سجل دخولك لإضافة ملاحظات خاصة لكل قسم
· اشترك الآن
Background
- Benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy is a histologic diagnosis (smooth, elastic, firm nodular enlargement) of the prostate (epithelial and/or stromal)
- BPH occurs frequently in the lateral and middle lobes (subsequently compresses the urethra)
- This condition is common in men > 50 years old (not premalignant)
- BPH can lead to chronic bladder outlet obstruction (urinary retention, impaired kidney function, recurrent urinary tract infections, gross hematuria, and bladder stones)
- There are pharmacological and surgical therapeutic modalities
سجل دخولك لإضافة ملاحظات خاصة لكل قسم
· اشترك الآن
Clinical features
- Urinary frequency
- Urinary urgency
- Nocturia (needing to get up frequently at night to urinate)
- Hesitancy (difficulty initiating the urinary stream; interrupted, weak stream
- Incomplete bladder emptying (feeling of persistent residual urine)
- Staining (needing to strain or push to initiate and maintain urination to fully empty the bladder)
- Decreased force of stream
- Dribbling (small amounts of urine due to a poor urinary stream)
سجل دخولك لإضافة ملاحظات خاصة لكل قسم
· اشترك الآن
Diagnosis
- Digital rectal examination (DRE)
- Serum labs
- Prostate-specific antigen (PSA) is not specific for benign prostatic hyperplasia (can be elevated in prostatic cancer)
- Urinalysis
- Urine culture (to exclude infectious causes of irritation voiding)
- Electrolyte, blood urea nitrogen (BUN), and creatinine
- Invasive studies
- Ultrasonography (abdominal, renal, transrectal)
- International Prostate Symptom Score (I-PSS)
- The severity of BPH can be determined with IPSS/American Urological Association Symptom Index (AUA-SI)
سجل دخولك لإضافة ملاحظات خاصة لكل قسم
· اشترك الآن
Treatment
- Pharmacological therapy
Medical therapy for benign prostatic hyperplasia Alpha-adrenergic antagonists (eg, terazosin, tamsulosin) - Relax smooth muscle in bladder neck, prostate capsule and prostatic urethra
- Usual first line therapy
- Adverse effects: orthostatic hypotension, dizziness
5-Alpha reductive inhibitors (eg, finasteride, dutasteride) - Inhibit conversion of testosterone to dihydrotestosterone (DHT)
- Reduce prostate gland size
- Effectiveness may take 6-12 months
- Adverse effects: decreased libido, erectile dysfunction
Antimuscarinics (eg, tolterodine) - Used to treat overactive bladder (urinary frequency, urgency and incontinence)
- Adverse effects: urine retention, dry mouth
- Surgical therapy
- Transurethral resection of the prostate (TURP)
- Open prostatectomy (indications include patients with very large prostates, patients with concomitant bladder stones or bladder diverticula, and patients who cannot be positioned for transurethral surgery)
سجل دخولك لإضافة ملاحظات خاصة لكل قسم
· اشترك الآن
Complications
- Bladder outlet obstruction with acute urinary retention (distention of bladder and/or hydronephrosis)
- Recurrent urinary tract infections
سجل دخولك لإضافة ملاحظات خاصة لكل قسم
· اشترك الآن
Supplementary tables
- Table 1: comparison of benign prostatic hyperplasia and prostate cancer
| Benign Prostatic Hyperplasia (BPH) | Prostate cancer | |
| Risk factors |
|
|
| Affected part |
|
|
| Examination |
|
|
سجل دخولك لإضافة ملاحظات خاصة لكل قسم
· اشترك الآن
احصل على التجربة الكاملة
اشترك للوصول لفيديوهات الشرح التفصيلي والبطاقات التعليمية التفاعلية وأسئلة الممارسة مع تتبع التقدم.
فيديوهات الشرح
بطاقات تفاعلية
أسئلة ممارسة
اشترك الآن