BPH Flashcards
What is benign prostatic hyperplasia?
- Periurethral hyperplasia of stroma and epithelium in prostatic transition zone
- Prostatic smooth muscle cells + hyperplasia both involved
Aetiology of BPH?
- Unknown (DHT required; converted from testosterone by 5a-reductase)
- possible role of impaired apoptosis, oestrogen, other GFs
Epidemiology of BPH?
- Age related
- 25% require treatment
How common is BPH?
Extremely common: 50% or 50y, 80% or 80y
What causes the clinical features of BPH?
Outlet obstruction and compensatory changes in detrusor function
What are the voiding symptoms of BPH?
- Straining
- Hesitancy
- Incomplete Emptying
- Terminal Dribbling
What are the storage symptoms of BPH?
-frequency, urgency, nocturia, urgency incontinence
What causes the storage symptoms of BPH?
thought to be due to detrusor overactivity and/or decreased complicance
DRE findings of BPH?
-Prostate smooth, rubbery and enlarged (symmetrically)
Complications of BPH?
- Retention
- Overflow incontinence
- Hydronephrosis
- Infection
- Gross haematuria
- Bladder stones
Approximate prostate sizes by fruit?
Approximate Prostate Sizes • 20 cc – chestnut • 25 cc – plum • 50 cc – lemon • 75 cc – orange • 100 cc – grapefruit
How may severity of BPH be assessed on history?
AUA Prostate Symptom Score FUNWISE Frequency Urgency Nocturia Weak stream Intermittency Straining Emptying, incomplete feeling of Each symptom graded out of 5 0-7: Mildly symptomatic 8-19: Moderately symptomatic 20-35: Severely symptomatic
History features to ascertain in BPH?
- LUTS and impact on QoL
e. g. AUA Sx index
Ix in BPH workup?
- DRE
- Urinalysis (exclude UTI)
- Cr +/- renal U/S for hydronephrosis
- PSA to r/o Ca
- Uroflowmetry to measure flow rate
- PVR (optional)
- Cystoscopy prior to surgical intervention
- Biopsy if suspicious for malignancy
What are the absolute indications for BPH surgery?
- Renal failure with obstructive uropathy
- Refractory urinary retention
