Benign Prostatic Hyperplasia Flashcards
Define Benign Prostatic Hyperplasia?
Slowly progressive nodular hyperplasia of the periurethral (transitional) zone of the prostate gland
It is the most frequent cause of LUTS in adult males
What is the aetiology of Benign Prostatic Hyperplasia?
Linked with hormonal changes (e.g. androgens)
What are the risk factors for Benign Prostatic Hyperplasia?
Reduced risk with soya/vegetable based diets
Negative association with cirrhosis
What is the epidemiology of Benign Prostatic Hyperplasia?
COMMON
70% of men > 70 yrs have histological Benign Prostatic Hyperplasia (50% of them will experience symptoms)
More common in the West than the East
More common in Afro-Carribeans
How can the Obstructive and Irritative symptoms be remembered?
FUND HIPS Frequency Urgency Nocturia Dysuria Hesitancy Incomplete Voiding Poor Stream Smell/odour
What are the Acute Retention Symptoms of Benign Prostatic Hyperplasia?
Sudden inability to pass urine
Associated with severe pain
What are the Chronic Retention Symptoms of Benign Prostatic Hyperplasia?
Painless
Frequency - with passage of small volumes of urine
Nocturia is a major feature
What do we see on a DRE for Benign Prostatic Hyperplasia?
The prostate is usually smoothly enlarged with a palpable midline groove
What’s important to remember about the enlarged prostate in Benign Prostatic Hyperplasia?
There is poor correlation between the size and the severity of the symptoms
What are the signs of Acute Retention in Benign Prostatic Hyperplasia?
Suprapubic pain
Distended palpable bladder
What are the Signs of Chronic Retention in Benign Prostatic Hyperplasia?
A large distended painless bladder (volume > 1 L)
Signs of renal failure
What investigations do we do for Benign Prostatic Hyperplasia?
Urinalysis
Bloods
Midstream Urine
Imaging
What do we look for on a Urinalysis for Benign Prostatic Hyperplasia?
Check for UTI signs and blood
What bloods do we do for Benign Prostatic Hyperplasia?
U&Es - check for impaired renal function
PSA
Why do we do a MSU for Benign Prostatic Hyperplasia?
MC&S
What imaging do we do for Benign Prostatic Hyperplasia?
US of urinary tract (check for hydronephrosis)
Bladder scanning to measure pre- and postvoiding volumes
Transrectal US (TRUS)
Flexible Cystoscopy
Why do we do a TRUS for Benign Prostatic Hyperplasia?
Allows assessment of bladder size and volume
What is the Emergency Management plan for Benign Prostatic Hyperplasia?
Catheterisation
What is the Conservative management plan for Benign Prostatic Hyperplasia?
Only if mild
Watchful waiting
What is the medical management plan for Benign Prostatic Hyperplasia?
Selectiver 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%
What is the surgical management plan for Benign Prostatic Hyperplasia?
TURP
Open Prostatectomy
What are the possible complications of Benign Prostatic Hyperplasia?
Recurrent UTI Acute or chronic urinary retention Urinary stasis Bladder diverticula Stone development Obstructive renal failure Post-obstructive diuresis
What are the complications of TURP?
Retrogade ejaculation Haemorrhage Incontinence TURP syndrome Urinary infection Erectile dysfunction Urethral stricture
What is Retrogade Ejaculation?
You ejaculate up into your bladder because the internal urinary sphincter is relaxed
What is TURP syndrome?
Seizures or cardiovascular collapse caused by hypervolaemia and hyponatraemia due to absorption of glycine irrigation fluid
What is the prognosis for patients with Benign Prostatic Hyperplasia?
Mild symptoms are usually well controlled medically
Most patients get significant relief from surgery
