BPH/TURP

Benign prostatic hyperplasia is a nonmalignant increase in stromal and epithelial cells, usually centred around the prostatic urethra. As the gland enlarges, it narrows the bladder outlet. Increased alpha-1 adrenergic smooth-muscle tone adds a dynamic component, so obstruction can worsen even when the anatomical enlargement has not changed. The bladder initially compensates by generating stronger contractions. With persistent resistance, it may become irritable, producing frequency, urgency, and nocturia, or eventually decompensate, leaving residual urine and causing weak emptying or retention. This is why a patient may report both voiding symptoms—hesitancy, a weak or intermittent stream, and straining—and storage symptoms such as urgency and frequent nighttime urination. BPH is not synonymous with every cause of lower urinary tract symptoms. Dysuria, fever, and pyuria point toward infection; a painful distended bladder with inability to void indicates acute retention; neurological disease, urethral stricture, bladder pathology, and malignancy can produce similar complaints. The experienced clinician does not label every weak stream “BPH” before checking for these alternatives. A useful pattern is an older man with gradually worsening hesitancy, reduced stream, incomplete emptying, and nocturia...