Case 5: Benign Prostatic Hyperplasia
Where is the prostate gland located?
The prostate gland is located at the base of the bladder, completely encircling the urethra
What happens to the prostatic urethra as the prostate gland enlarges?
The prostatic urethra becomes compressed leading to bladder outlet obstruction
What are some of the symptoms of BPH?
Need to frequently urinate in small amounts, feeling of incomplete bladder emptying, slow urinary flow, hesitation, needing to void at night, and in extreme cases complete urinary retention
What are cases where prostate biopsy is recommended?
If there is an elevation of PSA, or if there is nodularity of the prostate
What should be included in the differential for BPH?
Prostate cancer, urethral stricture, UTI, prostatitis, and neurological conditions
What is the definition of micturition?
Physiologic act of voiding that involves contraction of the detrusor muscle and relaxation of the bladder neck and urinary sphincters
What are examples of the alpha-1 blockers that can be used to help relaxthe bladder neck and prostatic urethra?
Alfuzosin, doxazosin, tamsulosin, terazosin, and silodosin
What is the enzyme that is responsible for converting testosterone to the more potent dihydrotestosterone?
5 alpha reductase
What is an example of a 5 alpha reductase inhibitor?
What should be included in a physical exam when assessing for BPH?
A digital rectal exam, and a UA and PSA should be ordered
What are some states that call for urgent urological intervention?
Renal compromise, elevated creatinine, and a palpable bladder on physical exam
If medical management is not effective for BPH what is the surgical intervention that can be performed?
Transurethral resection of the prostate, or TURP.