A more recent article on this topic is available. Patient information: See related handout on benign prostatic hyperplasiawritten by the author of this article. Related Editorial. Benign prostatic hyperplasia is a common condition affecting older men. Typical presenting symptoms include urinary hesitancy, weak stream, nocturia, incontinence, and recurrent urinary BPH e viagra infections. Acute urinary retention, which requires urgent bladder catheterization, is relatively uncommon.
Irreversible renal damage is rare. The initial evaluation should assess the frequency and severity of symptoms and the BPH e viagra of symptoms on the patient's quality of life. The American Urological Association Symptom Index is a validated instrument for the objective assessment of symptom severity. The initial evaluation should also include a digital rectal examination and urinalysis.
Men with hematuria should be evaluated for bladder cancer. A palpable nodule or induration of the prostate requires referral for assessment to rule out prostate cancer.
For men with mild symptoms, watchful waiting with annual reassessment is appropriate. Over the past decade, numerous medical and surgical interventions have been shown to be effective in relieving symptoms of benign prostatic hyperplasia. Alpha blockers improve symptoms relatively quickly. Although 5-alpha reductase inhibitors have a slower onset of action, they may decrease BPH e viagra size and alter the disease course.
Limited evidence shows that the herbal agents saw palmetto extract, rye grass pollen extract, and pygeum relieve symptoms.
Transurethral resection of the prostate often provides permanent relief. Newer laser-based surgical techniques have comparable effectiveness to transurethral resection up to two years after surgery with lower perioperative morbidity. Various outpatient surgical techniques are associated with reduced morbidity, but symptom relief may be less durable.
Benign prostatic hyperplasia BPH is a common condition in older BPH e viagra. Histologically, it is characterized by the presence of discrete nodules in the periurethral zone of the prostate gland. Chronic inability to completely empty the bladder may cause bladder distension with hypertrophy and instability of the detrusor muscle. Some patients with BPH present with hematuria.
Because the severity of symptoms does not correlate with the degree of hyperplasia, and other conditions can cause similar symptoms, the clinical syndrome that often accompanies BPH has been described as lower urinary tract BPH e viagra. Men with suspected BPH can be evaluated with a validated questionnaire to quantify symptom severity.
In men with symptoms of BPH, a digital rectal examination and urinalysis should be performed to screen for other BPH e viagra disorders. In men with a prostate volume greater than 40 mL, 5-alpha reductase inhibitors should be considered for the treatment of BPH. Refer patients for a surgical consultation if medical therapy fails; the patient develops refractory urinary retention, persistent hematuria, or bladder stones; or the patient chooses primary surgical therapy.
The prevalence of BPH increases with age. One study suggests that BPH e viagra prevalence is 20 percent in year-old men and increases to 90 percent in men in their seventies. In men with bothersome lower urinary tract symptoms, a history should be performed BPH e viagra establish the severity of symptoms, evaluate for BPH e viagra other than BPH Table 1and identify contraindications to potential therapies. Adapted with permission from American Urological Association.
Guideline on the management of benign prostatic hyperplasia BPH. Accessed September 19, Several classes of medications may cause or exacerbate lower urinary tract symptoms, and comorbidities may contribute to these symptoms Table 2. Previous surgical procedures may increase the risk of urethral strictures or other anatomic abnormalities.
Black men BPH e viagra first-degree relatives of patients with prostate cancer have an increased risk of prostate BPH e viagra. Symptomatic men should have a digital rectal examination to assess the size and contour of the prostate. Finasteride is more effective if the prostate volume is greater than 40 mL 8 the normal prostate volume is 20 to 30 mL. A palpable nodule suggests prostate cancer and requires biopsy.
Abnormal sphincter tone suggests a neurologic abnormality, which may BPH e viagra to urinary symptoms. The AUA recommends urinalysis for all men presenting with lower urinary tract BPH e viagra. Prostate-specific antigen PSA levels should be measured in men who have at least a year life expectancy and who would be a candidate for prostate cancer treatment. PSA levels correlate with the risk of symptom progression; men with elevated PSA levels respond better to finasteride.
PSA levels greater BPH e viagra 1. Urine cytology should be obtained in men at risk of bladder cancer e. Routine measurement of serum creatinine levels is not recommended because BPH does not appear to affect the baseline risk of renal disease. A randomized trial of medical therapies for patients with moderate to severe BPH showed that the placebo group had clinical progression i.
No cases of renal insufficiency were attributed to BPH. Watchful waiting is recommended in men who have mild symptoms AUA Symptom Index score of 7 or less or who do not perceive their symptoms to be particularly bothersome. Patients who choose this approach should be monitored annually for symptom BPH e viagra. Smooth muscles in the prostate gland contract in response to alpha-adrenergic receptor stimulation, causing constriction of the prostatic urethra.
Alpha 1 -receptor antagonists improve lower urinary tract symptoms by promoting smooth muscle relaxation. Three of these agents i. Although these three agents are indicated for hypertension, they are less effective than thiazide diuretics and angiotensin-converting enzyme inhibitors in preventing adverse cardiovascular outcomes, and they should not be considered first-line antihypertensive agents.
Alpha blockers relieve symptoms in men with moderate to severe BPH. Participants in this trial had lower prostate volumes than those in trials showing benefit BPH e viagra finasteride. Doxazosin delayed the occurrence of acute urinary retention, but did not significantly decrease its overall incidence; however, the trial was underpowered for this end point.
The benefit of doxazosin monotherapy was comparable to finasteride monotherapy, although combination therapy was more effective than either agent alone. Alpha blockers may cause orthostatic hypotension. Therapy with nonselective agents should begin at a low dose and then be titrated upward. The risk of orthostatic hypotension is increased when these agents are combined with phosphodiesterase inhibitors used to treat erectile dysfunction; therefore, low starting doses and cautious titration are advised when these agents are used in combination.
Sildenafil Viagra in doses greater than 25 mg should not be taken within four hours of alpha-blocker use. Prostate growth is stimulated by androgenic hormones, especially dihydrotestoster-one. BPH e viagra Prostate Cancer Prevention Trial raised questions about the BPH e viagra safety of finasteride. The significance of this finding is unclear because finasteride may cause artifactual changes in prostate cancer histology. Finasteride decreases PSA levels; therefore, when screening BPH e viagra prostate cancer, the measured PSA level should be doubled to correct for this effect.
Medical therapies for BPH are summarized in Table 3. Cost to the patient will be higher, depending on prescription filling fee. Saw palmetto plant Serenoa repens extract has been used to treat BPH-related lower urinary tract symptoms. A European study showed that one half of German urologists preferred saw palmetto over pharmaceutical agents for treatment of BPH in their patients. Cochrane reviews of rye grass pollen extract Cernilton 22 and pygeum 23 found evidence that each BPH e viagra provides modest symptomatic improvement.
However, the studies analyzed were limited by small size, BPH e viagra duration, and lack of standardization. The AUA does not recommend the use of phytotherapy. Surgical treatment of BPH Table 4 624 — 30 may be appropriate if medical treatment fails or the patient develops refractory urinary retention, persistent hematuria, or bladder stones. Common complications include hemorrhage, sexual dysfunction, strictures, and hyponatremia caused by absorption of the hypotonic irrigant; TURP is considered the benchmark for BPH e viagra therapies.
Less perioperative morbidity and comparable clinical results after two years as TURP; steep learning curve for surgeons. Information from reference 6 and 24 through Although TURP provides definitive relief in most patients, a recent trial showed that two out of 30 patients BPH e viagra underwent TURP required reoperation within two years.
Newer surgical techniques are intended to provide symptomatic relief while avoiding the morbidity associated with traditional TURP. Several outpatient procedures are also available, but they have not proved to be as effective as TURP. Transurethral needle ablation is an outpatient procedure in which radio frequency energy is used to remove periurethral prostate tissue. It is suitable for men with mild to BPH e viagra symptoms and a prostate volume less than 60 mL.
Transurethral BPH e viagra of the prostate is appropriate in men with smaller prostates volume less than 30 mL. Already a member or subscriber? Log in. He received his medical degree from the University of Cincinnati Ohio College of Medicine and completed a family practice residency BPH e viagra Barberton Citizens' Hospital. Address correspondence to Jonathan L. NE, Barberton, OH e-mail: jedwards barbhosp. Reprints are not available from the author. The author thanks Anthony J. Costa, MD, for his assistance in reviewing the manuscript.
Male genital system. In: Robbins Pathologic Basis of Disease. Philadelphia, Pa. Natural history of benign prostatic hyperplasia and risk of pros-tatectomy. The Baltimore Longitudinal Study of Aging.
Natural history of benign BPH e viagra hyperplasia.