Benign prostatic hyperplasia (Complete) Flashcards
What are the main risk factors for BPH?
Age (50% at age 50 and 80% at age 80)
Ethnicity: Blacks > White > Asian
What are the main signs/symptoms of BPH?
Voiding (obstructive) symptoms:
Hesitancy (difficulty starting or maintaing urinary flow)
Weak or intermittent urinary flow
Straining
Terminal dribbling
Incomplete emptying
Storage (irritation) symptoms:
Urgency
Urgency incontinence
Nocturia
Increased urinary frequency
Post-micturation:
Dribbling
Signs:
Symmetrically enlarged prostate
Give examples of voiding symptoms in patients with BPH (5)
Hesitancy (difficulty starting or maintaing urinary flow)
Weak or intermittent urinary flow
Straining
Terminal dribbling
Incomplete emptying
Give examples of storage symptoms in patients with BPH. (4)
Urgency
Urgency incontience
Nocturia
Increased urinary frequency
What are the main complicatons that can arise as a result of BPH?
Urinary retention
UTI
Obstructive uropathy (leads to hydronephrosis)
What are the main investigations performed for patients suspected of BPH?
Bedside:
Urine dipstick: Rule out UTI
Bloods:
U&Es: Check especially if chronic retention is suspected which can cause renal impariement.
PSA: Check if patient worried for prostate cancer or obstructive symptoms.
Other:
Urinary frequency-volume chart: For at least 3 days [helps distingush obstructive or irritative pathology]
International prostate symptom score (IPSS): Define severity of symptoms
What scoring system is used to determine severity of BPH?
International prostate symptom score (IPSS)
For IPSS, what is the score range for the following:
Mildly symptomatic
Moderatley symptomatic
Severely symptomatic
Mild: 0-7
Moderate: 8-19
Severe: 20-35
Urinary frequency chart must be done for at least how many days?
At least 3 days
What is the management plan for a patient with BPH who is mildly symptomatic?
Watchful waiting
What is the management plan for a patient with BPH who is moderately/severely symptomatic?
Medicine:
First line: Alpha-1-antagonists: e.g. tamsolusin, alfusozin.
5 alpha-reductase: For significantly enlarged prostate at high risk of progression. (e.g. finasteride)
Anticholinergics: If a mixture of voiding and storage symptoms that have not been managed by alpha-1-antagonist alone.
Surgery:
Transurethral resection of prostate (TURP): If previous management innefective.
Name examples of alpha-1-antagonists in management of BPH.
Tamsulosin
Alfuzosin
What are complications of alpha-1-antagonists?
Dizziness
Postural hypotension
Dry mouth
Deppresion
How does alpha-1-antagonists work?
Relaxes smooth muscle of bladder and prostate
Give an example of a 5 alpha-reductase inhibitor
Finasteride
When would a 5 alpha reductase inhibitor be considered in a patient with BPH?
If patient has significantly enlarged prostate and high risk of progression
What is the effect of 5 alpha reductase inhibitors?
Reduces prostate size and slows down disease progression.
This however takes time (up to 6 months) to start showing effects
What are some adverse effects of alpha 5 reductase inhibitor?
Erectile dysfunction
Loss of libido
Gynaecomastia
Ejaculation problems
When would a patient be considered for combination therapy with alpha-1-antagonist and 5 alpha-reductase inhibitor?
If moderate-severe voiding symptoms and enlarged prostate
What surgical option can be considered in patients with BPH?
Transurethral resection of the prostate (TURP)
What are the main complications of TURP?
Turp syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of the prostate
What is the most common complication of TURP?
Anteretrograde ejaculaton
What is a serious complication of TURP?
TURP syndrome which presents as:
Fluid overload
Hyponatraemia
Glyceine toxicity
How does TURP syndrome occur?
Occurs when too much of the fluid used to wash the area around the prostate during the procedure is absorbed into the bloodstream.
This tends to cause hyponatraemia
