<prompt> Which is the most common cause of urinary retention in an elderly man ?ConstrictionBladder neck hypertrophyCa prostrateBPH  <response>: Ans: d BPH Ref: Bailey, 24th ed, p. 1372Since nothing is mentioned about patients diabetic history or neurological dysfunction the best answer for this question is BPH benign prostatic hypertrophy.Benign Prostatic HypertrophyOccurs in men over 50 yrs of age; by age of 60 yrs 50 of men have histolosical evidence of BPH.Is a common cause of significant lower urinary tract symptoms in men and is the most common cause of bladder outflow obstruction in men 70 yrs of age.Aetiology -As age advances S. testosterone levels slowly but significantly decrease; however, levels of oestrogenic steroids are not decreased equally. Secretion of intermediate peptide growth factors also plays a part.Pathology - Affects both glandular epithelium connective tissue stroma to variable degrees.Adenosis, epitheliosis and stromal proliferation on different proportions.Zonal or surgical division of prostate3 distinct zonesa The peripheral zone - 70 volume of young adult prostate Ca Prostate commonly arise hereb The central zone - 25c The transition zone - 5 BPH most commonly arise hereMedical management of BPHa a-Adrenergic blockers - e.g.; Prazosin. Terazosin al blockers Tamsulosin a la blocker. Activation of al receptors in the bladder neck, prostrate urethra increase their smooth muscle tone, their blockade relaxes these structures, reducing the dynamic obstruction increasing the urine flow rate.b 5 a reductase inhibitor - e.g.; Finasteride.Prevent conversion of testosterone to more active dihydrotestosterone responsible for androgenic action in many tissues including prostrate. It results in reduction in size of gland and improvement in symptoms. 6 months therapy is required.Notes - a- blockers afford faster and greater symptomatic relief than finasteride.Absolute indications for surgical treatment of BPH Refractory urine retention failing at least one attempt at catheter removal. Recurrent UTI from BPH. Bladder stones due to BPH. Renal insufficiency due to BPH. Larger bladder diverticula secondary to BPH. Recurrent gross hematuria from BPH. 