Benign Prostatic Hyperplasia Flashcards
Define
Increase in size of the prostate gland without malignancy present
Causes
- Benign nodular or diffuse proliferation of the musculofibrous and glandular layers of the prostate
- Likely aetiology is a failure of apoptosis
- Note: Inner (transitional) zone enlarges in contrast to peripheral layer expansion seen in prostate carcinoma
Risk factors
advancing age
Epidemiology
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
Symptoms
Obstructive Symptoms
- Hesitancy
- Poor or intermittent stream
- Terminal dribbling
- Incomplete voiding
Irritative/Storage Symptoms
- Frequency
- Urgency
- Urge incontinence (leakage of urine that accompanies an intense desire to pass water with failure of restraint)
- Nocturia
TIP: the obstructive and irritative symptoms can be remembered using the mnemonic FUND HIPS
- Frequency
- Urgency
- Nocturia
- Dysuria
- Hesitancy
- Incomplete voiding
- Poor stream
- Straining
Acute Retention Symptoms
- Sudden inability to pass urine
- Associated with SEVERE PAIN
Chronic Retention Symptoms
- Painless
- Frequency - with passage of small volumes of urine
- Nocturia is a major feature
Signs
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
Urinalysis
- Check for UTI signs and blood
Bloods
- U&Es - check for impaired renal function
- PSA
Midstream Urine
- MC&S
Imaging
- US of urinary tract (check for hydronephrosis)
- Bladder scanning to measure pre- and postvoiding volumes
- Transrectal Ultrasound Scan (TRUS) - allows assessment of bladder size and volume
- Flexible Cystoscopy
Management
In Emergency (acute urinary retention)
- Catheterisation
Conservative (if mild)
- Watchful waiting
Medical
- Selective a-blockers (e.g. tamsulosin) relax the smooth muscle of the internal urinary sphincter and prostate capsule
- 5a-reductase inhibitors (e.g. finasteride) will inhibit the conversion of testosterone to dihydrotestosterone, which can reduce prostate size by around 20%
Surgery
- TURP
- Open prostatectomy
Complications
- Recurrent UTI
- Acute or chronic urinary retention
- Urinary stasis
- Bladder diverticula
- Stone development
- Obstructive renal failure
- Post-obstructive diuresis
- Complications of TURP
- Retrograde ejaculation (you ejaculate up into your bladder because the internal urinary sphincter is relaxed)
- Haemorrhage
- Incontinence
- TURP syndrome
- DEFINITION: seizures or cardiovascular collapse caused by hypervolaemia and hyponatraemia due to absorption of glycine irrigation fluid
- Urinary infection
- Erectile dysfunction
- Urethral stricture
Prognosis
Mild symptoms are usually well controlled medically
Most patients get significant relief from surgery
