Benign diseases of the prostate Flashcards
What are the different zones of the prostate called
central peripheral anterior transitional
What is BPH
Benign prostatic hyperplasia -big under microscope (histological)
What is BPE
Benign prostatic enlargement (BPE) – big prostate gland
What is BPO
Benign prostatic obstruction (BPO) – symptoms associated with a big prostate
What is BOO
Bladder outflow obstruction (BOO) – bladder neck and prostate causing obstruction and symptoms
What characterises BPH
Characterised by fibromuscular and glandular hyperplasia
What zone of the prostate does BPH usually affect
Transition zone
What % of men will have BPH by the age of 60
50%
What are the two main categories of lower urinary tract symptoms
Voiding Storage
What are voiding symptoms
Obstructive - Hesitancy - Poor stream - Terminal dribbling - Incomplete emptying
What are storage symtpoms
Irritative - Frequency - Nocturia - Urgency +/- urge incontinence
How do assess LUTS from prostate disease
International prostate symptom score sheet
What is the International prostate symptom score sheet scored out of
Total score is out of 35
What are the ranges on the International prostate symptom score sheet
Mild: 0-7 Moderate: 8-19 Severe: ≥ 20
What areas do you examine if if patient has LUTS
Abdomen Penis Urinalysis
What do you examine in the abdomen in patient with LUTS symptoms
palpable bladder
What do you examine on the penis in patient with LUTS symptoms
External urethral meatal stricture Phimosis Digital rectal examination (DRE) to assess prostate size Suspicious nodules or firmness
What investigations should you do for LUTS
MSSU Bloods Renal tract USS (if renal failure or bladder stone suspected) Flexible cystoscopy if haematuria Urodynamic studies in selected cases TRUS-guided prostate biopsy if PSA raised or abnormal DRE
What do you inves in the urinalysis for patient with LUTS symptoms
Blood - PSA - Urine and creatinine (if chronic urinary retention) Signs of UTI
What is treatment for uncomplicated LUTS from prostate disease
Watchful waiting Medical therapy Surgical intervention
What medicines are used for treatment for uncomplicated LUTS from prostate disease
Alpha blockers 5 alpha reductase inhibitors (Finasteride or Dutasteride) Combination of both ^^
What can be done surgically for treatment for uncomplicated LUTS from prostate disease
TURP (prostate size <100cc) (transurethral resection of prostate) Open retropubic or transvesical prostatectomy (prostate size >100cc) Endoscopic ablative procedures
What is treatment for complicated LUTS from prostate disease
No role for Medical therapy (except for acute urinary retention) Most patients will require surgery eg. cystolitholapaxy and TURP for patients with BPO and bladder stones Some patients do not need any treatment (especially if residuals are relatively low, asymptomatic and no complications)
What is the main treatment for Lower Urinary Tract Symptoms due to Benign Prostate Obstruction
Alpha blockers
What do alpha blockers do
Alpha blockers cause smooth muscle relaxation and antagonise the ‘dynamic’ element to prostatic obstruction
How do alpha blockers work
Smooth muscle of bladder neck (i.e. intrinsic urethral sphincter) and prostate innervated by sympathetic alpha-adrenergic nerves (mostly alpha-1a subtype
What are the different categories of alpha blocker
Non-selective Selective short Selective long Highly selective
What are the non selective alpha blockers
phenoxybenzamine
What are the selective short acting alpha blockers
prazosin, indoramin
What are the selective long acting alpha blockers
alfuzosin, doxazosin, terazosin
What are the highly selective alpha blockers
tamulosin
What is the prefferred alpha blocker and why
Tamsulosin (best as stops older people falling over when they stand up)
What is a possible side effect of alpha blockers
Can give retrograde ejaculation
What do 5a-reductase inhibitors do to the prostate
Reduces prostate size and reduces risks of progression of BPE (but only if >25cc prostate)
What does 5a-reductase do in the body
5a-reductase converts testosterone to dihydrotestosterone
What drugs is best for treating the LUTS symptoms
Combination therapy of 5ARIs + alpha blockers most effective in reducing risk of progression of BPE and can also reduce prostatic vascularity and hence reduces haematuria due to prostatic bleeding
What is a possible side effect of 5a-reductase inhibitors
Can give erectile dysfuction
When can you start 5a-reductase inhibitors
Need to determine size before starting and only really start if its beyond a certain size
What are possible complications of Benign outlet obstruction (x7)
Progression of LUTS (worsening) Acute urinary retention (painful) Chronic urinary retention (painless) Urinary incontinence (overflow) UTI Bladder stone formation Renal failure from obstructed ureteric outflow due to high bladder pressure
What is TURP
Transurethral resection of prostate (TURP) - GOLD STANDARD
