Condition- Benign Prostatic Hyperplasia Flashcards
What is benign prostatic hyperplasia?
Slowly progressive nodular or diffuse hyperplasia of the periurethral (transitional) zone of the prostate gland.
Describe how you can differentiate between benign and malignant enlargement of the prostate…
In BPH the inner transitional zone enlarges rather than peripheral layer expansion seen in prostate carcinoma
What is the cause of BPH?
UNKNOWN Age related changes in androgen/oestrogen balance
What are the two main changes in BPH which cause LUTS and obstruction of urinary outlet?
Static: Narrowing of the urethral lumen by increased benign prostatic tissue Dynamic: Increase in stromal muscle tone mediated by a1 receptors
List the presenting symptoms of BPH
LUTS:
- Storage:
- Increased frequency
- Increased Urgency
- Nocturia
- Voiding:
- Weak stream
- Hesitancy
- Intermittency
- Straining
- Incomplete emptying
- Post-void dribbling
What are the syptoms of acute vs chronic retention syndrome…
ACUTE
- Sudden onset inability to urinate
- SEVERE PAIN
CHRONIC
- Painless
- Frequency
- Nocturia
What are the signs of BPH on physical examination
- DRE: smoothly enlarged, palpable midline groove
- Signs of Acute retention: suprapubic pain, palpable distended bladder
- Signs of Chronic retention: painless, distended bladder
List some of the appropriate investigations for BPH?
- Urinalysis: to check for UTI
- Bloods:
- U&Es- check for impaired renal impairment
- PSA- to rule out cancer
- MSU:
- MC&S
- Imaging:
- US of urinary tract
- Transrectal US (TRUS)- to asses bladder size and volume +/- biopsy
- Flexible cytoscopy
How would you manage a patient with acute urinary retention?
Catheterisation
What sort of advice would you give to a patient with mild BPH?
- Avoid caffeine
- Alcohol to reduce urgency
- Relax when voiding
- Control urgency by practising distracting exercises
Which 2 classes of medications could you use to manage someone with BPH?
- Selective a1a blocker (TAMSULOSIN): relax SM of internal urinary sphicter + prostate capsule
- 5a-reductase inhibitor (FINASTERIDE): inhibits conversion of DHT to testosterone
What advice should you give to a sexually active patient who is on FINASTERIDE for BPH management?
The Finasteride is excreted in the semen so a condom should be worn during intercourse
List three types of surgery that could be performed on a patient with BPH
- TURP: transurethral resection of prostate
- TUIP: Transurethral incision of prostate
- Open Prostatectomy
List some of the compliactions of BPH
- UTI
- Acute or chronic urinary retention
- Bladder diverticuli
- Stones
- Obstructive renal failure
- Complications of TURP