Common condition in older men

It is caused by hyperplasia of the stromal and epithelial cells of the prostate. Enlargement of the transitional zone of ther prostate

Risk factors

• age
  • around 50% of 50-year-old men will have evidence of BPH and 30% will have symptoms
  • around 80% of 80-year-old men have evidence of BPH
• ethnicity: black > white > Asian

PC

• voiding symptoms (obstructive):
  • weak or intermittent urinary flow
  • straining
  • hesitancy
  • terminal dribbling
  • incomplete emptying
• storage symptoms (irritative)
  • incontinence
  • frequency
  • urgency
  • nocturia
• post-micturition
  • dribbling

On examination:

• DRE - Smooth, soft symmetrical mass with a maintained central sulcus

Investigations

• dipstick urine - Normal in uncomplicated BPH
• U&Es: particularly if chronic retention is suspected
• PSA: should be done if there are any obstructive symptoms, or if the patient is worried about prostate cancer
• urinary frequency-volume chart
  • should be done for at least 3 days
• International Prostate Symptom Score (IPSS)
  • tool for classifying the severity of lower urinary tract symptoms (LUTS) and assessing the impact of LUTS on quality of life
  • Score 20–35: severely symptomatic
  • Score 8–19: moderately symptomatic
  • Score 0–7: mildly symptomatic