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Benign Prostatic Hyperplasia (BPH)

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Topic updated on 02/09/17 7:06am

Snapshot
  • A 45-year-old man presents to the office complaining with trouble upon urination. Over the years he states that his stream has gone from normal to weak, to now just dribbling. On digital rectal exam a smooth non-nodular and enlarged prostates is felt.
Introduction
  • Hyperplasia of the periurethral/transitional prostate causing bladder outlet obstruction
  • Common after age 45
    • patient's age is his percent chance of having BPH
  • Pathological process mediated by dihydrotestosterone
  • Does not predispose to prostate cancer
Presentation
  • Symptoms
    • increased urinary frequency
    • increased urinary urgency
    • nocturia
    • decreased size and force of urinary stream
    • sensation of incomplete emptying
    • hematuria
  • Physical exam
    • rectal shows enlarged rubbery and firm prostate
      • is an insensitive test for diagnosis
Evaluation
  • Diagnosis based on symptomatic scoring system
    • prostate size (>30 mL)
    • maximum urinary flow (<10mL / sec)
    • postvoid residual volume (>50mL)
  • Serology
    • PSA often slightly elevated (normal < 4 ng/mL)
      • not specific
  • Histology
    • hyperplasia of stromal and glandular tissue
    • gross appearance shows yellow nodules
  • Transrectal ultrasound
    • only if mass detected on digital rectal exam or PSA elevated
Differential
  • Prostate cancer, prostatitis
Treatment
  • Medical
    • Terazosin (alpha-1 antagonist)
    • Finesteride 5-α reductase inhibitor)
    • avoid anticholinergics, antihistaminergics, narcotics
  • Surgery
    • in refractory cases
    • transurethral resection of prostate (TURP)
      • can result in retrograde ejaculation
Prognosis, Prevention, and Complications
  • Complications 
    • obstructive uropathy
      • distention. hypertrophy, and diverticula of the bladder
      • hydronephrosis 
      • UTIs
    • prostatic infarcts
 

 



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(M3.RL.11) A 70-year-old male presents to his primary care physician with complaints of urinary frequency, urgency and nocturia. Physical exam shows an enlarged, rubbery, non-tender and firm prostate without discrete nodules or masses. Which of the following treatments for this condition is matched with its most common side effect? Topic Review Topic

1. Prazosin - Hypertension
2. Finasteride - Hair loss
3. Transurethral electrovaporization (TUEVP) - Urinary incontinence
4. Holmium laser treatment (HLT) - Infection
5. Transurethral resection of the prostate (TURP) procedure - Retrograde ejaculation

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