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PEER REVIEW: BENIGN PROSTATIC HYPERPLASIA
Benign Prostatic Hyperplasia (BPH) Benign Prostatic Hyperplasia (BPH)
Written by Dr Stefanie Croghan - Specialist Registrar in Urology and Mr James Forde - Consultant Urologist Both prostatic enlargement Background and Definition Written by Dr Stefanie Croghan - Specialist Registrar in Urology and Mr James Forde and consequent lower urinary The prostate gland is located just tract symptoms increase with Consultant Urologist, Blackrock Clinic inferior to the bladder, and typically age; prostate volume has been approximates the size of a walnut or chestnut in young adult men, weighing 18-20g.1,2 It is composed of a combination of fibromuscular stroma and glandular elements, and serves in the production and liquefaction of the ejaculate.1 Benign prostatic hyperplasia (BPH) refers to a non-malignant process resulting in enlargement of the prostate gland (Figure 1).
observed to increase at a rate of 0.6ml [-9.9-62.1ml] per year in one longitudinal study.6,7 The interplay of further potential risk factors is incompletely understood, however obesity, hypertension, obesity, diabetes, diets lacking in fruit, vegetables and fibre and sex hormone levels have been implicated in the development of BPH.8
Background and Definition
The prostate gland is located just inferior to the bladder, and typically approximates the size 1,2 It is composed Dr Stefanie18-20g. Croghan, Mr James Forde,of a of a walnut or chestnut in young adult men, weighing Epidemiology
Specialist Registrar in Urology
Consultant Urologist
combination ofcommon fibromuscular stroma and glandular elements, and serves in the production BPH is an extremely Clinical Consequences
process. Figures quote prevalence (on pathological inspection) of ~50% in men aged >50 years and >80% in men aged >70.3
BPH may be asymptomatic, or may result in bladder outlet 1 obstruction, causing lower urinary tract symptoms (LUTS) or urinary retention, which may be acute or chronic.5,8 Chronic urinary retention risks increased bladder pressure with transmission to the upper urinary tracts, causing hydronephrosis and renal impairment. In addition, high residual volumes of urine within the bladder predispose a patient to urinary tract infections, which may progress to epididymoorchitis or pyelonephritis.5,8
Presentation
Haematuria may occur, but must
be fully investigated for other and liquefaction of the ejaculate. Benign prostatic hyperplasia (BPH) refers to a nonPatients may present with a variety of lower urinary tract symptoms, including a weak stream of urine, straining to void, intermittency of the urinary stream, a feeling of incomplete bladder emptying, urinary frequency and urinary urgency. The extent of these symptoms and their impact on a patient’s quality of life may be quantified using the validated International Prostate Symptom Score (IPSS).9
causes before being ascribed to BPH. The presence of nocturnal enuresis (bed-wetting) is a sign of high-pressure chronic retention, and should be enquired about. The presence of neurological symptoms may suggest a nonprostatic cause of LUTS. Clinical history taking should seek the presence of medical conditions
Pathophysiology & Risk Factors malignant process resulting in enlargement of the prostate gland (Figure 1). BPH results from an increase in the number of epithelial and stromal cells in the region of the prostate surrounding the urethra.4 The enlarged prostate may exert an obstructive effect on the urethra via both dynamic (contraction of prostatic smooth muscle) and static (direct local influence of increased volume) effects.5
Figure 1 – Anatomy of Benign Prostatic Hyperplasia (BPH) Figure 1: Anatomy of Benign Prostatic Hyperplasia (BPH)
HOSPITALPROFESSIONALNEWS.IE | HPN • AUGUST 2022
