Pathophysiology
1) hyperplasia of glands with or without hyperplasia of smooth muscle cells in prostate 2) occurs mostly in transition zone surrounding the urethra 3) resistance to flow eventually weakens the detrusor muscle
Signs and Symptoms
1) urinary frequency 2) difficulty initiating voiding 3) diminished stream 4) incomplete bladder emptying with postvoid leakage 5) nocturia 6) recurrent UTIs 7) renal insufficiency 8) hematuria 9) diffuse enlargement of prostate on rectal exam
Characteristic Test Findings
Laboratory – increased serum PSA
Histology/Gross Pathology
1) enlarged gland compresses urethra 2) hyperplasia of glands and stroma
Inheritance/Epidemiology
occurs in > 90% of men by age 70 years
Treatment
1) finasteride to decrease prostate size and increase flow rate (inhibits 5 alpha reductase, which blocks conversion of testosterone to dihydrotestosterone) 2) terazosin to relax smooth muscle around bladder neck (adrenergic blocker) 3) transurethral prostatic resection if there is inadequate response to medical therapy
Tips for USMLE
1) BPH is not a precursor to carcinoma 2) if a 78 year old man reports that over the past 2 months his urinary stream has become weaker and increasingly difficult to initiate and he still has to go after he urinates, think BPH
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