Benign Prostatic Disease Flashcards
two key pathophysiological factors of benign prostatic hyperplasia
increased prostatic tissue leading to narrowing of urethra and smooth muscle hyperplasia leading to increased tone
what are the voiding LUTS
hesitance, slow stream, terminal dribbling, residual volume
what are the storage LUTS
frequency, nocturia, urgency, urge incontinence
what are the two types of LUTS
voiding and storage
score sheet for assessing LUT symptoms
international prostate symptoms score sheet (IPSS)
what is the scale of IPSS
0-7 mild
8-19 moderate
20-35 severe
what would you examine the abdomen for in benign prostatic hyperplasia
a palpable bladder
what is phimosis
foreskin not retract back over glans
what would you do a digital rectal exam to check for in BPH
prostate enlargement (>2 fingers breadth)
nodules or firm prostate
reduced anal tone
what would reduced anal tone suggest about the origin of LUTS
a neurological cause
why might a UTI be caused by BPO
urinary retention
what flow rate is abnormal
<20ml/s
imaging in BPO
CT/ultrasound for a mass hydronephrosis or stones
cytoscopy (if haematuria)
post-voiding blasdder residual ultrasound
bloods in BPO
PSA, urea and creatinine
reasons for doing a prostate biopsy in BPO
a suspicious DRE or raised PSA
what does a urodynamic study do
measures the bladder pressures and muscle activity
what about the BPO will alter the treatment route
whether it’s complicated or uncomplicated
treatment route in uncomplicated BPO
just let it be
alpha blockers to reduce muscle tone (tamsulosin and alfuzosin)
or 5 alpha reductase inhibitors to reduce testosterone and shrink the prostate
how long do 5 alpha reductase inhibitors take to work
about 6 months
how long do alpha blockers take to work
a few days
side effect of alpha blockers
weak ejaculation
side effects of 5 alpha reductase inhibitors
sexual dysfunction and breast growth
what doe TURP stand for
Transurethral Resection of Prostate
how long is TURP surgery effective for
10-15 years
true/false medical therapy in the treatment of complicated BPO is effective
false - rarely effective
treatment route in complicated BPO
medical therapy can be but is rarely effective
TURP surgery
catheterisation: either long term or intermittent self-administered
what makes complicated BPO complicated
risk of causing kidney damage, severe symptoms on IPSS, just generally more severe
7 complications of complicated BPO
- progression of LUTS
- acute urinary retention
- chronic urinary retention
- urinary incontinence
- UTI
- bladder stone
- renal failure
how could BPO cause renal failure
high pressure bladder that can’t fully void obstructs the ureters
normal size of a 20 year old prostate in cubic cm
15cc
what part of the prostate is most hyperplasia-ed in BPH
transistional
