(GP)

Overview

• BPH → benign glandular and stromal hyperplasia of the transitional zone of the prostate
• The prevalence of histological BPH increases with age, affecting approximately 42% of men 51-60 yrs old and 82% of men 71-80 yrs old
• Aetiology → DHT is a potent prostatic growth factor, androgen/oestrogen imbalance as men age
• Progression from pathological BPH to clinical BPH (i.e. the presence of symptoms) may require additional factors
• Risk Factors → >50 yrs old and positive family history

Amitriptyline ⇒ contraindicated in BPH as can cause urinary retention.

Making Diagnosis

Clinical Features:

• Typically manifests with features of uncomplicated lower urinary tract symptoms (LUTS)
  • Storage (aka irritative) Symptoms → frequency, urgency, nocturia
  • Voiding (aka obstructive) Symptoms (often predominant symptom) → weak stream, hesitancy (difficulty initiating urination), intermittency, straining to urinate, sensation of incomplete emptying, and post-void dribbling
• May have fever with dysuria → suggestive of a complicated UTI
• FUN (Storage) WISE (Voiding)

Investigations:

• Transrectal ultrasound-guided needle biopsy → gold standard.