Benign Prostatic Hyperplasia: Part 1
Justin Bailey, MD, and Heidi James, MD
Dr. Justin Bailey joins Heidi to review the presentation and evaluation of benign prostatic hyperplasia (BPH).
- BPH refers to an increase in size of the prostate gland that constricts the ureter and impairs the flow of urine.
- Symptoms progress gradually over time.
- Presenting symptoms are broadly grouped as lower urinary tract symptoms and can be subdivided as follows::
- Storage symptoms
- Frequency
- Urgency
- Nocturia
- Incontinence
- Voiding symptoms
- Slow stream
- Straining with voiding
- Urinary intermittency
- Dribbling
- Stop/start stream
- Potential complications
- Urinary retention
- Scarred, atonic bladder
- Bladder infections
- Bladder stones and diverticula
- Renal damage
- *Does not increase prostate cancer risk*
- Differential diagnosis
- Stricture, trauma
- Urinary tract infection
- Prostate cancer
- Neurogenic bladder
- Diuretics
- Too much fluid intake
- Poorly controlled diabetes
- Red flags
- Hematuria
- Incontinence
- Urinary retention
- Trauma
- Screening scores
- Physical exam
- Digital rectal exam
- Abdominal exam to assess for urinary retention
- Investigations
- Prostate-specific antigen (PSA), urinalysis, glucose, renal function
- Culture and sensitivity if concerned re: infection
- Consider other labs as needed
- Consider obtaining post-void residual
- Ultrasound or magnetic resonance imaging generally not indicated
- Urodynamics may be required in preparation for surgery
PEARL: Benign prostatic hyperplasia can present with both storage and voiding symptoms. Appropriate evaluation includes performing a digital rectal exam and ruling out other conditions through history and investigations.
RELATED CONTENT:
Crunch Time FM GU: Acute Urinary Retention & Benign Prostatic Hypertrophy
EMA 2012 August: Abstract 19: Management Of Acute Urinary Retention: A Worldwide Survey Of 6074 Men With Benign Prostatic Hyperplasia
