[7] Benign Prostatic Hypertrophy Flashcards
What % of 60 year olds have BPH?
70%
What % of 80 year olds have BPH?
90%
What is BPH?
Benign nodular or diffuse hyperplasia of stromal and epithelial cells
Where does BPH affect?
The inner (transitional) layer of the prostate
What is the result of BPH affecting the inner layer of the prostate?
Causes urethral compression
How is DHT produced?
It is produced from testosterone in stromal cells by 5alpha-reductase enzyme
What effect does DHT have on the prostate?
It causes the production of DHT-induced growth factors, which increase stromal cells and decrease epithelial cell death
What are the categories of symptoms of BPH?
Storage symptoms
Voiding symptoms
Symptoms secondary to stasis
What are the storage symptoms of BPH?
Nocturia
Frequency
Urgency
Overflow incontinence
What are the voiding symptoms of BPH?
Hesitancy Straining Poor stream/flow + terminal dribbling Strangury Incomplete emptying
What symptom does strangury produce?
Urinary tenesmus
What are the symptoms secondary to stasis in BPH?
Bladder stones
UTI
What is found on PR examination in BPH?
Smoothly enlarged prostate
Definable median sulcus
Is the bladder palpable in BPH?
Not usually, unless acute-on-chronic obstruction
What investigations should be done in BPH?
Blood Urine Imaging Urodynamics Voiding diary
What bloods should in done in BPH?
U&E
PSA
What urine investigations should be done in BPH?
Dip
MC&S
What imaging should be done in BPH?
Transrectal US, with or without biopsy
What urodynamic study should be done in BPH?
Pressure/flow cystometry
What is involved in the conservative management of BPH?
Decrease intake of caffeine and alcohol
Double voiding
Bladder training
What is involved in bladder training?
Hold on to urine to increase time between voiding
When is medical management of BPH useful?
In mild disease, and while awaiting TURP
What is the first line medical treatment of BPH?
Alpha-blockers
Give two examples of alpha-blockers?
Tamsulosin
Doxazosin
How do alpha-blockers work in BPH?
They relax prostate smooth muscle
What are the side effects of alpha blockers?
Drowsiness
Decreased BP
Depression
Extra-pyramidal side effects
What is the second line medical treatment of BPH?
5alpha-reductase inhibitors
Give an example of a 5-alpha-reductase inhibitor?
Finasteride
How do 5-alpha-reductase inhibitors work in BPH?
They inhibit the conversion of testosterone to DHT
When are 5-alpha-reductase inhibitors preferred in BPH?
Where there is a significantly enlarged prostate
What are the side effects of 5-alpha-reductase inhibitors?
Erectile dysfunction (Excreted in semen, so have to use condoms)
What are the indications for the surgical management of BPH?
Symptoms affecting QoL
Complications of BPH
What are the options for surgical management of BPH?
TURP
Transurethral incision of prostate (TUIP)
Transurethral electrovaporisation of prostate
Laser prostatectomy
Open retrograde prostatectomy
What happens in TURP?
Cystoscopic resection of lateral and middle lobes
What % of patients who have TURP become impotent?
<14%
What is the advantage of TUIP over TURP?
There is less destruction, and therefore a lower risk of sexual dysfunction
When does TUIP have similar benefits to TURP?
When small prostate (<30g)
What happens in transurethral electrovaporisation of prostate?
Electric current is used to cause tissue vaporisation
What is the advantage of laser prostatectomy over TURP?
It has a similar efficacy as TURP, but reduced risk of erectile dysfunction and retrograde ejaculation
What is open retropubic prostatectomy used for?
Very large prostates (>100g)
What are the immediate complications of TURP?
TUR syndrome
Haemorrhage
What happens in TUR syndrome?
Absorption of large quantities of fluids leads to reduced sodium
What are the early complications of TURP?
Haemorrhage
Infection
Clot retention
What does clot retention as a complication of TURP require?
Bladder irrigation
What are the late complications of TURP?
Retrograde ejaculation Erectile dysfunction Incontinence Urethral stricture Recurrence
