BPH Flashcards
DDx for bladder outlet obstruction?
GU
- bph
- urethral stone
- urethral stricture
NEOPLASTIC
- prostate cancer
- bladder cancer
Infectious
- chronic prostatitis (type 3?)
Iatrogenic
- antihistamines-> decrease PSNS tone
- diuretics -> increase urine production
- opiates -> impair autonomic dysfunction
- TCA -> anticholinergic effects
What is the Pathophysiology of BPH?
Static: enlarged prostate
Dynamic: increased a2-adrenergic tone in prostate
How common is bph?
85% of men will have it by the age of 80.
S + S of BPH?
Irritation -> uninhibited detrusor contractions
- nocturia
- Polyuria
- urgency
- urge incontinence
Urinary outflow obstruction
- hesitancy
- weak stream
- dribbling
- incomplete emptying
- recurrent UTIs
PR
- bph is symmetrically enlarged, firm prostate (like tip of nose)
Ix for BPH?
Urinalysis
PSA (prostate cx)
- low sensitivity
- earlier detection does not alter life
If suspecting AKI ->. US kidney ureter bladder
Treatment of BPH?
Non-pharmacological
- watchful waiting in most
PHARM
- alpha blocker addresses dynamic component e.g prazosin
- 5a-reductase inhibitors adress static component -> reduce prostate size (reduce progression to surgery but not as good for symptomatic as alpha blocker)
Surgery for TURP? Indications? Why is it better than medical management?
TURP - transurethral resection of prostate
Failure of conservative management. Refractory urinary retention
Persistent haematuria
Reduces symptoms significantly than other methods without any greater risk of sexual dysfunction/incontinence
Complications of TURP?
Haemorrhage Infection Anaesthesia Damage to local structures - sexual dysfunction - strictures TURP syndrome - hyponatraemia due to absorption of hypotonic irrigant
Complications of BPH?
Incomplete emptying of bladder -> UTI
Acute urinary retention, due to prostatic infarction +/- post renal AKI
