Darius is 63 years old and began to awake at night to urinate. When he went to the bathroom, he had to strain to initiate the flow, and the stream of urine was weak

Question

Over time, the pattern became more apparent during the day; he often had a sense of urgency and felt he was going to the bathroom frequently. When he did, however, he did not always feel he had emptied his bladder, and he tended to dribble throughout the day. Much to his reluctance, his wife urged him to see a physician. At the doctor's office, his case history was carefully taken, a digital rectal exam was performed, and lab work was ordered. His blood results were unremarkable, but his urinalysis showed an elevated white blood cell count and bacteria. His physician diagnosed Darius with benign prostatic hyperplasia and urinary tract infection.

How does BPH contribute to the signs and symptoms of bladder dysfunction, and how was Darius prone to developing a urinary tract infection?

What are the static and dynamic components of BPH? Why are ?1-adrenergic receptor blockers sometimes used to treat prostatic hyperplasia?

How would the prostate feel during a digital rectal exam with benign prostatic hyperplasia, acute bacterial prostatitis, and prostate cancer?

Why does the patient with prostate cancer present with symptoms later in the disease?

Answer 1

Because the prostate encircles the urethra, benign prostatic hyperplasia occludes urinary outflow from the bladder. Residual urine remaining in the bladder contributes to feelings of frequency, urgency, and nocturia. Overflow incontinence occurs if the bladder becomes particularly distended. Darius developed a urinary tract infection as a result of his inability to completely empty his bladder and subsequent urinary retention.

The static component of BPH involves the increase in physical size of the prostate due to hyperplastic change. The dynamic component involves an alteration in tone of the prostatic smooth muscle. The use of α1-receptor blockers for the treatment of BPH functions to block neural transmission to smooth muscle and inhibit contraction.

The prostate exhibiting benign hyperplasia would feel enlarged, smooth, and rubbery. The cancerous prostate would feel fixed with hard, nodular areas. A rectal exam for acute bacterial prostatitis would reveal a warm, swollen, tender prostate with scattered softened areas.

In benign prostatic hyperplasia, the prostate is enlarged throughout the gland with discrete periurethral lesions. Because the urethra is compressed early in the disease, signs and symptoms appear quickly. With prostate cancer, the peripheral regions (particularly the posterior aspect) of the gland are affected. The urethra remains open and unaffected until the cancer has progressed. Bladder symptoms therefore arise later in the course of the disease.