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.
Benign prostate hyperplasia
_ 80% of men have evidence of BPH by age 80 yr.
_ 10% to 30% of men with BPH have occult prostate cancer.
_ Multifactorial; a functioning testicle is necessary for development of BPH (as evidenced by the absence in males who were castrated before puberty).
_ 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.
_ 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.
_ Transrectal ultrasound
_ Urethral cystoscopy
_ 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.