BPH Flashcards
What causes BPH?
What part of the prostate does if affect?
Hyperplasia of the stromal and epithelial cells of prostate due to failure of apoptosis in these cells
Leads to increase in prostate size by >30ml w/o malignancy
Effects the TRANSITIONAL ZONE
What is the difference between BPE and BPH?
BPE= clinical diagnosis due to the manifestation of symptoms:
- LUTS
- DRE findings
- uroflowmetry
- imaging
BPH:
-histological diagnosis
What are the 2 types of LUTS?
What is the relationship between degree of BPE and retention?
Voiding symptoms:
- straining
- hesitancy
- poor stream
- intermittency
- terminal dribble
- feeling of incomplete emptying
- haematuria
Storage:
- frequency
- urgency
- nocturia
- nocturnal enuresis (bed wetting)
Symptoms are proportional to degree of BPE
What investigations are indicated in someone with possible BPH?
DRE
- smooth + symmetrical
- enlarged
- central sulcus intact
Abdo exam
-looking for palpable bladder to see if retaining
Urinary frequency volume chart
Urine dip stick
- infection
- haematuria
PSA
How would uroflowmetry differ between normal person and someone with BPH?
Normal:
- will reach max flow rate (30ml/sec) very quickly
- finished voiding within 30 secs
BPH:
- takes longer to reach max flow rate and max rate is reduced from normal
- graph tails off due to problems completely emptying
How is BPH managed?
What are the possible SE of medication?
Alpha-1-adrenoreceptor antagonist
TAMSULOSIN
-acts to inhibit NAd on SM of prostate and bladder neck to decrease obstruction
SE:
- retrograde ejaculation-> need to warn patient might experience cloudy urine but that its not a problem
- dizziness
- postural hypotension-> need to be careful with patients already at high risk of falling
- floppy iris during cataracts surgery
5-alfa reductase inhibitors
-blocks production of dihydrotestosterone to try and decrease prostate size
Transurethral resection of prostate (TURP)
-when patients not responding to medication and keep developing complications
