BPH Flashcards
1
Q
Pathophys of BPH
A
- Prostate converts testosterone to dihydrotestosterone (DHT) using 5-alpha reductase
- DHT is more potent
- Prostate retains ability to respond to testosterone and so levels of DHT remain high through life
2
Q
RF BPH
A
- Older age
- FH - 1st degree
- Black african or Caribbean
- Obesity
3
Q
Symptoms of BPH
A
Voiding symptoms:
* Hesitancy
* Weak stream
* Terminal dribbling
* Incomplete empying
Storage symptoms:
* Frequency
* Nocturia
* Urge incontinence
Less common - haematuria, haematospermia
4
Q
Examination for BPH
A
- Smooth, firm symmetrical prostate
- More rounded and greater than 2 finger widths may indicate enlarged
- Patient should complete IPSS questionaire
International prostate symptom score - scoring LUTS
5
Q
Differentials for BPH
A
- Prostate cancer - craggy, nodular, asymmetric prostate on exam, raised PSA
- UTI - dysuria, loin or suprapubic pain, nitrite/leukocyte +ve dip
- OAB - storage LUTs dominate, good flow rate
- Bladder cancer - haematuria, LUTS less common
6
Q
Investigations for ?BPH bedisde and bloods
A
- Urinary frequency and volume chart - completed by patients
- Urinalysis - exclude UTI
- Post void bladder scan - assess for chronic retention
7
Q
When should PSA test be counselled for?
A
- Black African or Caribbean men 40yrs and older presenting with LUTS
- All other men over age of 50yrs presenting with LUTS
8
Q
Further investigations for BPH
A
- USS renal tract - calculate volume of prostate, assess for retention or hydronephrosis
- Urodynamic studies if diagnosis uncertain and concern re detrusor failure
9
Q
Management of BPH - monitoring and advice
A
- Reassure
- Symptom diary
- Medication review - cause of LUTs
- Lifestyle - avoid caffeine, reduce alcohol
10
Q
Medical management BPH
A
- Tamsulosin - alpha adrenorecpetor antagonist - relax smooth muscle, benefit within days
- If still symptomatic, Finasteride - 5-a reductase inhibitor but take up to 6 months for benefit, reduce prostatic volume
- ED - PDE5 inhibitors eg Sildenafil
- Anticholinergic if severe LUTS - avoid if retention
11
Q
Surgical management of BPH
A
- Used when refractory to medical management or develop complications of BPH eg high pressure retention
- Minimally invasive eg Steam treatment or Urolift to more invasive eg TURP, HOLEP
12
Q
How is TURP performed? What are some complications?
A
- Removal of obstructive prostate tissue using diathermy
- Increases luminal size
- Improvement within few months
- Complications: TURP syndrome, haemorrhage, sexual dysfunction, retrograde ejaculation, urethral stricture
13
Q
What is TURP syndrome?
A
- Rare but life threatening
- TURP requires the use of hypoosmolar irrigation during procedure if using monopolar energy
- This can result in significant fluid overload and dilutional hyponatraemia as fluid enters circulation via venous bleeds
- Use of glycine as irrigating agent can lead to more neural issues as it can act as inhibitory neurotransmitter
14
Q
How do patients present with TURP syndrome?
A
- Confusion
- Nausea
- Agitation
- Visual changes
15
Q
What is HOLEP?
A
- Holmium laser enucleation of prostate
- Using Holium:YAG laser
- Used to heat and dissect sections of prostate and bladder
- BUT technically challenging