(U)- BPH Flashcards
What is BPH caused by?
Hyperplasia of stromal and epithelial cells of the prostate due to increased DHT
How does BPH usually present?
Lower urinary tract symptoms
What are the typical lower urinary tract symptoms that occur with prostate pathology?
Hesitancy– Difficulty starting and maintaining flow
Weak flow
Urgency – Sudden urge to pass urine
Frequency – Needing to pass urine often, usually with small amounts
Intermittency – Flow that starts, stops and varies in rate
Straining to pass urine
Terminal dribbling – Dribbling after finishing urination
Incomplete emptying – Unable to fully empty bladder, with chronic retention
Nocturia – Having to wake to pass urine multiple times at night
What scoring system can be used to assess severity of lower urinary tract symptoms?
IPSS (international prostate symptom score)
What is done on initial assessment of men with LUTS?
DRE
Abdominal exam
Urinary frequency volume chart
Urine dipstick
Prostate-specific antigen
Why is it essential to counsel patients before testing PSA?
75% false positives
15% false negatives
False positive leads to further investigations, may lead to complications etc.
False negatives may lead to false reassurance
What can cause raised PSA?
Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise (cycling especially)
Recent ejaculation or prostate stimulation
On examination of the prostate what does a benign prostate feel like vs a cancerous prostate?
Benign
-Smooth
-Symmetrical
-Slightly soft
-Central sulcus
Cancerous
-Firm/hard
-Asymmetrical
-Craggy or irregular
-No central sulcus
What medical options are used to manage BPH?
Alpha-blockers
Tamsulosin- rapidly improves symptoms, A1 blocker can cause postural hypotension
5-alpha reductase inhibitors
Finasteride- prevents DHT formation, reducing size of the prostate
Why does finasteride take 6 months for there to be improved symptoms?
5-alpha reductase converts testosterone to DHT, which is more potent
With reduced DHT the prostate no longer grows, but it does not shrink straight away, it takes a while for the prostate to reduce in size
Therefore, it takes time before symptoms improve
What surgical options are available for BPH?
Transurethral resection of the prostate (TURP)
Transurethral electrovapourisation of the prostate (TEVAP/ TUVP)
Holmium laser enucleation of the prostate (HoLEP)
Open prostatectomy, via abdominal or perineal incision
What is the most common surgical treatment of BPH?
Transurethral resection of the prostate
What are the major complications of transurethral resection of the prostate?
Bleeding
Infection
Urinary incontinence
Erectile dysfunction
Retrogade ejaculation
Urethral strictures
Failure to resolve symptoms