Benign Prostatic Hyperplasia Flashcards
What is Benign Prostatic Hyperplasia?
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
What percentage of men have BPH over 80?
90%
What is the most common cause of bladder outlet obstruction in men?
BPH
What hormones play a large role in BPH?
Androgens
What does the prostate convert testosterone into?
Dihydrotestosterone (DHT)
What enzyme does the prostate use to convert Testosterone into DHT?
5a-reductase
What is more potent, testosterone or DHT?
DHT
What transforming growth factor may have a role in inducing proliferation and apoptosis in the prostate leading to BPH?
Transforming growth factor Beta
What is the term for what TGFB does?
static component
What is the dynamic component?
increased alpha mediate prostatic smooth muscle contraction due to hyperplasia
What are the risk factors for BPH?
Age, Family history, African Caribbean, obesity
What are the clinical features of BPH?
LUTS- Voiding or storage symptoms
haematuria and haematospermia can also occur
What are voiding symptoms?
hesitancy, weak stream, terminal dribbling, incomplete emptying
What are storage symptoms?
Urinary frequency, noctuid, urge incontinence, nocturnal enuresis
What examinations would you need to do for BPH?
DRE to check if it is prostate cancer
How would the prostate feel if it is BPH?
Firm, smooth, symmetrical prostate but enlarged- greater than two finger widths
What is the IPSS?
Internation prostate symptom score
What questions would be asked about in the IPSS?
Incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia and Quality of life
What are the differential diagnosis for BPH?
Prostate cancer, UTI, Overactive bladder, bladder cancer
What investigations would you do for someone with BPH?
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
What is the life style management for BPH?
Symptom diary, reduce caffeine and alcohol, and medication review
What is the medication management for BPH?
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%
What are the side effects of alpha adrenoreceptor blockers?
postural hypotension, asthenia, rhinitis, retrograde ejaculation, floppy iris syndrome
What is the surgical management of BPH?
TURP- removal of obstructive prostate tissue using a diathermy loop to increase the urethral lumen size
What are the complications of TURP?
Haemorrhage, sexual dysfunction, retrograde ejaculation, urethral stricture
What other techn?iques can be used in BPH
HoLEP, PBP, TUVP, TUMT
What are the complications of BPH?
High pressure retention, post renal kidney injury, UTIs, haematuria
What is TURP syndrome?
rare but potentially life treating complication of TURP, hypoosmolar irrigation during the procedure can cause significant fluid overload and hyponatreamia
What is the presentation of TURP syndrome?
confusion, nausea, agitation, visual changes
How is TURP syndrome treated?
addressing the fluid overload and reduce hyponatraemia
