Presentation
Some degree of BPH is present in 50% of men over 50 years old and 90% of men over 90 years old. BPH is not cancerous and there is no conclusive evidence that it can lead to cancer. [famplan.org.hk]
BPH Case Report Chief Complaint: LF is a 64-year-old white male presenting with fatigue and sleep pattern changes that have lasted over the past several years. [uspharmacist.com]
Patients present with symptoms of bladder irritation ( urinary frequency, urgency, urge incontinence ), bladder outlet obstruction (urinary hesitancy, straining to urinate, sensation of incomplete voiding), and/or hematuria. [amboss.com]
The prostate is a gland about the size of a walnut that is only present in men. It is located just below the bladder and surrounds the urethra, the tube through which urine flows from the bladder and out through the penis. [mayo.edu]
Dysuria and hematuria are not commonly associated with BPH and may be an indication that another disease process is present. [accessmedicine.mhmedical.com]
Entire Body System
- Weakness
Common symptoms of BPH include: Frequently feeling the need to urinate Difficulty starting and stopping a stream of urine Constant feeling of a full or not completely empty bladder A weak urine system BPH does not cause prostate cancer, affect a man's [kinkly.com]
Over time, the bladder muscles get weak, which makes it harder for it to empty. [webmd.com]
Symptoms Prostate gland hypertrophy is related to lower urinary tract symptoms, such as a urine stream that is hesitant, interrupted or weak and an urgent need to empty the bladder. [cirse.org]
When patients develop clinically significant BPH, they complain to clinicians of lower urinary tract symptoms (LUTS) such as increased urinary frequency, nocturia, urinary hesitancy, urine stream weakness, postvoid dribbling, and incomplete bladder emptying [accessmedicine.mhmedical.com]
Storage symptoms include urinary frequency, urgency, and nocturia, whereas emptying symptoms include weak stream, hesitancy, intermittency, incomplete emptying, straining, and postvoid dribbling. [mdedge.com]
- Swelling
Symptoms of AUR include: suddenly not being able to pee at all severe lower tummy pain swelling of the bladder that you can feel with your hands Go immediately to your nearest A&E if you experience the symptoms of AUR. [nhs.uk]
These additional cells cause your prostate gland to swell, which squeezes the urethra and limits the flow of urine. BPH is not the same as prostate cancer and doesn’t increase the risk of cancer. [healthline.com]
[…] fibrillation (fast heartbeats or fluttering in your chest) or chest pain floppy iris syndrome (eye complication during cataract surgery) abnormal ejaculation penis erection that is painful or lasts 4 hours or longer ( priapism ) fatigue or weakness swelling [drugs.com]
Men should contact a health care provider right away if they experience swelling or discomfort in their legs. Infection. Use of a Foley catheter after benign prostatic hyperplasia surgery may increase the risk of a UTI. [niddk.nih.gov]
- Fatigue
BPH Case Report Chief Complaint: LF is a 64-year-old white male presenting with fatigue and sleep pattern changes that have lasted over the past several years. [uspharmacist.com]
[…] first dose effect) heart fibrillation (fast heartbeats or fluttering in your chest) or chest pain floppy iris syndrome (eye complication during cataract surgery) abnormal ejaculation penis erection that is painful or lasts 4 hours or longer ( priapism ) fatigue [drugs.com]
Possible side effects of alpha-adrenergic blockers are orthostatic hypotension (dizziness upon standing, due to a fall in blood pressure), fatigue and headaches. [hopkinsmedicine.org]
The most common side effects of alpha-blockers are light headedness, dizziness and fatigue. 5-alpha-reductase inhibitors (finasteride and dutasteride) are medicines that can reduce the size of the prostate gland. [vikaspedia.in]
- Asymptomatic
BPH can be asymptomatic, but for many men it is associated with lower urinary tract symptoms. [pharmaceutical-journal.com]
However, in some individuals, the condition is asymptomatic and may go undetected. Hormonal changes Research suggests that hormonal changes that occur as a man ages play an important role in the development of an enlarged prostate. [news-medical.net]
Although a degree of prostatomegaly may be completely asymptomatic, the most common presentation is with lower urinary tract symptoms (LUTS) including 1-4 : poor stream despite straining hesitancy, frequency and incomplete emptying of the bladder nocturia [radiopaedia.org]
- Malaise
[…] of urinary symptoms when taking cold or sinus drugs, and previous urinary tract infections or prostatitis (inflammation of the prostate, which may cause pain in the lower back and the area between the scrotum and rectum, and chills, fever and general malaise [hopkinsmedicine.org]
Gastrointestinal
- Nausea
[…] fluttering in your chest) or chest pain floppy iris syndrome (eye complication during cataract surgery) abnormal ejaculation penis erection that is painful or lasts 4 hours or longer ( priapism ) fatigue or weakness swelling in hands, ankles or feet headache nausea [drugs.com]
[…] throat, arms, hands, feet, ankles, or lower legs difficulty breathing or swallowing chest pain dizziness or fainting when standing up suddenly sudden decrease or loss of vision blurred vision sudden decrease or loss of hearing chest pain, dizziness, or nausea [niddk.nih.gov]
Psychiatrical
- Fear
At that follow-up appointment, he was told he was "ready for surgery"—despite his fears of potentially developing a bad outcome based on his father's experience—and was told that the department would be in touch to schedule a TURP. [psnet.ahrq.gov]
Urogenital
- Urinary Retention
Some men with an enlarged prostate need surgery to relieve urinary retention. Urinary tract infections (UTIs). Inability to fully empty the bladder can increase the risk of infection in your urinary tract. [mayoclinic.org]
Incidence of Urinary retention: The incidence of urinary retention is 4.5–18/1000 man-years. Symptoms (LUTS), prostate size and a low maximum flow rate are risk factors for urinary retention. [urology-textbook.com]
"( 4 ) Nevertheless, maintaining a high index of suspicion for chronic urinary retention and renal failure is prudent, as this case illustrates. [psnet.ahrq.gov]
retention (AUR) requiring catheterization, and urinary obstruction requiring surgery (partial or complete prostatectomy). [ti.ubc.ca]
The complications of benign prostatic hyperplasia may include acute urinary retention chronic, or long lasting, urinary retention blood in the urine urinary tract infections (UTIs) bladder damage kidney damage bladder stones Most men with benign prostatic [niddk.nih.gov]
- Bladder Distention
Some patients present with sudden, complete urinary retention, with marked abdominal discomfort and bladder distention. [msdmanuals.com]
Neurologic
- Dizziness
Finasteride increased sexual dysfunction; alpha blockers increased dizziness, postural hypotension and asthenia. [ti.ubc.ca]
[…] used in the treatment of BPH include: Terazosin ( Hytrin ) Doxazosin ( Cardura, Cardura XL ) Alfuzosin ( Uroxatral ) Tamsulosin ( Flomax ) Silodosin ( Rapaflo ) Side effects that may occur with alpha-blockers include: hypotension (low blood pressure), dizziness [drugs.com]
[…] adverse effects are less frequent with the more selective alpha blockers, they increase the risk of ejaculatory dysfunction. 3 Other adverse effects of alpha blockers include retrograde ejaculation, erectile dysfunction, nasal congestion, hypotension, dizziness [nps.org.au]
Also, these medicines sometimes make people feel dizzy, lightheaded, or tired. Alpha blockers are new drugs, so doctors do not know their long-term effects. [healthengine.com.au]
[…] or fainting when standing up suddenly sudden decrease or loss of vision blurred vision sudden decrease or loss of hearing chest pain, dizziness, or nausea during sexual activity These side effects are mostly related to phosphodiesterase-5 inhibitors. [niddk.nih.gov]
- Abnormal Gait
Gait. Abnormal gait may suggest a neurologic condition such as Parkinson disease or stroke that can also affect lower urinary tract function. Lower abdomen. A palpable bladder suggests urinary retention. External genitalia. [mdedge.com]
Workup
Primary care physicians are uniquely positioned to screen for BPH, conduct a timely diagnostic workup, and if indicated, initiate medical therapy. [mdedge.com]
Treatment
Drug treatment combinations may also be more effective for some patients than use of a single drug. Common medications used for treatment of BPH Alpha-blockers : Alpha-blockers are a class of drugs considered to be first-line treatment for BPH. [drugs.com]
Treatment Conservative treatment for prostate gland hypertrophy includes making changes to your lifestyle, such as reducing stress and avoiding drinking fluids in the evening. [cirse.org]
BPH treatment BPH treatment usually depends on your symptoms. [healthdirect.gov.au]
These are still indications for aggressive treatment but are less frequently encountered. In modern practice the level of bother from the symptoms most often drives treatment decision-making. [healthcare.utah.edu]
The treatment depends on the severity of symptoms. [nps.org.au]
Prognosis
MRI enlarged transition zone heterogeneous signal with an intact low signal pseudocapsule in the periphery Treatment and prognosis Medical management for early disease typically commences with an alpha blocker such as tamsulosin given in combination with [radiopaedia.org]
[…] developed breast cancer (~ 200 times expected rate). 2, 24 In a 7-year prostate cancer prevention trial (n=18,882) fewer men on finasteride vs. placebo developed tumours, 18.4% vs. 24.4%, but more men on finasteride had high-grade tumours with a worse prognosis [ti.ubc.ca]
Due to the more progressive nature of the disease in men with larger glands and/or higher PSA values, conservatively treated patients (watchful waiting or placebo groups) face an increasingly worse prognosis, enhancing the difference over time in outcomes [auanet.org]
Etiology
Etiology The etiology is not fully understood The following factors play a role in prostatic hyperplasia and growth Hormonal factors Androgens : Dihydrotestosterone ( DHT ) is a potent prostatic growth factor Gene amplification of androgen receptors : [amboss.com]
You are here: Urology Textbook > Prostate > BPH > Definition, epidemiology, etiology Benign prostatic hyperplasia (1/6): definitions, epidemiology and etiology Benign prostatic hyperplasia (2/6): signs and symptoms Benign prostatic hyperplasia (3/6): [urology-textbook.com]
Roehrborn CG, McConnell JD: Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. Campbell-Walsh Urology. [springermedizin.de]
The etiology is unknown but probably involves hormonal changes associated with aging. [msdmanuals.com]
Diet-Induced Hyperinsulinemia as a Key Factor in the Etiology of Both Benign Prostatic Hyperplasia and Essential Hypertension?. Nutr Metab Insights. 2018. 11:1178638818773072. [Medline]. [Full Text]. Egan KB. [medscape.com]
Epidemiology
Epidemiologic Risk Factors for Benign Prostatic Hyperplasia (BPH): The epidemiology of BPH is fairly constant, some genetic factors or environmental influences may modestly increase the risk for BPH. [urology-textbook.com]
In parallel, epidemiological studies demonstrated that diet may play an important role on incidence and development of prostatic diseases. [urotoday.com]
References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Roehrborn CG, McConnell JD: Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. Campbell-Walsh Urology. [springermedizin.de]
Epidemiology of clinical benign prostatic hyperplasia. Asian Journal of Urology. July 2017. Benign Prostatic Hyperplasia. Mayo Clinic. Benign Prostatic Hyperplasia (BPH). Johns Hopkins Medicine. [everydayhealth.com]
Pathophysiology
Roehrborn CG, McConnell JD: Benign prostatic hyperplasia: etiology, pathophysiology, epidemiology, and natural history. Campbell-Walsh Urology. [springermedizin.de]
References: [2] [3] [4] [5] [6] Pathophysiology The prostate consists of three distinct histologic zones The inner central zone The middle transition zone: BPH develops in this zone. The outer peripheral zone: Prostate cancer develops in this zone. [amboss.com]
Pathophysiology, epidemiology, and natural history of benign prostatic hyperplasia. Rev Urol. 2004;6(suppl 9):S3-S10. 4. Abrams P, Chapple C, Khoury S, et al. Evaluation and treatment of lower urinary tract symptoms in older men. [uspharmacist.com]
Pathology and Pathophysiology of Benign Prostatic Hyperplasia Macroscopic Anatomy of BPH: The enlargement of the periurethral prostate [fig. prostate zones in BPH ] can affect the so-called middle lobe, the lateral lobes or a combination of both. [urology-textbook.com]
BPH involves the stromal and epithelial elements of the prostate arising in the periurethral and transition zones of the gland (see Pathophysiology ). [medscape.com]
Prevention
The goals of drug therapy are symptom relief and prevention of complications. [ti.ubc.ca]
Surgical procedures for BPH include: Transurethral resection of the prostate (TURP) Laser surgery Open prostatectomy Transurethral incision of the prostate (TUIP) (2,6,10,12) Benign Prostatic Hyperplasia Prevention There is no definitive way to prevent [everydayhealth.com]
Prevention BPH affects many males as they get older, and it may not be possible to prevent it. [medicalnewstoday.com]
These classes of medications will often be used in combination to prevent urinary obstruction and ease symptoms. Medication doesn’t help everyone. [pcf.org]
How can benign prostatic hyperplasia be prevented? Researchers have not found a way to prevent benign prostatic hyperplasia. [niddk.nih.gov]