Benign prostatic hypertrophy Flashcards
How common is it?
Moderate to severe lower urinary tract symptoms are present in about 30% of men older than 50 years of age. The most common cause being benign prostatic hypertrophy
Who does it affect?
Elderly men (>60 usually)
What causes it?
Hyperplasia of both glandular and connective tissue elements. The aetiology is unknown.
What risk factors are there?
Age.
BPH has been linked to the metabolic syndrome, however the mechanism for this association is fully understood.
How does it present?
Increased frequency of micturition, nocturia, delay in initiation of micturition and post-void dribbling are common symptoms. Acute urinary retention or retention with overflow incontinence also occurs.
Signs on examination?
An enlarged smooth prostate.
Investigations
Serum electrolytes and renal ultrasonography are performed to exclude renal damage resulting from obstruction.
Prostate cancer may present with similar symptoms. Serum PSA may be elevated in benign disease but an elevated value is usually an indication for specialist referral and prostate biopsy.
Treatment
If mild symptoms, then “watchful waiting”.
Selective α1-adrenoceptor antagonists, such as tamsulosin, relax smooth muscle in the bladder neck and prostate producing an increase in urinary flow rate and an improvement in obstructive symptoms.
The 5α-reductase inhibitor finasteride blocks conversion of testosterone to dihydrotestosterone (the androgen responsible for prostatic growth) and is an alternative to α-antagonists, particularly in men with significantly enlarged prostates.
Patients with acute retention of urine or retention with overflow require urethral catheterisation or, if this is not possible, suprapubic catheter drainage.
Further management is then with prostatectomy or a permanent catheter.
Conditions that would present similarly
Prostate cancer.
