Benign prostatic hyperplasia

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Benign prostatic hyperplasia

Reproductive system


Benign prostatic hyperplasia


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USMLE® Step 1 questions

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Benign prostatic hyperplasia

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USMLE® Step 1 style questions USMLE

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A 67-year-old man presents to the office after an episode of lightheadedness. He experienced this episode last night when he got up from a chair to go to the kitchen and suddenly felt like he was going to fall, but he was able to grab the couch for balance. He does not recall experiencing similar symptoms in the past. He did not lose consciousness or hit his head. The patient was recently started on a new medication for benign prostatic hyperplasia. Other medications include metformin for type 2 diabetes mellitus and ibuprofen for osteoarthritis. Blood pressure is 124/82 mmHg and pulse is 75/min while supine and 80/62 mmHg and 89/min while standing. Digital rectal examination shows a symmetrically enlarged non-tender prostate. Electrocardiogram shows a normal sinus rhythm. Which of the following agents is the most likely cause of this patient’s condition?  

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α1 -antagonists

benign prostatic hyperplasia p. 727

Benign prostatic hyperplasia (BPH) p. 678, 731

α-blockers for p. 245

hydronephrosis and p. 623

incontinence with p. 624

postrenal azotemia p. 626

tamsulosin for p. 681

treatment p. 727

BPH (benign prostatic hyperplasia)

azotemia with p. 626

hydronephrosis in p. 623

5 α-reductase inhibitors

benign prostatic hyperplasia p. 727

PDE-5 inhibitors p. 678, 681

benign prostatic hyperplasia p. 727


In benign prostatic hyperplasia, or BPH, prostatic refers to the prostate gland, hyperplasia means an increase in the number of cells, and benign means that these cells aren’t malignant, so they don’t invade neighboring tissues.

So, benign prostatic hyperplasia is the non-cancerous growth of the prostate gland.

This condition is common in men over 50, and is often considered a normal part of aging.

The prostate is a small gland, about the size and shape of a walnut, that sits under the bladder and in front of the rectum.

The urethra which is the tube through which urine leaves the bladder, goes through the prostate before reaching the penis.

And that part of the urethra is called the prostatic urethra.

The prostate is covered by a capsule of tough connective tissue and smooth muscle.

Beneath this layer, the prostate can be divided into a few zones.

The peripheral zone, which is the outermost posterior section, is the largest of the zone and contain about 70% of the prostate’s glandular tissue.

Moving inward, the next section is the central zone which contains about 25% of the glandular tissue as well as the ejaculatory ducts that join with the prostatic urethra.

Last, is the transitional zone, which contains around 5% of the glandular tissue as well as a portion of the prostatic urethra.

The transitional zone gets its name because it contains transitional cells which are also found in the bladder.

At the microscopic level, each of the tiny glands that make up the prostate is surrounded by a basement membrane made largely of collagen.


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  2. "Harrison's Principles of Internal Medicine 20th Ed" McGraw Hill / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine, 8e" McGraw Hill (2019)
  4. "Current Medical Diagnosis and Treatment 2020" McGraw Hill (2020)
  5. "Management of Benign Prostatic Hyperplasia" Annual Review of Medicine (2016)
  6. "Post-micturition dribble in men: causes and treatment" Nursing Standard (2008)
  7. "Post-micturition dribble in men: causes and treatment" Nursing Standard (2008)

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