Which is the most common cause of urinary retention in an elderly man ?
Ans: d (BPH) Ref: Bailey, 24th ed, p. 1372Since nothing is mentioned about patient's diabetic history or neurological dysfunction the best answer for this question is BPH (benign prostatic hypertrophy).Benign Prostatic HypertrophyOccurs in men over 50 yrs of age; by age of 60 yrs 50% of men have histolosical evidence of BPH.Is a common cause of significant lower urinary tract symptoms in men and is the most common cause of bladder outflow obstruction in men >70 yrs of age.Aetiology -As age advances S. testosterone levels slowly but significantly decrease; however, levels of oestrogenic steroids are not decreased equally. Secretion of intermediate peptide growth factors also plays a part.Pathology - Affects both glandular epithelium & connective tissue stroma to variable degrees.Adenosis, epitheliosis and stromal proliferation on different proportions.Zonal or surgical division of prostate3 distinct zonesa) The peripheral zone - 70% volume of young adult prostate (Ca Prostate commonly arise here)b) The central zone - 25%c) The transition zone - 5% (BPH most commonly arise here)Medical management of BPHa) a-Adrenergic blockers - e.g.; Prazosin. Terazosin (al blockers) & Tamsulosin (a la blocker). Activation of al receptors in the bladder neck, prostrate & urethra increase their smooth muscle tone, their blockade relaxes these structures, reducing the dynamic obstruction & increasing the urine flow rate.b) 5 a reductase inhibitor - e.g.; Finasteride.Prevent conversion of testosterone to more active dihydrotestosterone responsible for androgenic action in many tissues including prostrate. It results in reduction in size of gland and improvement in symptoms. 6 months therapy is required.Notes - a- blockers afford faster and greater symptomatic relief than finasteride.Absolute indications for surgical treatment of BPH# Refractory urine retention (failing at least one attempt at catheter removal).# Recurrent UTI from BPH.# Bladder stones due to BPH.# Renal insufficiency due to BPH.# Larger bladder diverticula secondary to BPH.# Recurrent gross hematuria from BPH.
Constriction
Bladder neck hypertrophy
Ca prostrate
BPH
Prostate & Seminal Vesicles