Benign prostatic hyperplasia Flashcards
What are LUT storage and voiding symptoms?
Storage
- Frequency
- Nocturia
- Urgency
- Incontinence
Voiding
- Hesitancy
- Straining
- Poor or intermittent stream
- Incomplete emptying
- Dribbling
- Haematuria and dysuria
What is BPH?
Increased size of the prostate gland due to an increase in the number of epithelial and stromal cells in the periurethral area of the prostate.
Is BPH normal with advancing age? Before what age is it uncommon?
Is it more common in a specific ethnicity?
Yes
Uncommon before 40/45
More common in Afro-American than White men as they have higher levels of testosterone, 5-a reductase activity and androgen receptor expression.
What percentage of men between 71-80 will have BPH?
82%
Name some LUTS
Urinary frequency Urinary urgency Hesitancy Incomplete bladder emptying Pushing or straining Haematuria Bladder stones or UTI
What is the I-PSS? What is it used for?
International prostate symptoms score and is a questionnaire used to assess the impact on QOL of LUTS.
What things would you want to ask when taking a history of a patient presenting with LUTS?
- The symptoms present, storage, voiding or mixture?
- Duration of the symptoms
- PMH: DM, neurological disease, urethral stricture history, history of UTIs?
- Past surgical history
- Allergies
- Drug history
What things would you consider doing when examining a patient presenting with LUTS?
- General examination and fitness for surgery incase required
- Abdominal examination
- Checking for palpable bladder - indicating chronic outflow obstruction or neurogenic bladder
- Palpable kidney? (typically can’t palpate kidneys)
- Genital examination
- Check for lesion causing urethral obstruction due to lesion for eg.
- Focused neurological examination
- Lower limb to rule out spinal injury causing LUTS
- Urinalysis
- Rule out UTI
- DRE
- Tone of anal sphincter and pelvic floor
→ Normal prostate 20g (fingers breadth)
→ 3 fingers breadth (45-60g)
→ Symptoms unusual below 2 fingers breadth
→ Firm but not hard and smooth without nodules
- Tone of anal sphincter and pelvic floor
- PSA test to rule out prostatic cancer
What does a frequency volume chart document?
Documents the time a person voids and documents the quantity as well as episodes of incontinence
Management of BPH aims?
Improve urinary symptoms
Improve QOL
Reduce complications of bladder outflow obstruction
What life style changes could help with BPH?
- drinking fewer fizzy drinks and less alcohol and caffeine
- Drinking less fluids in the evenings
- Emptying bladder before long journeys
- Double voiding
- Eating more fibre to avoid constipation and excessive pressure on the bladder
- Bladder training
What medical therapy is available to help with BPH? (2)
How do they work?
Alpha-blockers
They work by reducing the muscle tone in the neck of the bladder by binding to the alpha receptors causing them to relax and allowing urine to pass.
Tamsulosin is usually used
5-alpha reductase inhibitors
- They work by shrinking the prostate gland by inhibiting the conversion testosterone into dihydrotestosterone
- Example is finasteride or dutasteride
What risk is associated with the use of tamsulosin
Risk of floppy iris syndrome
When would we use a less selective alpha blocker such as doxazosin?
Less selective alpha blockers can also act on alpha receptors in blood vessels causing vasodilation.
This means if a patient who has HTN also has BPH, we can treat both conditions with 1 drug.
When would we use combination therapy for BPH?
- Combination therapy is better than monotherapy for patients, particularly if their symptoms are very bothersome.
- Typically, use 5-a reductase inhibitors and alpha blockers together and then stop alpha blockers 6 months after as 5a begin to work
- Treatment should be continued for at least one year.
