Benign prostatic hypertrophy Flashcards
Define Benign prostatic hypertrophy
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.
BPH presentation
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
What to ask about frequency when taking history
How many times void a day?
And how many times rise at night?
Small or large volumes?
Signs of BPH
• 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
Investigations
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.
Management of BPH
Watchful waiting
Alpha blockers (Doxazocin)
5-alpha reductase inhibitor (Finasteride)
Surgery
What surgical options for BPH are there
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
Differential diagnosis
Bladder tumours, stones, trauma, neurogenic
Prostate cancer
Urethral strictures
UTI