Pathophysiology
1) hyperplasia of glands with or without hyperplasia of smooth muscle cells in the prostate 2) occurs mostly in transistion 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 empyting with postvoid leakage 5) nocturia 6) recurrent UTIs 7) renal insufficiency 8) hematuria 9) diffuse enlargement on rectal exam
Characteristic Test Findings
Laboratory – 1) increased 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
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 ni eck (adrenergic blocker) 3) transurethral prostatic resection if there is inadequate response to initial medical management
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 urge to void after micturition, think BPH
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