FN: BPH Flashcards
Epi
70% @ 60 yrs
90% @ 80yrs
Epi
70% @ 60 yrs
90% @ 80yrs
Path
- Benign nodular or diffuse hyperplasia of stromal and epithelial cells
- Affects inner (transitional) layer of prostate (cf. Ca) - urethral compression
- DHT produced from testosterone in stromal cells by 5alpha reductase enzyme
- DHT-induced GFs - raised stromal cells and reduced epithelial cell death
Presentation
Storage symptoms
Voiding symptoms
Storage symptoms
Nocturia
Freqeuncy
Urgency
Overflow incontinence
Voiding symptoms
Hesitancy Straining Poor stream/flow + terminal dribbling Strangury (urinary tenesmus) Incomplete emptying: pis en doux
Other symptoms
Bladder stones secondary to stasis
UTI secondary to stasis
Examination
PR
- smoothly enlarged prostate
- Definable median sulcus
Bladder not usually palpable unless acute on chronic obstruction
Investigations
Blood: U+E, PSA (after PR) Urine: dip, MC+S Imaging: transrectal US ± biopsy Urodynamics: pressure/flow cstometry Voiding diary
Mx conservatuce
reduced caffeine, EtOH
Double voiding
Bladder trainingL hold on - raised time between voiding
Mx medical
Useful in mild disease and while awaiting TURP
1st - alpha-blockers
2nd - 5alpha - reductase
Alpha-blockers
- Tamsulosin, doxazosin
- Relax prostate smooth muscle
Alpha blockers SE
Drowsiness, reduced BP, depression m EF, increased wt, extra-pyramidal signs
5 alpha reductase
Finasteride
Inhibit conversion of testosterone - DHT
Preferred if significantly enlarged prostate
5 alpha reductase SE
Excreted in semen (use condoms), ED
Surgical Mx indications
Symptoms affect QoL
Complciatino sof BPH
Surgical MX
TURP - cystoscopic resectino of lateral and middle lobes
Transurethral incisions of prestate (TUIP)
Tranurethral electrovaporisation of prostate
Electric current - tissue vaporisation
Laser prostatectomy
reduced ED and retrograde ejaculation
Similar efficiacy as TURP
Open retropubic prostatectomy
Used for very large prostates >100g
TURP complciations immediate
TUR syndrome - absorption of large quality of fluids - reduced NA
Haemorrhage
TURP complications early
Haemorrhage
Infection
Clot retention: requires bladder irrigation
LAte complications of TURP
Retrograde ejaculation: common
ED 10%
Incontinence
