Benign prostatic hyperplasia Flashcards
What is BPH?
Its an increase in benign prostatic tissue (espech the periurethral (transitional) zone), narrowing the urethral lumen and…
an increase in prostatic smooth muscle tone
BPH is the most common cause of what in men?
LUTS - lower urinary tract symptoms
caused by bladder outlet obstruction
Explain the aetiology of BPH
Unkown
Link with age related hormonal changes (causing androgen/oestrogen imbalances)
What are the risk factors for BPH?
Age 50+
Others; Non asian Family hx Smoking Male pattern baldness Metabolic syndrome
Reduced risk with soya/vegetable based diets and negative association with cirrhosis
Summaries the epidemiology of benign prostatic hyperplasia
COMMON
70% of men > 70 yrs have histological BPH (50% of them will experience symptoms)
More common in the west than the east
More common in Afro-Caribbeans
What are the presenting symptoms of bph
Storage symptoms; FUUN
Voiding symptoms; HISID-W
What is the acronym for the storage symptoms in bph? What does it stand for?
Storage symptoms also called Irritative symptoms
FUUN; Frequency Urgency Urge incontinence * Nocturia
*leakage of urine due to failure of restraint
What is the acronym for the Voiding symptoms in bph? What does it stand for?
Also called obstructive symptoms
HISID-W;
Hesitancy
Intermittency
Straining
Incomplete emptying
Dribbling (terminal)
Weak stream
Definitions;
Intermittency - ceasing and beginning again:
What are symptoms of complicated bph?
Fever + Dysuria - if UTI
Acute Urinary retention - with severe pain
Chronic retention - painless. nocturia big feature
Antother mmemonic for bph symptoms? - easier one?
FUND HIPS
Frequency
Urgency
Nocturia
Dysuria
Hesitancy
Incomplete voiding
Poor stream
Straining
Recognise the signs of bph on physical examination
DRE - the prostate is usually smoothly enlarged with a palpable midline groove
NOTE: there is poor correlation between the size and the severity of the symptoms
Signs of Acute Retention;
Suprapubic pain
Distended, palpable bladder
Signs of Chronic Retention;
A large distended painless bladder (volume > 1 L)
Signs of renal failure
Investigations for BPH?
Urinalysis;
- Pyuria- pus. if UTI.
PSA;
- Increased = prostate cancer or prostatitis
Volume charting
- Finds out if nocturia or polyuria to differentiate obstructive and irritative.
Global bother score and IPSS
Others;
US - If hx haemuaturia, urine tract surgery, stones etc
cystoscopy
uroflometry - urine flow rate
Generate a management plan for benign prostatic hyperplasia
Non bothersome symptoms;
- Conservative (if mild); Watchful waiting
- Behaviour modification;
- Fluid restriction
- Bladder training
Bothersome but surgery not indicated;
- Alpha blocker + behaviour
- The sins; Doxazosin, …sin etc - 5a-reductase inhibitors + behvaiour
- the rides; Finasteride
- reduce prostate size
Bothersome, surgery indicated
- Minimally invasive; TURP, TUVP
- Prostate less than 80g
- TURP -Transurethral resection of the prostate
- Vaporisation
prostate more than 80g = Open prostatectomy
In Emergency (acute urinary retention); Catheterisation
When is surgery indicated in bph?
recurrent haematuria
UTIs
bladder stones
renal insufficiency
failure of medication
Complications of turp?
Retrograde ejaculation (you ejaculate up into your bladder because the internal urinary sphincter is relaxed)
Haemorrhage Incontinence TURP syndrome Urinary infection Erectile dysfunction Urethral stricture
