Benign Prostate Hyperplasia Flashcards
What is BPH?
slowly progressive nodular hyperplasia of the periurethral (transitional) zone of the prostate gland
Most common cause of LUTS in adult males
Describe the aetiology of BPH
UNKNOWN
Link with hormonal changes (e.g. androgens)
List 3 risk factors for BPH
Increasing age
FHx
Metabolic syndrome (Obesity, DM, CHD)
Describe the epidemiology of BPH
COMMON
70% of men > 70 yrs have histological BPH (50% of them experience sx)
How can symptoms of BPH be classified?
Obstructive + Irritative
Acute Retention vs Chronic Retention
What is found on DRE in BPH?
Smooth enlargement with a palpable midline groove
poor correlation between size + severity of symptoms
What are the acute and chronic retention symptoms in BPH?
Acute: Sudden inability to pass urine Associated with SEVERE PAIN Chronic: Painless Frequency: with passage of small volumes of urine Nocturia is a major feature
How may differentials differ in urinalysis of suspected BPH?
Uncomplicated BPH: NORMAL
UTI: PYURIA
Cancer: HAEMATURIA
How is BPH treated in an emergency (acute urinary retention)?
Catheterisation
What basic investigations should be performed in suspected BPH? What results are seen?
Urinalysis (normal) Midstream urine MC+S Bloods; U+Es (check renal function) PSA (elevated) ALP (to exclude bone mets in Ca)
What imaging investigations should be performed in suspected BPH? What results are seen?
US of urinary tract (check for hydronephrosis)
Bladder scanning to measure pre- + postvoiding volumes
Flexible Cystoscopy (mass, stone, stricture)
Transrectal Ultrasound Scan (TRUS) + biopsy
What medical management may be used in BPH?
Selective a-blockers (e.g. tamsulosin) relax smooth muscle of internal urinary sphincter + prostate capsule
5a-reductase inhibitors (e.g. finasteride) inhibit conversion of testosterone to dihydrotestosterone, which can reduce prostate size
List 7 complications of BPH
Recurrent UTI Acute or chronic urinary retention Urinary stasis Bladder diverticula Stone development Obstructive renal failure Post-obstructive diuresis
List 7 complications of TURP in BPH
Retrograde ejaculation (ejaculate up into bladder because internal urinary sphincter is relaxed) Haemorrhage Incontinence TURP syndrome UTI Erectile dysfunction Urethral stricture
What is TURP syndrome?
seizures or cardiovascular collapse caused by hypervolaemia + hyponatraemia due to absorption of glycine irrigation fluid
