Bph
2
Benign Prostatic Hyperplasia BPH is a benign growth of nodules in the periurethral region of the prostate that can impact on urination due to compression of the urethra through both direct growth but also because of an increase in tone of smooth muscle mediated by the alpha-1 adrenoreceptor. BPH is a benign condition and does not lead to cancer. Epidemiology: 50% at 50yrs and 80% at 80yrs, about one third of males will develop clinically relevant BPH. Risk factors: - Age - FHx Clinical presentation: - Storage symptoms: o Frequency o Urgency o Nocturia - Voiding symptoms o Weak stream o Hesitancy o Intermittency o Straining o Incomplete emptying o Post-void dribbling Investigations: - Urinalysis for pyruria (UTI a greater risk) - PSA: elevated relative to age guideline, malignancy - Ultrasound: to rule out malignancy, look for hydronephrosis and also urolithiasis - CT abdomen: same as ultrasound, indicated if haematuria, recurrent UTI, UT surgery. - PR Examination - Global bother score - International prostate symptom score… Treatment: If not severe, just monitor.
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Transcript of Bph
Benign Prostatic Hyperplasia
BPH is a benign growth of nodules in the periurethral region of the prostate that can impact on urination due to compression of the urethra through both direct growth but also because of an increase in tone of smooth muscle mediated by the alpha-1 adrenoreceptor. BPH is a benign condition and does not lead to cancer.
Epidemiology: 50% at 50yrs and 80% at 80yrs, about one third of males will develop clinically relevant BPH.
Risk factors:
- Age- FHx
Clinical presentation:
- Storage symptoms:o Frequencyo Urgencyo Nocturia
- Voiding symptomso Weak streamo Hesitancyo Intermittencyo Strainingo Incomplete emptyingo Post-void dribbling
Investigations:
- Urinalysis for pyruria (UTI a greater risk)- PSA: elevated relative to age guideline, malignancy
- Ultrasound: to rule out malignancy, look for hydronephrosis and also urolithiasis- CT abdomen: same as ultrasound, indicated if haematuria, recurrent UTI, UT surgery.- PR Examination
- Global bother score- International prostate symptom score…
Treatment:
If not severe, just monitor.
If more severe:
- Alpha blocker – relaxes the prostate smooth muscle- PDE-5-inhibitor (sildenafil) – mostly with comorbid erectile dysfunction- NSAIDs- Behavioural management (limiting intake of fluids etc..)
- 5-alpha reductase inhibitor prevents DHT production and reduces the size of the prostate.
- SURGERY MAY ULTIMATELY BE NECESSARY, ESP. IF BIGGER THAN 80GM.
