Benign Disease of the prostate Flashcards
What is benign prostatic hyperplasia?
Benign nodular/diffuse proliferation of the musculofibrous and glandular layers of the prostate. The transitional zone experiences the most enlargement, compared to prostate cancer which enlarges the peripheral zone of the prostate
What are features of BPH?
Lower urinary tract symptoms:
- Nocturia
- Frequency
- Urgency
- Post-micturition dribbling
- Poor stream/flow
- Hesitancy
- Overflow incontinence
- Haematuria
- Bladder stones
What are voiding lower urinary tract symptoms?
- Poor stream
- Hesitancy
- Terminal dribbling
- Incomplete voiding
- Urinary retention
- Overflow incontinence
- Episodes of near retention
What are storage/Irritative lower urinary tract symptoms?
- Increased frequency of urination
- Increased urgency of urination
- Painful urination
- Nocturia
What tests might you do in someone with suspected BPH?
- Bloods - U+E’s, PSA
- MSU
- Flow rate study + Post-void residual
- Renal tract USS
- Consider flexible cystoscopy
- Consider transrectal US and biopsy if cancer suspected
When would you consider using flexible cystoscopy?
If haematuria is a problem
What would you look for on examination of someone with suspected BPH?
- Abdomen - Palpable bladder
- Penis - External urethral meatal stricture, Phimosis
- DRE - Assess size, Suspicious nodules/firmness
- Urinalysis - Blood, Signs of UTI
What lifestyle advice would you give someone who is suffering from BPH?
- Avoid caffeine and alcohol
- Relax when voiding
- Void twice in a row to aid emptying
- Distraction methods for urgency
- Bladder training
What medical management would you use 1st line for those having symptoms of LUTS caused by BPH?
Alpha-blockers e.g. tamsulosin - Smooth muscle of bladder neck (i.e. intrinsic urethral sphincter) and prostate innervated by sympathetic alpha-adrenergic nerves (mostly alpha-1a subtype). Alpha blockers cause smooth muscle relaxation and antagonise the ‘dynamic’ element to prostatic obstruction
What are side effects to alpha-blockers?
- Drowsiness
- Depression
- Dizziness
- Hypotension
- Dry mouth
- Ejaculatory failure
- Extra-pyramidal signs
- Nasal congestion
What can be used as medical management of BPH?
- Alpha-blockers
- 5alpha-reductase inhibitors
What are examples of 5alpha-reductase inhibitors?
Finasteride
How do 5alpha-reductase inhibitors work?
Decrease conversion of testosterone to the more potent androgen dihydrotestosterone
What are surgical options for BPH management?
- Transurethral resection of the prostate (TURP)
- Transurethral incision of the prostate (TUIP)
- Retropubic prostatectomy
- Transurethral laser prostatectomy
- Robotic prostatectomy
What are risks of having a TURP procedure?
- Haematuria/haemorrhage
- Haematospermia
- Hypothermia
- Urethral trauma/stricture
- Post TURP syndrome
- Infection/prostatitis
- ED
- Incontinence
- Clot retention
- Retrograde ejaculation
