Benign prostate enlargement Flashcards
what is the aetiology of benign prostate enlargement / hyperplasia?
variety of factors:
- age related change in hormones with balance androgen/estrogen imbalance
what factors determine if a BPE progresses ?
vascular changes
prostatitis
changes in glandular capsule
what does clinical BPE present like?
LUTS;
storage: frequency, nocturne, urgency, incontinence
voiding: poor stream, hesitancy/strain, terminal dribbling, incomplete emptying, dysuria
what are the chances of men developing benign prostate enlargement?
60yrs = 50% 85yrs = 90%
what part of the prostate is predominantly affected?
transitional zones
describe the pathology of benign prostatic hyperplasia.
increased stroll:epithelial ratio
an increase in benign tissue narrowing the urethral lumen
increased prostatic smooth muscle tone mediated via alpha-adrenegeric receptors
how do you assess severity of LUTS?
international prostate symptom score sheet (IPSSS)
frequency volume charts (nocturia)
what are the 1st line investigations for BPE?
digital rectal exam urinalysis PSA IPSSS global bother score
what is the treatment algorithm for BPE?
uncomplicated:
- watchful waiting then..
- Alpha blocker or 5-a reductase inhibitor then…
- TURP or open prostatectomy
what endoscopic surgery is used to treat BPE?
transurethral resection of the prostate
what open surgery is used to treat BPE?
open retropubic or transvesical prostatectomy
when is open surgery required instead of endoscopic?
if the prostate is > 100cc
endoscopic is preferred choice if < 100cc
how does alpha blockers work to treat BPE?
treat LUTS caused by BPE as they block the smooth muscle of the bladder neck and prostate which are innervated by alpha receptors
how does 5a-reductase inhibitors work?
they convert testosterone to dihydrotestosterone
reduce prostate size and progression
also reduces prostate vascularity and hence resolve haematuria due to prostate bleeding
what is the gold standard surgery for BPE?
TURP
