Benign Prostate Hypertrophy Flashcards
What causes BPH
Hyperplasia of stromoal and epithelial cells of the prostate
presentation of BPH
Lower UTI symptoms
Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining
Terminal dribbling
Incomplete emptying
Nocturia
What scoring system is used for BPH
International prostate symptoms score
What scoring system is used for BPH
International prostate symptoms score
Assessment for BPH
Digital rectal examination
Abdominal examination
Urinary frequency volume cahrt
Prostate specific antigen - PSA for cancer
What find abnormal on abdo exma in BPH
Palpable bladder
How long record urine output for chart
3 days
Is PSA reliable?
No - not specific at all, a bit sensitive
75% false positives
15% false negatives
Causes of raised PSA
Prostate cancer
BPH
prostatitis
UTIs
Vigorosu exercise - cycling
Recent ejaculation or prostate stimulation
What does a BPH feel like
Smooth, symmetrical, slightly soft, maintained central sulcus
Whast does a cancerous prostate feel like
Firm/hard, asymmetrical, craggy or irregular, loss of central sulcus
Medical options for BPH
Alpha blockers eg tamulosin
5-alpha reducatse inhibitors eg finasteride
What des tamulosin do>
Alpha blocker - smooth muscle relaxation 0> rapid symptom improvement
What does finasteride do
5-alpha reductase inhibitor
Gradually reduces size of prostate
How do 5-alpha reductase inhibitors work
Stops 5AR enzyme converting testosterone to DHT = more potent androgen
Reduce DHT levels - reduce prostate size
Works over 6 months
Surgical options BPH
Transurethral resection of prostate (TURP )
Transurethral electroaporisation of teh prostate (TEVAP/TUVP)
Holmium laser enucleation of the prostate (HoLEP)
Open prostatectomy via abdo or perineal incision
What is the notable side effect of tamsulosina nd other alpha blockers
Postural hypotension
Most common side effect of finasteride
Sexual dysfunction due to reduced DTH
What is TURP
Most common surgical treatment of BPH ‘
Removes part of prostate from inside urethra
Resectoscope inseted, prostate tissue removed with diathermy loop - more space for urin
Major complications of TURP
Bleeding
infection
Urinary incontinecne
Erectile dysfunctuion
Retrograde ejaculation
Urethral strictures
Failure to resolve symptoms
How do other surgical options for BPH work
Transurethral electrovaporisation of the prostate (TEVAP / TUVP) involves inserting a resectoscope into the urethra. A rollerball electrode is then rolled across the prostate, vaporising prostate tissue and creating a more expansive space for urine flow.
Holmium laser enucleation of the prostate (HoLEP) also involves inserting a resectoscope into the urethra. A laser is then used to remove prostate tissue, creating a more expansive space for urine flow.
Open prostatectomy involves an open procedure to remove the prostate. An abdominal or perineal incision can be used to access the prostate. Open surgery is less commonly used as it carries an increased risk of complications, a more extended hospital stay and longer recovery than other surgical procedures.
