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Benign Prostatic Hyperplasia (BPH)

Definition:
  • Non-malignant enlargement of the prostate gland due to proliferation of stromal and epithelial cells.
Etiology:
  • Exact cause unknown, but related to ageing and the influence of androgens (testosterone).
  • Common in men >50 years of age.
Clinical Presentation:
  • LUTS (Lower Urinary Tract Symptoms):
    • Obstructive: weak stream, hesitancy, incomplete emptying, post-micturition dribble, straining.
    • Overactive/Irritative: urgency, frequency, nocturia.
  • Recurrent UTIs.
  • Bladder stones.
  • Acute urinary retention.
Investigations:
  • DRE (Digital Rectal Examination): Enlarged, smooth, firm prostate.
  • PSA (Prostate-Specific Antigen): Elevated but non-specific, done to exclude prostate cancer.
  • Urinalysis: Rule out UTI.
  • Uroflowmetry: Measure urinary flow rate.
  • Post-micturition bladder scan: Assess residual urine volume.
  • Cystoscopy.
Management:
  • Watchful waiting for mild symptoms.
  • Alpha-blockers (e.g., tamsulosin): Relax the smooth muscle of the prostate and bladder neck.
  • 5-alpha-reductase inhibitors (e.g., finasteride): Shrink the prostate by reducing dihydrotestosterone (DHT) levels.
  • Minimally invasive therapies: TUMT (transurethral microwave thermotherapy), TUNA (transurethral needle ablation).
  • Surgery: TURP (transurethral resection of the prostate) for those with significant symptoms or complications.
Complications:
  • Urinary tract infections.
  • Acute urinary retention.
  • Chronic kidney disease due to chronic bladder outlet obstruction.
Prognosis:
  • Most men experience progression of symptoms over time, but timely treatment can manage symptoms effectively.

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