Benign Prostatic Hyperplasia Flashcards
What is BPH?
- non-cancerous hyperplasia of the glandular-epithelial and stromal tissue of the prostate leading to an increase in its size
What are the RF for BPH?
- Age
- 40% >50 have BPH
- 90% > 80 have BPH
- Afro American /afro carribean
- Higher testosterone
- Obesity
- FHx
What is the most common cause of bladder outlet obstruction and LUTS in men?
- BPH
What is the function of the enzyme 5a reductase found in the prostate?
- converts testosterone to DHT (more potent)
What screening tool is used to evaluate and quantify LUTS?
- International Prostate Symptom Score (IPSS)
Describe the classification of IPSS
- 1-7
- Mild sx
- 8-19
- Moderate sx
- 20-35
- Severe
What questions will you ask in the IPSS?
“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)
What Ex would you perform for BPH?
- 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
What are the differentials for BPH?
- 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
What ix would you order for BPH?
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
How would you mx BPH?
- 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)
What are the cx of BPH?
- urinary retention
- recurrent UTI
- CKD
- Bladder calculi
- Haematuria
What are the s.e. of tamsulosin?
- postural hypotension
- retrograde ejaculation
- Floppy Iris Syndrome (occurs intra-operatively in those undergoing cataract surgery)
What is a rare but life threatening cx of TURP?
- TURP Syndrome
- fluid overload
- hyponatraemia
What are the sx of TURP syndrome?
- confusion
- nausea
- agitation
- visual changes
How does Finasteride work?
- Inh. 5a reductase type 2
- Apoptosis of prostatic epithelial cells & reduction in prostate volume
*takes 6 months for clinical effect
What are the SE of finasteride?
- reduced libido
- erectile dysfunction
- ejaculatory dysfunction (less common)
When would you consider a DRE on men?
- LUTS (e.g. nocturia, frequency, hesitancy, urgency or retention)
- Haematuria
- Unexplained symptoms that may be explained by advanced prostate cancer (e.g lower back pain, bone pain, weight loss)
- Erectile dysfunction
- Other reasons to be concerned of prostate cancer (e.g. elevated PSA)
