Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland. Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary frequency, urgency, nocturia, incomplete emptying, terminal dribbling, overflow or urge incontinence, and complete urinary retention. Diagnosis is based primarily on digital rectal examination and symptoms; cystoscopy, transrectal ultrasonography, urodynamics, or other imaging studies may also be needed. Treatment options include 5 alpha-reductase inhibitors, alpha-blockers, tadalafil, and surgery.
Using the criteria of a prostate volume > 30 mL and a moderate or high American Urological Association Symptom Score (see Table: American Urological Association Symptom Score for Benign Prostatic Hyperplasia), the prevalence of BPH in men aged 55 to 74 without prostate cancer is 19%. But if voiding criteria of a maximal urinary flow rate < 10 mL/sec and a postvoid residual urine volume > 50 mL are included, the prevalence is only 4%. Based on autopsy studies, the prevalence of BPH increases from 8% in men aged 31 to 40 yr to 40 to 50% in men aged 51 to 60 yr and to > 80% in men > 80 yr.
The etiology is unknown but probably involves hormonal changes associated with aging.
American Urological Association Symptom Score for Benign Prostatic Hyperplasia
Over About the Past Month
How often have you had a sensation of not emptying your bladder completely after you finish urinating?
How often have you had to urinate again < 2 h after you finished urinating?
How often have you stopped and started again several times when urinating?
How often have you found it difficult to postpone urination?
How often has your urinary stream been weak?
How often have you had to push or strain to begin urination?
How many times did you most typically get up to urinate between going to bed at night and waking in the morning?
American Urological Association symptom score = total ______.
CHAPTER 5 GENITOURINARY DISORDERS CASE STUDY 55 6.The primary care provider (PCP) asked for a postvoiding residual (PVR) urine test. You use a bedside bladder scanner and document that S.M. voided 60 mL and his PVR is 110 mL. You report the PVR to the PCP. What is the significance of his PVR? The significance of his post voiding residual is the retention that the Patient still has in his bladder. The normal residual urine ranges from 0 to 15 ml; however, for patients with enlarged prostates 50 ml is acceptable Lewis, et. al (2014).7.Commonly used medications for BPH are 5-alpha reductase inhibitors, such as finasteride (Proscar) and alpha-blocking drugs, such as tamsulosin (Flomax). Howdo these drugs differ? 5-alpha reductase inhibitors- those drugs work to reduces the size of the prostate gland. Finasteride blocks the 5-alpha reductase enzyme that converts testosterone which surpresses androgen (Lewis et. Al, 2014, p. 1416,) Alpha-blocking drugs- this drug promotes smooth muscle relaxation in the prostate gland and facilitates urinary flow through the urethra. (Lewis et. Al, 2014, p.1417).8.The PCP ordered tamsulosin (Flomax) 0.4 mg/day PO. You enter S.M.'s room to teach him about this medication. What side effects will you tell S.M. about? (Select all that apply.)A, C, D, F9.S.M. asks, “Will this condition affect my relationship with my wife?” What