genitourinary disorders
Benign Prostatic Hyperplasia (BPH)
Key Points
Benign prostatic hyperplasia (BPH) is extremely common with aging but only sometimes causes symptoms. Acute urinary retention can develop with exposure to cold, prolonged attempts to postpone voiding, immobilization, or use of anesthetics, anticholinergics, sympathomimetics, opioids, or alcohol. Evaluate patients with a digital rectal examination and usually urinalysis, urine culture, and PSA. In men with BPH, avoid use of anticholinergics, sympathomimetics, and opioids. Consider relieving troublesome obstructive symptoms with alpha-adrenergic blockers (eg,terazosin,doxazosin,tamsulosin,alfuzosin), 5 alpha-reductase inhibitors (finasteride,dutasteride), ortadalafil, especially if there is concomitant erectile dysfunction. Consider TURP or other ablation technique if BPH causes complications (eg, recurrent calculi or infection, bladder dysfunction, upper tract dilation) or if bothersome symptoms are drug resistant. 