Benign prostatic hyperplasia (Investigations and diagnosis (IPSS ( …
Benign prostatic hyperplasia
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.
The prevalence of BPH increases with age and affects 42% men between ages 51-60 years and 82% men between 71-80 years.
Changes in prostatic scrotal epithelial interactions that occur with age.
Investigations and diagnosis
Ensure DRE is performed after PSA as can increase PSA value.
"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
Diary of the frequency and volume of voiding
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
Same as above but additionally, a 5-alpha reductase inhibitor e.g. finasteride 5mg OD
Mild disease and NO bother
Behavioural management like limitation on fluid or bladder training.
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