Aging

Etiology DHT and 5-alpha reductase

Men who had orchiectomy at young age will not

develop BPH

The self-administered questionnaire

Weak urinary stream

Abdominal straining
Postvoiding residual volume by U/S or by a Assessment of the severity
catheter
Terminal dribbling

Assess for Hydronephrosis Hesitancy

Obstructive voiding symptoms (early)
Incomplete emptying
Alpha-adrenergic agonists
Intermittency
Oral and topical cold remedies
Retention: the most serious one
Antihistamines Signs and symptoms
Nocturia
TCA (antidepressants)

Avoid medications that worsen symptoms like: Frequency

Testosterone replacement

Dysuria
Diuretics
Irritative voiding symptoms (late)
Urge incontinence
Antichlinergics
Whatchful waiting for patients with
Urgency
Antispasmodics mild symptoms
Benign prostatic hyperplasia
Reduce alcohol intake
Smooth, firm and elastic enlargement of the prostate
On DRE
Reduce late day and evening water consumption
Behavior modifications
Physical examination Bladder distension
Limit caffeine intake

Abdominal examination There might be inguinal hernia that occurs due to

straining
1st generation are not used anymore due to their
systemic SEs

2nd generation like doxazosin GUE to exclude cystitis

Alpha- adrenergic antagonists
3rd generation are alpha1 selective antagonist, they have Treatment options Urea and creatinine to check the kidney function
less side effects, like tamsulosin and alfuzosin

PSA to exclude prostatic cancer

Like finasteride and dutasteride to reduce the size of the Investigations
prostate Sonography to calculate the size of the prostate ,
5-alpha reductase inhibitors
state of upper tract and the post voiding residual
volume of urine
If the prostate is more than 50g
Pressure flow studies and flow rate
To relief dynamic symptoms

To decrease the need for surgery Combination of the both

Long-term benefits of 5-alpha reductase inhibitors

Failure of medical therapy
Reluctant urinary retention
Recurrent UTI
Hydronephrosis
Pharmacological treatment
Like Saw palmetto
Phytotherapy 1. Urethral stricture.
2. Bladder neck contracture.
3. Neurogenic bladder: history of CVA, D.M. and
spinal cord injury.
4. Cystitis. Simulate BPH and can be a
Differential diagnosis
complication of this disease.
5. Bladder tumor. Esp. CIS which cause irritative
Voiding symptom
6. Vesicle stone.
Indications 7. Ca. prostate.

Recurrent hematuria

Bladder stone or Bladder diverticulum

Surgical intervention

Transurethral resection of the prostate (TURP)

Transurethral incision of the prostate (TUIP)

Surgical options
Open prostatectomy