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Benign prostatic hypertropy is a common
disease among older man. It can frequently interfere with urination in these individuals.
The causes of BPH are unknown. The condition involves an increse in size of the prostate.
Symptoms
Symptoms and complications of BPH include acute urinary retention, presence of blood in
urin, urinary tract infection, bladder stones, a bladder that does not contract properly,
and renal failure due to obstructive uropathy. The magnitudes of these risks have been
poorly defined but appear to be low.
Diagnosis
Obtaining a medical history from men with urinary symptoms is a key step in assessing
whether those symptoms are likely due to BPH or to some other process. Among men over 50,
BPH is the dominant cause of urinary symptoms. Any condition causing increased urinary
frequency, such as diabetes or the nocturnal diuresis of congestive heart failure, can
masquerade as BPH. Urinary symptoms in men under 50 are more likely to be due to another
problem.
Physical Examination
Men with urinary symptoms should have a digital rectal examination. An enlarged, firm
prostate is the characteristic finding with BPH.
Diagnostic Tests
A urinalysis should be performed to detect pyuria or hematuria, and a serum creatinine to
determine whether there is evidence of obstructive uropathy. Many urologists recommend a
determination of serum prostate-specific antigen (PSA) in addition to the digital rectal
examination to attempt to rule out prostate cancer, either as the primary cause of
the patient’s symptoms or, more likely, as a concomitant disease process.
Treatment
1. Watchful Waiting: “Watchful waiting” is a strategy of monitoring for symptom
progression and BPH complications on a periodic basis and is not the same as “doing
nothing.”
2. Pharmacologic Treatment: Two classes of drugs are used in the treatment of BPH:
alpha-blockers and 5-alpha-reductase inhibitors. Medications in both classes can reduce
symptoms of BPH; as yet, there is no evidence that these medications reduce the rate of
BPH complications. Long-term controlled outcome data are not yet available for either
class of drug.
3. Surgical Treatment: Prostatectomy is now usually performed transurethrally; open
prostatectomies are reserved for very large prostates.
4. Other Therapies include balloon dilation of the prostate, electrical vaporization,
transurethral microwave thermotherapy, and transurethral needle ablation of the prostate.
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