Benign prostatic hyperplasia is a noncancerous enlargement of the prostate that becomes very common as men age. The growing gland narrows the urethra and causes a weak stream, frequent urination and waking at night to urinate.
Key symptoms
- Weak stream, hesitancy and straining
- Frequent urination and urgency
- Waking at night to urinate
- Feeling of incomplete emptying or dribbling
What you find on exam
- Digital rectal exam: smooth, enlarged, rubbery prostate
- Palpable bladder if urine is retained
- Neurologic check of the legs and perineum
- Symptom score such as the IPSS
Tests
- Urinalysis for blood or infection
- PSA after shared decision-making
- Post-void residual by bladder scan
- Creatinine if retention or kidney problems are suspected
Treatment basics
- Lifestyle: less fluid at night, less caffeine and alcohol
- Alpha blocker such as tamsulosin
- 5-alpha reductase inhibitor such as finasteride for a large gland
- Tadalafil in selected men
- Surgery such as TURP for retention or when medicines fail
Red flags
- Unable to urinate (acute urinary retention)
- Visible blood in the urine
- Rising creatinine or hydronephrosis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.