benign%20prostatic%20hyperplasia
BENIGN PROSTATIC HYPERPLASIA
Benign prostatic hyperplasia (BPH) is a histopathological diagnosis characterized by epithelial cell & smooth muscle cell proliferation in the transition zone of the prostate leading to a non-malignant enlargement of the gland, which may result in lower urinary tract symptoms, including voiding and storage symptoms.
It is commonly called enlarged prostate.
Etiology is unknown but due to its similarity to the embryonic morphogenesis of the prostate has led to the hypothesis that BPH may be the result of "reawakening" in adulthood of embryonic induction processes.

History

  • Beginning & frequency of symptoms
  • History of recurrent urinary tract infections (UTIs), hematuria, erectile dysfunction, hypotension & fainting
  • How much liquid the patient typically drinks each day
  • Frequency of caffeine & alcohol use
  • General medical history, including past illnesses or surgeries & intake of medications such as decongestants, antihistamines, antidepressants & diuretics

Physical Examination

  • Examine the abdomen & look for signs of distended bladder
  • Check for:
    • Discharges from the urethra
    • Swelling or tenderness of the scrotum
  • Perform digital rectal exam (DRE) for the examination of the prostate
    • Detection of hard or firm areas in the prostate raises suspicion of prostate cancer
  • Focused neurological examination

International Prostate Symptom Score (IPSS)

  • Scoring system used to screen & diagnose benign prostatic hyperplasia (BPH), as well as to monitor & guide decisions in managing the disease
  • Contains 8 questions (7 regarding symptoms & 1 for patient’s quality of life (QoL)
  • According to the scoring system, the scores are categorized as follows:
    • Mild if the score is 7 or less
    • Moderate if the score is 8 to 19
    • Severe if the score is 20 to 35
  • For questions on the quality of life (QoL), a score of 6 means that the patient perceives a “terrible” quality of life (QoL) while a score of 0 indicates that the patient is “delighted” with their quality of life (QoL)

Laboratory Tests

Urinalysis

  • Urine sample is tested for signs of infections & microscopic hematuria

Frequency volume chart

  • Provides useful information including frequency, total voided volume, functional capacity, fluid intake habits & demonstrates nocturnal polyuria

Prostate-specific antigen (PSA)

  • Performed to detect or rule out prostate cancer & it also reflects the size of the prostate gland

Optional Tests

Urodynamic tests

  • These procedures checks how well the sphincter & urethra & the bladder stores & releases urine
  • Mostly focuses on the ability of the bladder to hold the urine, as well as to empty steadily & completely
  • May include uroflowmetry (measures how rapid the bladder releases urine), postvoid residual measurement (evaluates how much urine has remained in the bladder)

Cystoscopy

  • Used to look inside the urethra & bladder to check for blockage & stones in the lower urinary tract
  • Used to find the cause of urinary tract problems such as frequent urinary tract infections (UTIs), hematuria, urinary frequency, urinary urgency, urinary retention, urinary incontinence, pain or burning sensation before, during or after urination, trouble in starting urination, completing urination or both, abnormal cells such as cancer cells found in the urine sample
  • Can be used to treat problems such as bleeding & blockage in the urethra, remove stones, remove or treat abnormal tissue
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