Benign diseases of the prostate Flashcards
Prostate is divided into different zones, name these 3 zones
Transition zone (5% gland tissue) Peripheral zone (70% gland tissue) Central zone (25% gland tissue)
Most prostate cancers occur in what zone of the prostate
Peripheral
Transition zone of the prostate is the area that…
surrounds the urethra as it enters the prostate gland
List common benign diseases of the prostate (4)
Benign prostatic enlargement (BPE)
Benign prostatic hyperplasia (BPH)
Benign prostatic obstruction (BPO) - caused by the first 2
Bladder outflow obstruction (BOO) - caused by the first 2
Lower urinary tract symptoms may manifest in prostatic diseases - list some of these symptoms (7)
Voiding symptoms
- Hesistancy
- Poor flow
- Terminal (post-void) dribbling
- Incomplete emptying
Storage symptoms
- Frequency
- Urgency/ incontinence
- Nocturia
Benign prostatic hyperplasia predominantly affects what zone of the prostate
transition
Benign prostatic hyperplasia presents as lower urinary tract symptoms (LUTS) due to bladder outflow obstruction (as prostate surrounds urethra)
So what are the symptoms (7) of BPH
Storage symptoms
- Frequency,
- urgency,
- and nocturia
Voiding symptoms
- Hesistancy
- Poor flow
- Terminal dribbling
- Incomplete emptying
Assessment of lower urinary tract symptoms (LUTS) can be done by what methods by the patient themselves
Symptom scoring system, e.g. international prostate symptom score sheet
Frequency volume charts
The international prostate symptom score sheet filled out by the patient is a way of assessing LUTS, total score is out of 35; what score indicates
- mild LUTS
- moderate LUTS
- severe LUTS
0-7
8-19
≥20
Examination of BPH (2)
Rectal exam - enlarged smooth prostate
Abdo exam - +/- palpable bladder
BPH high risk in what age males
> 50
Investigations of benign prostatic hyperplasia (think urine, self tests (2), bloods (2), imaging (2))
Urinalysis - MSSU (any blood?)
International prostate symptom score (Self questionnaire)
Frequency volume charting (at home)
Bloods - prostate specific antigen, U+Es to check renal function
Imaging - renal tract USS (to see bladder/prostate size, any hydronephrosis), cystoscopy
Treatment of UNCOMPLICATED benign prostatic obstruction (due to BPE/BPH)
- mild LUTS
- medical (2)
- surgical
Watchful waiting if mild symptoms (score 0-7)
Combination of
- Alpha blockers (Tamsulosin) - relax the muscle tone
- 5-alpha-reductase inhibitors (finasteride) - reduce prostate size
Surgical
-Transurethral resection of prostate (TURP)
Over time, BPH results in
BPO/BOO
5-alpha-reductase inhibitors reduce prostate size by
inhibiting formation of dihydrotestosterone (DHT) from testosterone
The smooth muscle of the bladder neck and prostate is largely innervated by what nerves thus allowing the use of alpha blockers to relax muscle tone
Sympathetic alpha-adrenergic nerves releasing adrenaline/noradrenaline
Name some commonly used alpha blockers
Tamsulosin
Terazosin
Name 2 5-alpha-reductase inhibitors used in BPH (reduce prostate size)
finasteride
dutasteride
Gold standard surgical treatment for BPH is transurethral resection of prostate (TURP) - when is this indicated
Bothersome LUTS due to BPH
Complications attributed to BPH - renal insufficiency, bladder stones, recurrent haematuria or UTIs, urinary retention
Complications of bladder outflow obstruction
Renal insufficiency from obstructed outflow due high bladder pressure
bladder stones,
recurrent haematuria or UTIs,
urinary retention
Treatment of complications of BPH leading to bladder outflow obstruction
- bladder stone
- urinary retention
Cystolitholapaxy (to dissolve bladder stones if present)
Catheterisation
Complicated bladder outflow obstruction ultimately needs
surgical treatment
