BPH (Benign Prostatic Hyperplasia) & Management Methods

Benign prostatic hyperplasia (BPH) is the benign growth of the prostate, generally originating in the periureteral and transition zones, with subsequent obstructive and irritative voiding symptoms.

_ Synonyms

Benign prostate hyperplasia
BPH
Prostatic hypertrophy
_ 80% of men have evidence of BPH by age 80 yr.

_ 10% to 30% of men with BPH have occult prostate cancer.

CAUSE
_ Multifactorial; a functioning testicle is necessary for development of BPH (as evidenced by the absence in males who were castrated before puberty).
CLINICAL

_ Digital rectal examination (DRE) reveals enlargement of the prostate.

_ Focal enlargement may be indicative of malignancy.

_ There is poor correlation between size of prostate and symptoms (BPH may be asymptomatic if it does not encroach on the urethral lumen).

_ Most patients with BPH report difficulty in initiating urination (hesitancy), decrease in caliber and force of stream, incomplete emptying of bladder often resulting in double voiding (need to urinate again a few minutes after voiding), postvoid “dribbling,” and nocturia.
LABORATORY TESTS

_ Prostate-specific antigen (PSA)

_ Urinalysis, urine culture, and sensitivity to rule out infection (if suspected).

_ Blood urea nitrogen and creatinine to rule out postrenal insufficiency.

IMAGING STUDIES

_ Transrectal ultrasound

_ Uroflowmetry

_ Urethral cystoscopy

MANAGEMENT

_ Asymptomatic patients with prostate enlargement caused by BPH generally do not require treatment.

_ TURP is the most commonly used surgical procedure for BPH.


_ Laser therapy for BPH is a less invasive alternative to TURP

_ Transurethral needle ablation with radiofrequency to remove periurethral prostate tissue is being increasingly used in patients with prostate volume >60 mL and moderate symptoms.

_ Balloon dilation of the prostatic urethra is less effective than surgery for relieving symptoms but is associated with fewer complications.

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