2013年10月2日 星期三

攝護腺肥大

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=NAlkaline & 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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