Benign prostatic hypertrophy is non-malignant enlargement of the prostate gland. Patient presents with weak urine stream, urinary urgency, increased urinary frequency, terminal dribbling, urinary hesitancy, urinary retention, burning micturition and incontinence. Per rectal examination reveals enlarged prostate.
Medications:
- If post void urine more than 50 mls – Tab. Flodart SR 0.4 (Tamsulosin 0.4 mg) 1 tablet once a day. Increase to 0.8 mg once a day if needed.
- If prostrate size is more than 40 cc. – Tab. Dutaprost 0.5 (Dutasteride 0.5 mg) 1 tablet once a day.
- Review medications after 6 months of treatment. Consider surgery if refractory Benign Prostatic Hyperplasia symptoms, calculi, recurrent urinary infection, renal dysfunction, persistent hematuria.
General advice:
- Regular voiding of urine every 2 – 3 hours to reduce the pressure on bladder muscles.
- Avoid drinking large amount of fluids at bedtime.
- Void urine before bedtime.
- Advice pelvic floor muscle exercises.
Investigations:
- Urine routine – to rule out infection.
- Prostate specific antigen (total and free) – to monitor prostatic activity.
- Renal function test – to rule out renal impairment.
- USG abdomen – to assess the prostatic size, post-void residue.
Referral:
Consider referral to urologist if symptoms persists in spite of treatments or if patient presents with additional complications. or if prostrate specific antigen is above 2.6 ng/ml.