BPH and Prostatitis 3.1

Question 1

Mens health poorer than womens because they are reluctant to access health services, less interested/concerned about their health, less likely to report symptoms, behaviours and attitudes related to career and lifestyle choices, sociocultural and biological factors

true or false

Answer 1

true :(

Question 2

What is the difference between hypertrophy and hyperplasia for benign prostatic…?

> enlarged prostate

Answer 2

Hyperplasia = increased number of cells

Hypertrophy = increased cell size

Question 3

What is the most common benign tumour in men?

Answer 3

Benign prostatic hyperplasia

> not cancer

> doest not raise the risk of prostate cancer

Question 4

What condition is associated with the most lower urinary tract symptoms in those >50 years in men?

Answer 4

Benign prostatic hyperplasia

Question 5

What causes BPH? Risk factors?

Answer 5

Causes: directly related to ageing and hormonal activity

Risk factors: NONE known (other than testicles functioning normally)

> removing testicles (e.g. due to cancer) results in prostate shrinking

Question 6

What does enlarged prostate lead to?

Answer 6

Obstructs urethra and bladder = LUTS associated with BPH

> 50% of males aged 51-60 years

> 90% of those over 85 years old

Question 7

Pathophysiology of BPH?

Answer 7

Prostate divided into an inner and outer zone

> inner zone = BPH

> outer zone = Malignancies

• Testosterone converted by 5-alpha reductase to dihydrotestosterone (DHT)
• DHT stimulates hormone growth factors –> influence cell division/proliferation –> prostate enlargement and hyperplasia

> more cell proliferationa and less cell death

Question 8

What are some signs and symptoms of BPH? Why do this these things occur?

Answer 8

Prostate enlargement compresses urehtra which in addition to increase adrenergic tone causes outlet obstruction

> benign clinical enlargement (BCE)

> bladder outlet obstruction (BOO)

> lower urinary tract symptoms (LUTS)

> failure to store urine (irritative symptoms)

• frequency
• nocturia = get up at night to shishi
• urge incontinence and urgency = sudden urge to urina

> failure to empty the bladder (obstructive symptoms)

• hesitancy to initiate urination
• poor flow
• dribbling after urination
• incomplete emptying sensation

Question 9

What laboratory findings and investigations to do for BPH?

Answer 9

U & Es, FBC, LFTs

> ALP elevations: prostate malignancy

Prostate Specific Antigen (PSA)

> rules out cancer, levels raised in BPH

Digital Rectal Examination (DRE)

> general idea about the size and condition of the prostate

Transrectal ultrasound (TRUS)

Urinalysis

> rules out infection

Question 10

What are complicatiosns with BPH?

Answer 10

Acute urinary retention (emergency treatment required)

Renal impairment

Haematuria due to bladder obstruction (blood in urine, rupture of veins in urethra)

Recurrent UTI

Severity of symptoms not related to prostate size

Question 11

What is prostatitis? 3 main types?

Answer 11

Inflammation of the prostate gland

Affects men at any age

Major effect on quality of life

3 main types

> acute bacterial

> chronic bacterial

> chronic non-bacterial

Question 12

Explain acute bacterial prostatitis

Answer 12

• Associated with acute UTI, trauma, bladder outflow obstruction
• Can progress to chronic
• Least common form of prostatitis
• Serious

Question 13

Explain chronic bacterial prostatitis

Answer 13

• Chronic/relapsing UTI
• Associated with pain/discomfort
• Rare

Question 14

Explain chronic non-bacterial prostatitis

Answer 14

AKA chronic pelvin pain syndrome = pelvic pain, LUTS

> pain affects lower abdomen; lower back, rectu, penis, testicles, perineum

> not associated with UTI

> 90-95% of cases of chronic prostatitis

Question 15

Signs and symptoms of prostatitis?

Answer 15

• LUTS
• Perineal pain, prostatic tenderness and fever (acute prostatitis)
• Chronic pelvin pain (chronic prostatitis)
• Chronic prostatitis symptom index (CPSI)

> used to define severity; also for monitoring