BPH Flashcards
What is BPH
BPH is a histological diagnosis and is characterised by non-cancerous hyperplasia of the glandular-epithelial and stromal tissue of the prostate leading to an increase in its size.
What is the most common cause of bladder outlet obstruction
BPH
What is the pathophysiology of BPH
Unclear however androgens play a part in the development of BPH
What is the role of 5a-reductase
This enzyme is in the prostate and converts testosterone into dihydrotestosterone which is more potent that testosterone itself
What are the risk factors for BPH
Age
Family history
Afro-caribean
Ethnicity
Obesity
What are the clinical features of BPH
Voiding sx: Hesitancy Weak stream Terminal dribbling Incomplete emptying
Storage sx:
- frequency
- nocturia
- nocturnal enuresis
- urge incontinence
Haematuria
Haematosperimia
What can be felt on DRE
Smooth englarged prostate
Symmetrical
what are the differential diagnosis of BPH
Prostate cancer - ( DRE = craggy, nodular prostate)
UTI - will have dysuria also
Overactive bladder
Bladder cancer
What are the investigations for BPH
Urinalysis
PSA - to rule of cancer
Ultrasound scan
Urodynamic studies
What is the conservative management for BPH
Symptom diary
Lifestyle advice => less alcohol and caffiene
What is the medical management of BPH
Alpha adreno-receptor anatagonist - tamsulosin - reduces the dynamic component: provides symptomatic benefit
2nd line if above doesnt work:
- 5a reductase inhibitors: finasteride - decreases prostatic volume
What is the surgical management
TURP
What is TURP
endoscopic removal of obstructive prostate tissue using a diathermy loop to increase the urethral lumen size
What is the main complication of BPH
High pressure retention - this is where chronic or acute on chronic urinary retention results in post renal kidney injury
Other complications are:
UTIs
Haematuria
What is the life-threatening complication of TURP
TURP Syndrome
TURP uses hypoosmolar irrigation during the procedure which can result in significant fluid overload and hyponatremia as the fluid enters the circulation through the exposed venous beds.
