Benign Prostatic Hyperplasia Flashcards
In what age group is benign prostatic hypertrophy most common?
60+
Which tissues are affected by benign prostatic hypertrophy?
glandular and connective tissue elements of the prostate
Give 9 symptoms of benign prostatic hypertrophy:
1) post-void dribbling
2) difficulty or delay in urination
3) intermittency
4) frequency
5) incontinence
6) hesitancy
7) retention
8) nocturia
9) haematuria (rupture of prostatic vein)
Give two physical exams required to investigate for benign prostatic hypertrophy:
1) digital rectal exam
2) abdominal examination for bladder enlargement (retention)
How does a hypertrophic prostate feel upon digital rectal examination?
enlarged and smooth
Give 5 investigations used to aid the diagnosis of benign prostatic hypertrophy:
1) urine culture
2) measurement of serum prostate-specific antigen (PSA)
3) renal function tests (e.g. GFR)
4) ultrasound
5) measurement of the urinary flow rate
What does PSA stand for?
prostate-specific antigen
Name two drug groups used to treat benign prostatic hypertrophy:
1) alpha blockers
2) 5-alpha reductase inhibitors
Give an example of an alpha-blocker drug:
tamsulosin
Give an example of a 5-alpha-reductase inhibitor drug:
finasteride
How do alpha blocker drugs treat benign prostatic hypertrophy?
they relax the prostate, reducing the obstruction for urine
How do 5-alpha-reductase inhibitors treat benign prostatic hypertrophy?
they block the conversion of testosterone to dihydrotestosterone, the androgen primarily responsible for prostatic growth and enlargement
Give 2 examples of surgical treatment used to treat severe benign prostatic hypertrophy:
1) transurethral resection of the prostate
2) laser therapy (vaporisation of the prostate)
what is benign prostatic hyperplasia?
benign enlargement of the prostate gland, specifically the transition zone causing compression of the urethra
what is the epidemiology of benign prostatic hyperplasia?
- VERY COMMON in ELDERLY MEN
- 80% of 80yrs have evidence of benign prostatic hyperplasia
what is the aetiology of benign prostatic hyperplasia?
UNKNOWN
- age, hormones and lifestyle factors
what is the pathophysiology of benign prostatic hyperplasia?
- overgrowth of the nodular prostatic tissue, specifically in the transition zone
- overgrown compresses the prostatic urethra > obstruction and lower UTI symptoms
what are the clinical features of benign prostatic hyperplasia?
LOWER UTI SYMPTOMS
what are the investigations for benign prostatic hyperplasia?
- urine dipstick
- bloods = U+Es, PSA
- urinary frequency-volume chart for at least 3 days
- digital rectal exam to asses prostate size and nodules
- 2 week wait if suspected prostate cancer
what scoring system is used to assess severity of benign prostatic hyperplasia?
international prostate symptom score (IPSS)
- 20-35 = severe
- 8-19 = moderate
- 0-7 = mild
what is the management of benign prostatic hyperplasia?
- watchful waiting if mild
- lifestyle modifications eg fluid restriction, avoid caffein and alcohol
- medical therapy
- surgery = transurethral resection of the prostate or laser prostatectomy for moderate-severe
what are the side effects of alpha 1 blockers?
- dizziness
- postural hypotension
- dry mouth
- depression
how long do 5 alpha reductase inhibitors take to work?
6 months
what are the side effects of 5 alpha reductase inhibitors?
- erectile dysfunction
- reduced libido
- ejaculation problems
- gynaecomastia
- DECREASES PSA LEVELS
what are the differential diagnosis for benign prostatic hyperplasia?
- prostate cancer
- UTI
- neurogenic bladder dysfunction
- urethral strictures
