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Benign Prostatic Hyperplasia - Coggle Diagram
Benign Prostatic Hyperplasia
Definition;also called prostate gland enlargement
Epidimeology; older men 51-60yrs, 82% of men between the ages of 71 and 80 years
pathophysiology; increase in activity of 5-alpha reductase with age leading to inc levels of DHt and oestrogen, these then bind to androgen receptors within the prostate causing hyperplasia. Growth here begins to compress on the urethra resulting in the symptoms seen in BPH
aetiology; Hyperplasia of the epithelial and stromal compartments, particularly in the transitional zone, may be attributed to various factors including shifts in age-related hormonal changes creating androgen/oestrogen imbalances. Changes in prostatic stromal-epithelial interactions that occur with ageing and increases in prostatic stem ce
Risk factors; age, Afro-carribean, diabetes and obesity
Signs; smooth enlarged prostate, palpabale bladder
Symptoms; voiding ( weak stream, hesitancy,terminal dribbling) , Storage (nocuria, urgency, urgency incontinence) Lower abdominal pain
investigations; urinalysis (pyuria indicates infection), Prosate-specific antigen, U&E.International Prostate Symptom Score (I-PSS): a 7-symptom questionnaire with an additional bother score to predict progression and outcome [2]
management;
conservative; reduce caffiene intake, treat constipation, reduce fluid intake, bladder training
Bothersome No surgery; 1. alpha-agonist e.g tamsulosin 2. 5-a reductase inhibitor e.g finesteride 3. combination of the two. With each include behavioural management
Transurethral incision of the prostate (TUIP)if prostate volume is greater than 30 grams.
Indications for surgery
U- urinary tract infection
S- Bladder stone
R-recurrent and refractory urinary retention
H; Haematuria
E-elevated creatinine
E-elevated creatinine
S- symptom deterioration