BPH Flashcards
1
Q
What are the common Lower Urinary Tract Symptoms (LUTS)? Divide in to obstructive/voiding and storage/irritatitve.
A
Voiding (obstructive) symptoms: - Hesitancy - Poor flow/weak stream - Irregular or intermittent stream - Post-micturition dribble - Incomplete emptying/urinary retention straining
Secondary storage (irritative) symptoms:
- Frequency
- Urgency
- Nocturia
- Haematuria
- Urge incontinence
- Suprapubic pain
2
Q
What are some DDx for LUTS?
A
- Benign and neoplastic conditions of the lower urinary tract - UTI, prostatis, overactive bladder syndrome, cancer
- Neurological conditions -parkinson’s, stoke, spinal injury, prior pelvic injury
- Other causes: iatrogenic medications, polyuria and nocturia from sleep apnoea, renal dysfunction
3
Q
How do you assess the severity of LUTS?
A
- Impact on quality of life - what can’t you do because of these symptoms?
- International Prostate Symptom Score
- Duration of symptoms
4
Q
What are key important questions you need to ask on history?
A
- FHx of cancers - prostate, bladder, BRAC gene
- Medications – diuretics, anti-cholinergics
- EtOH, caffeine intake, drinking amount/pattern
- Fever/ dysuria ? prostatits /UTI
5
Q
Investigations for BPH
A
- Urine analysis & MCS
- EUC renal function
- PSA because symptomatic
- Renal tract USS
- Bladder Diary
6
Q
What are the management options for BPH?
A
- Conservative/lifestyle: weight reduction, reduce caffeine intake/diuretics/anti-cholinergics, bladder training & pelvic floor exercises
- Alpha-1 blockers (inhibits contraction of smooth muscle at prostate & bladder neck)
A) Prazocin 0.5mg daily, increase to 2mg (S/E hypotension)
B) Tamsulosin “Flomaxtra” selective for bladder and prostate. 400microg daily – authority script for LUTS - 5-alpha reductase inhibitors (5-ARIs) reduce testosterone conversion to dihydrotestosterone -> reduces prostate size
A) finasteride
B) dutasteride
Used in combination medication with A-1 blockers
4) TURP
