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Benign Prostatic Hyperplasia (Diagnosis (Frequency volume chart (Measure…
Benign Prostatic Hyperplasia
Key Facts
Prostate secretes 70% of the volume of seminal fluid and is hormone dependent
The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body
Increase in size of the prostate WITHOUT the presence of malignancy
Epidemiology
More common over 60
Unusual before the age of 45
Common - 24% of men 40-64 and 40% of men over 60
Affects Afro-Caribbean's more severely than white men, probably due to high levels of testosterone
Risk Factors
Increases with age
Castration (removal of testicles) is PROTECTIVE
Androgens e.g. testosterone DO NOT CAUSE BPH but are a requirement for BPH
BPH is not seen in those with castration prior to puberty or genetic disease that inhabit androgen action or production
Pathophysiology
Inner (transitional) zone enlarges in contrast to peripheral layer expansion seen in prostate carcinoma
As the prostate gets bigger, it may squeeze or partly block the urethra (narrows it)
Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate
This often causes problems with urinating
Clinical Presentation
In a small number of cases, BPH may cause the bladder to become occuluded leading to anuria - may lead to UTI, bladder stones or kidney damage
BPH doesn't affects a mans ability to father children
Acute urinary retention
Abdominal exam reveals enlarged bladder
BPH doesn't cause prostate cancer or erection problems
Lower Urinary Tract Symptoms (LUTS)
Poor stream/flow
Hesitancy
Post-micturition dribbling
Overflow incontinence
Urgency
Haematuria
Frequency
Bladder stones
Nocturia (>30% voided volume at night)
Delay in initiation of micturition
Incomplete emptying of bladder
Differental Diagnosis
Bladder tumour, bladder stones, trauma, prostate cancer, chronic prostatitis, UTI
Diagnosis
Serum prostate specific antigen (PSA) - may be raised in large BPH
Biopsy and endoscopy
Transrectal ultrasound - to see size of prostate
Mid-stream urine sample - to exclude infection
Serum electrolytes and renal ultrasound - to exclude renal damage caused by obstruction
Flow rates and residual volume - max flow rate < 10ml per second is suggestive of bladder outflow obstruction due to BPH
Digital Rectal Exam - feel prostate and would feel enlarged but SMOOTH
Frequency volume chart
Measure volumes voided and time over MINIMUM of 3 days
Calculates whether nocturic (>30% voided volume at night)
Treatment
Lifestyle
Relax when voiding
Void twice in a row to aid emptying
Avoid caffeine and alcohol to reduce urgency and nocturia
Drugs
First line: Alpha 1 antagonists
5-alpha-reductase inhibitor
Useful in mild disease or those awaiting surgery
If symptoms are minimal then watchful waiting
Surgery - usually reserved for those with a large prostate or failure to response to an adequate trial of medical therapy
Complications if untreated
Haematuria
UTI
Acute retention
Bladder calculi