Management of the complications of BPH/BOO

Abstract

Most men will develop histological BPH if they live long enough. Approximately, half will develop benign prostatic enlargement (BPE) and about half of these will get BOO with high bladder pressures and low flow, this in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS) but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic), haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction. Recognition of the complications of BPH/BOO early allows more effective management of these complications. This is particularly important for the more serious urinary infections and also for high-pressure chronic retention (HPCR). Complications of LUTS/BPH are very rare in clinical trials because of their strict inclusion and exclusion criteria but are more common in real life practice.

Therapy of calcium oxalate urolithiasis in a rhesus macaque (Macaca mulatta)

“…Another cause for urolithiasis in men is hyperuricosuria, which leads to acid urine and favours the formation of uric acid stones such as calcium oxalate stones . In humans, a chronic urinary infection has been described as a risk factor for the formation of urinary stones . Although this was not observed in our case, there was no information about former urinary infections.…”

Bilateral Hydroureteronephrosis with a Hypertrophied, Trabeculated Urinary Bladder

“…In high-pressure chronic retention, there is bladder outflow obstruction and high voiding detrusor pressure with a poor flow rate, leading to persistently high pressure within bladder; this causes retrograde pressure and bilateral hydronephrosis (22). The increased intravesical pressure further causes detrusor hypertrophy with connective tissue collagen impregnation, leading to a hypertrophied and trabeculated bladder (23).…”

“…The histopathological report confirmed chronic pyelonephritis involving both kidneys with a hypertrophied, trabeculated bladder and attenuation of the epithelium. Speakman et al (22) have observed that the most common pathophysiological findings in men with obstructive nephropathy is chronic interstitial pyelonephritis.…”

Management of benign prostate hyperplasia (BPH) by combinatorial approach using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors

“…It affects over 50% of men by the age of 50 and above and its prevalence increases further with the advancing age (Lim, 2017). It results from a non-cancerous enlargement of the prostate gland that is accompanied by multiple complications, including the lower urinary tract symptoms (LUTS), i.e., frequency, urgency, hesitancy, intermittency, and weak stream (Speakman and Cheng, 2014). The other risk factors, both modifiable and non-modifiable, that augment the risk of development as well as progression of BPH, besides others, include racial and genetic predisposition (Chughtai et al, 2016;Parsons, 2007).…”