Benign prostatic hyperplasia
Updates to Article Attributes
Benign prostatic hypertrophy (BPH) is an extremely common condition in elderly men and is a major cause of outflow obstruction. Although the term prostatomegaly is often used interchangeably, strictly speaking prostatomegaly may refer to any cause of prostatic enlargement.
Epidemiology
By the age of 60, 50% of men have BPH, and by 90 years of age the prevalence has increased to 90%. As such it is often thought of essentially as a 'normal' part of ageing 1.
Clinical presentation
Although a degree of prostatomegaly may be completely asymptomatic, the most common presentation is with lower urinary tract symptoms (LUTS) including 1-4:
- poor stream despite straining
- hesitancy, frequency and incomplete emptying of the bladder
- nocturia
An enlarged prostate may also be incidentally found on imaging of the pelvis or on rectal exam.
Pathology
Benign prostatic hypertrophy is due to a combination of stromal hypertrophy and glandular hyperplasia, predominantly of the central zone (as opposed to prostate cancer which typically originates in the peripheral zone).
Complications of untreated benign prostatic hypertrophy include 4:
- urinary retention
- hydronephrosis and hydroureter and eventual renal failure
- recurrent urinary tract infection
- bladder calculi and bladder diverticula
- recurrent gross haematuria
Radiographic features
Ultrasound
Ultrasound has become the standard first line investigation after the urologist's finger. Typically there is an increase in volume of the prostate with a calculated volume exceeding 30cc ( (A x B x C)/2 ). The central gland is enlarged, and is hypoechoic or of mixed echogenicity. Calcification can be seen both within the hypertrophied gland as well as in the pseudocapsule (representing compressed peripheral zone).
Post micturition residual volume is typically elevated.
Fluoroscopy : IVP
The bladder floor can be elevated and the distal ureters lifted medially (J-shaped ureters or Fishhook ureters). Chronic bladder outlet obstruction can lead to detrusor hypertrophy , trabeculation and formation of bladder diverticula.
CT
Not typically used to asses the prostate, BPH is more frequently an incidental finding. Extension above the symphysis pubis was used as a marker on axial imaging, however now that volume acquisition and coronal reformats are standard, the same criteria as on US can be used (>30 cc;30cc)
MRI
Typically demonstrates the enlarged central zone to be heterogenous in signal with an intact low signal pseudocapsule around its periphery.
Treatment and prognosis
Medical management for early disease typically commences with finasteride (a 5-alpha-reductase inhibitor).
Surgical management for symptomatic patients is typically with a transurethral resection of the prostate (TURP), and careful patient selection is important given the high prevalence of both BPH and lower urinary symptoms (LUTS) in this population.
Urodynamic studies and prostate size estimation are often used to guide therapy, although prostate size in isolation is a poor predictor of symptom severity 4.
-</ul><p>An enlarged prostate may also be incidentally found on imaging of the pelvis or on rectal exam. </p><h4>Pathology</h4><p>Benign prostatic hypertrophy is due to a combination of stromal hypertrophy and glandular hyperplasia, predominantly of the central zone (as opposed to <a href="/articles/prostatic-carcinoma-1">prostate cancer</a> which typically originates in the peripheral zone).</p><p>Complications of untreated benign prostatic hypertrophy include 4:</p><ul>- +</ul><p>An enlarged prostate may also be incidentally found on imaging of the pelvis or on rectal exam. </p><h4>Pathology</h4><p>Benign prostatic hypertrophy is due to a combination of stromal hypertrophy and glandular hyperplasia, predominantly of the central zone (as opposed to <a href="/articles/prostatic-carcinoma-1">prostate cancer</a> which typically originates in the peripheral zone).</p><p>Complications of untreated benign prostatic hypertrophy include <sup>4</sup>:</p><ul>
-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasound has become the standard first line investigation after the urologist's finger. Typically there is an increase in volume of the prostate with a calculated volume exceeding 30cc ( (A x B x C)/2 ). The central gland is enlarged, and is hypoechoic or of mixed echogenicity. Calcification can be seen both within the hypertrophied gland as well as in the pseudocapsule (representing compressed peripheral zone).</p><p>Post micturition residual volume is typically elevated.</p><h5>Fluoroscopy : IVP</h5><p>The bladder floor can be elevated and the distal ureters lifted medially (<a href="/articles/j-shaped-ureters">J-shaped ureters</a> or <a href="/articles/fishhook-ureters">Fishhook ureters)</a>. Chronic bladder outlet obstruction can lead to <a href="/articles/detrusor-hypertrophy">detrusor hypertrophy</a> , trabeculation and formation of <a href="/articles/bladder-diverticula">bladder diverticula</a>.</p><h5>CT</h5><p>Not typically used to asses the prostate, BPH is more frequently an incidental finding. Extension above the symphysis pubis was used as a marker on axial imaging, however now that volume acquisition and coronal reformats are standard, the same criteria as on US can be used (>30 cc)</p><h5>MRI</h5><p>Typically demonstrates the enlarged central zone to be heterogenous in signal with an intact low signal pseudocapsule around its periphery.</p><h4>Treatment and prognosis</h4><p>Medical management for early disease typically commences with finasteride (a 5-alpha-reductase inhibitor).</p><p>Surgical management for symptomatic patients is typically with a <a href="/articles/transurethral-resection-of-the-prostate-turp">transurethral resection of the prostate (TURP)</a>, and careful patient selection is important given the high prevalence of both BPH and lower urinary symptoms (LUTS) in this population.</p><p>Urodynamic studies and prostate size estimation are often used to guide therapy, although prostate size in isolation is a poor predictor of symptom severity <sup>4</sup>. </p>- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasound has become the standard first line investigation after the urologist's finger. Typically there is an increase in volume of the prostate with a calculated volume exceeding 30cc ( (A x B x C)/2 ). The central gland is enlarged, and is hypoechoic or of mixed echogenicity. Calcification can be seen both within the hypertrophied gland as well as in the pseudocapsule (representing compressed peripheral zone).</p><p>Post micturition residual volume is typically elevated.</p><h5>Fluoroscopy : IVP</h5><p>The bladder floor can be elevated and the distal ureters lifted medially (<a href="/articles/j-shaped-ureters">J-shaped ureters</a> or <a href="/articles/fishhook-ureters">Fishhook ureters)</a>. Chronic bladder outlet obstruction can lead to <a href="/articles/detrusor-hypertrophy">detrusor hypertrophy</a> , trabeculation and formation of <a href="/articles/bladder-diverticula">bladder diverticula</a>.</p><h5>CT</h5><p>Not typically used to asses the prostate, BPH is more frequently an incidental finding. Extension above the <a href="/articles/symphysis-pubis">symphysis pubis</a> was used as a marker on axial imaging, however now that volume acquisition and coronal reformats are standard, the same criteria as on US can be used (>30cc)</p><h5>MRI</h5><p>Typically demonstrates the enlarged central zone to be heterogenous in signal with an intact low signal pseudocapsule around its periphery.</p><h4>Treatment and prognosis</h4><p>Medical management for early disease typically commences with finasteride (a 5-alpha-reductase inhibitor).</p><p>Surgical management for symptomatic patients is typically with a <a href="/articles/transurethral-resection-of-the-prostate-turp">transurethral resection of the prostate (TURP)</a>, and careful patient selection is important given the high prevalence of both BPH and lower urinary symptoms (LUTS) in this population.</p><p>Urodynamic studies and prostate size estimation are often used to guide therapy, although prostate size in isolation is a poor predictor of symptom severity <sup>4</sup>. </p>
Unable to process the form. Check for errors and try again.