Benign Disease of the Prostate Flashcards
(40 cards)
What is BPE/H
Benign prostatic enlargement / hyperplasia
What is BPO
Benign prostatic obstruction
What is BOO
Bladder outflow obstruction
What causes benign prostatic hyperplasia and where is affected
Fibromuscular and glandular hyperplasia
Transition zone affected which surrounds urethra
Which is why likely to present LUTS
Hormone dependent condition
How are the symptoms of BPE scored
IPSS
- International Prostate Severity Score
What are the voiding symptoms of BPE due to obstruction and the storage symptoms due to irritation of bladder?
LUTS due to BOO Voiding problem (obstruction) - SSHEDS - Strain - Stream poor / stop start / difficulty initiating - Hesitation - Emptying incomplete - Dribbling - terminal - Stranguary - urinary tenesmus
Storage (irriration)
- Frequency
- Urgency
- Nocturia - 2+ times
- Overflow incontinence
- Haematuria
What can be found on examination of BPE
Palpable bladder if in retention
Enlarged smooth prostate - if can feel on DRE likely enlarged
Urethral stricture
Phismosis - can’t retract foreskin
Is BPE common ?
Part of ageing process in men
How do you diagnosis BPE
Other tests depending on Sx
PSA prior to DRE as will elevate
DRE
Urinanalysis + MSSU to look for UTI as cause
FBC, U+E to see if retention / abnormal kidney function
Post-void bladder USS = large residual volume or hydronephrosis
Trans-rectal USS / MRI +- biopsy to rule out prostate cancer
- if PSA raised or abnormal DRE
Renal tract USS if abnormal U+E
Cystoscopy if haematruia
How do you treat uncomplicated BPE
Watch and wait - diet / bladder retrain
Alpha blocker - relax smooth muscle, lower BP = 1st line (doxasin / tamsulosin)
5 alpha reductase inhibitor - finasteride
TURP if failed medical = day case procedure
Endoscopic ablation or prostatectomy
Long term urethral or suprapubic catheter
What do 5 alpha reductase inhibitors do (finasteride)
Stop conversion of testosterone to dihydrotestosterone which makes prostate grow Shrinks prostate Reduce LUTS Reduce vascularity and haematuria Reduce prostate cancer risk Takes 6 months to work
What are the complications of BPE/O
Acute and chronic retention Overflow Incontinence UTI due to stasis Bladder stones Renal failure due to high bladder pressure
What are the complications of surgery
TURP syndrome - hyponatraemic state Urethral stricture UTI Retrograde ejaculation as sphincter destroyed (common) Perforation of prostate
Other Bleeding in urine or sperm Infections Stress incontinence Erectile dysfunction Prostatic regrowth
How do you treat the complications of BPE
Cystolitholapaxy of bladder stones
Long term urethral or suprapubic catheter if incontinence
Clean intermittent catheterisation if detrusor under activity
Why do you do urinalysis
Exclude infection
Why is it important to do U+E
To see if retention causing renal failure
What should you always do after initial management of BOO if haematuria
Cystoscopy to look for bladder Ca
What will USS show
Large residual volume
Hydronephrosis
What does TURP syndrome cause and what puts you at higher risk
Venous destruction and absorption of irrigation fluid
Hyponatraemia and fluid overloaded
RF
- CCF
- Time >1 hour
- Large amount of fluid used
- Larged blood loss
- Large section resected
How do you Rx
Fluid restrict
Rx hypoNa
What do A blocker do (tamsulosin / Doxazain)
Lower BP
Relax smooth muscle
What are voiding issues (due to obstruction)
Hesitation Poor stream Terminal dribbling Intermittent Incomplete emptying
What are storage symptoms / LUTS
Frequency Urgency Nocturia Overflow incontinence Haematuria UTI
How do you investigate LUTS
Urinanalysis PSA before DRE DRE Bladder diary Post void USS of bladder to see volume Urodynamic studies for voiding issue
