BPH - benign prostatic hyperplasia Flashcards
What does BPH stand for?
Benign prostatic hyperplasia
What is BPH?
Common condition affecting older men - enlargement of the prostate when there is hyperplasia of the stromal and epithelia cells. It presents with LUTS.
What are the symptoms of BPH?
Urinary hesitancy, urgency, frequency Nocturia Weak urine flow Straining to pass urine Terminal dribbling after urination Chronic urinary retention - feeling of incomplete emptying
What investigations can be done if a man presents with lower urinary tract symptoms?
Digital rectal examination Abdo exam Urinary frequency volume chart Urine dipstick PSA blood test
Why may a PSA not be reliable for diagnosing conditions?
It has a high rate of false positives. Can be raised by multiple things - prostate cancer - BPH - prostatitis - UTIs - vigorous exercise - recent prostate stimulation
What can raise PSA levels?
- prostate cancer
- BPH
- prostatitis
- UTIs
- vigorous exercise
- recent prostate stimulation (so if testing this, take bloods before a DRE when possible)
How does BPH feel on a DRE?
Smooth, symmetrical, slightly soft enlarged prostate
How does prostate cancer feel on a DRE?
firm, hard, asymmetrical, irregular and lumpy
- loss of central sulcus
How is BPH managed?
Alpha blockers - tamsulosin - 400mg once daily - relaxes smooth muscle
5 - alpha reductase inhibitors - finasteride - 5mg once daily - gradually reduces the size of the prostate
Surgery
How do 5 alpha reductase inhibitors work?
Gradually reduce the size of a prostate by stopping the conversion of testosterone into dihydrotestosterone (the more potent form).
Takes up to 6 mnths to improve symptoms
What are the main side effects of finasteride?
Sexual dysfunction
Breast abnormalities
What are the main side effects of tamsulosin?
Postural hypotension and dizziness
Sexual dysfunction
Nausea and vomiting
What are the surgical options for BPH?
TURP - transurethral resection of the prostate
Open prostatectomy
What are some complications of TURP?
Bleeding Infection Urinary incontinence Erectile dysfunction Retrograde ejactulation Urethral strictures
Which part of the prostate is most commonly affected in BPH?
Transitional (Central) zone
