Prostatic Hyperplasia Flashcards
What is the prostate?
What is its function?
An exocrine gland, found at the base of the bladder, surrounding the urethra
It secretes a thick white fluid that is mixed with sperm to produce semen, this fluid is alkaline to neutralise the acidity of the vagina
Prostate also contains smooth muscle to help expel semen during ejaculation
What are the causes of prostate enlargement?
Benign prostatic hyperplasia (BPH)
Prostate cancer
What is BPH?
Hyperplasia (increased no. of cells) of the prostate
Not caused by malignancy
Which men are most often affected by BPH?
Men over 60
It affects many men, nearly all men would develop it if they were to live long enough
What is the pathogenesis of BPH?
Hyperplasia (increased no. of cells) of the glandular and connective tissue elements of the gland
Enlargement of the inner part of the prostate
Which part of the prostate enlarges in BPH compared to prostatic cancer?
BPH: inner zone
Cancer: peripheral zones
What are the clinical features of BPH?
Increased frequency of urination
Nocturia: needing to urinate through the night
Delay in initiating urination
Reduced force of urinary stream
Post-void dribbling
Urinary retention causing overflow incontinence
Why does BHP cause problems with urination?
The urethra runs through the prostate, so if it is enlarged it obstructs the flow of urine
What should the prostate feel like in BPH?
Smooth, if it is not consider cancer
Investigations of BPH?
Blood:
- PSA
- U+E to see if BPH has caused any renal damage
USS: to check for renal damage caused by BPH
Digital rectal examination: is it smooth, how enlarged is it?
Trans-rectal USS: to rule out cancer
Biopsy: to rule out cancer
Cystoscopy
What is PSA?
Prostate Specific Antigen
A glycoprotein that is expressed by the prostate
If someone has a raised PSA, what could be the cause?
Old age, it’s raised in 80% of men aged 80
Prostate cancer
BPH
Infections: prostatitis
Sigmoidoscopy or anything that causes trauma to the prostate
What should you feel for in a digital rectal examination of the prostate?
If it is enlarged
If it is excessively hard or soft
If it is smooth or if there are nodules/irregularities
Why does BPH not occur in men who have had been castrated for medical reasons?
Removal of the testicles means no production of testosterone
No testosterone means no dihydrotestosterone
No dihydrotestosterone means no prostatic enlargement because it is this hormone that stimulates the prostate to grow
What is dihydrotestosterone and what does it do?
It is the breakdown product of testosterone
It stimulates the prostate to grow
What should you do if you have a patient with a raised PSA?
Do a digital rectal exam to assess condition of prostate
Refer to a specialist for a biopsy to rule out cancer
Management of BPH?
In mild cases with few symptoms: watchful waiting
Lifestyle changes
- reduce caffeine and alcohol to reduce urgency + Nocturia
- train the bladder to hold on to urine, to reduce frequency
Medication
Catheterisation
Surgery
What drugs are used to treat BPH?
Alpha adrenoreceptor antagonists (alpha blockers)
5-alpha reductase inhibitors
A combo of both!
How do alpha blockers work?
Relax bladder smooth muscle to increase urine flow, reducing symptoms of obstruction
How do 5-alpha reductase inhibitors work?
Block conversion of testosterone to dihydrotestosterone
So the dihydrotestosterone can’t stimulate prostate growth
What surgical methods can be used to treat BPH?
TURP: transurethral resection of the prostate
TUIP: transurethral incision of the prostate
Prostatectomy
What is TURP?
Transurethral resection of the prostate
Part of the prostate is cut out, via the urethra
What is TUIP?
Transurethral incision of the prostate
Removes some of the prostate but not all of it
Which of TURP and TUIP have worse side effects?
TURP: more of prostate is removed
There’s a 14% chance of becoming impotent with this operation
