Benign prostate hyperplasia Flashcards
what is the definition of BPH?
Non-cancerous enlarged prostate, increased number of epithelial and stromal cells in the periurethral area of the prostate
what is the epidemiology of BPH?
Increases with age
42% of men between 50 and 60
82% of men between 70 and 80
what is the aetiology of BPH?
The aetiology of benign prostatic hyperplasia (BPH) is multifactorial involving smooth muscle hyperplasia, prostatic enlargement, and bladder dysfunction, as well as input from the central nervous system.
Changes in prostatic stromal-epithelial interactions that occur with ageing and increases in prostatic stem cell numbers are also aetiological considerations. Progression from pathological BPH to clinical BPH (i.e., the presence of symptoms) may require additional factors such as prostatitis, vascular effects, and changes in the glandular capsule
what are the risk factors for BPH?
Over 50
Family history, non-asian race, smoking, male pattern baldness, metabolic syndrome
what is the pathophysiology of BPH?
BPH involves hyperplasia of both epithelial and stromal prostatic components. A key characteristic of BPH is increased stromal:epithelial ratio. Over time, prostatic hyperplasia can result in bladder outlet obstruction. Obstruction has both a prostatic component due to increased epithelial tissue, particularly in a transition zone, and a dynamic component due to increases in stromal smooth muscle tone. A large number of alpha-adrenergic receptors are present in the prostate capsule, stroma, and the bladder neck. The predominant alpha-1 receptor in prostatic stromal tissue is the alpha-1A receptor. Treatment of symptomatic BPH is mainly accomplished via the reduction of the size of the glandular component following inhibition of the formation of dihydrotestosterone by 5-alpha-reductase inhibitors and through relaxation of smooth muscle tone with alpha-blockers.
what are the key presentations of BPH?
Presence of risk factors
Storage and voiding symptoms
what are the signs of BPH?
Risk factors
what are the symptoms of BPH?
Fever
Dysuria
Urinary retention
Stage and voiding symptoms
what are the first line and gold standard investigations for BPH?
Urinalysis - normal in uncomplicated BPH; pyuria may indicate UTI; haematuria might indicate cancer
PSA - elevation greater than age guideline
International prostate symptom score - Mild score: 0 to 7, Moderate score: 8 to 19, Severe score: 20 to 35
Volume charting - diary of frequency and volume of voiding
Digital rectal examination
Transrectal ultrasound
what are the differential diagnoses for BPH?
Overactive bladder, prostatitis, prostate cancer, UTI
how is BPH managed?
Non-bothersome:
Wait and watch
Bothersome with no surgery indications:
Alpha-blockers (terazosin) or 5-alpha-reductase inhibitor (finasteride) or phosphodiesterase-5 inhibitor (sildenafil) or anticholinergic agent (tolterodine), combination
Bothersome with indications for surgery:
Minimally invasive therapy or moderately invasive therapy
Bothersome with indication for surgery, <80g:
Open, laparoscopic or robotic-assisted prostatectomy or laser enucleation
how is BPH monitored?
Monitor clinical symptoms in patients with BPH who are on watchful waiting or are treated with medical or surgical therapies by intermittently assessing the International Prostate Symptom Score
what are the complications of BPH?
BPH regression, UTI, renal insufficiency, infections, stones, haematuria
what is the prognosis of BPH?
The majority of patients with BPH can expect at least moderate improvement of their symptoms with a decreased bother score and improved quality of life.
