Benign prostatic hyperplasia Flashcards
What is BPH?
BPH is the hyperplasia of the stromal and epithelial cells of the prostate
What are the LUTS that occur with prostate pathology?
Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining to pass urine
Terminal dribbling
Incomplete emptying
Nocturia
What is the pathophysiology of BPH?
An increased in the activity of the enzyme, 5-alpha reductase, causes an increase in dihydrotestosterone and oestrogen.
DHT acts on androgen receptors in the prostate to cause hyperplasia
Where in the prostate does hyperplasia occur?
Hyperplasia typically occurs in the transition zone, which causes compression of the prostatic urethra
What are the differentials of BPH?
Prostate cancer
UTI
Neurogenic bladder dysfunction
Urethral stricture
What makes up the initial assessment of a man presenting with LUTS?
DRE - prostate examination
Abdominal examination
Urinary frequency volume chart
Urine dipstick
PSA for prostate cancer
What are the common causes of a raised PSA?
Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise
Recent ejaculation
What does a normal prostate feel like?
Smooth
Symmetrical
Slightly soft
Maintained central sulcus
What is the international prostate symptom score?
A 7-symptom questionnaire that predicts progression and outcome of BPH
How is the severity of LUTS classified?
By IPSS score:
- Mild - score 0-7
- Moderate - score 8-19
- Severe - score 20-35
What lifestyle modifications can improve symptoms of BPH?
Fluid restriction
Avoidance of caffeine and alcohol
Timed voiding
What is the first line pharmacological management of BPH?
Alpha antagonists - tamsulosin
What are the side effects of alpha blockers?
Postural hypotension
Dizziness
Dry mouth
Depression
What is the second line pharmacological management of BPH?
5-alpha reductase inhibitors e.g finasteride
What are the side effects of finasteride?
reduced libido
Erectile dysfunction
Gynaecomastia
Reduced ejaculate volume
