Benign Prostatic Hyperplasia Flashcards
Benign prostatic hyperplasia
Condition involving proliferation of different prostate layers, particularly the inner layers.
Effects men histologically from ~40 years, but sometimes may not show until decades later.
Aetiology of benign prostatic hyperplasia
- decreased testosterone, increased dihydrotestosterone
- inflammation - i.e. chronic infections, autoimmune conditions
statistics of men with BPH at 1) 31-40 years, 2) 51-80 years, 3) >80 years
- 8%
- 40-50%
- > 80%
Clinical features of BPH
Stoarge symptoms
- frequency
- nocturia
- urge incontinence
Clinical features of BPH
Voiding symptoms
- hesitancy
- poor stream
- dribbling
Acute complication of BPH
acute urinary retention
requires immediate catheterisation
Prostate findings on rectal exam in BPH
enlarged, smooth, firm, non-tender
Investigations in suspected BPH
- urinalysis, culture, MSU, & PSA
- frequency-volume charts
- post-void residual urine measurement (bladder scan)
- IPSS score
- USS urinary tract
- uroflowmetry
- cystoscopy
- urodynamics
BPH differentials
- prostate cancer
- prostatitis
Managing BPH
- Lifestyle alterations
- Medications
- Referral
- Surgery
Lifestyle alterations to help with BPH
- avoiding fluids before bed
- reducing alcohol and caffeine consumption
- ‘double voiding’
Medications used for BPH
- tamsulosin (alpha blocker - reduce smooth muscle tone, immediate effect)
- finasteride (5-alpha-reductase-inhibitor, reduce conversion testosterone to DHT, 6-12 months, reduce PSA)
Common side effects of tamsulosin
- dizziness
- postural hypotension
- dry mouth
- depression
- drowsiness
Side effects of 5-alpha-reductase inhibitors
- impotence
- reduced libido
Surgical procedure for BPH
Transurethral resection of the prostate (TURP)
