Benign Prostatic Hyperplasia

• prostate

• Affects 50% men over 45, 75% 70-80

• asymptomatic or mild symptoms

Pathology

• Nodular hyperplasia of paraurethral glands

• compression of normal glandular tissue to form fibrous surgical capsule

• double layer of cells in gland

Symptoms

• Bladder outlet obstruction

  • Hesitancy, worse with full bladder or at night

  • Poor stream, made worse by full bladder or straining

  • Frequency

  • Urgency

  • Nocturia

  • Post-micturition dribbling

  • Double micturition ('pis-a-deux')

• Gradually increasing, fluctuant symptoms

• May go into acute retention

Complications

• Chronic retention

  • Infection

  • Overflow incontinence

• Detrusor hyperplasia

  • bladder diverticulae

  • stone

• Progressive renal parenchymal damage

Management

• History and effect of symptoms on patient

• Rectal examination of prostate

• MSU

• Catheterise to relieve any residual urine

  • monitor fluid and electrolyte balance

• Serum PSA

• finasteride, alpha-adrenergic blockers

• Cystoscopy

• Trans-urethral resection of prostate

• Retropubic prostatectomy

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