Hiperplasia prostática benigna

Abstract

Benign prostatic hyperplasia (BPH) is highly prevalent in primary care. It is the main reason for consultation because of uro-logical problems in adult males and is the first diagnosis that we should think in patients older than 50 years consulting forobstructive (difficulty initiating urination, decreased force and caliber of urine stream, postvoid dribbling, sensation of incom-plete emptying) and/or irritative symptoms (urinary urgency, frequency, nocturia) accounting several months of evolution.Diagnosis of BPH is usually made on clinical grounds and should be presumed in all patients 50 years old or older who com-plain for slowly progressive irritative or obstructive urinary symptoms with spontaneous remission and recurrence which hasno other clear condition to explain those symptoms.The only useful physical examination maneuver is digital rectal examination, whose main objective is to try to rule outprostate cancer. Although the prostate may be enlarged in BPH, it is important to note that the size of the gland correlatespoorly with the presence or absence of obstruction to urinary flow and that a preserved prostate volume do not exclude thediagnosis of obstructive BPH.The only two laboratory studies that should ordered as routine part of the initial evaluation are urinalysis and serum creati-nine (both serve to rule out other diagnoses and to detect complications).The dosage of the prostate specific antigen (PSA) in BPH evaluation is controversial. Most practice guidelines defined it asan optional study, depending on the clinical judgment of the physician. Prostate ultrasound with assessment of bladder residual urine volume and urine flow assessment are also optional diagnostic studies that can assist in monitoring and in mak-ing therapeutic decisions.BPH complications are rare and include acute urinary retention, renal failure, urinary tract infections, bladder stones andmacrohematuria.Management strategies for this entity include watchful waiting, medical therapy (alphablocker drugs, inhibitors of 5-alfareductasa or herbal) and surgical treatment, either through minimally invasive techniques (i.e. such as conventionaltransurethral resection, bipolar transurethral resection and laser procedures) or by open prostatectomy.