Benign Prostatic Hypertrophy
- causes and risk factors
- signs, symptoms, and diagnosis
- pathophysiology
- treatments
- consequences and course
- the patient
- health care team
- community involvement
- resources and references
Benign prostatic hypertrophy, or BPH, is a common affliction of older men.
Causes and Risk Factors
Signs, Symptoms, and Diagnosis
- history
- physical exam
- lab investigations
- diagnostic imaging
History
Obstructive symptoms include:
- hesitancy
- decreased size and force of stream
- stream interruption
- urinary retention
- post-void dribbling
- overflow incontinence
Irritative symptoms include:
- urgency
- frequency
- nocturia
- hematuria
- urge incontinence
A voiding diary and sexual function questionnaire can also be helpful to determine course of action.
Physical Exam
Physical exam must include DRE for size, symmetry, nodularity, and texture of prostate.
Lab Investigations
Urinalysis should be done for hematuria.
PSA level should be measured in the following circumstances:
- if life expectancy is over 10 years
normal PSA is below 4.0 µg/ml, though patient's age and rate of PSA change should be considered.
PSA above 10 µg/ml is considered abnormal. It is difficult to know what to do for levels between 4-10 µg/ml.
Optional testing includes:
- renal function tests
- post-void residual volume by ultrasound
Diagnostic Imaging
Cytourethroscopy, cytology, prostate ultrasound or biopsy, or IVP are NOT recommended for initial evaluation.
Pathophysiology
Treatments
Watchful waiting, with lifestyle modifications, are used for mild symptoms, or those considered non-bothersome by patients.
Lifestyle modifications
- fluid restriction (including alcohol and caffeine)
- avoidance of medications such as antihistamines, diuretics, antidepressants, and decongestants
- pelvic floor exercises
- bladder retraining (organized voiding)
Medications
alpha receptor antagonists: relax smooth muscle around the prostate and bladder neck
- terazosin (Hydrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Xatral)
5-alpha reductase inhibitor
- finasteride (Proscar)
Phytotherapies such as saw palmetto berry extract are considered safe, but require more studies before being recommended as standard therapy.
Transurethral resection of the prostate (TURP)
Absolute indications include failed medical therapy, intractable urinary retention, and renal insufficiency. Complications include impotence, incontinence, ejaculatory difficulties, and decreased libido.
Other surgical approaches include TUIP (transurethral incision of the prostate), others.
Consequences and Course
Late complications include:
- hydronephrosis
- loss of renal concentrating ability
- systemic acidosis
- renal failure
The Patient
Health Care Team
Community Involvement
Resources and References