BPH Flashcards
Pathology of BPH
Benign nodular or diffuse proliferation of musculocutaneous and glandular layers of the prostate
Inner (transitional zone) zone enlarges in contract to the peripheral Zone where expansion is seen in prostate carcinoma
Symptoms of BPH
LUTS Voiding Terminal dribble Incomplete emptying Poor flow Hesitancy
Storage Nocturia Frequency Urgency Incontinence
Ix
IPSS DRE MSU U&E TRUS biopsy PSA
TX
Con: avoid caffeine, alcohol = reduced the urgency and nocturia
Relax when voiding
Bladder training
MED: drugs - alpha blockers - tamsulosin, alfuzosin, doxazosin, terzosin they woke by dec smooth muscle tone
5 alpha reductase inhibitors, finesteride, dec conversion of testosterone to dihydrotestosterone
Surg - TURP, TUIP, TULIP, prostatectomy
Why should men taking finesteride use condoms if they’re wife is pregnant or likely to become pregnant
Finesteride dec conversion of testosterone to dihydrotestosterone which is more potent
Finesteride can be excreted in semen
So if the baby is male the external genitalia may not develop normally
What is TURP
Transurethral resection of the prostate
Advice for patients following TURP
Avoid driving for 2 weeks avoid sex for 2 weeks Ejaculate may be reduced due to retrograde ejaculation, this may make you infertile Pass blood in the urine for 2 weeks - haematuria, haemorrhage, - haematospermia - hypothermia - urethral trauma/stricture - post TURP syndrome - absorption of washout causing CNS and CVS disturbance - infection - prostatitis - erectile dysfunction - incontinence - clot retention near strictures - retrograde ejaculation
What is a TUIP
Transurethral incision of the prostate - less destruction than TURP, and less risk to sexual function, gives a similar benefit, small glands may be the best surgical option
What is retropubic prostatectomy
Open operation done when the prostate is very large
What is TULIP
Transurethral laser induced prostatectomy
Maybe as good as TURP
Newer type of prostatectomy
Robotic
