Benign prostatic hypertrophy Flashcards

1
Q

Define Benign prostatic hypertrophy

A

Benign prostatic hypertrophy (BPH) is the increase in size of the prostate without malignancy present. It is normal with increasing age.

40% of 50yr old M and 90% of 90yr old M will develop it.

More common in African american than white.

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2
Q

BPH presentation

A

HIFU

Hesitancy - stand in toilet before initiating, with poor stream, dribbling, and stop during the act

Frequency - commonest presentation

Incomplete emptying - always temptation no matter how many times try to void

Urgency - fear and quickly fearing incontinence or accident

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3
Q

What to ask about frequency when taking history

A

How many times void a day?

And how many times rise at night?

Small or large volumes?

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4
Q

Signs of BPH

A

• Palpable bladder – causes could be obstruction or neuro caused.

• PR:
o Poor anal tone (neuro related palpable bladder)
o Size of prostate
o Texture: firm but not hard, smooth without nodules

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5
Q

Investigations

A

PR

Symptom scoring systems

Urine flow meter readings

Prostate volume assessment (PR and trasrectal USS)

Renal function tests and USS

Urine dipstick

U&E - kidney function

FBC

LFTs - isolated elevation of alkaline phosphate indicates malignancy of prostate to bone. Or pagets of bone undiagnosed

PSA - elevated with a large benign prostate.

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6
Q

Management of BPH

A

Watchful waiting

Alpha blockers (Doxazocin)

5-alpha reductase inhibitor (Finasteride)

Surgery

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7
Q

What surgical options for BPH are there

A

Transurethral resection of the prostate (TURP) is first line.

Holmium laser enucleation of the prostate (HoLEP) equally effective.

Transurethral incision of the prostate (TUIP)

Open prostatectomy - rarely needed unless very large

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8
Q

Differential diagnosis

A

Bladder tumours, stones, trauma, neurogenic

Prostate cancer

Urethral strictures

UTI

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