Updated: 5/30/2018

Benign Prostatic Hyperplasia (BPH)

Topic
Review Topic
0
0
Questions
3
0
0
Evidence
3
0
0
Overview
 

 
Snapshot
  • A 52-year-old man presents to his primary care physician with nocturia and increased day-time urinary frequency. He notices that he needs to strain when beginning to void and tends to dribble after he finishes urinating. Medical history is significant for hypertension treated with hydrochlorothiazide and type 2 diabetes mellitus treated with metformin. On digital rectal exam, there is a non-tender, smooth, elastic, and firm enlarged prostate. A urinalysis and prostate-specific antigen level is ordered.
Introduction
  • Clinical definition
    • benign hyperplasia of the stromal and epithelial cells of the prostate that results in lower urinary tract symptoms (LUTS) such as
      • post-void dribbling
      • increased urinary frequency and urgency
      • nocturia
      • weak urinary stream
  • Epidemiology
    • demographics
      • men > 45 years of age
  • Pathogenesis
    • unclear; however, chronic inflammation and hormonal and vascular mechanisms may play a role
  • Associated conditions
    • obesity and metabolic syndromes
    • hypertension
    • type 2 diabetes mellitus
  • Prognosis
    • symptoms slowly and progressively worsen
Presentation
  • Symptoms 
    • issues with urinary storage
      • e.g., nocturia, increased urinary frequency, urinary incontinence, and urgency
    • issues with voiding
      • e.g., weak urinary stream, hesistancy, straining to void, and post-void dribbling
    • irritative issues
      • e.g., urgency and increased urinary frequency
  • Physical exam
    • digital rectal exam
      • a non-tender, smooth, elastic, and firm enlarged prostate
Studies
  • Labs
    • urinalysis
      • to detect the presence of a urinary tract infection or blood
    • prostate-specific antigen
      • non-specific
  • Diagnostic criteria
    • this is a clinical diagnosis based on history (e.g., storage, voiding, and/or irritating urinary symptoms) and physical exam (e.g., a non-tender, smooth, elastic, and firm enlarged prostate)
Differential
  • Prostate cancer
  • Prostatitis
  • Urinary tract infection
  • Bladder cancer
Treatment
  • Medical
    • α1-blockers (e.g., terazosin and tamsulosin) 
      • indication
        • considered initial therapy in patients with LUTS secondary to BPH
          • results in immediate relief
          • caution in patients on a phosphodiesterase-5 inhibitor as this can cause severe hypotension
    • 5α-reductase inhibitors (e.g., finasteride)
      • indication
        • can be used as alternative treatment in patients with LUTS secondary to BPH who cannot tolerate α1-blockers
          • takes time (6-12 months) for symptom improvement to be appreciated
    • phosphodiesterase-5 inhibitors (e.g., sildenafil)
      • indication
        • a reasonable treatment option in patients with LUTS secondary to BPH who have erectile dysfunction
  • Surgical
    • transurethral resection of the prostate
      • indication
        • a treatment option in patients who are unresponsive to medical treatment
        • in patients with recurrent UTIs, bladder stones, or gross hematuria secondary to their BPH
Complications
  • UTI
  • Nephrolithiasis
  • Bladder stones
  • Chronic kidney disease

 
 

 

 

Please rate topic.

Average 4.8 of 5 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (3)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

(M1.RP.65) A 71-year-old man complains of urinary hesitancy and nocturia of increasing frequency over the past several months. Digital rectal exam was positive for a slightly enlarged prostate but did not detect any additional abnormalities of the prostate or rectum. The patient’s serum PSA was measured to be 6 ng/mL. Image A shows a transabdominal ultrasound of the patient. Which of the following medications should be included to optimally treat the patient's condition? Review Topic

QID: 101283
FIGURES:
1

Clonidine

0%

(0/55)

2

Finasteride

95%

(52/55)

3

Dihydrotestosterone

0%

(0/55)

4

Diphenhydramine

2%

(1/55)

5

Furosemide

2%

(1/55)

M1

Select Answer to see Preferred Response

PREFERRED RESPONSE 2
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (5)
Topic COMMENTS (11)
Private Note