Benign Prostate Hypertrophy: An Educational Ultrasound Images and Pharmacotherapy Mini-Review

Background: A benign increase in the size of prostate (Enlargement) can be asymptomatic, but it can cause symptoms resulting from pressure on the urethra, including frequency of urination, difficulty in starting urination, poor urine stream, dribbling after urination, and inability to pass urine. Ultrasonography has been used as early as 1971 for the diagnosis of prostatic enlargement. Patients and Methods: The case of a 53-year old diabetic and hypertensive male who had refractory psoriasis and developed benign enlargement is described and an educational ultrasound images are presented. Results: The patient was complaining of dribbling after micturition for few weeks. He was not having difficulty in starting urination nor complained of frequent micturition, and the urine stream was considered normal. The urinary bladder was normal, but with mild hazy wall outline. Pre-voiding volume was 248 ml, and post-voiding volume was 9 ml. Ultrasound of the prostate showed enlarged prostate with homogenous texture. Prostate volume was 36.6 ml (Normal: 25 ml). Therefore, Oral finasteride was started. Conclusion: Many medications have been used in the treatment of benign enlargement of the prostate during the 1960s, 1970s, and 1980s, including progestational agents, Amino acids, spironolactone, candicidin, nystatin, flutamide, bromocriptine, alpha-adrenergic blockers, Serenoa repens (Saw palmetto extracts), and mepartricin. However, the current evidence-based opinion suggests that benign enlargement of the prostate can be initially treated with medications that can reduce the volume of the prostate such as finasteride and dutasteride. Tamsulosin or alfuzosin can be added to further improve lower urinary symptoms.