A 60-year-old man presents to the physician’s office complaining of waking up during the night to urinate, urinary hesitancy, and a weak urinary stream for the past 6 months. Physical examination reveals a firm and enlarged but intact median sulcus. Laboratory tests reveal a normal urinalysis, normal renal function and a normal prostate-specific antigen (PSA).
Which of the following areas of the prostate is most likely affected in the disease process that you suspect is occurring?
The correct answer is:
A) Central periurethral zone
This patient is suffering from benign prostatic hyperplasia (BPH). The prevalence of BPH increases with age such that 70% of men who are 60 years or older will have BPH, and 80% of men who are 80 years or older will have BPH. BPH can present with urinary frequency, urgency, nocturia, incontinence, weak urinary stream, straining to void, hesitancy and terminal dribbling. The digital rectal exam (DRE) typically reveals a firm, smooth, intact median sulcus of the prostate. BPH usually affects the central periurethral zone of the prostate.
Key Learning Point
Benign prostatic hyperplasia (BPH) typically affects the central periurethral zone of the prostate and can present with urinary frequency, urgency, nocturia, incontinence, weak urinary stream, straining to void, hesitancy and terminal dribbling.
