Benign prostatic hyperplasia Flashcards
What is benign prostatic hyperplasia (BPH)?
Very common benign condition in men of increasing age caused by hyperplasia of the stromal and epithelial cells of the prostate
How common is BPH?
Affects up to 40% of men over 40, and 90% of men over 80
What causes BPH?
Lifelong exposure to androgens
Genetic component
Dietary components (E.g. High red meat diet)
Describe the pathophysiology of BPH
- Microscopically there is hyperplasia of both the connective (stromal) tissue, and of the glandular (epithelial) tissue
- Thought to be the result of a failure of apoptosis
- The prostate naturally grows throughout life - it grows in response to dihydrotestosterone (breakdown product of testosterone)
- The majority of growth occurs in the transitional zone
Does BPH increase cancer risk?
No
BPH occurs in transitional zone
Prostate cancer occurs in peripheral zone
What is meant by LUTS?
Lower Urinary Tract Symptoms
How will BPH present?
LUTS:
- Frequency
- Nocturia
- Hesitation
- Reduced force
- Post-void dribbling
- Urinary retention
- Incontinence
What is meant by urinary frequency?
Increased number of toilet trips required
What is meant by urinary urgency?
An increased need to urinate urgently
What is the main symptom score used in BPH?
IPSS - International Prostate Symptoms Score
What investigations are required in BPH?
Urine dipstick
PSA blood test
Bladder diary
Fluid chart - Input and output
Rectal exam
Uroflow? Ultrasound? Bladder scan?
What are some lifestyle management options in BPH?
- Reduce caffeine
- Reduce citrus intake
- Reduce spicy food intake
- Reduce alcohol intake
- Increase water intake
- Stop drinking fluids 2-3 hours before bed
What are some drugs used to manage BPH?
Alpha-Blockers
5-alpha reductase inhibitors
What is the MOA of alpha-blockers in BPH?
They relax the smooth muscle of the prostate
Example of an alpha blocker in BPH management
Tamsulosin (400mcg OD)
MOA of 5-alpha reductase inhibitors in BPH
Block testosterone and actually help reduce the size of the prostate
Example of a 5a reductase inhibitor in BPH
Finasteride
Side effects of 5a-reductase inhibitors
- Decreased libido
- Depression
- Anxiety
- Erectile dysfunction
What are the 2 types of catheter?
- Transurethral
- Suprapubic
How is suprapubic catheterisation performed?
With ultrasound, usually in theatre and passes through the skin and into the bladder
What are some surgical management options in BPH?
Trans-urethral resection of the prostate (TURP)
Trans-urethral electrovaporisation of the prostate (TUVP)
Holmium laser enucleation of the prostate (HoLEP)
Open prostatectomy via abdominal or perineal incision
What is involved in transurethral resection of the prostate?
What is involved in holmium laser enucleation of the prostate (HoLEP)
- Follows the anatomical plane between the gland and capsule
- Minimal bleeding
- Next day discharge without catheter
What are some indications for prostate surgery in BPH?
- Failed medical treatment and lifestyle changes
- Recurrent retention
- High pressure chronic retention - Renal impairment
- Recurrent haematuria related to enlarged prostate
- Bladder stones
- Bladder diverticulum
- Recurrent infections
