Question

A 68-year-old man presents to the physician with a complaint of urinary frequency. He states that he has noted increased urgency and frequency for approximately 1 year, but his symptoms have become progressively worse. He states that currently he seems to have to urinate "all the time" and often feels as if he has not completely emptied his bladder. He must get up to urinate three or four times each night. In addition, in the last month, he sometimes has postvoid dribbling. He denies fevers, weight loss, or bone pain. His medical history is notable only for hypertension. His medications include atenolol and aspirin. The family history is negative for malignancy.

On examination, he appears healthy. His vital signs are notable for a blood pressure of 154/192 mm Hg. Prostate is diffusely enlarged without focal nodule or tenderness. Benign prostatic hyperplasia is suspected.
Questions:
1. How would you make the diagnosis of benign prostatic hyperplasia?
2. What factors are known to be responsible for the pathogenesis of this disorder?
3. How would you classify this patient's symptoms? What is the mechanism by which benign prostatic hyperplasia causes these symptoms?

Answer 1

1) Diagnosis: a)Digital rectal examination

b)Blood tests

c)Urine tests

d)PSA blood antigen

2)Androgens are reduced in old age thus is the most important factor in pathogenesis of BPH

3)Lower Urinary Tract Symptoms (LUTS) .

BPH causes LUTS by obstructing the urethra or by opressing it thus causing an increase in the urethral resistance and also increases work of detrusor muscle for voiding.

Explanation:

1)BPH is diagnosed by different tests mentioned above.

2)BPH is caused by decrease in androgens which usually results in enlargement of prostate.

3)Symptoms are classified as upper urinary tract symptoms and Lower urinary tract symptoms.BPH causes symptoms by obstructing the urethra or by opressing it thus causing an increase in the urethral resistance and also increases work of detrusor muscle for voiding.