A 68-year-old man comes to the office due to a weak urinary stream, hesitancy, and straining on micturition. These symptoms have been present for the past 2 years but have gradually become more severe and are beginning to affect his quality of life. The patient recently started noticing continuous urine leakage, nocturia, frequent urination, and urgency. Rectal examination reveals a smooth, enlarged prostate with no tenderness to palpation. Prostate-specific antigen is within the normal range. Urinalysis reveals 20-30 red blood cells per high power field and no urinary casts. Cystoscopy is performed and shows increased bladder wall trabeculations with normal appearing mucosa. Which of the following is the most likely cause of this patient's hematuria?

Question

A 68-year-old man comes to the office due to a weak urinary stream, hesitancy, and straining on micturition.  These symptoms have been present for the past 2 years but have gradually become more severe and are beginning to affect his quality of life.  The patient recently started noticing continuous urine leakage, nocturia, frequent urination, and urgency.  Rectal examination reveals a smooth, enlarged prostate with no tenderness to palpation.  Prostate-specific antigen is within the normal range.  Urinalysis reveals 20-30 red blood cells per high power field and no urinary casts.  Cystoscopy is performed and shows increased bladder wall trabeculations with normal appearing mucosa.  Which of the following is the most likely cause of this patient's hematuria?

Quizplus · Accepted Answer

Eductional Objective: Benign prostatic hyperplasia (BPH) is associated with stromal and glandular growth in the periurethral and transitional zone of the prostate.  The hyperplastic cells are supported by the formation of new blood vessels, which may be friable.  Therefore, BPH is often associated with microscopic or gross hematuria.

A 68-Year-Old Man Comes to the Office Due to a Weak