BENIGN PROSTATIC HYPERPLASIA (BPH)

 

INTRODUCTION: This is enlargement, or hypertrophy, of the prostate gland. The prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine. Incomplete emptying of the bladder and urinary retention leading to urinary stasis may result in hydronephrosis, hydroureter, and urinary tract infections (UTIs). The cause is not well understood, but evidence suggests hormonal involvement. BPH is common in men older than 40 years.

CLINICAL MANIFESTATIONS: The prostate is large, rubbery, and nontender. Prostatism (obstructive and irritative symptom complex) is noted. Hesitancy in starting urination, increased frequency of urination, nocturia, urgency, abdominal straining. Decrease in volume and force of urinary stream, interruption of urinary stream, dribbling. Sensation of incomplete emptying of the bladder, acute urinary retention (more than 60 mL), and recurrent UTIs. Fatigue, anorexia, nausea and vomiting, and pelvic discomfort are also reported, and ultimately azotemia and renal failure result with chronic urinary retention and large residual volumes.

ASSESSMENT AND DIAGNOSTIC METHODS: Physical examination, including digital rectal examination (DRE), and health history. Urinalysis to screen for hematuria and UTI. Urodynamic studies, urethrocystoscopy, and ultrasound may be performed. Complete blood studies, including clotting studies.

Medical Management: The treatment plan depends on the cause, severity of obstruction, and condition of the patient. Treatment measures include the following: Immediate catheterization if patient cannot void (an urologist may be consulted if an ordinary catheter cannot be inserted). A suprapubic cystostomy is sometimes necessary. Watchful waiting, to monitor disease progression.

PHARMACOLOGIC MANAGEMENT: Alpha-adrenergic blockers (fpr example, alfuzosin, terazosin), which relax the smooth muscle of the bladder neck and prostate, and 5-alpha-reductase inhibitors. Hormonal manipulation with antiandrogen agents (finasteride [Proscar]) decreases the size of the prostate and prevents the conversion of testosterone to dihydrotestosterone (DHT).

SURGICAL MANAGEMENT: Minimally invasive therapy: transurethral microwave heat treatment (TUMT; application of heat to prostatic tissue); transurethral needle ablation (TUNA; via thin needles placed in prostate gland); prostatic stents (but only for patients with urinary retention and in patients who are poor surgical risks). Surgical resection: transurethral resection of the prostate (TURP; benchmark for surgical treatment); transurethral incision of the prostate (TUIP).

RELATED;

1.  PELVIC INFLAMMATORY DISEASE

2.  MEDICINE AND SURGERY TOPICS

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