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Benign prostatic hyperplasia (Investigations and diagnosis (IPSS (Urgency,…
Benign prostatic hyperplasia
Definition
An increase in benign prostatic tissue.
Leads to hypertrophy
The increase in tissue narrows the urethral lumen causing the classic LUTs and an increase in prostatic smooth muscle cells tone mediated by alpha-adrenergic receptors.
Epidemiology
The prevalence of BPH increases with age and affects 42% men between ages 51-60 years and 82% men between 71-80 years.
Aetiology
Changes in prostatic scrotal epithelial interactions that occur with age.
Risk factors
FHx
Non-Asian race
50 years
Smoker
Symptoms
Storage
Increased urgency
Nocturia
Increased frequency
Voiding
Hesitancy
Intermittency
Weak stream
Straining
Incomplete emptying
Post-void dribbling
Investigations and diagnosis
PSA
DRE
Ensure DRE is performed after PSA as can increase PSA value.
Urinalysis
IPSS
Urgency
Weak stream
Intermittency
Straining
Frequency
Nocturia
Incomplete emptying
"If you were to spend the rest of your life with these urinary symptoms, how would you feel?
Score of 0-5 for each quiestion
Mild = 0-7
Moderate = 8-19
Severe = 20-35
Volume charting
Diary of the frequency and volume of voiding
Management
Mild disease WITH bother
PDE-5 inhibitor e.g. sildenafil 25-100mg OD
NSAID e.g. celecoxib 100mg OD
Alpha-blocker e.g. tamsulosin 0.4mg OD
Moderate/Severe disease
Same as above but additionally, a 5-alpha reductase inhibitor e.g. finasteride 5mg OD
Mild disease and NO bother
Watchful waiting
Behavioural management like limitation on fluid or bladder training.
Ongoing
If abnormal DRE +- increased PSA +- progressive BPH +- complications
Prostate <80g = surgical referral to urology with some invasive therapy like laser ablation
Prostate >80g = surgical referral to urology then possible prostatectomy via TURP