BPH/TURP

Benign prostatic hyperplasia is a nonmalignant increase in both stromal and epithelial prostatic cells. As the gland enlarges around the urethra, resistance at the bladder outlet rises. The obstruction has two components: the enlarged tissue creates a relatively fixed narrowing, while alpha-1–adrenergic smooth-muscle tone creates a dynamic narrowing that can vary with medication and physiologic stress. The bladder initially compensates by generating stronger contractions. Over time, obstruction and incomplete emptying can irritate the detrusor muscle, producing storage symptoms such as frequency, urgency, and nocturia in addition to voiding symptoms such as hesitancy, weak stream, intermittency, straining, and a sensation of incomplete emptying. A symptom pattern can suggest BPH, but it does not prove it; infection, medication effects, neurologic bladder dysfunction, and other urologic disease can produce similar lower urinary tract symptoms. This distinction explains the different medication roles. An alpha-1 antagonist relaxes smooth muscle and can improve flow relatively quickly, but it does not remove the enlarged tissue. Finasteride reduces the androgen-driven stimulus for prostatic growth and is used at a different dose; its benefit is not an immediate treatment...