11. BENIGN PROSTATIC HYPERPLASIA
The
disorder appears most often after the age of 40 years, when 55% males show
enlargement after the age of 80, however, 75% males show signs of enlargement.
The lesion is a nodular fibromatous
hyperplasia which originates in the part of the gland situated close to the
urethra mostly in the lateral lobes (Fig. 26.5). This results in narrowing of
the urethra and obstruction bladder (BOO).
11.1 CLINICAL PRESENTATION
The
onset is insidious and most patients when questioned will admit to a reduction
of force of the stream. Increased frequency of micturation is the earliest
presenting symptom. At first it is nocturnal and later presents both by night
and by day. The vesical sphincter becomes stretched, a little urine escapes
into the prostatic urethra, causing a reflex desire to void, thus urgency is
added to the frequency.
Some
patients notice that they must wait patiently for urination to start
(hesitancy)
Pain
occurs with cysititis or acute retention of urine and stress incontinance is
seen with chronic retention on coughing sneezing. The other symptoms
encountered are haematuria and those related to renal insufficiency because of
chronic retention.
A
rectal examination (P.R) is carried out in all cases to note the enlargement of
the lateral lobes and the free mobility of the mucosa over the enlarged
prostate.
Among
the tests required to assess the patient and to establish the diagnosis are
examination of the blood for blood urea estimation. Examination of the urine
for evidence of infection and presence of sugar. Intravenous urography to
identify back pressure effects Fig.26.6. Urodynamics to estimate flow.
Ultrasound
examination to assess size of prostate and residual urine.
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