Benign prostatic hyperplasia Flashcards
Risk factors
Age
Black > white > asian
Presentation
Lower urinary tract symptoms
- voiding
- storage
- post-micturation
- complications
Voiding symptoms
Weak or intermittent urinary flow
Straining
Hesitance
Terminal dribbling
Incomplete emptying
Storage symptoms
Urgency
Frequency
Urgency incontinence
Nocturia
Post-micturition symptoms
Dribbling
Complications
UTI
Retention
Obstructive uropathy
Assessment
Urine dipstick
U&Es: particularly if chronic retention is suspected
PSA if obstructive symptoms
Urinary frequency volume chart
International prostate symptom score
Common causes of raised PSA
Prostate cancer
Benign prostatic hyperplasia
Prostatitis
UTI
Vigorous exercise
Recent ejaculation or prostate stimulation
BPH on examination
Smooth
Symmetrical
Slightly soft
Central sulcus
Management
Watchful waiting
Alpha-1antagonists (tamsulosin, alfuzosin)
- decrease smooth muscle tone of prostate
- dizziness, postural hypotension, dry mouth, depression
5 alpha-reductase inhibitors (finasteride)
- block conversion of testosterone to dihydrotestosterone
- reduces prostate volume
- erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
Surgical option
Transurethral resection of prostate
Complications of TURP
Bleeding
Infection
Urinary incontinence
Erectile dysfunction
Retrograde ejaculation
Urethral strictures
Failure to resolve symptoms
