Benign Prostatic Hypertrophy (BPH)

Morgan McDowell, DNP, APRN, WHNP-BC, AGPCNP-BC, presented “Benign Prostatic Hypertrophy (BPH)” 

How to cite: McDowell, Morgan. “Benign Prostatic Hypertrophy (BPH).” July 2025. Accessed Mar 2026. https://grandroundsinurology.com/benign-prostatic-hypertrophy-bph/

Benign Prostatic Hypertrophy (BPH) – Summary

Morgan McDowell, DNP, APRN, WHNP-BC, AGPCNP-BC, Director of APP Education, Centra Health, Lynchburg, Virginia, delivers an in-depth overview of benign prostatic hyperplasia (BPH) grounded in the American Urological Association (AUA) guidelines. She begins this 45-minute presentation with foundational anatomy and epidemiology, clarifying key diagnostic terminology, distinguishing BPH from benign prostatic enlargement, obstruction, and bladder outlet obstruction. Lower urinary tract symptoms (LUTS) and overactive bladder are also addressed.

Evaluation begins with history and physical examination, urinalysis, postvoid residual, and symptom scoring with the International Prostate Symptom Score. She emphasizes the value of bladder diaries and flow rate analysis.

Dr. McDowell discusses first-line treatment strategies, including timed voiding, fluid management, and avoidance of bladder irritants such as caffeine and alcohol. Pharmacologic management includes α-blockers and 5α-reductase inhibitors. Combination therapy is appropriate for larger prostates and more severe symptoms. Additional options include PDE-5 inhibitors and agents targeting overactive bladder symptoms.

Dr. McDowell transitions to surgical interventions, explaining indications such as urinary retention, renal insufficiency, recurrent infections, or patient preference. She details classic and emerging procedures, including Transurethral Resection of the Prostate (TURP), Transurethral Incision of the Prostate (TUIP), Holmium Laser Enucleation of the Prostate (HoLEP), Prostate Artery Embolization (PAE), UroLift, Rezūm, laser ablation, Transurethral Vaporization of the Prostate (TUVP), Aquaablation, iTind, and Optilume. Each is discussed with attention to prostate size suitability, outcomes, complications, and patient selection.

Dr. McDowell highlights the role of imaging, morphology, and patient values in choosing treatment, reinforcing the advanced practice provider’s central role in BPH evaluation, counseling, and ongoing care. This comprehensive review equips clinicians with actionable guidance to individualize management strategies.