Week 8 530A Benign Prostatic Hyperplasia (BPH) Paper

Week 8 530A Benign Prostatic Hyperplasia (BPH) Paper

Week 8 530A Benign Prostatic Hyperplasia (BPH) Paper

BPH is a frequent cause of urinary tract symptomatology in men, especially the lower. It is most prevalent in older men as its incidence increases with aging. In the United States, the condition is 50% prevalent in those over 50 years, 70% in those between 60 to 69 years, and over 80% for those aged 80 years and above (Ng & Baradhi, 2021). This assignment describes the BPH, including its pathogenesis, clinical manifestations, evaluation, and treatment options.

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Pathogenesis of BPH

BPH refers to the nonmalignant proliferation of stromal and glandular prostatic tissue of the transitional zone of the prostate (Ng & Baradhi, 2021).BPH development is complex and multifactorial, involving the interaction of hormonal factors and other risk factors such as genetic susceptibility, metabolic syndrome, and obesity.The prostate contains type II 5 alpha-reductase that converts circulating testosterone to potent dihydrotestosterone (DHT). This hormone has autocrine and paracrine effects that stimulate the proliferation of the transformational zone’s prostatic stromal and glandular tissues (Madersbacher et al., 2019). Consequently, lower urinary tract symptoms (LUTS) and bowel outlet obstructions ensue via static and dynamic components, which causes periurethral compression.

Clinical Presentation

BPH manifests with LUTS, which encompasses bladder outlet obstruction (BOO) and bladder irritative symptoms or rather storage LUTS due to overactive bladder (Madersbacher et al., 2019). Irritative symptoms correlate with detrusor overactivity and include urinary frequency, nocturia, urinary urgency and urge incontinence, and occasional dysuria (Ng &Baradhi, 2021). Additionally, BPH presents with voiding LUTS or obstructive symptoms, principally due to bowel outlet obstruction. These include straining, hesitancy, intermittent stream, prolonged terminal dribbling, perception of incomplete emptying, and acute urinary retention (Ng & Baradhi, 2021). Furthermore, some patients may occasionally present with gross hematuria. On digital rectal examination (DRE), findings suggestive of BPH include symmetrically enlarged, smooth, non-tender, firm prostate with elastic or rubbery texture.

Evaluation

Evaluation of a patient with suspected BPH should be systematic. Initial evaluation includes a detailed history and physical examination complemented with laboratory and imaging tests. Additionally, the severity of symptoms should be evaluated using an international prostate symptom score (IPSS) (Ng & Baradhi, 2021). Laboratory tests and imaging are principally required to rule out other prostate conditions, such as prostatitis and prostate cancer, and other urinary tract abnormalities. Laboratory tests include urinalysis, renal function tests, serum prostate-specific antigen (PSA) levels, while imaging studies include flow studies, transrectal ultrasound, and cystoscopy (Madersbacher et al., 2019). Finally, histological evaluation demonstrates both stromal and glandular proliferation of both periurethral and transition zones.

Treatment

Treatment options are guided by symptom severity and the size of the prostate. They include nonpharmacological, pharmacological, and surgical options. LUTS, with little effect, is majorly managed by watchful waiting and nonpharmacological methods such as patient education about bladder emptying techniques, dietary advice, review of medications to stop non-essential drugs, and avoidance of alcohol and caffeine (Miernik & Gratzke, 2020). Pharmacological therapy for BPH includes alpha-blockers, 5 alpha-reductase inhibitors, antimuscarinics, and phosphodiesterase 5 inhibitors (Miernik & Gratzke, 2020). The subsequent details, mechanisms of action, and the side effects of the medications are beyond the scope of this paper. These agents are mainly considered for symptomatic relief of moderate to severe LUTS and considered the first line for uncomplicated LUTS attributable to BPH. Finally, surgical options, chiefly transrectal resection of the prostate (TURP), are considered the gold standard and are indicated when there is an insufficient response to medical therapy, complicated BPH, and intolerable complications on pharmacotherapy (Miernik & Gratzke, 2020).

Conclusion

BPH is a benign condition whose incidence increases with rising age. The condition predominantly causes LUTS that can be managed conservatively, medically, or surgically depending on the severity. A careful evaluation of a patient suspected to have BPH is required to rule out other conditions such as prostatitis and prostate cancer.

References

Madersbacher, S., Sampson, N., & Culig, Z. (2019). Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: A mini-review. Gerontology, 65(5), 458–464. https://doi.org/10.1159/000496289

Miernik, A., & Gratzke, C. (2020). Current treatment for benign prostatic hyperplasia. Deutsches Arzteblatt International, 117(49), 843–854. https://doi.org/10.3238/arztebl.2020.0843

Ng, M., & Baradhi, K. M. (2021). Benign Prostatic Hyperplasia. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558920

Describe benign prostatic hypertrophy (BPH) and discuss the pathogenesis, clinical manifestations, evaluation, and treatment of BPH.