BPH Flashcards
BPH occurrence
Affects 24% of men aged 40-64, 40% of men >60 years
BPH cause
Benign nodular or diffuse proliferation of musculofibrous + glandular layers of prostate
Inner (transitional) zone enlarges in contrast to peripheral zone expansion seen in prostatic carcinoma
Experience LUTS
BPH progression
Repeat healthcase visits
Retention risk + recurrent infection
BPH surgery costly
LUTS symptoms
Polyuria Nocturia Urgency Incontinence Hesitancy Intermittency Involuntary interruption of voiding Weak urinary stream Straining to void Dysuria Sensation of incomplete emptying Post-micturition dribbling
BPH assessment
general medical + drug history
Focused physical exam
Abdo exam + external genitalia + DRE
BPH investigations
Urine dipstick Frequency vol. chart IPSS PSA test Serum creatinine
PSA
Mandatory in men with LUTS suggestive of BPH obstruction or abnormal prostate on DRE
>4ug suggestive of prostate cancer?
Causes of increased PSA
DRE Sex BPH Infection/prostatitis UTI (wait 6 months for PSA to normalise) Age Urethral catheterisation Prostatic biopsy
BPH secondary care investigations
Cystoscopy
Imaging of upper urinary tract
Flow rate measurement- normal >15ml/sec
Post-voidal residual volume measurement
BPH management
Bothersome or complicate or IPSS >7
No–> active surveillance- reassurance, information, lifestyle
Yes –> Active intervention- conservative/drugs/surgery
BPH conservative management- storage symptoms
Fluid advice
Supervised bladder training
Lifestyle advice- less caffeine, carbonated drinks, alcohol
Containment products
BPH conservative management- voiding symptoms
Intermittent catheterisation
Urethral milking for post-micturition dribbling
BPH risk of progression
>70yrs + LUTS Moderate to severe symptoms (IPSS >7) PSA>1.4 Prostate estimated >30cm Flow rate<12ml
BPH drug management- moderate to severe
Alpha blocker (tamsulosin
BPH drug management- LUTS + prostate>30g or PSA>1.4 + high risk progression
5 alpha reductase inhibitor (finasteride)