Benign Prostatic Hyperplasia Flashcards
Define:
Slowly progressive nodular and diffuse hyperplasia of the transitional zone of the prostate gland.
Most frequent cause of LUTS in males
Aetiology:
Though there is a decrease in testosterone with age there is an increase in 5a-reductase and so an increase in dihydrotestosterone = enlargement of the prostate gland.
Risk factors:
There is an increased risk in those with cirrhosis.
There is a reduced risk in soya/vegetable based diets.
Epidemiology:
Very common
70% of men >70 years
24% if 40-64 years
More common in the west and in Afro-Caribbeans.
Symptoms:
FUND HIPS
Frequency Urgency Nocturia Dysuria Hesitancy Incomplete voiding Poor stream Smell/odour
Haematuria
UTI
Bladder stones
What symptoms are there in urinary retention?
Acute = severe pain Chronic = no pain but nocturia
Signs:
DRE - palpable smoothly nodular mass with palpable midline groove
Acute retention = suprapubic pain and distended, palpable bladder
Chronic = palpable distended bladder
May have signs of renal failure
Investigations:
Urinanalysis - UTI and blood
MSU = MC&S
US of the urinary tract (rule out hydronephrosis and see how much fluid is in the bladder)
TRUS (volume, size and biopsy of the bladder)
Flexible cystoscopy
Management:
If in retention - catheterisation
Conservative (watchful waiting) - lifestyle –> reduce alcohol and caffeine, distraction techniques for urgency and relaxation
Medical:
- 5a-reducatse inhibitors e.g. Finasteride
- Selective alpha-blockers e.g. tamsulosin
TURP (transurethral resection of prostate)
TUIP (transurethral incision of prostate) - this is less damage to the sexual function but less benefit
Open prostatectomy
Complications:
Recurrent UTIS (stasis of urine allows the bacteria to grow) Bladder diverticula Obstructive renal failure Post-obstructive diversis Stone development Urinary retention
Prognosis:
Mild symptoms can be treated with medical intervention but most symptoms clear up with surgical.
