Benign prostatic hyperplasia: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*May be asymptomatic | |||
*Urinary frequency | *Urinary frequency | ||
*Nocturia | *Nocturia | ||
*Difficulty starting urination | *Difficulty starting urination | ||
*Weak stream | *Weak stream | ||
*[[Acute urinary retention]] | *[[Acute urinary retention]] (BPH is most common cause) | ||
===Complications=== | ===Complications=== | ||
| Line 15: | Line 16: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Urinary retention DDX}} | |||
==Evaluation== | ==Evaluation== | ||
| Line 24: | Line 25: | ||
==Management== | ==Management== | ||
*May require urinary catheterization for [[acute urinary retention]] | *May require urinary catheterization for [[acute urinary retention]] | ||
**If difficult to place standard foley, consider placing [[Coude catheter]], which navigates the S-shaped curve of the bulbous urethra; this curve is exaggerated in BPH | |||
*Lifestyle modifications (limiting fluid/diuretic intake, avoiding constipation, increasing activity/weight loss), timed-voiding/double-voiding, Kegels | |||
*Alpha-1-receptor antagonists (e.g. [[tamsulosin]] 0.4mg nightly) most commonly used for lower urinary tract symptoms | |||
*Depending on symptoms, PCP/urologist may also treat with PDE-5 inhibitor, 5-alpha-reductase inhibitors, Beta-3 adrenergics, anticholinergics | |||
==Disposition== | ==Disposition== | ||
*Discharge | *Discharge | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Urology]] | |||
Latest revision as of 18:36, 21 March 2021
Background
- Benign, noncancerous increase in the size of the prostate
Clinical Features
- May be asymptomatic
- Urinary frequency
- Nocturia
- Difficulty starting urination
- Weak stream
- Acute urinary retention (BPH is most common cause)
Complications
Differential Diagnosis
Urinary retention
- Obstructive causes
- BPH
- Prostate cancer
- Blood clot
- Urethral Stricture
- Bladder Calculi
- Bladder neoplasm
- Foreign body, urethral or bladder
- Ovarian/uterine tumor
- Incarcerated uterus
- Neurogenic causes
- Multiple sclerosis
- Parkinson's
- Brain tumor
- Cerebral vascular disease
- Cauda equina syndrome
- Spinal cord compression (non-traumatic)
- Intervertebral disk herniation
- Neuropathy
- Nerve injury from pelvic surgery
- Postoperative retention
- Trauma
- Urethral injury
- Bladder injury
- Spinal cord injury
- Extraurinary causes
- Perirectal or pelvic abscesses
- Rectal or retroperitoneal masses
- Fecal impaction
- Abdominal Aortic Aneurysm
- Psychogenic causes
- Psychosexual stress
- Acute anxiety
- Infection
- Cystitis
- Prostatitis
- Herpes Simplex (genital)
- Herpes Zoster involving pelvic region
- Local Abscess
- PID
- Meds
- Anticholinergics
- Antihistamines
- Cold meds
- Sympathomimetics
- TCA
- Muscle relaxants
- Opioids
Evaluation
Workup
Diagnosis
Management
- May require urinary catheterization for acute urinary retention
- If difficult to place standard foley, consider placing Coude catheter, which navigates the S-shaped curve of the bulbous urethra; this curve is exaggerated in BPH
- Lifestyle modifications (limiting fluid/diuretic intake, avoiding constipation, increasing activity/weight loss), timed-voiding/double-voiding, Kegels
- Alpha-1-receptor antagonists (e.g. tamsulosin 0.4mg nightly) most commonly used for lower urinary tract symptoms
- Depending on symptoms, PCP/urologist may also treat with PDE-5 inhibitor, 5-alpha-reductase inhibitors, Beta-3 adrenergics, anticholinergics
Disposition
- Discharge