Benign Prostatic Hyperplasia Flashcards
What is Benign Prostatic Hyperplasia?
A benign condition caused by hyperplasia of the stromal and epithelial cells of the prostate gland.
Epidemiology of BPH (3).
- 50% of 50 year old men have evidence of BPH - 30% have symptoms.
- 80% of 80 year old men will have evidence of BPH.
- Black > White > Asians.
Clinical Presentation of BPH.
LUTS - Lower Urinary Tract Symptoms.
Give 9 Clinical Features of LUTS.
- Hesitancy (V/O).
- Weak Flow (V/O).
- Urgency (S/I).
- Frequency (Small but Frequent) (S/I).
- Straining to Void (V/O).
- Terminal Dribbling (V/O + Post-Micturitive).
- Incomplete Emptying (V/O).
- Nocturia (S/I).
- Intermittency (Flow Start, Stop, Restart) (V/O).
V/O = Voiding / Obstructive Symptoms. S/I = Storage / Irritative Symptoms.
Assessing Severity of LUTS (2).
- IPSS - International Prostate Symptom Score.
2. 0-7 = Mildly Symptomatic; 8-19 = Moderately Symptomatic; 20-25 Severely Symptomatic.
Pathophysiology of BPH (3).
- Overgrowth of Prostatic Tissue in the Transitional Zone of the Prostate around the Prostatic Urethra.
- Hyperplasia of Cellular Elements in Prostate (e.g. Epithelium, Smooth Muscle, Fibrous Tissue).
- Formation of Large Nodules.
Why is compression of the prostatic urethra a gradual change?
Hyperplasia is gradual.
BPH Effects on Bladder (4).
- Detrusor muscle of bladder has to generate higher pressure to eject urine - compensatory hypertrophy.
- Visible as trabeculations.
- Eventual Decompensation - Bladder will relax and become a big flabby sac with little power of contraction.
- If obstruction is not relieved - bilateral hydroureter and hydronephrosis.
What is Hydronephrosis?
Progressive Atrophy of the Renal Parenchyma leading to a progressive loss of renal function.
What is Obstructive Nephropathy?
- Definition.
- Common Cause.
- Common Complication.
Definition : A state of renal dysfunction caused by obstruction to the flow of urine.
Common Cause : BPH.
Common Complication : Infection - Stasis.
Initial Investigations of BPH (5).
- DRE - Prostate Exam (Size, Shape, Characteristics).
- Abdominal Exam - Distended Palpable Bladder.
- Urinary Frequency Volume Chart (3 days of Fluid Intake/Output).
- Urine Dipstick - Infection, Haematuria.
- PSA.
Management of Benign Prostatic Hyperplasia (3).
- Reassurance and Lifestyle Management.
- Medical Management - a-Blockers; 5-a-Reductase Inhibitors.
- Surgical Management - TURP, TUVP, HoLEP, Open Prostatectomy.
Lifestyle Management (3).
- Urgency/Nocturia - Reduce Caffeine and Alcohol Intake.
- Urgency - Practise Distraction Methods.
- Voiding - Bladder Training.
Examples of a-Blockers (4).
- Tamsulosin 400mg Once Daily.
- Alfuzosin.
- Doxazosin.
- Terazosin.
Mechanism of Action of a-Blockers.
a-1 antagonists that relax smooth muscle in the prostate and bladder.
Indication of a-Blockers.
1st line management if IPSS is 8 or more - rapid improvement in symptoms.
Contraindication of a-Blockers.
Postural Hypotension.
Adverse Effects of a-Blockers (4).
- Postural Hypotension (especially after the first dose).
- Dizziness.
- Dry Mouth.
- Depression.
Examples of 5-a-Reductase Inhibitor.
Finasteride.
Mechanism of Action of 5-a-Reductase Inhibitors.
Inhibit the enzyme that converts Testosterone into more active DHT and cause a reduction in prostate volume too.
Indication of 5-a-Reductase Inhibitors.
2nd line management of BPH to slow disease progression but can take up to 6 months for symptoms to improve.
Contraindication of 5-a-Reductase Inhibitor.
Pregnancy - Male Foetus (External Genitalia).
Adverse Effects of 5-a-Reductase Inhibitors (5).
- Erectile Dysfunction.
- Reduced Libido.
- Ejaculation Problems.
- Gynaecomastia.
- Hair Growth.
What is TURP?
Transurethral Resection of the Prostate - resectoscope access the Prostate through penile urethra and shave off tissue using Diathermy to create a wider space for urine to flow through.
Complications of TURP (5).
FIRES :-
- Failure to Resolve Symptoms.
- Incontinence.
- Retrograde Ejaculation.
- Erectile Dysfunction.
- Strictures.
* Bleeding, Infection, Pain.
What is TUVP?
Transurethral Electrovaporisation of the Prostate - resectoscope is inserted into the urethra and then a rollerball electrode is rolled across the prostate to vaporise the tissue and create a more expansive space for urine flow.
What is HoLEP?
Holmium Laser Enucleation of the Prostate - resectoscope is inserted into the urethra and then laser is used to remove prostate tissue and create a more expansive space for urine flow.
What is an Open Prostatectomy?
An abdominal/perineal incision is used to assess the prostate and then the prostate is removed - less preferred due to increased risk of complications, longer hospital stay and recovery.
