Benign Prostatic Hyperplasia

Key Features

Essentials of Diagnosis

• Obstructive or irritative voiding symptoms

• Enlarged prostate on rectal examination

• Absence of urinary tract infection, neurologic disorder, urethral stricture disease, prostatic or bladder malignancy

General Considerations

• Smooth, firm, elastic enlargement of the prostate

Etiology

• Multifactorial

• Endocrine: dihydrotestosterone (DHT)

• Aging

Demographics

• The most common benign tumor in men

• Incidence is age related

• Prevalence

  • ~20% in men aged 41–50

  • ~50% in men aged 51–60

  • > 90% in men aged 80 and older

• Symptoms are also age related

  • At age 55, ~25% of men report obstructive voiding symptoms

  • At age 75 years, 50% of men report a decrease in the force and caliber of the urinary stream

Clinical Findings

History and Physical Examination

• History to exclude other possible causes of symptoms

• Physical examination, digital rectal examination (DRE), and a focused neurologic examination

• DRE: note size and consistency of the prostate

• Examine lower abdomen for a distended bladder

Symptoms and Signs

• Can be divided into obstructive and irritative complaints

• Obstructive symptoms

  • Hesitancy

  • Decreased force and caliber of stream

  • Sensation of incomplete bladder emptying

  • Double voiding (urinating a second time within 2 h)

  • Straining to urinate

  • Postvoid dribbling

• Irritative symptoms

  • Urgency

  • Frequency

  • Nocturia

• American Urological Association (AUA) Symptom Index (Table 23–3) should be calculated for all patients starting therapy

  • Seven questions quantitate the severity of obstructive or irritative complaints on a scale of 0–5. Thus, the score can range from 0 to 35

  • An estimation of post-void residual can provide important information on bladder emptying and the need for more urgent intervention