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Prostatic Hyperplasia (Management (PSA, Renal biochem i.e. U&E, IPSS…
Prostatic Hyperplasia
Definition: Prostatic hyperplasia is a condition in which the glandular organ the prostate increases in size without signs of malignancy.
NOTE: the prostate secretes 70% of the seminal fluid. It is stimulated by testosterone released by the Ledwig cells
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Pathophysiology
In BPH the inner transitional zone enlarges and the peripheral layer doesn't grow (Different to Prostatic Cancer)
This enlargement can cause there to be pressure put on the urethra and cause there to be problems with voiding or storage
Can either be due to benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate
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Management
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IPSS: looks at the impact BPH is having on the patient's life . 7 domains and each is scored 0-5. 1-7 is mild. 8-19 is moderate and 20-35 is severe.
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Frequency Urine Volume chart for a minimum of 3 days. Look at residual volume <10ml there will be a bladder outflow obstruction
Treatment
Use Alpha Blockers (tamsulosin ). They work by relaxing the bladder neck and the prostatic muscles.This allows an increase in urinary flow and improves symptoms . SE: dizziness, depression, drowsiness, reduced BP and ejaculatory failure.
Avoid: caffeine, alcohol. Void twice in a row and relax when voiding
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5 Alpha Recutase Inhibitors (finasteride). These work by inhibiting the testosterone conversion to dihydrotestosterone. This normally causes increased prostatic growth . Main SE is impotence
Surgery
GOLD STANDARD: TURP. SE: impotence, incontinent and erectile dysfunction
Needed if there is blood in the urine, urinary retention, failed voiding or recurrent obstructions
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