Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

228 Benign Disorders of the Rectum and Anus Benign Prostatic Hyperplasia

■Condyloma may require repeated treatment; if perianal disease can-

not be eradicated, consider intrarectal involvement that may require

treatment

complications and prognosis

■Hemorrhoidectomy:

➣Bleeding uncommon but not rare complication of hemor-

rhoidectomy or hemorrhoid banding; may occur up to 2 wk after

procedure

➣Infection may occur & present only w/ urinary retention; fever,

pain may be relatively late &/or subtle

➣Lateral internal sphincterotomy may produce incontinence, esp

in women

■Prolapse:

➣W/ surgery, bleeding, infection may occur

➣Recurrence of prolapse may be common

➣Transabdominal surgery may rarely result in impotence in men

➣Prolapse may produce incontinence

■Condyloma: at risk for late squamous cancer

■Incontinence:

➣Inadequate resolution of symptoms w/ surgery may occur

➣Bleeding & infection uncommon acute complications

Benign Prostatic Hyperplasia............................

CLAUS G. ROEHRBORN, MD

history & physical

History

■Disease affects usually men >40 years

■Increasing incidence with advancing age (60% men in their 60s, 80%

men in their 80s)

■Ask about lower urinary tract symptoms (LUTS): frequency, urgency,

nocturia, weak stream, straining, incomplete emptying, intermit-

tency

■Duration of symptoms and onset

■Medications affecting bladder and sphincter function: anticholiner-

gics, alpha sympathomimetics, cold medicines containing sympa-

thomimetics, antihistamines, steroid hormones