(U)- BPH Flashcards

1
Q

What is BPH caused by?

A

Hyperplasia of stromal and epithelial cells of the prostate due to increased DHT

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2
Q

How does BPH usually present?

A

Lower urinary tract symptoms

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3
Q

What are the typical lower urinary tract symptoms that occur with prostate pathology?

A

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

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4
Q

What scoring system can be used to assess severity of lower urinary tract symptoms?

A

IPSS (international prostate symptom score)

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5
Q

What is done on initial assessment of men with LUTS?

A

DRE
Abdominal exam
Urinary frequency volume chart
Urine dipstick
Prostate-specific antigen

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6
Q

Why is it essential to counsel patients before testing PSA?

A

75% false positives
15% false negatives

False positive leads to further investigations, may lead to complications etc.

False negatives may lead to false reassurance

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7
Q

What can cause raised PSA?

A

Prostate cancer
BPH
Prostatitis
UTI
Vigorous exercise (cycling especially)
Recent ejaculation or prostate stimulation

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8
Q

On examination of the prostate what does a benign prostate feel like vs a cancerous prostate?

A

Benign
-Smooth
-Symmetrical
-Slightly soft
-Central sulcus

Cancerous
-Firm/hard
-Asymmetrical
-Craggy or irregular
-No central sulcus

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9
Q

What medical options are used to manage BPH?

A

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

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10
Q

Why does finasteride take 6 months for there to be improved symptoms?

A

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

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11
Q

What surgical options are available for BPH?

A

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

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12
Q

What is the most common surgical treatment of BPH?

A

Transurethral resection of the prostate

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13
Q

What are the major complications of transurethral resection of the prostate?

A

Bleeding

Infection

Urinary incontinence

Erectile dysfunction

Retrogade ejaculation

Urethral strictures

Failure to resolve symptoms

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