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Benign Prostate Hyperplasia – clinical image

BPH begins to occur after the age of 30 years (histological BPH).

BPH is observed in the initial stages of the disease, while the patient is asymptomatic for a long time. This is because the bladder reacts with increasing obstruction force of the detrusor muscle contraction. Progressively with obstruction’s deterioration, the detrusor is unable to maintain a normal flow of urine resulting in the appearance of disease symptoms.Benign Prostate Hyperplasia clinical image

The symptoms of BPH are divided into 2 categories: obstructive and irritative type.

The obstructive symptoms include delay in starting urination, lessening of the urethral diameter and decrease of the urine radius strength, prolonged urination, “broken” urination, guttate urination, urinary retention and finally overflow incontinence.

Irritative symptoms include increased urination, nocturia, urgent incontinence, heartburn during urination and suprapubic pain. Hematuria may also be another manifestation of BPH., usually due to rupture of enlarged superficial veins of the gland. Exact etiology of prostatic haematuria is confirmed by cystoscopy and after having excluded all other possible causes.

Another symptom that can occur in BPH is dysuria – i.e. usually occurs in patients suffering from chronic prostatitis, and may be accompanied by pain and perineal pain during ejaculation. We should not forget that dysuria is not a feature of prostate disease, but appears in the presence of infection as well as an expression of bladder tumor.

Symptoms mainly affect the quality of life of patients suffering from irritative type BPH.

In this BPH type, frequent urination occurs largely in men with BPH but is pathognomonic for the disease, and as shown in other situations, such as after excessive fluid intake, in diabetes insipidus (wherein combined with polyuria), after receiving diuretics, in bladder neurological disorders and in inflammation cases.

Nocturia – i.e. the discomfort which the individual has to wake up one or more times during the night to urinate occurs in older people with reversal of circadian rhythm, and in people with heart failure. It is characterized by detrusor instability and not BPH if both conditions coexist in approximately 65-70%.

Urgent urination includes the discomfort of sudden forced desire to urinate which is difficult to halt and urge incontinence; the discomfort of involuntary urine leakage accompanied or immediately followed by a strong desire to urinate, along with symptoms specific to the instability of the detrusor and not for the clogging.

From the above it is easily understood that the symptoms of the lower urinary tract, currently listed as LUTS (Lower Urinary Tract Symptoms) while formerly called prostatism, also in many other situations.