Benign Prostatic Hyperplasia
Most males older than age 50 have some prostatic enlargement or benign prostatic hyperplasia (BPH). BPH becomes symptomatic when the prostate gland enlarges sufficiently to compress the urethra and cause some overt urinary obstruction. As the prostate enlarges, it may extend toward the bladder and obstruct urine outflow by compressing or distorting the prostatic urethra. BPH also may cause a weakening of the detrusor musculature that retains urine when the rest of the bladder empties. Depending on the size of the enlarged prostate, the age and health of the patient, and the extent of the obstruction, BPH may be treated surgically or symptomatically.
Causes
The cause of BPH is unknown. It’s known that circulating male hormones or androgens, specifically testosterone, and aging are necessary for BPH to develop.
Complications
Because BPH causes urinary obstruction, a patient may have one or more of the following complications:
urinary retention or incomplete bladder emptying, leading to urinary tract infection (UTI) or calculi
bladder wall trabeculation
detrusor muscle hypertrophy
bladder diverticula and saccules
urethral stenosis
hydronephrosis
overflow incontinence
acute or chronic renal failure
acute postobstructive diuresis.
Assessment
Clinical features of BPH depend on the extent of prostatic enlargement and the lobes affected. Characteristically, the patient complains of obstructive voiding symptoms: decreased urine stream caliber and force, an interrupted stream, urinary hesitancy, and difficulty starting urination, which results in straining and a feeling of incomplete voiding.
As the obstruction increases, the patient may report irritative voiding symptoms; frequent urination with nocturia, dribbling, urine retention, incontinence and, possibly, hematuria.
Physical examination may reveal a visible midline mass above the symphysis pubis, which represents an incompletely emptied bladder. The distended bladder can be palpated. Rectal examination discloses an enlarged prostate.
Diagnostic tests
The following tests help to confirm this diagnosis:
Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
Elevated blood urea nitrogen and serum creatinine levels suggest impaired renal function.
Cystoscopy allows the physician to determine the size of the gland and identify the location and degree of obstruction.
Urinalysis and urine culture show hematuria, pyuria and, when the bacterial count exceeds 100,000/mm3, UTI.
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