Benign Prostatic Hyperplasia Flashcards
1
Q
BPH PATHOLOGY
A
- Nodular hyperplasia of the transitional zone of prostate
- Prostatic urethra constirction = urinary problems
- BOO =
- Hydroureter = hydronephrosis
- Bladder diverticulum & bladder stones
- Urinary stasis = UTI
2
Q
BPH AETIOLOGY
A
- 40% of men in 5th decade
- 90% of men in 9th decade
- Black > White > Asian
3
Q
BPH CLINICAL FEATURES
A
1. Voiding
- Hesitancy, poor stream, incomplete emptying, pis-en-deux
2. Storage
- Frequency, nocturia, urgency
3. Post-micturation
- Dribbling
4. Examination
- Palpate enlarged bladder
- DRE reveals enlarged prostate
4
Q
BPH INVESTIGATIONS
A
IPSS score used to for severity of symptoms
- Dips/Cultures
* Check for infection - Bloods
- FBC, U&Es - anaemia in renal failure
- PSA if prostate cancer uspected
- Imaging
- Urodynamics/renal ultrasound (volume of residual urine present)
- Cytoscopy
- If cancerous ump felt on DRE and PSA raised then needle biopsy needed
5
Q
BPH MANAGEMENT
A
- Conservative*
- avoid caffiene/sugary drinks, late evening fluids
- Medical*
- alpha- blocker (e.g. TAMSULOSIN or ALFUZOSIN)
- 5alpha-reducatase inhibitor (e.g. FINASTERIDE or DUTASTERIDE)
3. Surgery
- Trans-urethral resection of prostate
- Laser vapourisation or enucleation
6
Q
Alpha1-antagonist MOA
A
- Decrease smooth muscle tone
7
Q
Alpha1-antagonist Side Effects
A
- Dizziness
- Postural hypertension
- Dry mouth
- Depression
8
Q
5Alpha-reductase inhibitor MOA
A
- Block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH
- Causes reduction in prostate volume and hence may slow disease progression.
- Takes time to work - up to 6 months
9
Q
5Alpha-reductase inhibitor side effects
A
- erectile dysfunction,
- reduced libido,
- ejaculation problems,
- gynaecomastia
10
Q
BPH COMPLICATIONS
A
- Acute urinary retention
- Overflow incontinence
- Acute renal failure
- Bladder stones
- Recurrent UTI
- Haematuria
