Benign prostatic hyperplasia Flashcards
What is benign prostatic hyperplasia (BPH)?
BPH is a common condition seen in older men.
What are the risk factors for BPH?
Age, ethnicity, and family history.
Around 50% of 50-year-old men will have evidence of BPH, and 30% will have symptoms. Around 80% of 80-year-old men have evidence of BPH. Ethnicity: black > white > Asian.
What are the lower urinary tract symptoms (LUTS) associated with BPH?
Voiding symptoms (obstructive) and storage symptoms (irritative).
Voiding symptoms include weak or intermittent urinary flow, straining, hesitancy, terminal dribbling, and incomplete emptying. Storage symptoms include urgency, frequency, urgency incontinence, nocturia, and post-micturition dribbling.
What are the complications of BPH?
Urinary tract infection, retention, and obstructive uropathy.
What assessments are used for BPH?
Dipstick urine, U&Es, PSA, urinary frequency-volume chart, and International Prostate Symptom Score (IPSS).
What does the International Prostate Symptom Score (IPSS) classify?
The severity of lower urinary tract symptoms (LUTS) and their impact on quality of life.
Score 20-35: severely symptomatic, Score 8-19: moderately symptomatic, Score 0-7: mildly symptomatic.
What are the management options for BPH?
Watchful waiting, alpha-1 antagonists, 5 alpha-reductase inhibitors, combination therapy, antimuscarinic drugs, and surgery.
What are alpha-1 antagonists used for in BPH management?
They decrease smooth muscle tone of the prostate and bladder and are considered first-line for moderate-to-severe voiding symptoms.
Examples include tamsulosin and alfuzosin.
What are the adverse effects of alpha-1 antagonists?
Dizziness, postural hypotension, dry mouth, and depression.
What do 5 alpha-reductase inhibitors do?
They block the conversion of testosterone to dihydrotestosterone (DHT), which induces BPH.
An example is finasteride.
When are 5 alpha-reductase inhibitors indicated?
If the patient has a significantly enlarged prostate and is at high risk of progression.
What are the adverse effects of 5 alpha-reductase inhibitors?
Erectile dysfunction, reduced libido, ejaculation problems, and gynaecomastia.
What does combination therapy for BPH involve?
Using an alpha-1 antagonist and a 5 alpha-reductase inhibitor together.
Supported by the MTOPS trial and NICE.
What should be tried if storage and voiding symptoms persist after alpha-blocker treatment?
An antimuscarinic (anticholinergic) drug such as tolterodine or darifenacin.
What surgical option is available for BPH?
Transurethral resection of prostate (TURP).
What is TURP syndrome?
TURP syndrome is a rare and life-threatening complication of transurethral resection of the prostate surgery.
What causes TURP syndrome?
It is caused by irrigation with large volumes of glycine, which is hypo-osmolar and is systemically absorbed when prostatic venous sinuses are opened up during prostate resection.
What are the consequences of TURP syndrome?
This results in hyponatremia, and when glycine is broken down by the liver into ammonia, it leads to hyper-ammonia and visual disturbances.
What are the typical presentations of TURP syndrome?
TURP syndrome typically presents with CNS, respiratory, and systemic symptoms.
What are the risk factors for developing TURP syndrome?
Risk factors include: surgical time > 1 hr, height of bag > 70cm, resected > 60g, large blood loss, perforation, large amount of fluid used, and poorly controlled CHF.
