BPH Flashcards
Epidimiology of BPH?
70% at 60yrs
90% at 80 yrs
Pathophysiology of BPH?
- Benign nodular or diffuse hyperplasia of stromal and epithelial cells
- affects inner (transitional) layer of prostate giving urethra compression
- DHT produced in stromal cells by 5ar
- DHT induced GFs increases stromal cells and decr. epithelial cell death
Presentation of BPH?
Storage symptoms: nocturia, frequenct, urgency, overflow incont
Voiding symptoms: hesitance, straining, poor flow, strangling, incomplete emptying
Bladder stones 2o to stasis
UTI for ditto
Examination in BPH?
PR: smoothly enlarged prostate with defined median sulcus
Bladder not usually palpable unless acute on chronic obstruction
Ix in BPH?
Bloods: U+Es, PSA (after PR) Urine dip may transrectal us and biopsy voiding diary urodynamics
Management of BPH?
Conservative: cut caffience, alcohol, double voiding, bladder training
Medical: useful in mild disease and while awaiting TURP
1st: a blockers eg tamsulosin/doxaflosin
Relax prostate smooth muscle
2nd: 5ar inhibitos: finasteride
inhibit conversion of testosterone to DHT
preferred if significantly enlarged
S/E of medical treatments for BPH?
a blockers: drowsiness, decreased BP, depressoin, dizziness
FInasteride: excreted in semen, ED
Indications for surgical management of BPH?
symptoms affect QoL
Complications of BPH
options for surgical management of BPH?
TURP, 14% become impotent
TUIP < destruction gives less risk to sexual fx
similar benefits if small prostate
laser prostatectomy: similar efficacy and less ED/retrograde ej
open retropubic: used for v large prostates >100g
Complications of TURP?
Immediate: TURP syndrome- absorption of large volume of fluids gives low NA
Haemorrhage
Early: Haemorrhage, infection, clot retention
Late: retrograde ej ED Incontinence Stricture recurrence
