Benign Prostatic Hypertrophy (BPH, Benign Prostatic Enlargement, BPE)

Last updated 23.02.13

 

Index

 

Definition

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Features

-  BPH = Histological diagnosis describing periurethral prostatic hyperplasia

 

Risk Factors

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Causes

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Associated S/S

-  Lower Urinary Tract Symptoms (LUTS)

-  Voiding symptoms

-   Hesitancy

-   Poor urinary stream

-   Intermittent flow

-   Incomplete emptying

-   Postvoid dribbling

-   Overflow incontinence

-  Storage symptoms

-   Frequency

-   Nocturia

-   Urgency

-   Urge incontinence

-  Haematuria

-  Recurrent UTI

-  Urinary retention

-  Palpable bladder

-  Anuria

 

DDx

-  Voiding S/S: bladder neck stenosis, urethral stricture, poor detrusor contractility

-  Storage S/S: UTI, bladder calculi, urothelial carcinoma, overactive bladder

 

International Prostate Symptom Score (IPSS)

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Ix

-  DRE (PR)

-  Size

-  DDx prostate Ca

-  Urine dipstick + MCS

-  Exclude UTI

-  Detect haematuria

-  +/- US

-  Prostate size usually inaccurate by TA

-  PSA

-  +/- Post void residual volumes

-  +/- Uroflowmetry

 

Mx

-  Watchful waiting

-  Medications

-  Commence in primary care setting

-  Alpha blockers

-   Assist voiding symptoms

-   Efficacy similar between selective & non-selective

-   Selective may have fewer side effects but not on PBS

-   Prazosin (Minipress)

-   On PBS

-   Start small dose 0.5mg Nocte (as risk of postural hypotension)

-   Up to 2mg BD

-   Tamsulosin (Flomaxtra)

-   +/- $60 for 30 tablets

-   0.4mg Daily

-  5 alpha reductase inhibitors

-   Shrink prostate to assist voiding symptoms

-   Block conversion of testosterone to DHT

-   Finasteride (Type 2 only)

-   Dutasterise (1 & 2)

-  Antimuscurinics (M3)

-   Bladder relaxation to assist storage symptoms

-   Contraindicated if high post void residuals as risk of acute urinary retention

-   May impair cognitive function

-  Surgery

-  More effective than medical

-  Indicated if

-   Refractory urinary retention

-   Bladder stones

-   Recurrent UTIs

-   Persistant haemturia

-  TURP

-  Green light LASER prostatectomy

-  Holium LASER enucleation

-  Transurethral needle ablation

-  Transurethral microwave thermotherapy

-  Open prostatectomy

-   Reserved only for very large prostates

 

 

 

References

 

http://www.racgp.org.au/download/documents/AFP/2011/October/201110arianayagam.pdf