Which assessment findings are typically associated with benign prostatic hypertrophy?
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Last reviewed: 12 Oct 2022 Show
Last updated: 27 Jan 2022 SummaryThe etiology of benign prostatic hyperplasia (BPH) is multifactorial involving smooth muscle hyperplasia, prostatic enlargement, and bladder dysfunction, as well as input from the central nervous system. Presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining). Physical examination may demonstrate prostate size/volume ≥30 grams, nodules or tenderness suspicious of prostate cancer or prostatitis. Evaluation includes history and examination including an abdominal exam for a palpable bladder, a digital rectal exam, and a neurologic assessment. Urinalysis, prostate-specific antigen (PSA) level, and International Prostate Symptom Score are first-line tests of powerful diagnostic impact in the appropriate patient groups. Given the debate regarding the morbidity and mortality reduction of prostate cancer with PSA testing, discuss the implications with the patient before testing. Use shared decision-making based on understanding the patient’s desires and risks associated with specific therapies to guide treatment strategies. If symptoms or disease severity warrant, initiate therapy with an alpha-blocker, 5-alpha-reductase inhibitor, combination therapy, or other agents depending on symptom profile. Common complications are disease progression and urinary retention, which may require invasive therapy. Failure or intolerance of medical management or renal complications are indications for surgical intervention. There are a host of procedural treatments, which have unique risk/benefit profiles for consideration. DefinitionLower urinary tract symptoms (LUTS) caused by bladder outlet obstruction due to BPH, also known as benign prostatic enlargement, are predominantly due to 2 components: a static component related to an increase in benign prostatic tissue narrowing the urethral lumen and a dynamic component related to an increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors. Symptoms related to bladder outlet obstruction may also be contributed by bladder overactivity. LUTS are further defined as storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).[1] History and exam
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More investigations to consider Treatment algorithmnon-bothersome symptomsbothersome symptoms with no indications for surgerybothersome symptoms with indication for surgery: prostate volume ≤30 gramsbothersome symptoms with indication for surgery: prostate volume 30-80 gramsbothersome symptoms with indication for surgery: prostate volume ≥80 gramsContributorsAuthorsClaus Roehrborn, MDProfessor Urology University of Texas Southwestern Medical Center Dallas TX DisclosuresCR is on an ad board for Teleflex; consults for Teleflex, Zenflow, and Medeon; and has done research with Zenflow and Teleflex. CR is an author of several references cited in this topic. Ramy Goueli, MDAssistant Professor Urology University of Texas Southwestern Medical Center Dallas TX DisclosuresRG declares that he has no competing interests. AcknowledgementsProfessor Claus Roehrborn and Dr Ramy Goueli would like to gratefully acknowledge Professor Michael T. Flannery and Dr Erika Abel, the previous contributors to this topic. Regretfully, Professor Flannery died in December 2020. DisclosuresEA declares that she has no competing interests. Peer reviewersChristopher R. Chapple, BSc, MD, FRCS (Urol), FEBUConsultant Urological Surgeon Royal Hallamshire Hospital Honorary Senior Lecturer of Urology University of Sheffield Newcastle University Visiting Professor of Urology Sheffield Hallam University Adjunct Secretary responsible for Education European Association of Urology Sheffield UK DisclosuresCRC is Chairman of NICE Male LUTS Guidelines Development Group. Robert Pickard, MD, FRCS (Urol)Professor of Urology Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK DisclosuresRP has received funding from the UK NHS (NIHR) to undertake commissioned reviews of treatment for benign prostatic enlargement. Steven K. Brooks, MDChief Department of Surgery South Seminole Hospital Longwood FL DisclosuresSKB is a member of the National Speakers Bureau for Boehringer Ingelheim, Astellas Pharmaceuticals, and Glaxo Pharmaceuticals and has served as a consultant for these companies. What do you assess with benign prostatic hypertrophy?Diagnosis. Digital rectal exam. The doctor inserts a finger into the rectum to check your prostate for enlargement.. Urine test. Analyzing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.. Blood test. ... . Prostate-specific antigen (PSA) blood test.. What are some diagnostic test findings that can be associated with BPH?Other tests such as urine flow study, digital rectal exam, prostate-specific antigen (PSA) blood test, cystoscopy, ultrasound or prostate MRI may be used to confirm the diagnosis. Treatment for BPH may depend on the severity of the symptoms and range from no treatment to medication or surgery.
What is benign prostatic hyperplasia characterized by?(beh-NINE prah-STA-tik HY-per-PLAY-zhuh) A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine.
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