Benign prostate Hyperplasia

Question 1

Define Benign Prostate Hyperplasia

Answer 1

As all men grow older, prostate enlarge-and it most it grows big enough to be BPEnlargement
BPH is only considered BPH after histology
People suffer from Bladder outflow obstruction-BOO as BPE gets larrger

Question 2

Aetiology and risk factor of Benign Prostate Hyperplasia

Answer 2

As all men grow older, their prostate grows naturally. That benign prostate enlargement (BPE). Histology is what diagnoses BPH
Usually happens in transition zone between central prostate and peripheral zone (where cancers tend to be)-BPH tends to presents much earlier than cancer

Risk factors:
Age-older the worse-older the more Sx you have
FHx, 
cigarette
High test levels
obesity, diabetes
afro-carribean

Question 3

Epidiemology of BPH

Answer 3

nearly everyone-45% of 50-60. 75% over 80

Global prevalence is 25%

Question 4

Signs and Sx of BPH

Answer 4

Lower urinary tract symptoms (LUTS)-questionnaires available

Voiding–Obstruction-`m
MORE COMMON IN BPH
Incomplete emptying, intermittency, weak stream, straining,
WEAK FLOW

Storage–detrusor overactivity-can be 2nd to obstruction
frequency, urgency, nocturia (and score tells you how severe LUTS are)
STRONG FLOW

can also have UTI’s

Palpable bladder
DRE-mass palpable, smooth, regular
Frequency Volume chart

Question 5

Investigations for BPH

Answer 5

Urinalysis/dipstick-normal
Flow rate–slower flow, flatter curve)
+post void residual bladder scan

Blood test-U&E (retention can affect kidneys, or exclude AKI), PSA (not too raised )

Ultrasound, cystoscopy

Question 6

Management of BPH

Answer 6

If its not a bother to the person, can just not do anything
Reassure that it’s not cancer

Medical management
alpha blockers-tamsulosin (relaxes prostate)
5alpha reductase inhibitors-finasteride (only if prostate very large)

Surgical -medical doesn’t always work—-Transurethral resection of prostate–> core out the center part of the prostate via cystoscopy
It grows back in 10 years

If unfit for surgery-long term catheter

Question 7

Complication of BPH

Answer 7

BPH progress, and cause worse QOL

reccurent UTI

Renal failure as retention start causing post renal AKI

Bladder stones

medication can cause hypotension/orthostatic

surgery-small risk of incontinence, erectile dysfunction

Question 8

Prognosis of BPH

Answer 8

Most people will be fine and the medical therapy will be enough to make QOL better

But 20% progress, and 6% get AKI