Overview
Definition
Non-malignant enlargement of the prostate gland, leading to bladder outlet obstruction.
Epidemiology
Extremely common in older men (affects >50% of men over 60, and up to 90% over 85).
Etiology & Risk Factors
- Proliferation of the stromal and glandular elements of the prostate, driven by Dihydrotestosterone (DHT). Occurs predominantly in the transitional zone of the prostate.
Clinical Symptoms
- LUTS (Lower Urinary Tract Symptoms):
- Obstructive: Hesitancy, weak stream, straining to void, incomplete emptying, post-void dribbling
- Irritative: Urgency, frequency, nocturia (waking up to pee)
Clinical Approach
Diagnosis
- Digital Rectal Exam (DRE): Smooth, firm, elastic, and enlarged prostate
- Urinalysis: To rule out UTI or hematuria
- PSA (Prostate-Specific Antigen): Often mildly elevated, but primarily used to screen for prostate cancer
- Post-Void Residual (PVR) volume via ultrasound
Management
- Alpha-1 Blockers (Tamsulosin, Terazosin): First-line. Relaxes smooth muscle in the bladder neck and prostate for rapid symptom relief.
- 5-Alpha Reductase Inhibitors (Finasteride, Dutasteride): Blocks conversion of testosterone to DHT, shrinking the prostate over 6-12 months.
- Surgery (TURP - Transurethral Resection of the Prostate): For refractory symptoms or complications (recurrent UTIs, renal failure)
Complications
- Acute Urinary Retention (painful inability to void, requires foley catheter)
- Recurrent UTIs
- Bladder stones
- Obstructive nephropathy (post-renal AKI)