🔸What is BPH?
Benign prostatic hyperplasia (BPH) is a histologic diagnosis that refers to the proliferation of glandular epithelial tissue, smooth muscle, and connective tissue within the prostatic transition zone.
شروع BPH از سنین ۴۰ الی ۴۵ سالگی هست و تا ۸۰ سالگی به ۸۰ درصد مردان میرسد.
🔸Terminology:
BPH: Benign prostatic hyperplasia
BPE: Benign prostatic enlargement
BPO: Benign prostatic obstruction
💭 نکتهی مهم این است که BPH مخفف هایپرپلازی به معنای افزایش تعداد سلولی هست نه هایپرتروفی که به معنای افزایش اندازه سلولهاست.
🔸Clinical manifestation:
BPH can be asymptomatic, and the correlation between symptoms and the presence of prostatic enlargement on physical examination or transrectal ultrasonographic assessment is poor.
🔻Typical manifestations of LUTS/BPH include:
▪️Storage (irritative) symptoms:
- Urinary frequency,
- urgency,
- nocturia,
- incontinence
▪️Voiding symptoms:
- Slow urinary stream,
- straining to void,
- urinary intermittency (stream starting and stopping during micturition),
- hesitancy,
- splitting of the voiding stream,
- terminal dribbling
💭 Storage symptoms are often more bothersome than voiding symptoms.
🔻Physical examination findings:
▪️Digital rectal examination (DRE): a nontender, enlarged prostate. The size of the prostate on examination does not correlate well with symptom severity.
🔻Complications:
▪️Acute urinary retention
▪️Chronic obstruction:
- increase the risk of urinary tract infections,
- bladder stones,
- formation of bladder,
- diverticuli,
- kidney damage
☑️ BPH is not a risk factor for prostate cancer. BPH occurs primarily in the central or transitional zone of the prostate, whereas prostate cancer originates primarily in the peripheral part of the gland.
🔸Differential diagnosis:
Many other urologic conditions can present with lower urinary tract symptoms (LUTS):
▪️Urologic causes of obstruction:
- Urethral stricture,
- bladder neck contracture,
- prostate cancer
▪️Other urologic conditions:
- Urinary infections
- bladder cancer
▪️Non-urologic conditions:
- Cardiovascular disease
- Neurologic disease
- Endocrine disease
- Polydipsia
- Nocturnal polyuria