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Flashcards in FN: BPH Deck (46):
1

Epi

70% @ 60 yrs
90% @ 80yrs

2

Epi

70% @ 60 yrs
90% @ 80yrs

3

Path

1. Benign nodular or diffuse hyperplasia of stromal and epithelial cells
2. Affects inner (transitional) layer of prostate (cf. Ca) - urethral compression
3. DHT produced from testosterone in stromal cells by 5alpha reductase enzyme
4. DHT-induced GFs - raised stromal cells and reduced epithelial cell death

4

Presentation

Storage symptoms
Voiding symptoms

5

Storage symptoms

Nocturia
Freqeuncy
Urgency
Overflow incontinence

6

Voiding symptoms

Hesitancy
Straining
Poor stream/flow + terminal dribbling
Strangury (urinary tenesmus)
Incomplete emptying: pis en doux

7

Other symptoms

Bladder stones secondary to stasis
UTI secondary to stasis

8

Examination

PR
-smoothly enlarged prostate
- Definable median sulcus

Bladder not usually palpable unless acute on chronic obstruction

9

Investigations

Blood: U+E, PSA (after PR)
Urine: dip, MC+S
Imaging: transrectal US ± biopsy
Urodynamics: pressure/flow cstometry
Voiding diary

10

Mx conservatuce

reduced caffeine, EtOH
Double voiding
Bladder trainingL hold on - raised time between voiding

11

Mx medical

Useful in mild disease and while awaiting TURP
1st - alpha-blockers
2nd - 5alpha - reductase

12

Alpha-blockers

- Tamsulosin, doxazosin
- Relax prostate smooth muscle

13

Alpha blockers SE

Drowsiness, reduced BP, depression m EF, increased wt, extra-pyramidal signs

14

5 alpha reductase

Finasteride
Inhibit conversion of testosterone - DHT
Preferred if significantly enlarged prostate

15

5 alpha reductase SE

Excreted in semen (use condoms), ED

16

Surgical Mx indications

Symptoms affect QoL
Complciatino sof BPH

17

Surgical MX

TURP - cystoscopic resectino of lateral and middle lobes

18

Transurethral incisions of prestate (TUIP)

19

Tranurethral electrovaporisation of prostate

Electric current - tissue vaporisation

20

Laser prostatectomy

reduced ED and retrograde ejaculation
Similar efficiacy as TURP

21

Open retropubic prostatectomy

Used for very large prostates >100g

22

TURP complciations immediate

TUR syndrome - absorption of large quality of fluids - reduced NA
Haemorrhage

23

TURP complications early

Haemorrhage
Infection
Clot retention: requires bladder irrigation

24

LAte complications of TURP

Retrograde ejaculation: common
ED 10%
Incontinence

25

Path

1. Benign nodular or diffuse hyperplasia of stromal and epithelial cells
2. Affects inner (transitional) layer of prostate (cf. Ca) - urethral compression
3. DHT produced from testosterone in stromal cells by 5alpha reductase enzyme
4. DHT-induced GFs - raised stromal cells and reduced epithelial cell death

26

Presentation

Storage symptoms
Voiding symptoms

27

Storage symptoms

Nocturia
Freqeuncy
Urgency
Overflow incontinence

28

Voiding symptoms

Hesitancy
Straining
Poor stream/flow + terminal dribbling
Strangury (urinary tenesmus)
Incomplete emptying: pis en doux

29

Other symptoms

Bladder stones secondary to stasis
UTI secondary to stasis

30

Examination

PR
-smoothly enlarged prostate
- Definable median sulcus

Bladder not usually palpable unless acute on chronic obstruction

31

Investigations

Blood: U+E, PSA (after PR)
Urine: dip, MC+S
Imaging: transrectal US ± biopsy
Urodynamics: pressure/flow cstometry
Voiding diary

32

Mx conservatuce

reduced caffeine, EtOH
Double voiding
Bladder trainingL hold on - raised time between voiding

33

Mx medical

Useful in mild disease and while awaiting TURP
1st - alpha-blockers
2nd - 5alpha - reductase

34

Alpha-blockers

- Tamsulosin, doxazosin
- Relax prostate smooth muscle

35

Alpha blockers SE

Drowsiness, reduced BP, depression m EF, increased wt, extra-pyramidal signs

36

5 alpha reductase

Finasteride
Inhibit conversion of testosterone - DHT
Preferred if significantly enlarged prostate

37

5 alpha reductase SE

Excreted in semen (use condoms), ED

38

Surgical Mx indications

Symptoms affect QoL
Complciatino sof BPH

39

Surgical MX

TURP - cystoscopic resectino of lateral and middle lobes

40

Transurethral incisions of prestate (TUIP)

41

Tranurethral electrovaporisation of prostate

Electric current - tissue vaporisation

42

Laser prostatectomy

reduced ED and retrograde ejaculation
Similar efficiacy as TURP

43

Open retropubic prostatectomy

Used for very large prostates >100g

44

TURP complciations immediate

TUR syndrome - absorption of large quality of fluids - reduced NA
Haemorrhage

45

TURP complications early

Haemorrhage
Infection
Clot retention: requires bladder irrigation

46

LAte complications of TURP

Retrograde ejaculation: common
ED 10%
Incontinence

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