BPH Flashcards
What does BPH stand for?
benign prostatic hyperplasia
What is BPH?
Diffuse hyperplasia of the periurethral (transitional) zone
What is the epi of BPH?
- Prevalence increases with age
2. More common in Afro-Caribbeans
What are LUTS symptoms?
storage and voiding symptoms
What are the storage symptoms?
- Frequency
- Urgency
- Nocturia
- Dysuria
What are the voiding symptoms?
- Hesitancy
- Incomplete voiding
- Poor stream
FUND HIPS
What bedside tests are done for BPH?
- Urinalysis: exclude UTI and check for bloods
2. DRE
What does DRE show for BPH?
- smoothly enlarge
2. palpable midline groove
What bloods are done for BPH?
- PSA: high >4
2. U+Es check impaired renal function
What imaging is done for BPH?
Transrectal US-guided needle biopsy: gold standard
How do you diagnose BPH?
o HISTOLOGICAL diagnosis that requires biopsy
o Benign prostatic enlargement – clinical finding
o To be classed as hyperplasia – histological finding needed
Is PSA specific?
no
What is the conservative management for BPH?
- Monitor symptom progression
- Lifestyle e.g. avoid caffeine
- Medication review
What is the medical treatment for BPH?
- 1st line : Selective a1-blockers e.g. tamsulosin
- 5a-reductase inhibitors e.g. finasteride
What is an example of a Selective a1-blocker?
tamsulosin
What is an example of a 5alpha reductase inhibitor?
finasteride
When do you do surgical treatment for BPH?
if chosen, or refractory to medical Tx
What is the surgical treatment for BPH?
Transurethral resection of the prostate (TURP)
What is TURP?
visualise the prostate through the urethra – removing the tissue by electrocautery or sharp dissection
Why is a medication review for BPH important?
anticholinergics lead to urinary retention; diuretics etc
How do you manage BPH in emergency (acute urinary retention)?
catheterisation
What other medications can be used?
- Anticholinergics e.g solifinacen: reduce contraction
- Beta 3 agonist: mirabegron
- PDE5 inhibitors
What other surgical methods are there?
- HoLEP
- Urolift
- Rezum
- PAE
How can you find urinary retention?
- Palpable bladder
- Dull percussion
- Consider CISC
What do you do if failed urinary catherterisation?
- Catheter introducer (senior input)
- Suprapubic
- Flexi guided catheterisation
How do you managed acute urinary retention?
- Painful
- Retained Volume <1-1.5L
- Catheterize
- Consider TWCO +/- alpha blockers
How do you manage chronic urinary retention?
- Painless
- RV>1-1.5L
- If no symptoms and tests normal can observe
- Otherwise needs BOO surgery
What are foley catheters?
- Simplastic (ST)
- PTFE coated (ST)
- Hydrogel coated and silicone (LT)
How are catheters measured in size?
French or Charriere
What are special catheters?
- 3 way
2. Coudettip
