Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 > Benign prostatic hyperplasia (URO) > Flashcards

Benign prostatic hyperplasia (URO) Flashcards

1
Q

Define BPH.

A

Benign glandular and stromal hyperplasia of the transitional zone of the prostate

Hyperplasia of the epithelium and stromal prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the LUTS/bladder outlet obstruction in BPH due to? (2)

A
  • static component - related to increase in benign prostatic tissue narrowing urethral lumen
  • dynamic component - increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can the LUTS in BPH be defined into? (2)

A
  • storage symptoms - frequency, urgency, nocturia, incontinence
  • voiding symptoms - weak stream, dribbling, dysuria, straining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does the prevalence of BPH increase with?

A

Age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the epidemiology of BPH.

A
  • 42% of men 51-60 affected
  • 82% of men 71-80 affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the aetiology of BPH.

A
  • DHT is a potent prostatic growth factor
  • androgen/oestrogen imbalance as men age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference between pathological and clinical BPH?

A

The presence of symptoms means clinical vs pathological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which drug is contraindicated in BPH and why?

A

Amitriptyline - can cause urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the purpose of PSA (BPH)?

A

PSA produced by luminal cells in prostate help liquify semen after ejaculation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the predominant receptor in prostatic stromal tissue?

A

Alpha-1 adrenergic receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does prostatitis present? (4)

A
  • pain in perineum/penis/rectum/back
  • obstructive voiding symptoms
  • fevers and rigors
  • DRE –> tender, boggy prostate

BPH characterised by voiding LUTS, prostatitis characterised by pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we manage prostatitis? (2)

A
  • quinolone (e.g. ciprofloxacin) for 14 days
  • screening for STI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical features of BPH? (4)

A
  • storage symptoms
  • voiding symptoms
  • UTIs
  • urinary retention (acute vs chronic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two types of LUTS in BPH?

A
  • voiding (obstructive) symptoms - often predominant
  • storage (irritative) symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the voiding (obstructive) symptoms in BPH? (6)

A

SW HIPS

  • straining to urinate
  • weak stream
  • hesitancy (difficulty initiating urination)
  • intermittency
  • post-void dribbling
  • sensation of incomplete emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the storage (irritative) symptoms of BPH? (3)

A

FUN

  • frequency
  • urgency
  • nocturia
  • (dysuria)
17
Q

What does a fever with dysuria suggest (BPH)?

A

Complicated UTI

18
Q

What are the features of acute vs chronic urinary retention in BPH?

A
  • acute - severe suprapubic pain, distended palpable bladder
  • chronic - painless, frequency, nocturia, large distended painless bladder, signs of renal failure
19
Q

What might you find on examination in BPH?

A
  • DRE: prostate usually smoothly enlarged with a palpable midline groove
  • feel against anterior wall of rectum (lies along posterior prostate)
  • hard nodules could be a sign of prostate cancer
  • NB: poor correlation between size and severity of Sx
20
Q

What are the risk factors for BPH? (6)

A
  • age >50
  • Fx of BPH
  • non-Asian race
  • cigarette smoking
  • male pattern baldness
  • metabolic syndrome
21
Q

What are the first-line investigations for BPH? (4)

A
  • urinalysis
  • PSA (prostatic-specific antigen)
  • IPSS (symptom score questionnaire)
  • frequency/volume chart and voiding diary
22
Q

What is the gold-standard investigation for BPH?

A

Transrectal ultrasound-guided needle biopsy

23
Q

What might urinalysis show in BPH?

A
  • uncomplicated BPH - normal
  • pyuria (pus in urine) –> UTI
  • haematuria –> cancer
24
Q

What does PSA show in BPH?

A
  • elevation greater than age guideline - rough indicator for prostate size
  • increased PSA suggests underlying prostate cancer or prostatitis
  • results can guide men with LUTS
25
What is the IPSS (BPH)?
International Prostate Symptom Score: self-administered questionnaire with 8 questions (7 on Sx from 0-5): - mild: 0-7 - moderate: 8-19 - severe: 20-35 1 additional question on QOL (bother score) scored from 0-6
26
What is post-void volume a measure of in BPH? (1 + 3)
Urinary retention - <50mL = adequate bladder emptying - 50-100mL = normal in elderly - >200mL = abnormal - due to incomplete bladder emptying or bladder outlet obstruction
27
What does BPH feel like on DRE?
Smooth enlarged prostate + palpable midline groove
28
What are some differential diagnoses for BPH? (8)
- overactive bladder (frequency, incontinence, nocturia) - prostatitis (fever, suprapubic pain, tender enlarged prostate on DRE) - prostate cancer (abnormal DRE, low free PSA) - UTI - bladder cancer (haematuria, suprapubic pain, bladder spasms with abnormal voiding, tobacco Hx) - neurogenic bladder (Hx vascular disease, Parkinson's, MS, DM with neuropathy) - bladder underactivity - urethral stricture
29
How do we manage emergency BPH?
Catheterisation
30
How do we manage mild BPH?
Conservative management: - monitor symptom progression (watchful waiting) - lifestyle - avoid caffeine and alcohol, relax when voiding, control urgency, reduce fluids at night
31
What is the first and second-line drug for BPH?
- **1st-line: alpha1-blockers (tamsulosin)** - bind to a1 receptors to relax smooth muscle of bladder to decrease resistance to urinary flow - **2nd-line/adjunct: 5-alpha-reductase inhibitors (finasteride)** - reduced conversion of testosterone to DHT --> reduced prostate growth - (phosphodiesterase-5 inhibitors e.g. sildenafil) - (anticholinergic agent - tolterodine)
32
What are some side effects of tamsulosin (a1-blocker in BPH)? (3)
- dizziness - postural hypotension - may also cause retrograde ejaculation
33
What are some side effects of finasteride (5-a-reductase inhibitor in BPH)? (4)
- diminished libido - erectile dysfunction - gynaecomastia - decreases PSA levels
34
What can we do if medical management does not work for BPH? (3)
- TUIP (transurethral incision of prostate) - less destruction=less risk to sexual function, but smaller benefit than TURP - TURP (transurethral resection of prostate) - standard for prostate size<80g and LUTS, or TUVP (transurethral vaporisation of prostate) - open prostatectomy
35
What are some side effects of TURP for BPH? (4)
- retrograde ejaculation - most common complication - TURP syndrome - hyponatraemia, fluid overload, glycine toxicity - urethral stricture/UTI - perforation of prostate
36
What are some complications of BPH? (10)
- BPH progression - recurrent UTI due to residual urine - acute/chronic urinary retention --> bladder stones - sexual dysfunction - bladder hypertrophy --> obstructive renal failure --> post-obstructive diuresis - stone development - hydronephrosis - TURP complications - TURP syndrome (hyponatraemia, fluid overload, glycine toxicity) - haematuria - overactive bladder
37
What is the prognosis of BPH managed with medications vs surgery?
- meds - mild Sx usually well-controlled with meds - surgery - most patients get significant relief from surgery

Year 3 (212 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions