Urology: BPH Flashcards
Define BPH [1]
Increase in the size of the prostate WITHOUT the presence of malignancy
Which patient populations (apart from older men) is BPH more common in? [1]
Affects Afro-Caribbean’s more severely than white men, probably due to the high levels of testosterone
State the male LUTS from BPH that can be split into voiding [5], storage [4] and post micturition symptoms [1].
Voiding:
SHITE
- Straining
- Hesitancy
- Intermittant stream
- Terminal dribbling
- (incomplete) emptying
Storage:
- Urgency
- Frequency
- Incontinence
- Nocturia
Post mic:
- Dribbling (more delayed than terminal dribbling)
Investigations for BPH? [5]
- Digital rectal examination (prostate exam) to assess the size, shape and characteristics of the prostate
- Abdominal examination to assess for a palpable bladder and other abnormalities
- Urinary frequency volume chart, recording 3 days of fluid intake and output
- Urine dipstick to assess for infection, haematuria (e.g., due to bladder cancer) and other pathology
- Prostate-specific antigen (PSA) for prostate cancer, depending on the patient preference
- IPSS
Mild, moderate and severe IPSS scores? [3]
- Mild symptoms 0 - 7
- Moderate 8 – 19
- Severe 20-35
Which prostate zone is enlarged in BPH? [1]
transitional zone
What is the max flow rate score that is suggestive of bladder outflow obstruction due to BPH? [1]
Max flow rate < 10ml per second is suggestive of bladder outflow obstruction due to BPH
State two complications of not treating BPH [2]
Renal failure: post-renal AKI
Severe UTI leading to sepsis
How do you treat patient with BPH with minimal symptoms? [1]
- If symptoms are minimal then: watchful waiting and advise lifestyle changes
What IPSS score would you offer treatment for BPH? [1]
> 7
What technique can assist with post mic dribbling? [1]
Urethral milking
What are the drug treatment options & order for BPH w/ bothersome symptoms but no indications for surgery? [4]
FIRST LINE: for moderate to severe LUTS
- Alpha 1 antagonists e.g. ORAL TAMSULOSIN
- 5-alpha-reductase inhibitor e.g. ORAL FINASTERIDE / DUTASTERIDE
- phosphodiesterase-5 (PDE-5) inhibitor: tadalafil
- anticholinergics: oxybutynin; tolterodine; solifenacin
Second line:
- Combine alpha 1 antagonist and 5-alpha reductase inhibitor
LUTS + what size prostate [1] or PSA score [1] would you move to second line treatment for BPH? [1]
- Prostate larger than 30g
- PSA > 1.4
BPH Treatment:
The general idea is that [] are used to treat immediate symptoms, and [] are used to treat enlargement of the prostate.
They may be used together where patients have significant symptoms and enlargement of the prostate.
The general idea is that alpha-blockers are used to treat immediate symptoms, and 5-alpha reductase inhibitors are used to treat enlargement of the prostate.
They may be used together where patients have significant symptoms and enlargement of the prostate.
Describe the MoA of finasteride [4]
5-alpha-reductase inhibitor:
* Blocks conversion of testosterone to DHT;
* DHT is considered to be the primary androgen playing a role in the development and enlargement of the prostate gland. It serves as the hormonal mediator for the hyperplasia upon accumulation within the prostate gland
Describe the MoA of tamulosin [3]
Alpha blocker:
* Blockade of α1-adrenergic receptors in prostate, urethra, bladder neck and detrusor muscle
* Relaxation of smooth muscle resulting in improved urinary flow
Describe the pathophysiology of TURP syndrome? [3]
How serious is it? [1]
It is caused by irrigation with large volumes of glycine, which is hypo-osmolar and is systemically absorbed when prostatic venous sinuses are opened up during prostate resection
This results in hyponatremia, and when glycine is broken down by the liver into ammonia, hyper-ammonia and visual disturbances.
TURP syndrome is a rare and life-threatening complication
