BPH Flashcards

1
Q

What does BPH stand for?

A

benign prostatic hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is BPH?

A

Diffuse hyperplasia of the periurethral (transitional) zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the epi of BPH?

A
  1. Prevalence increases with age

2. More common in Afro-Caribbeans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are LUTS symptoms?

A

storage and voiding symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the storage symptoms?

A
  1. Frequency
  2. Urgency
  3. Nocturia
  4. Dysuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the voiding symptoms?

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

FUND HIPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What bedside tests are done for BPH?

A
  1. Urinalysis: exclude UTI and check for bloods

2. DRE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does DRE show for BPH?

A
  1. smoothly enlarge

2. palpable midline groove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What bloods are done for BPH?

A
  1. PSA: high >4

2. U+Es check impaired renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What imaging is done for BPH?

A

Transrectal US-guided needle biopsy: gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is PSA specific?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the conservative management for BPH?

A
  1. Monitor symptom progression
  2. Lifestyle e.g. avoid caffeine
  3. Medication review
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the medical treatment for BPH?

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

- 5a-reductase inhibitors e.g. finasteride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an example of a Selective a1-blocker?

A

tamsulosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
What do you do if failed urinary catherterisation?
1. Catheter introducer (senior input) 2. Suprapubic 3. Flexi guided catheterisation
26
How do you managed acute urinary retention?
1. Painful 2. Retained Volume <1-1.5L 3. Catheterize 4. Consider TWCO +/- alpha blockers
27
How do you manage chronic urinary retention?
1. Painless 2. RV>1-1.5L 3. If no symptoms and tests normal can observe 4. Otherwise needs BOO surgery
28
What are foley catheters?
1. Simplastic (ST) 2. PTFE coated (ST) 3. Hydrogel coated and silicone (LT)
29
How are catheters measured in size?
French or Charriere
30
What are special catheters?
1. 3 way | 2. Coudettip