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Urology > Benign Prostatic Hyperplasia > Flashcards

Benign Prostatic Hyperplasia Flashcards

1
Q

What is Benign Prostatic Hyperplasia?

A

Enlargement of the prostate gland due to non-cancerous hyperplasia of the glandular epithelial and stromal tissue of the prostate leading to an increase in its size

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2
Q

What percentage of men have BPH over 80?

A

90%

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3
Q

What is the most common cause of bladder outlet obstruction in men?

A

BPH

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4
Q

What hormones play a large role in BPH?

A

Androgens

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5
Q

What does the prostate convert testosterone into?

A

Dihydrotestosterone (DHT)

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6
Q

What enzyme does the prostate use to convert Testosterone into DHT?

A

5a-reductase

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7
Q

What is more potent, testosterone or DHT?

A

DHT

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8
Q

What transforming growth factor may have a role in inducing proliferation and apoptosis in the prostate leading to BPH?

A

Transforming growth factor Beta

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9
Q

What is the term for what TGFB does?

A

static component

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10
Q

What is the dynamic component?

A

increased alpha mediate prostatic smooth muscle contraction due to hyperplasia

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11
Q

What are the risk factors for BPH?

A

Age, Family history, African Caribbean, obesity

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12
Q

What are the clinical features of BPH?

A

LUTS- Voiding or storage symptoms

haematuria and haematospermia can also occur

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13
Q

What are voiding symptoms?

A

hesitancy, weak stream, terminal dribbling, incomplete emptying

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14
Q

What are storage symptoms?

A

Urinary frequency, noctuid, urge incontinence, nocturnal enuresis

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15
Q

What examinations would you need to do for BPH?

A

DRE to check if it is prostate cancer

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16
Q

How would the prostate feel if it is BPH?

A

Firm, smooth, symmetrical prostate but enlarged- greater than two finger widths

17
Q

What is the IPSS?

A

Internation prostate symptom score

18
Q

What questions would be asked about in the IPSS?

A

Incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia and Quality of life

19
Q

What are the differential diagnosis for BPH?

A

Prostate cancer, UTI, Overactive bladder, bladder cancer

20
Q

What investigations would you do for someone with BPH?

A

Urinary frequency and volume charts, bedside urinalysis (UTI) with a post void bladder scan (chronic retention), PSA (Malignancy), Ultrasound scan of the renal tract to calculate the volume of the prostate and look for urinary retention or hydronephorisis, urodynamic studies to look for bladder outlet obstruction

21
Q

What is the life style management for BPH?

A

Symptom diary, reduce caffeine and alcohol, and medication review

22
Q

What is the medication management for BPH?

A

Alpha adrenoreceptor antagonist e.g. tamsulosin- relaxes the prostatic smooth muscle
Then 5a reductase inhibitors such as finasteride as prevent conversion of testosterone to DHT so decrease prostatic volume but takes 6 months, also decrease PSA by 50%

23
Q

What are the side effects of alpha adrenoreceptor blockers?

A

postural hypotension, asthenia, rhinitis, retrograde ejaculation, floppy iris syndrome

24
Q

What is the surgical management of BPH?

A

TURP- removal of obstructive prostate tissue using a diathermy loop to increase the urethral lumen size

25
Q

What are the complications of TURP?

A

Haemorrhage, sexual dysfunction, retrograde ejaculation, urethral stricture

26
Q

What other techn?iques can be used in BPH

A

HoLEP, PBP, TUVP, TUMT

27
Q

What are the complications of BPH?

A

High pressure retention, post renal kidney injury, UTIs, haematuria

28
Q

What is TURP syndrome?

A

rare but potentially life treating complication of TURP, hypoosmolar irrigation during the procedure can cause significant fluid overload and hyponatreamia

29
Q

What is the presentation of TURP syndrome?

A

confusion, nausea, agitation, visual changes

30
Q

How is TURP syndrome treated?

A

addressing the fluid overload and reduce hyponatraemia

Urology (23 decks)

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