Condition- Benign Prostatic Hyperplasia Flashcards

1
Q

What is benign prostatic hyperplasia?

A

Slowly progressive nodular or diffuse hyperplasia of the periurethral (transitional) zone of the prostate gland.

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2
Q

Describe how you can differentiate between benign and malignant enlargement of the prostate…

A

In BPH the inner transitional zone enlarges rather than peripheral layer expansion seen in prostate carcinoma

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3
Q

What is the cause of BPH?

A

UNKNOWN Age related changes in androgen/oestrogen balance

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4
Q

What are the two main changes in BPH which cause LUTS and obstruction of urinary outlet?

A

Static: Narrowing of the urethral lumen by increased benign prostatic tissue Dynamic: Increase in stromal muscle tone mediated by a1 receptors

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5
Q

List the presenting symptoms of BPH

A

LUTS:

  1. Storage:
  • Increased frequency
  • Increased Urgency
  • Nocturia
  1. Voiding:
  • Weak stream
  • Hesitancy
  • Intermittency
  • Straining
  • Incomplete emptying
  • Post-void dribbling
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6
Q

What are the syptoms of acute vs chronic retention syndrome…

A

ACUTE

  • Sudden onset inability to urinate
  • SEVERE PAIN

CHRONIC

  • Painless
  • Frequency
  • Nocturia
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7
Q

What are the signs of BPH on physical examination

A
  • DRE: smoothly enlarged, palpable midline groove
  • Signs of Acute retention: suprapubic pain, palpable distended bladder
  • Signs of Chronic retention: painless, distended bladder
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8
Q

List some of the appropriate investigations for BPH?

A
  1. Urinalysis: to check for UTI
  2. Bloods:
    • U&Es- check for impaired renal impairment
    • PSA- to rule out cancer
  3. MSU:
    • MC&S
  4. Imaging:
    • US of urinary tract
    • Transrectal US (TRUS)- to asses bladder size and volume +/- biopsy
    • Flexible cytoscopy
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9
Q

How would you manage a patient with acute urinary retention?

A

Catheterisation

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10
Q

What sort of advice would you give to a patient with mild BPH?

A
  • Avoid caffeine
  • Alcohol to reduce urgency
  • Relax when voiding
  • Control urgency by practising distracting exercises
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11
Q

Which 2 classes of medications could you use to manage someone with BPH?

A
  • Selective a1a blocker (TAMSULOSIN): relax SM of internal urinary sphicter + prostate capsule
  • 5a-reductase inhibitor (FINASTERIDE): inhibits conversion of DHT to testosterone
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12
Q

What advice should you give to a sexually active patient who is on FINASTERIDE for BPH management?

A

The Finasteride is excreted in the semen so a condom should be worn during intercourse

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13
Q

List three types of surgery that could be performed on a patient with BPH

A
  • TURP: transurethral resection of prostate
  • TUIP: Transurethral incision of prostate
  • Open Prostatectomy
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14
Q

List some of the compliactions of BPH

A
  • UTI
  • Acute or chronic urinary retention
  • Bladder diverticuli
  • Stones
  • Obstructive renal failure
  • Complications of TURP
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