Benign Prostatic Hyperplasia Flashcards
Define BPH
Non-cancerous growth of the prostate gland, leading to narrowing of the urethral lumen and LUTS
Aetiology of BPH
Age-related hormonal changes -> androgen/oestrogen imbalance -> Hyperplasia of epithelial and stomal compartments
Changes in prostatic stromal-epithelial interactions
Prostatitis, vascular effects and changes in the glandular capsule (pathological -> clinical)
Epidemiology of BPH
Prevalence increases with age (>50)
Global lifetime prevalence is 25%
Black > Caucasian > Asian
Symptoms of BPH
Voiding symptoms: hesitancy, straining, poor stream, incomplete emptying, dribbling, intermittency, double micturition
Storage symptoms: frequency, urgency, incontinence, nocturia
Fever
Signs of BPH
Distended bladder/palpable suprapubic mass
Urinary retention
Investigations for BPH
International prostate symptoms score
DRE: smooth enlargement, size of a ping pong ball
Urinalysis: rule out UTI
PSA: raised (DDx prostate cancer)
USS: rule out other causes, may show mass
CT abdomen/pelvis: rule out other causes, may show mass
Cystoscopy - mass, stone, stricture
Uroflowmetry: Peak urinary flow rate <15 L/second
Urodynamic study: abnormal bladder pressure/voiding
TRUS: rule out prostate cancer
How is severity classified for BPH
IPSS* and QoL score
0-7 mild
8-19 moderate
20-35 severe
What is the management for mild BPH
Watchful waiting (self-monitoring and yearly follow up)
Behavioural management programme (limit fluids, bladder training, treat constipation)
What is the management for moderate BPH
Alpha blocker e.g. tamsulosin oral
5 alpha-reductase inhibitor e.g. Finasteride oral
Phosphodiesterase-5 (PDE-5) inhibitor e.g. sildenafil oral
Anticholinergic e.g. tolterodine oral
What is the management for severe BPH
TUIP (transurethral incision of the prostate) if prostate volume <30g
Photoselective vaporisation of prostate (PVP)
Prostatic urethral lift (PUL)
Transurethral microwave therapy (TUMT)
Transurethral resection of the prostate (TURP) (monopolar or bipolar)
Open prostatectomy or laser enucleation (HoLEP or ThuLEP)
Complications of BPH
BPH progression UTI Renal insufficiency Bladder stones Haematuria Sexual dysfunction Acute urinary retention Overactive bladder TURP sundrome (hyponatraemia, fluid overload, glycine toxicity)
Prognosis for BPH
Majority of patients can expect at least moderate improvement of symptoms with reduced bother score and improve QoL
LUTS - may affect sexual wellbeing and erectile function
Medical therapy will affect sexual function
