Speaker A
Hi everyone, my name is Paulien. As a nuclear medicine resident, I often see patients with prostate cancer.
Overview of benign prostatic hyperplasia, its symptoms, diagnosis, and treatment options for medical students.
Key Takeaways
- BPH is common in older men and caused by hormonal changes leading to prostate enlargement.
- Symptoms result from urethral compression and include urinary difficulties and frequent urination.
- Diagnosis requires physical exams and tests to differentiate BPH from prostate cancer and assess severity.
- Medications can relieve symptoms and reduce prostate size; surgery is a last resort with possible complications.
- Understanding BPH helps doctors manage patient symptoms and improve quality of life.
What the video covers
- Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate affecting many aging men.
- The prostate gland surrounds the urethra and produces seminal fluid; it enlarges with age, potentially blocking urine flow.
- Hormonal changes, including increased estrogen and dihydrotestosterone, likely contribute to prostate growth in BPH.
- Symptoms include difficulty starting urination, incomplete emptying, frequent urination especially at night, urgency, and weak urine flow.
- Complications can include acute urinary retention, requiring urgent medical attention.
- Diagnosis involves rectal examination, urine analysis, PSA testing, uroflowmetry, and bladder ultrasound.
- Treatment is only necessary if symptoms are bothersome and includes medications like alpha-blockers and 5-alpha reductase inhibitors.
- Alpha-blockers relax prostate smooth muscle to improve symptoms quickly but do not reduce prostate size.
- 5-alpha reductase inhibitors reduce hormone-driven prostate growth, shrinking the gland and lowering surgery risk.
- Surgery, such as TURP, is reserved for severe cases but carries risks like infection, bleeding, incontinence, and erectile dysfunction.
Chapters
Full Transcript — Download SRT & Markdown
Speaker A
This is why I made a series of videos in which I explain everything related to the prostate, from benign prostatic hyperplasia to prostate cancer to some important diagnostic tools.
Speaker A
You can choose to watch them all, or you can go to the playlist and watch the videos that seem interesting to you.
Speaker A
In this video, I’ll tell you what benign prostatic hyperplasia is, and how you as a doctor can recognize, diagnose, and treat this disease.
Speaker A
The prostate is a gland in men that lies just under the bladder and surrounds the urethra.
Speaker A
The gland, along with the nearby seminal vesicles, produces much of the fluid that makes up a man's semen. The prostate is walnut-sized in young men but enlarges with age.
Speaker A
BPH affects about 50 percent of men between the ages of 51 and 60 and up to 90 percent of men older than 80.
Speaker A
Prostatic hyperplasia means an enlargement of the prostate, and benign means that the growth isn't cancer. An enlarged prostate gradually compresses the urethra and blocks the flow of urine. The precise cause of this disease is not known but probably involves changes caused by hormones.
Speaker A
Throughout their lives, men produce testosterone and small amounts of estrogen. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Some studies suggest that benign prostatic hyperplasia may occur because estrogen can stimulate prostate growth.
Speaker A
Another theory focuses on dihydrotestosterone. 5-alpha-reductase metabolizes circulating testosterone into dihydrotestosterone, which plays a role in prostate development and growth.
Speaker A
Some research has indicated that even with a drop in testosterone levels, older men continue to produce and accumulate high levels of dihydrotestosterone in the prostate, which may encourage prostate cells to continue to grow.
Speaker A
Benign prostatic hyperplasia first causes symptoms when the enlarged prostate begins to block the flow of urine. At first, men may have difficulty starting urination. Urination may also feel incomplete. Because the bladder does not empty completely, men have to urinate
Speaker A
more frequently, often at night. Also, the need to urinate may become more urgent. The volume and force of the urinary flow may diminish noticeably, and urine may dribble at the end of urination.
Speaker A
A patient of mine described the symptoms as follows: “When you live with prostatic hyperplasia, your life starts to revolve around your closest bathroom. You get uncomfortable standing for a prolonged period of time waiting to use the bathroom, get up several times a night,
Speaker A
and have to modify your intake of liquids because you won’t be near a bathroom for a few hours.” Sometimes men may not know they have a blockage until they cannot urinate. This was the case with this patient. He was on vacation with his family when he started feeling increased
Speaker A
discomfort when he needed to use the bathroom. He described the constant need to use the bathroom, but whenever they stopped for a rest, he could barely urinate. After a day of this, his symptoms increased to the point he could not make himself urinate. After another
Speaker A
painful 24 hours, this patient was evacuated to a hospital where he was diagnosed with acute urinary retention, one of the most common complications of prostate hyperplasia.
Speaker A
Prostatic hyperplasia can be diagnosed based on a rectal examination, an analysis of the urine, the PSA level, and sometimes uroflowmetry.
Speaker A
On a rectal examination, the prostate usually is enlarged and nontender, it has a rubbery consistency, and in many cases has lost the median furrow. Hard areas could point to prostate cancer.
Speaker A
A urine sample should be examined to make sure that there is no infection. PSA levels are measured because abnormally high levels of PSA may be an indication of cancer. PSA levels can be elevated in both hyperplasia and prostate cancer, but the levels
Speaker A
of PSA will usually be much higher in patients with prostate cancer. If you want to know what PSA exactly is and how it can help detect prostate abnormalities, go to the playlist and watch the video about PSA.
Speaker A
Men with symptoms of obstruction may also have a uroflowmetry. Doctors will ask the patient to urinate into a device that measures the volume and rate of the urine flow. Immediately after the uroflowmetry, the doctor will do a bladder ultrasound to determine how completely
Speaker A
the bladder has emptied. Both these tests help diagnose the severity of urinary obstruction. Treatment of prostatic hyperplasia is not necessary unless it causes especially bothersome symptoms.
Speaker A
It can be treated with medication or surgery. Medication options include alpha-blockers and five-alpha reductase inhibitors.
Speaker A
Smooth muscles in the prostate gland contract in response to alpha-receptor stimulation, causing constriction of the prostatic urethra. Alpha-blockers begin to work quickly and improve the symptoms by promoting smooth muscle relaxation, but do not affect the underlying disease process.
Speaker A
They are the first-line treatment for men with mild to moderate symptoms. Some of these drugs also lower blood pressure through their action on vascular smooth muscles. This is why the most important side effects are low blood pressure and dizziness.
Speaker A
Prostate growth is stimulated by hormones, especially dihydrotestosterone. Alpha-reductase inhibitors inhibit the conversion of testosterone to dihydrotestosterone, which stops the prostate from growing further and even causes it to shrink.
Speaker A
Alpha-reductase inhibitors not only provide symptomatic relief but also reduce the risk of urinary retention and the need for surgery. Most men see an improvement within six months of starting treatment. A small percentage of men who take alpha-reductase
Speaker A
inhibitors have decreased sex drive, erection problems, or symptoms of depression. If drugs are ineffective, surgery can be done.
Speaker A
Surgery offers the greatest relief of symptoms but may cause complications. The most common surgical procedure is the transurethral resection of the prostate (TURP), in which a doctor passes an endoscope through the urethra. Attached to the endoscope is a surgical instrument
Speaker A
that is used to remove parts of the prostate. This procedure can lead to complications such as infection and bleeding, urinary incontinence, and sometimes permanent erectile dysfunction.
Topics:Benign Prostatic HyperplasiaBPHProstate enlargementUrologyProstate symptomsUrinary retentionAlpha-blockers5-alpha reductase inhibitorsTURPProstate diagnosis
![[YBA] frosti — Transcript](https://i.ytimg.com/vi/KAH0o3xSL3w/maxresdefault.jpg)
