Benign prostate hyperplasia (BPH) Flashcards
What is benign prostate hyperplasia (BPH)?
Increase in the size of the prostate WITHOUT the presence of malignancy
Describe the epidemiology of BPH.
- Common - 24% of men 40-64 and 40% of men over 60
- More common over 60
Why is BPH more common with age?
- 5a reductase converts testosterone to dihydrotestosterone.
- 5a reductase increases with age.
- Dihydrotestosterone is more active.
What provides protection against BPH?
- Castration (removal of testicles) is PROTECTIVE:
- Androgens e.g. testosterone DO NOT CAUSE BPH but are a requirement for BPH
- BPH is not seen in those with castration prior to puberty
Give 6 symptoms of BPH.
LUTS:
1. Nocturia (>30% voided volume at night)
2. Frequency
3. Urgency
4. Post-micturition dribbling
5. Poor stream/flow
6. Hesitancy
7. Overflow incontinence
8. Haematuria
9. Bladder stones
10. Delay in initiation of micturition
11. Incomplete emptying
12. Straining
Also:
- Enlarged but smooth prostate.
Investigations for BPH.
- Digital Rectal Exam (DRE)
- To assess the size, shape and characteristics of the prostate
- A benign prostate feels smooth, symmetrical and slightly soft, with a maintained central sulcus - Abdominal examination
- To assess for a palpable bladder and other abnormalities - Urinary frequency-volume chart (AKA bladder diary)
- Recording 3 days of fluid intake and output - Urine dipstick urinalysis
- To assess for infection, haematuria (e.g. due to bladder cancer) and other pathology - Prostate-specific antigen (PSA)
- PSA slightly raised for prostate cancer
- Unreliable test! - Transrectal ultrasound
- To see the size of the prostate - Urodynamics - urine flow studies
- Max flow rate < 10ml per second is suggestive of bladder outflow obstruction due to BPH - Transurethral biopsy
- To exclude cancer
What information can you get from a bladder diary?
- Frequency.
- Volume.
- Functional capacity.
- Incontinence/day.
Describe the treatment for BPH.
- Mild symptoms: watchful waiting.
- Lifestyle changes.
- 1st line: Alpha-1-antagonists e.g. oral tamulosin.
- 2nd line: 5-alpha-reductase inhibitors e.g. oral finasteride.
- Surgery.
Give 2 lifestyle changes/conservative management for BPH.
- Reduce fluid intake/caffeine
- Urethral milking
- Incontinence pads
- Bladder training
How does tamulosin work in improving the symptoms of BPH?
Tamulosin is an alpha-1-antagonist. It works by relaxing the smooth muscle in the bladder neck and prostate and so increases urinary flow. This improves obstructive symptoms.
What are the side effects of tamsulosin?
Side effects:
Drowsiness, dizziness, depression, ejaculatory failure (since it’s a vasodilator), extra-pyramidal signs, weight increase and nasal congestion.
* AVOID in postural hypertension
How do 5-alpha-reductase inhibitors work in improving the symptoms of BPH?
5-alpha-reductase inhibitors block the conversion of testosterone to dihydrotestosterone (the androgen responsible for prostatic growth).
It gradually reduce the size of the prostate.
What are the side effects of 5-alpha-reductase inhibitors?
Side effects:
Impotence, decreased libido
What are the 2 options for surgery for BPH?
- Transurethral resection of prostate (TURP):
* GOLD STANDARD
* Less than 14% impotent, 1% incontinent & 10% erectile dysfunction - Transurethral incision of prostate (TUIP):
* Less destruction than TURP and less risk to sexual function,
best for smaller prostate
What scoring system is used for BPH?
International prostate symptom score (IPSS)
