BENIGN PROSTATIC HYPERTROPHY

EPIDEMIOLOGY
Common 24% if aged 40-64 40% if older

PATHOLOGY
Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate Inner (transitional) zone enlarges in contrast to peripheral layer expansion seen in prostate carcinoma

SIGNS AND SYMPTOMS

Nocturia Frequency Overflow incontinence Hesitancy Poor stream/flow Post-micturition dribbling Strangury Hematuria Bladder stones UTI Enlarged smooth prostate on DRE

INVESTIGATIONS
Mid-stream urine- urine culture U&E- presence of blood, leukocytes, bacteria, protein, or glucose. Ultrasound (increase residual volume, hydronephrosis) To rule out cancer: PSA, transurethral USS, biopsy

MANAGEMENT

Self-help

Avoid caffeine, alcohol (decrease urgency/nocturia) Relax when voiding. Void twice in a row to aid emptying Train bladder by holding on to increase time between voiding <14% become impotent, retrograde ejaculation Bleeding, clot retention, TUR syndrome (hyponatremia, fits) Relieve pressure on the urethra For small prostate Less destruction and risk to sexual function than TURP Open operation for large prostate

Transurethral resection of prostate (TURP)

Transurethral incision of prostate (TUIP)

Retropubic prostatectomy

Transurethral laser-induced prostatectomy(TULIP)

Drug

For mild disease and while awaiting for TURP Alpha-blocker:

Tamsulosin, alfuzosin, doxazosin, terazosin- decrease smooth muscle tone (prostate & bladder) SE: drowsiness, depression, dizziness, hypotension, dry mouth, nasal congestion, ejaculatory failure, extra-pyramidal sign, weight gain

5 alpha-reductase inhibitior
Finasteride (decrease testosterone conversion to dihydrotestosterone) SE : decrease libido, impotence

Wait and see: risk incontinence, retention and renal failure