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

RF BPH

A
  • Older age
  • FH - 1st degree
  • Black african or Caribbean
  • Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

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

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

Management of BPH - monitoring and advice

A
  • Reassure
  • Symptom diary
  • Medication review - cause of LUTs
  • Lifestyle - avoid caffeine, reduce alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do patients present with TURP syndrome?

A
  • Confusion
  • Nausea
  • Agitation
  • Visual changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If very large prostate what can be an option, or if not suitable for surgery?

A
  • Very large - simple prostatectomy
  • Not suitable for surgery but impact on QOL - prostate artery embolisation
17
Q

Complications of BPH

A
  • High pressure retention - chronic or acute on chronic retention causes post renal AKI
  • Recurrent UTI
  • Significant haematuria episode
18
Q
A