{"id":6844,"date":"2012-12-11T17:53:15","date_gmt":"2012-12-11T22:53:15","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=6844"},"modified":"2013-05-10T18:12:41","modified_gmt":"2013-05-10T22:12:41","slug":"benign-prostatic-hyperplasia-bph","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2012\/12\/benign-prostatic-hyperplasia-bph\/","title":{"rendered":"Benign Prostatic Hyperplasia (BPH)"},"content":{"rendered":"<p><strong>Pathophysiolog<\/strong>y<\/p>\n<p><strong>1)<\/strong> hyperplasia of glands with or without hyperplasia of smooth muscle cells in prostate <strong>2)<\/strong> occurs mostly in transition zone surrounding the urethra <strong>3)<\/strong> resistance to flow eventually weakens the detrusor muscle<\/p>\n<p><!--more--><\/p>\n<p><strong>Signs and Symptoms<\/strong><\/p>\n<p><strong>1)<\/strong> urinary frequency <strong>2)<\/strong> difficulty initiating voiding <strong>3)<\/strong> diminished stream <strong>4)<\/strong> incomplete bladder emptying with postvoid leakage <strong>5)<\/strong> nocturia <strong>6)<\/strong> recurrent UTIs <strong>7)<\/strong> renal insufficiency <strong>8)<\/strong> hematuria <strong>9)<\/strong> diffuse enlargement of prostate on rectal exam<\/p>\n<p><strong>Characteristic Test Findings<\/strong><\/p>\n<p><em>Laborator<\/em>y &#8211; increased serum PSA<\/p>\n<p><strong>Histology\/Gross Pathology<\/strong><\/p>\n<p><strong>1)<\/strong> enlarged gland compresses urethra <strong>2)<\/strong> hyperplasia of glands and stroma<\/p>\n<p><strong>Inheritance\/Epidemiology<\/strong><\/p>\n<p>occurs in &gt; 90% of men by age 70 years<\/p>\n<p><strong>Treatment<\/strong><\/p>\n<p><strong>1)<\/strong> finasteride to decrease prostate size and increase flow rate (inhibits 5 alpha reductase, which blocks conversion of testosterone to dihydrotestosterone) <strong>2)<\/strong> terazosin to relax smooth muscle around bladder neck (adrenergic blocker) <strong>3)<\/strong> transurethral prostatic resection if there is inadequate response to medical therapy<\/p>\n<p><strong>Tips for USMLE<\/strong><\/p>\n<p><strong>1)<\/strong> BPH is not a precursor to carcinoma <strong>2)<\/strong> 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<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[63],"tags":[5198,4363,4365,3502],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - 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