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.
