W3L3 BPH

Question 1

Physiology

Answer 1

• Continence mechanism
• Secret the prostatic fluid
• Help in antegrade ejaculation

Question 2

Definition

Answer 2

• Microscopic diagnosis char by cellular proliferation of stromal & epithelial elements of prostate
• The transition zone (inner gland) accounts for the majority of BPH tissue.
• Senile prostatic enlargement
• BPE

Question 3

Etiology

Answer 3

• Disease of aging, rarely identified in males younger than 40 years

Question 4

Symptomatology

Answer 4

• LUTS
• Urinary retention
• Overactive bladder (OAB)
• UTI
• Hematuria
• Renal insufficiency

Question 5

LUTs could be assessed by IPSS:

Answer 5

IPSS(Mild0-7, moderate8-19, severe 20-35)
– Incomplete emptying
– Frequency
– Intermittency
– Urgency
– Weak stream 
– Straining
– Nocturia

Question 6

Signs

Answer 6

• Age
• May be CKD
• May be full bladder
• DRE: 
  – Size
  – Consistency
  – Neurogenic assesment

Question 7

Investigations

Answer 7

Lab:
• Urine analysis
• S creatinine
• PSA(N:<4ng/MI)

Radiology:
• Abdominal & pelvic US: 
  – Kidneys – Bladder
  – Prostate – PVR
• TRUS
  – Accurate prostate size
  – Biopsy if needed

Uroflowmetry:

• best non invasive(LUTS)
• N: 125-150
• Qmax
  
  • 15ml/sec(xobs)
  • <10ml/sec(obs)
• monitor outcome ttt

Question 8

Treatment

Answer 8

1. Non surgical:
   - Self-Help
   - Fluid Management(1.5-2l)
   - Avoid caffeine & alcohol
   - Bladder retraining
2. Medical:
   -Indications:
   -Uncomplicated cases
   -Tolerate treatment
   -Type:
   – Alpha blocker:
   – Immeiate effect, No Effect size
   – alpha reductase inhibitors(finastride)
   • Decrease size
   • Long term Effect
3. Surgical:
   -Type:
   – Minimally invasive(TURP, laser)
   – Open Prostatectomy