BPH Flashcards
Define BPH
Benign prostatic hyperplasia - increase in the size of the prostate without the presence of malignancy
Briefly describe the pathophysiology of BPH
Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate
What are the risk factors of BPH?
Increasing age
What is the epidemiology
Common - 24% of men 40-64 and 40% of men over 60
Affects Afro-Caribbean’s more severely than white men, probably due to the high levels of testosterone
What are the symptoms
LUTS
- Hesitancy
- Frequency
- Nocturia
- Urgency
- Post- micturition dribble
What investigations would you do in BPH?
- DRE - feeling for an enlarged prostate but smooth
- Trans-rectal US - to show size of enlargement
- Serum PSA - may be raised
- Biopsy
- MSU
- Flow rate
- Frequency volume
What treatment would you do for minimal symptoms?
Watch and wait
What non-pharmacological treatment advice would you give?
- Avoid caffeine and alcohol to reduce urgency and nocturia
- Relax when voiding
- Void twice in a row to aid emptying
How do alpha-1-antagonists work and what is an example of this drug?
Tamsulosin
Relaxes smooth muscle in the bladder neck and prostate thereby producing increase in urinary flow rate and improvement in obstructive symptoms
How do 5-alpha-reductase inhibitors work?
Blocks the conversion of testosterone to dihydrotestosterone (active form) - the androgen responsible for prostatic growth
When would surgery be an option?
Surgery is required if there is acute urinary retention, failed voiding trials, recurrent gross haematuria (blood in urine), renal insufficiency due to obstruction or failure of medical treatment
What surgical options are there?
- Transurethral resection of prostate (TURP):
- Transurethral incision of prostate (TUIP) - Less destruction than TURP and less risk to sexual function, best for smaller prostate
