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A - MSRA Renal and Urinary [17] > [7] Benign Prostatic Hypertrophy > Flashcards

[7] Benign Prostatic Hypertrophy Flashcards

1
Q

What % of 60 year olds have BPH?

A

70%

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2
Q

What % of 80 year olds have BPH?

A

90%

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3
Q

What is BPH?

A

Benign nodular or diffuse hyperplasia of stromal and epithelial cells

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4
Q

Where does BPH affect?

A

The inner (transitional) layer of the prostate

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5
Q

What is the result of BPH affecting the inner layer of the prostate?

A

Causes urethral compression

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6
Q

How is DHT produced?

A

It is produced from testosterone in stromal cells by 5alpha-reductase enzyme

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7
Q

What effect does DHT have on the prostate?

A

It causes the production of DHT-induced growth factors, which increase stromal cells and decrease epithelial cell death

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8
Q

What are the categories of symptoms of BPH?

A

Storage symptoms
Voiding symptoms
Symptoms secondary to stasis

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9
Q

What are the storage symptoms of BPH?

A

Nocturia
Frequency
Urgency
Overflow incontinence

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10
Q

What are the voiding symptoms of BPH?

A 
Hesitancy
Straining
Poor stream/flow + terminal dribbling
Strangury 
Incomplete emptying
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11
Q

What symptom does strangury produce?

A

Urinary tenesmus

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12
Q

What are the symptoms secondary to stasis in BPH?

A

Bladder stones

UTI

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13
Q

What is found on PR examination in BPH?

A

Smoothly enlarged prostate

Definable median sulcus

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14
Q

Is the bladder palpable in BPH?

A

Not usually, unless acute-on-chronic obstruction

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15
Q

What investigations should be done in BPH?

A 
Blood
Urine
Imaging
Urodynamics
Voiding diary
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16
Q

What bloods should in done in BPH?

A

U&E

PSA

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17
Q

What urine investigations should be done in BPH?

A

Dip

MC&S

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18
Q

What imaging should be done in BPH?

A

Transrectal US, with or without biopsy

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19
Q

What urodynamic study should be done in BPH?

A

Pressure/flow cystometry

20
Q

What is involved in the conservative management of BPH?

A

Decrease intake of caffeine and alcohol
Double voiding
Bladder training

21
Q

What is involved in bladder training?

A

Hold on to urine to increase time between voiding

22
Q

When is medical management of BPH useful?

A

In mild disease, and while awaiting TURP

23
Q

What is the first line medical treatment of BPH?

A

Alpha-blockers

24
Q

Give two examples of alpha-blockers?

A

Tamsulosin

Doxazosin

25
Q

How do alpha-blockers work in BPH?

A

They relax prostate smooth muscle

26
Q

What are the side effects of alpha blockers?

A

Drowsiness
Decreased BP
Depression
Extra-pyramidal side effects

27
Q

What is the second line medical treatment of BPH?

A

5alpha-reductase inhibitors

28
Q

Give an example of a 5-alpha-reductase inhibitor?

A

Finasteride

29
Q

How do 5-alpha-reductase inhibitors work in BPH?

A

They inhibit the conversion of testosterone to DHT

30
Q

When are 5-alpha-reductase inhibitors preferred in BPH?

A

Where there is a significantly enlarged prostate

31
Q

What are the side effects of 5-alpha-reductase inhibitors?

A 
Erectile dysfunction
(Excreted in semen, so have to use condoms)
32
Q

What are the indications for the surgical management of BPH?

A

Symptoms affecting QoL

Complications of BPH

33
Q

What are the options for surgical management of BPH?

A

TURP
Transurethral incision of prostate (TUIP)
Transurethral electrovaporisation of prostate
Laser prostatectomy
Open retrograde prostatectomy

34
Q

What happens in TURP?

A

Cystoscopic resection of lateral and middle lobes

35
Q

What % of patients who have TURP become impotent?

A

<14%

36
Q

What is the advantage of TUIP over TURP?

A

There is less destruction, and therefore a lower risk of sexual dysfunction

37
Q

When does TUIP have similar benefits to TURP?

A

When small prostate (<30g)

38
Q

What happens in transurethral electrovaporisation of prostate?

A

Electric current is used to cause tissue vaporisation

39
Q

What is the advantage of laser prostatectomy over TURP?

A

It has a similar efficacy as TURP, but reduced risk of erectile dysfunction and retrograde ejaculation

40
Q

What is open retropubic prostatectomy used for?

A

Very large prostates (>100g)

41
Q

What are the immediate complications of TURP?

A

TUR syndrome

Haemorrhage

42
Q

What happens in TUR syndrome?

A

Absorption of large quantities of fluids leads to reduced sodium

43
Q

What are the early complications of TURP?

A

Haemorrhage
Infection
Clot retention

44
Q

What does clot retention as a complication of TURP require?

A

Bladder irrigation

45
Q

What are the late complications of TURP?

A 
Retrograde ejaculation
Erectile dysfunction
Incontinence
Urethral stricture
Recurrence

A - MSRA Renal and Urinary [17] (17 decks)

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