramyil V. The predictive value of intravesical prostatic protrusion on the outcome of trial without catheter in patients with acute urinary retention from benign prostatic hyperplasia at Jos University Teaching Hospital, Nigeria: a prospective observational study. Pan African Medical Journal. 2022; 42.
45. Rahardjo H, Gemilang B. Correlation of Intravesical Prostatic Protrusion in Benign Prostate Hyperplasia and Residual Lower Urinary Tract Symptoms After Surgery: A Systematic Review. Nephro-Urology Monthly. 2021.
46. Hussain E, Tappa M, Deuri Bharali M. Intravesical prostatic protrusion and prostate volume in patients with acute urine retention. International Surgery Journal. ; 9(2): p. 356.
47. Caro-Zapata FL, Vásquez-Franco A, Correa-Galeano ED, García-Valencia J. Infectious complications after open prostatectomy and transurethral resection of the prostate in patients with benign prostatic hyperplasia. Iatreia. 2018; 31(3): p. 274-283.
48. Park SC, Lee JW, Rim JS. Relationship between intravesical protrusion and pressure-flow study findings in patients with benign prostatic obstruction/lower urinary tract symptoms. VHL. ; 36(3): p. 165-170.
49. Carrero López VM, Cózar Olmo M, Miñana López B. Benign prostatic hyperplasia and lower urinary tract symptoms. Review of current evidence. Spanish Urological Acts. 2019; 40(5): p. 288-294.
50. Condori H, Raúl M, Loza C. Relationship of post-voiding residue, degree of bladder "trabeculation" and urinary flow in patients with symptomatic benign prostatic hyperplasia. Revista Medica Herediana. ; 23(3): p. 148-15.
51. León Estrada A. Manual flowmetry in the clinical and therapeutic evaluation of patients with benign prostatic hyperplasia. MEDISAN. 2022; 26(4).
52. Concheski Machado F, Nunes Lima R. BENIGN PROSTATIC HYPERPLASIA AND SUAS COMPLICAÇÕES. ResearchGate GmbH. 2022.
53. Zambrano N, Palma C. Treatment of benign prostatic hyperplasia and erectile dysfunction by the general practitioner. Revista Médica Clínica Las Condes. 2019; 29(2): p. 180-192.
54. Ávila Cabreja JA, García Méndez FM, Rodríguez Venegas ED, Peña Velázquez A. Effectiveness of Cucurbita pepo in the treatment of prostatic hyperplasia. Systematic review and meta-analysis. MediSur. 2021; 19(1): p. 157-165.
55. Lopez H, Medina. Drug treatment of benign prostatic hyperplasia. Review of the bibliography. Mexican Journal of Urology. 2019.
56. Bultó Gonzalvo R, Bernardello Ureta M, Cervera Alcaide J, Sanchez Rodriguez M, Franco M, Freixa Sala R, et al. Does previous treatment with 5-alpha reductase inhibitors have an impact on prostatic enucleation with holmium laser? Results of a prospective observational study and literature review. Spanish Urological Acts. 2023.
57. Fourmarier M, Chérasse A, Misrai V. Recent and emerging techniques in the treatment of symptomatic benign prostatic hyperplasia. EMC - Urology. 2021; 53(2): 1-8.
58. Yilmaz O, Hayit H, Yesildal C, Yenigurbuz S, Yilmaz F, Emre Kizilkan Y. Hounsfield Units: a promising non-invasive tool for the diagnosis of benign prostatic hyperplasia. Spanish Urological Acts. 2022; 46(7): p. 407-412.
59. Espinoza AR. Intraprostatic ethanol injection as an alternative therapy in patients with benign prostatic hyperplasia. Spanish Urological Acts. 2019; 43(3).
60. García Landaverde R, Silva Palomares M, Villegas Domínguez JE, Márquez Celedonio FG. Effect of tamsulosin on quality of life in patients with benign prostatic hyperplasia. Journal of Military Health. 2018; 72(3): 3-4.
61. Araujo da Silva MH, by Souza JA. Vulnerability of patients with prostatic hyperplasia treated with dutasteride and finasteride. Bioethics Journal. 2021; 29(2): p. 394-400.
62. Noroña Vásconez EF, Páez Vargas PC. Comparison of clinical results in patients with benign prostatic hyperplasia with initial pharmacological, non-pharmacological and surgical treatment, attended at the Pablo Arturo Suárez Hospital from January 2014 to December 2016. VHL. 2020; 31(1): p. 55-56.
63. Mexico GPCd. Clinical Practice Guide of Mexico. [Online].; 2018.. Available in: http://www.facmed.unam.mx/sg/css/GPC/SIDSS-GPC/gpc/docs/IMSS-176-09-ER.pdf.
64. Hernández HF, Ravelo MJ, Dreke Freire SC, Guedes Acosta AB. Homeopathic complex in the treatment of benign prostatic hyperplasia. Journal of Medical Sciences. Havana. 2015.
65. Rivera, Parra C. Usefulness of total prostate-specific antigen and free prostate-specific antigen index for detecting prostate cancer in asymptomatic patients. Clinical biochemistry. 2021.