Benign prostatic hyperplasia

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

• UTI
• Bladder stones
• CKD

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

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

See Also

• Acute urinary retention