benign prostatic hyperplasia Flashcards
what is the normal size of the prostates ?
20-25 ml
what is the role of alpha reductase enzyme in the prostate ?
it catalyzes the reaction between testosterone and DHT
DHT is then used to grow the prostates
how can we define benign prostatic hyperplasia histologically ?
by glandular, stromal and muscular hypertrophy
how can we define BPH clinically ?
by using the IPSS score , international prostate symptom score
what IPSS score would mild LUTS take ?
0-7
what IPSS score would moderate LUTS take ?
8-19
what IPSS score would severe LUTS take ?
20-35
what do male LUTS consist of ?
these are associated with voiding
storage
or post micturition
what are the LUTS associated with voiding ?
inconsistent stream terminal dribbling straining hesitancy incomplete emptying
what are the LUTS associated with storage ?
urgency
frequency
incontinence
nocturia
what are the LUTS associated with post-micturition ?
dribbling
what is the relationship between the symptom severity and the size of the prostate ?
no direct correlation
what are the consequences of BPH ?
increased risk of acute urinary retention
increased risk of surgery
deterioration in symptoms
what are the factors that may increase the onset of acute urinary retention ?
sexual excitement alcohol cold weather wetness withholding of micturition
what should be done at initial assessment for a man complaining of LUTS ?
digital rectal examination
urine dip stick test
ask patient to complete urinary frequency chart
when should PSA testing be offered ?
1- LUTS suggestive of bladder outlet obstruction secondary to BPE
2- Prostate feels abnormal on DRE
3- concern is about prostatic cancer
what are frequency volume charts mainly used for ?
these charts give an indication of voiding patterns as well as the severity of symptoms
what drug treatments should be offered for patients complaining of moderate to severe LUTS ?
alpha blockers
what drug treatments should be offered for patients complaining of moderate to severe LUTS along with a prostate heavier than 30g accompanied with a risk of progression of the disease ?
5 alpha reductase inhibitor
if the patient is complaining of severe symptoms of LUTS along with a PSA level higher than 1.4 mg/dl what is the best drug treatment ?
combination of alpha blockers and 5 alpha reductase inhibitor
if the patient is complaining of storage symptoms and symptoms that fall under OAB syndrome which drug treatment is the most appropriate ?
Mirabegron (antimuscarinic)
how often should the patient be reviewed after prescribing ann alpha blocker ?
review at 4-6 weeks then every 6-12 months
how often should the patient be reviewed after prescribing an 5ARI ?
review at 3-6 months then every 6-12 months
how often should a patient on anticholinergics be reviewed ?
review at 4-6 weeks then every 6-12 months
