BPH Flashcards

1
Q

What does BPH stand for?

A

benign prostatic hyperplasia

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2
Q

What is BPH?

A

Diffuse hyperplasia of the periurethral (transitional) zone

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3
Q

What is the epi of BPH?

A
  1. Prevalence increases with age

2. More common in Afro-Caribbeans

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4
Q

What are LUTS symptoms?

A

storage and voiding symptoms

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5
Q

What are the storage symptoms?

A
  1. Frequency
  2. Urgency
  3. Nocturia
  4. Dysuria
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6
Q

What are the voiding symptoms?

A
  1. Hesitancy
  2. Incomplete voiding
  3. Poor stream

FUND HIPS

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7
Q

What bedside tests are done for BPH?

A
  1. Urinalysis: exclude UTI and check for bloods

2. DRE

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8
Q

What does DRE show for BPH?

A
  1. smoothly enlarge

2. palpable midline groove

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9
Q

What bloods are done for BPH?

A
  1. PSA: high >4

2. U+Es check impaired renal function

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10
Q

What imaging is done for BPH?

A

Transrectal US-guided needle biopsy: gold standard

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11
Q

How do you diagnose BPH?

A

o HISTOLOGICAL diagnosis that requires biopsy
o Benign prostatic enlargement – clinical finding
o To be classed as hyperplasia – histological finding needed

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12
Q

Is PSA specific?

A

no

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13
Q

What is the conservative management for BPH?

A
  1. Monitor symptom progression
  2. Lifestyle e.g. avoid caffeine
  3. Medication review
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14
Q

What is the medical treatment for BPH?

A
  • 1st line : Selective a1-blockers e.g. tamsulosin

- 5a-reductase inhibitors e.g. finasteride

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15
Q

What is an example of a Selective a1-blocker?

A

tamsulosin

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16
Q

What is an example of a 5alpha reductase inhibitor?

A

finasteride

17
Q

When do you do surgical treatment for BPH?

A

if chosen, or refractory to medical Tx

18
Q

What is the surgical treatment for BPH?

A

Transurethral resection of the prostate (TURP)

19
Q

What is TURP?

A

visualise the prostate through the urethra – removing the tissue by electrocautery or sharp dissection

20
Q

Why is a medication review for BPH important?

A

anticholinergics lead to urinary retention; diuretics etc

21
Q

How do you manage BPH in emergency (acute urinary retention)?

A

catheterisation

22
Q

What other medications can be used?

A
  1. Anticholinergics e.g solifinacen: reduce contraction
  2. Beta 3 agonist: mirabegron
  3. PDE5 inhibitors
23
Q

What other surgical methods are there?

A
  1. HoLEP
  2. Urolift
  3. Rezum
  4. PAE
24
Q

How can you find urinary retention?

A
  • Palpable bladder
  • Dull percussion
  • Consider CISC
25
Q

What do you do if failed urinary catherterisation?

A
  1. Catheter introducer (senior input)
  2. Suprapubic
  3. Flexi guided catheterisation
26
Q

How do you managed acute urinary retention?

A
  1. Painful
  2. Retained Volume <1-1.5L
  3. Catheterize
  4. Consider TWCO +/- alpha blockers
27
Q

How do you manage chronic urinary retention?

A
  1. Painless
  2. RV>1-1.5L
  3. If no symptoms and tests normal can observe
  4. Otherwise needs BOO surgery
28
Q

What are foley catheters?

A
  1. Simplastic (ST)
  2. PTFE coated (ST)
  3. Hydrogel coated and silicone (LT)
29
Q

How are catheters measured in size?

A

French or Charriere

30
Q

What are special catheters?

A
  1. 3 way

2. Coudettip