BPH
78, M,
c/o having to wake up 6-7x at night (Nocturia) to urinate. Also
urgent, weak stream, terminal dribbling, and a need
to push in order to initiate micturition排尿.has
had 2 episodes of acute urinary retention (required Foley to relieve).
Denied wt loss, fatigue, bone pain. VS=N∘.
PE: cardiopulm & abd : unremarkable. Rectal exam: enlarged, nodular,
nontender prostate gland (rubbery w/o area of ↑consistency;
median ridge not palpable; postvoid catheterizationà150cc
residual urine) UA: 8 wbc/HPF; nitrate & leukocyte esterase (+);
proteinuria & slight hematuria (due to concomitant infxn).
CBC=N∘Alkaline
& acid phosphatase =N∘.
PSA=5.5 (N∘=4,
>10 suggest cancer); BUN & Cr=N∘.
Ca=N∘
US-prostate:
enlarged prostate w/o focal mass; transrectal guided Bx may performed in
multiple regions.
IVP:
elevated bladder, w/ impression of enlarged prostate on inf surface.
(Incidence
is proportional to age. >90% man has histological evidence of BPH at
85y.)
(generally originates in periurethral & transition zone) (while prostate Ca usu
present in peripheral aspect of prostate)
-it can
coexist w/ prostate cancer, but BPH is not a premalig
dz.
(Occurs
as hyperplasia of stromal & epith tiss) in periurethral zone of
aging men. It can cause urinary flow obst
± obst prostatism.
The size
of gland on PE dose not generally correlate w/ symp.
Condition will precipitate or worsen symp= cold exposure, Anti-Ach, anesthetic
drugs, alc.
(age-dependent changes of estrogen & androgens are believe the cause of BPH. Dz
start at 40y.)
Tx:
Finasteride;
TURP (transurethral resection of prostate).
Tx asso
UTI – Bactrim or ciprofloxacin
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