BPH (module 3) Flashcards
in BPH the prostate size increases due to
increased cell numbers
NOT increased cell size
which cells undergo hyperplasia in BPH
hyperplasia of prostatic stromal and epithelial cells results in nodular growth in the prostatic urethra
symptoms of BPH
continued enlargement can block the urethra
this causes LUTS:
frequency
incomplete emptying
hesitancy
intermittency
urgency
weak stream
staining
nocturia
symptoms of BPH are classified into
storage and voiding symptoms
which symptoms are storage symptoms
urinary frequency
urgency
nocturne
incontinence
which symptoms ate voiding symptoms
weak urinary stream
hesitancy
intermittency
straining
incomplete emptying
complications of BPH
poor bladder emptying leads to:
recurrent UTIs
urinary bladder stones
urinary retention
obstructive uropathy and renal failure
diagnosis of BPH
history of LUTS
rectal examination (smooth enlarged prostate)
prostate specific antigen (PSA)
trans-rectal US and biopsy (a negative prostate cancer biopsy helps confirm BPH)
prostate specific antigen
is a serine protease produced by the prostate involved in the liquefaction of sperm
is prostate specific but not cancer specific
what causes PSA to be increased
serum PSA increases with age, increasing size of prostate and in prostate cancer
can be elevated in urinary infections or after surgical instrumentation
what is IPSS
International prostate symptom score
based on 7 questions to score severity of LUTS
does not establish diagnosis
LUTS stands for
lower urinary tract symptoms
scoring of the IPSS
0-7: misty symptomatic
8-19: moderately symptomatic
20-35: severely symptomatic
what would an IPSS of 22 be?
severely symptomatic
what wound an IPSS of 9 be?
moderately symptomatic
3 classes of drugs used for the treatment of BPH
alpha blockers
5a-reductase inhibitors
anti-cholinergics
commonly used alpha blockers for BPH
prazocin, tamsulosin
which alpha blocker is more uro-selective
tamsulosin (alpha 1a adrenergic antagonist)
what do alpha blockers do to help BPH
relaxes smooth muscle in the prostate gland and bladder neck improving urinary flow
common side effect of alpha blockers
postural hypotension
5 alpha reductase inhibitors
5a-reductase is responsible for the conversion of testosterone to DHT in the prostate
DHT is known to be responsible for the enlargement of the prostate gland
commonly used 5a-reductase inhibitor
finasteride
dutasteride
5a-reductase inhibitor may also be used to treat
male pattern baldness
side effects of 5a-reductase inhibitors
erectile dysfunction
loss of libido
breast tenderness
how do anticholinergics help
treat symptoms of overactive bladder (storage symptoms)
side effects of anticholinergics
dry mouth and contipation
rarely blurred vision and confusion
may precipitate urinary retention (avoid in bladder outflow obstruction)
contraindications of anticholinergics
contraindicated in glaucoma, avoid in the elderly
combination treatment
a combination of an Alpha blocker and a 5a-reductase inhibitor is sometimes required in the medical management of patient with severe LUTS
indications for surgery
severe symptoms
failed medical treatment
complications of bladder outflow obstruction eg. urinary retention, bladder stones, UTI, upper tract obstruction/renal impairment
types of surgery for BPH
transurethral resection of the prostate (TURP)
laser ablation/resection
open prostatectomy
most commonly used surgical treatment of BPH
TURP
which type of patient should get TURP
patient with mainly storage symptoms rather than voiding symptoms
TURP is performed under
spinal or general anaesthetic
TURP involves
inserting a cystoscope and an electrical loop that cuts and diathermies bleeding vessels in the prostate gland.
irrigation fluid is also passed through the cystoscope.
prostate chips that have been removed will be sent off for histopathology
IDC is inserted at the end and remains in situ for 24 hours post op
recovery time for TURP
patients are expected to stay in hospital for approximately 1-2 days post operatively
recovery for most patients in about 2 weeks
how long must the patient have an IDC in after TURP
24 hours post op
possible risks of TURP
bleeding
infection
retrograde ejaculation
erectile problems
urinary incontinence
bladder neck stricture
what is TURP syndrome
dilution hyponatraemia after absorption of hypotonic irrigation solution used during the procedure
what irrigation fluid is usually used during TURP
glycine - this used to be used when monopolar electrical loops were used because it would not conduct electricity, now they have bipolar loops so they can use normal saline
when to do a TURP
- severe symptoms
- failed medical treatment
- complications of
when to reconsider whether TURP is appropriate
over 80s and under 50s
consider possible neurogenic cause for symptoms eg. CVA, diabetic
previous TURP
is increased PSA level diagnostic of BPH
it is not diagnostic of BPH or prostate cancer
how do you quantify symptoms of BPH
IPSS scale
