Benign Prostatic Hyperplasia Flashcards
1
Q
What is BPH?
A
- non-cancerous hyperplasia of the glandular-epithelial and stromal tissue of the prostate leading to an increase in its size
2
Q
What are the RF for BPH?
A
- Age
- 40% >50 have BPH
- 90% > 80 have BPH
- Afro American /afro carribean
- Higher testosterone
- Obesity
- FHx
3
Q
What is the most common cause of bladder outlet obstruction and LUTS in men?
A
- BPH
4
Q
What is the function of the enzyme 5a reductase found in the prostate?
A
- converts testosterone to DHT (more potent)
5
Q
What screening tool is used to evaluate and quantify LUTS?
A
- International Prostate Symptom Score (IPSS)
6
Q
Describe the classification of IPSS
A
- 1-7
- Mild sx
- 8-19
- Moderate sx
- 20-35
- Severe
7
Q
What questions will you ask in the IPSS?
A
“Over the past month how often have you…”
- Had the sensation of not emptying your bladder completely after you finish urinating? (incomplete emptying)
- Had to urinate again less than two hours after you finished urinating? (frequency)
- Found you stopped and started again several times when you urinated? (intermittency)
- Found it difficult to postpone urination? (urgency)
- Had a weak urinary stream? (weak stream)
- Had to push or strain to begin urination? (straining)
- Most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? (nocturia)
8
Q
What Ex would you perform for BPH?
A
- Abdomen - palpable bladder
- motor or sensory loss, checking knee, ankle jerks and plantar responses - exclude neurogenic bladder
- DRE
- more rounded prostate of greater than two finger widths
9
Q
What are the differentials for BPH?
A
- prostate cancer
- asymmetrical, craggy prostate, high PSA
- UTI
- Overactive bladder
- bladder ultrasound - low post-void residual volume
- Bladder cancer
- haematuria
- Chronic prostatitis
- Interstitial cystitis
- urethral structures
10
Q
What ix would you order for BPH?
A
Bedside
- urinary frequency and volume chart
- urineanalysis
- MSU for MCS
- post void bladder scan
Bloods
- PSA
- Routine bloods
- LFT
Imaging
- USS (abdo or transrectal)
Other
- urinary flow assessment
- Qmax (max flow rate)
- Post void volume
11
Q
A
12
Q
How would you mx BPH?
A
- Watchful Waiting (WW) - if sx minimal
- reasssurance, education, monitoring
- Pharma
- a-blockers (tamsulosin)
- if prostate enlargement mild but sx troublesome
- 5-a-reductase inh. (Finasteride)
- if prostate significantl enlarged/PSA >1.5
- can take up to 6 months to be effective
- a-blockers (tamsulosin)
- Surg
- transurethral resection of prostate (TURP)
- transurethral incision of prostate (TUIP) - small prostate (<30ml)
- Holmium Laser Enucleation of the Prostate (HoLEP)
- Prostatic urethral lift
- Open prostatectomy (very large prostate >80ml)
13
Q
What are the cx of BPH?
A
- urinary retention
- recurrent UTI
- CKD
- Bladder calculi
- Haematuria
14
Q
What are the s.e. of tamsulosin?
A
- postural hypotension
- retrograde ejaculation
- Floppy Iris Syndrome (occurs intra-operatively in those undergoing cataract surgery)
15
Q
What is a rare but life threatening cx of TURP?
A
- TURP Syndrome
- fluid overload
- hyponatraemia
