Benign prostatic hyperplasia Flashcards
BPH?
Slowly progressive nodular hyperplasia of the periurethral (transitional) zone of the prostate gland. Most common cause of lower urinary tract symptoms in males.
BPH risk factors?
reduced risk with vegetable based diets and increased risk with cirrhosis.
BPH epidemiology?
70% of men >70 have histological, 50% have symptoms. Most common in Afro-Caribbeans.
BPH obstructive symptoms (4)?
hesitancy, poor or intermittent stream, terminal dribbling, incomplete voiding
BPH storage symptoms (4)?
frequency, urgency, urge incontinence, nocturia
BPH acute retention symptoms (2)?
sudden inability to pass urine, associated with severe pain
BPH chronic retention symptoms (3)?
painless, nocturia, frequency
BPH signs?
prostate is smoothly enlarged with a palpable midline groove on DRE,
signs of acute retention (suprapubic pain, distended, palpable bladder)
signs of chronic retention (large distended painless bladder, signs of renal failure)
BPH investigations?
urinalysis to check for UTI,
U&Es to check for impaired renal function,
PSA,
USS of urinary tract to check for hydronephrosis,
transrectal USS allows assessment of bladder size and volume,
flexible cystoscopy.
BPH emergency management?
Catheretisation
BPH medical management?
watchful waiting if mild,
selective alpha-blockers (tamsulosin) to relax smooth muscle of the internal urinary sphincter and prostate capsule,
5alpha-reductase inhibitors (finasteride) to inhibit testosterone conversion to dihydrotestosterone which reduces the prostate size by 20%,
BPH surgical management?
TURP
BPH complications (7)?
recurrent UTI,
chronic urinary retention,
urinary stasis,
bladder diverticula,
stone development,
obstructive renal failure,
post-obstructive diuresis.
