Benign Prostatic Hypertrophy
Definition
Benign prostatic hypertrophy is defined as enlargement of the prostatic gland due to the proliferation of the glandular elements in the prostate causing nodules well encapsulated by other elements in the organ.
Clinical Menifestations
Increased frequency of urination : usually voiding only small amounts of urine
Interrupted sleep to urinate at night
Urinary urgency
Lack of control of urination
Hesitancy - delay in initiationg micturition
Hesitant, interrupted, weak urinary stream
Incomplete bladder emptying
The sensation of incomplete evacuation
Straining - The need to strain or push (Valsalva maneuver) to initiate and maintain urination
Decreased force of stream
Dribbling or dripping
PR - per rectal examination : prostate size assessed
Young adult prostate is approximately 20 g.
Most asymptomatic men have glands less than or equal to 2 fingerbreadths.
Investitations
Lab Studies
Urinalysis: for the presence of blood, leukocytes, bacteria, protein, or glucose.
Prostate-specific antigen (PSA):
Urine culture
Electrolytes, BUN, and creatinine
Imaging Studies
Ultrasonography (abdominal, renal, transrectal) and intravenous urography
CT scanning or MRI, have no role in the evaluation and treatment of patients with uncomplicated BPH.
Other Tests
Voiding diary (frequency voiding chart):
Flow rate - urodynamic studies
Postvoid residual (PVR) urine
Pressure flow studies
Urine cytology
Endoscopy of the lower urinary tract (cystoscopy)
Surgical Approaches
Transurethral resection of the prostate (TURP)
Open prostatectomy - transvesical prostatectomy
Laser enucleation of the prostate, similar to a TURP procedure
Transurethral needle ablation of the prostate (TUNA)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Differential Diagnosis (other disorders producing similar symptoms): -
Urethral stricture
Cancer of the prostate
Neurogenic bladder
Urinary bladder stones
Medical Treatment
Catheterization for retention
Suprapubic catheter at times
"Watchful waiting"
Dutas T = Dutasteride + Tamsulosin
Transurethral incision of the prostate (TUIP)
Balloon dilatation
α - Blockers (alpha blockers)
5-alpha-reductase inhibitors
Trans urethral laser resection
Trans urethral needle ablation
Micro wave thermal therapy
For symptomatic relief "terazosin"
Finasteride
