What is BPH?
Which areas enlarge?
Benign, nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate
Enlarged inner TZ
LUTS from BPH are caused by what 2 components?
Static - increased tissue bulk –> narrow urethral lumen
Dynamic –> prostate smooth muscle tone increased
What are LUTS?
Storage = FUN
Frequency, urgency, nocturia
Voiding = HIP
Hesitancy, incomplete emptying, poor-flow
Ix in BPH?
DRE, TRUSS +/- biopsy, PSA
Urinalysis, USS KUB
Scoring system for BPH?
IPSS - International prostate symptom score (/35)
Behavioural mx for BPH?
Avoid caffeine, alcohol
Void twice
Bladder training
Limit fuilds
Mx in BPH?
W+W
Pharma mx in BPH?
Alpha-blocker (tamsulosin, doxazosin)
5-alpha reductase inhibitor (finasteride)
Mechanism of alpha-blocker?
SEs?
Smooth muscle relaxation
Post hypo, dry mouth
Mechanism of 5-a reductase inhibitors?
Reduced conversion of testosterone to dihydrotestosterone
Mx of abnormal DRE / PSA?
Surgical referral
If prostate small - TURP / TUVP
If big - open prostatectomy
Comps of BPH
Progression
Sexual dysfunction
Urinary retention
TURP
Causes of urinary retention?
BPH / Ca Calculi Bladder cancer Faecal impaction Infection Anticholinergics Alcohol Neurological
Ix in acute urinary retention?
USS bladder (post-voidal) Urinalysis CT abdo pelvis
Mx of acute urinary retention
Immediate bladder decompression –> catheter
What type of Ca is prostate?
adenocarcinoma
Spread of prostate cancer?
Haematogenous [bone, lung, liver]
Local [seminal vesicles, bladder, rectum]
Lymph nodes
Prostate Ca grading?
Gleason score [level of differentiation]
Screening for prostate Ca?
PSA
look this up*
Pres of prostate Ca?
LUTS, haematuria
if mets –> bone pain, wt loss, anorexia, lethargy
Ix in prostate cancer?
PSA
DRE
TRUSS + biopsy
MRI / CT for staging
Mx for prostate Ca?
Radiotherapy (external or brachy)
Prostatectomy
Mx of mets in prostate Ca?
Androgen deprivation therapy –> goserelin, castration
Bisphosphonates
Palliative radio
Usual ca in bladder?
Transitional cell carcinoma (90%)