2. Benign prostatic enlargement Flashcards
(17 cards)
what is benign prostatic enlargement?
an enlargement of the prostate gland which is most often due to benign prostatic hyperplasia (BPH). BPH is a histological diagnosis and is characterised by non-cancerous hyperplasia of the glandular-epithelial and stromal tissue of the prostate leading to an increase in its size.
cause of BPE?
prostate converts testosterone to dihydrotestosterone (DHT) using the enzyme 5α-reductase. DHT is more potent and causes prostatic growth
risk factors for BPE?
- Age
- family history (first degree relatives),
- Afro Caribbean ethnicity
- obesity
clinical features?
voiding symptoms (hesitancy, weak stream, terminal dribbling, or incomplete empyting) or storage symptoms (urinary frequency, nocturia, nocturnal enuresis, or urge incontinence)
DRE finding?
A firm, smooth, symmetrical prostate is a reassuring sign that its not cancer (a more rounded prostate of greater than two finger widths may indicate enlargement)
what are the 7 questions in The International Prostate Symptom Score
- Had the sensation of not emptying your bladder completely after you finish urinating? (incomplete emptying)
- Had to urinate again less than two hours after you finished urinating? (frequency)
- Found you stopped and started again several times when you urinated? (intermittency)
Found it difficult to postpone urination? (urgency) - Had a weak urinary stream? (weak stream)
- Had to push or strain to begin urination? (straining)
- Most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? (nocturia)
differentials?
- Prostate cancer: asymmetrical craggy/nodular prostate and raised PSA are indicative of prostate cancer
- UTI: the addition of dysuria, loin or suprapubic pain, or pyrexia, in the presence of a nitrite- and/or leucocyte-positive urine dip
- Overactive bladder: bladder ultrasound will show a low post-void residual volume.
- Bladder cancer: haematuria is likely to be the predominant feature
Investigations?
- urinary frequency and volume chart
- urinalysis
- Prostate Specific Antigen (PSA) - raised
- USS
- Urodynamic studies - bladder contractility, flow rate, and storage capacity.
Management?
if no symptoms:
- reassure
- symptom diary
- medication review (especially iatrogenic causes of LUTS),
- lifestyle advice (e.g. moderating caffeine and alcohol intake)
if symptoms:
- α-adrenoreceptor antagonist (α-blockers)*, such as tamsulosin
- 5α-reductase inhibitors, such as Finasteride,
how do α-adrenoreceptor antagonist work?
Relax prostatic smooth muscle via blockade of α-adrenoceptors, thus reducing the dynamic component.
how do 5α-reductase inhibitors work?
prevent the conversion of testosterone to DHT, resulting in a decrease in prostatic volume.
what are the surgical management option for BPH?
TransUrethral Resection of the Prostate (TURP)
describe TransUrethral Resection of the Prostate (TURP)
endoscopic removal of obstructive prostate tissue using a diathermy loop to increase the urethral lumen size
complications for BPH?
high-pressure retention, where chronic or acute-on-chronic urinary retention results in a post-renal kidney injury. Other complications of the condition include recurrent UTIs or significant haematuria episodes.
what is TURP syndrome?
life-threatening complication of TURP. TURP can result in significant fluid overload and hyponatremia as the fluid enters the circulation through the exposed venous beds.
clinical features of TURP syndrome?
confusion, nausea, agitation, or visual changes
treatment of TURP syndrome?
addressing the fluid overload and carefully reducing the level of hyponatremia
