BENIGN PROSTATE HYPERPLASIA (BPH)
Sharmarke Magan MD
General consideration
BPH is noncancerous growth of prostate gland which can result obstruction of urine from bladder.
Roughly 30 million men have this benign swelling around the world.
This causes bladder outlet obstruction (OOB), it affects renal, urologic and reproductive systems.
It affects over 50% of men over 50 years, it’s exclusively for men.
Etiology is unknown; there are environmental and hereditary factors,
There is also systemic hormonal alteration that may be the cause.
Clinical Findings
Signs and Symptoms
Obstruction symptoms: Decrease force or caliber of urine stream
Hesitancy (difficulty initiating the urine stream)
Urine dribbling after finishing
Inability to voluntarily stop stream
Incontinence due to bladder over filling
Feeling of incomplete bladder emptying
Urinary retention
Irritative symptoms: Increased frequency
Nocturia (waking up at night to urinate)
Urge incontinence
Urgency
As well as Hematuria (blood in the urine), distended bladder
Increased post void residual.
Diagnostic/Imaging studies BPH is clinical finding, lab findings are only suggestive
Elevated BUN/Cr if obstructive uropathy is present.
UA- may show pyuria if infection or stones are present
PSA- may be elevated
Increased post void residual more than 100cc
US- Increase post-void residual, prostate enlargement or hydronephrosis, Transrectal US estimates the gland size
CT/MRI of pelvis-enlarged prostate
IVP-Bladder stones, trabeculated bladder, upper tract dilation, increased pos-void residual
Cystoscopy- demonstrates stones or stricture, shows site and configuration of obstruction
Needle biopsy to rule out cancer.
IPSS- have patient complete IPSS (international prostate symptoms score)
Differential Diagnosis
Prostaitis, Prostate Cancer, Urethral Stricture, Bladder Trauma, Interstitial Cystitis, Neurogenic Bladder, UTI...
Treatment
Can be treated inpatient or out patient depending on symptoms, need to manage fluid and electrolyte imbalance.
Ovoid large boluses of IV and/or oral fluids and alcohol intake
If in retention urethral catheterization may be needed
Avoid prolonged periods of not voiding
Avoid cold and flu drugs, especially anticholinergics and sympathomimetics
Surgery if there’s recurrent prostatic obstruction, intractable symptoms, renal insufficiency secondary to obstructive uropathy, bladder calculi, recurrent hematuria.
Surgical procedures TURP (transurethral prostate resection) and several less invasive
procedures.
Medications-can be used if there are no strong indication for surgery
Anti androgens-Proscar etc (use only as prescribed by your doctor)
Alpha adrenergic antagonist-Flomax etc (use only as prescribed by your doctor)
You may use combination therapy (use only as prescribed by your doctor)
Herbal medications- South African stargrass increases flow, decreases frequency and
nocturia. Saw Palmetto- Improves symptoms, mechanism not well understood.
Complications
Bladder stone, Renal failure, Erectile dysfunction, Hematuria, Urinary retention, Prostaitis.
Prognosis
10-30% have occult prostate cancer.
Up to 70% of patients improve with out treatment, 30% will require treatment
due to symptoms worsening.
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