Benign Prostatic Hyperplasia

Question 1

Whats the aetiology & pathological features?

Answer 1

Idiopathic
But, fluctuating levels ratio thoughout lifetime of oestrogen & androgens .
Hyperplasia of glandular celss leading to fibrotic development of tissue. Hyperplastic central zone displaces the peripheral zone, forming a pseudo-capsule.

Question 2

What are the clinical features of BPH?

Answer 2

1/3
Prostatic obstruction
Acute retention of urine
Chronic retention of urine(painless, ill from metabolic effects due to back pressure from kidneys.

Characterised by bladder neck dyssynergia

Question 3

What are the sx of prostatic obsteuction?

Answer 3

Hesitancy
Poor stream
Intermittint
Terminal dribbling

Due to incomplete bladder e,ptying:
Nocturia
UTIs

May also have detrussor instability
So might complain of urgency

Question 4

Sx of acute urine retention

Answer 4

Up40% never had obstruction before
Episode may be presipitated by anticholinergic drugs
Diuretics + alcohol
Sympt- sudden inability to pass urine and after some time acute severe suprapubic pain due to the distention of a previously normal bladder.

Signs
Severe pain
Unable to stay still
Bladder palpable & tender above pubis and below umbilicus.
Rectal examination- enarlged or pushed prostate.

Question 5

Invx?

Answer 5

Culture urine
Renal Funtion test: U&Es
Upper tract USS- only in prescence of urinary blood or abnormal renal funtion.
In the absence of these,
Micturition flow test performed. (90% with

Question 6

How would you manage prostatic obstruction?

Answer 6

Wait and see. If symptomatic,
Give a-androgeneric blocking agents
Divided into selective & non selective alpha blockers.

Question 7

Whatbare some minimally invasive therapies that can be used?

Answer 7

Thermotherapy-microwave + radiofrequency and temporary prostatic stents not fit for surgery
Who are in retention and do t want catheter.

Question 8

Whats the tratment of choice in prostates less than 100g?

Answer 8

Transurethral resection of prostate (TURP)

Question 9

Define BPH

Answer 9

Enlargement of the prostate gland in elderly men. May causebladder neck obstruction and urination probs.

Causes? Unknown, (less common in Asians)

Question 10

SS

Answer 10

Symptoms:
Frequency, urgency nocturia, haematuria, Acute/chronic urinary retention, weak stream, post-voidinh dribbling, hesitancy. Poss suprapubic pain (acute retention) flank pain.
Overflow incontinence.

Signs:
Enralged prostate on PR, smooth, tender, paplable, firm bladder if in retention.

Question 11

How do asses and diagnose?

Answer 11

Asses severity- use international prostate symptoms score.
0-5 ;incomplete emptying, frequency, intermittency, urgency, weak stream, straining. : in the past month: 
0- not at all
1. Less than 1 in 5 times 
2. Less than 1/2 the times
3. = 1/2 the times
4. More than 1/2 the times
5. Almost awlays. 

Nocturia- how many times do you get up at night to urinate? 0-5

0-7 mildly symptomatic
8-19 moderately symptomatic
20-35 : severly symptomatic

Question 12

Invx

Answer 12

Urine culture
Serum urea + cratenine (RF) 
PSA ⬆️ in prostate ca
Abdo Xray
Renal USS (upper tract dilation) 
Trans-rectal USS & biopsy to rule out cancer, 
PR
Complete Hx
Cystourethroscopy
Voiding assesment by USS

Question 13

Tx & managament

Answer 13

Mild- moderate: watch
Moderate: medical mx- w/ a- blockers e.g. Tamsulocin
5-a Reductase inhibitors - Finasteride

Deterioration in Renal Function/ dev of upper tract dilation- surgery- trans-urethral resection of prostate- TURP) or TUIP (transurethral incision of prostate) or open prostatectomy or TULIP (transurethral laser induced prostatectomy)

Question 14

What do you do in acut retention w/ or w/o overflow?

Answer 14

Relieve Pain!

Indwelling Catheterisation

Question 15

Whats the prevalence?

Answer 15

Present in almost ALL men over 40.
BPH -75% in those over 80, and 20% over 40 will require treatment for flow obstruction.
BPH- hyperplasia or hypetrophy- same.