Benign Prostatic Hyperplasia

This is a very common benign condition in men of increasing age. It is caused by hyperplasia of the stromal and epithelial cells of the prostate. It usually presents with lower urinary tract symptoms in older men.

 

Lower Urinary Tract Symptoms (LUTS)

  • Hesitancy
  • Urgency
  • Frequency
  • Intermittency
  • Straining to void
  • Terminal dribbling
  • Incomplete emptying

 

Assessment

  • Urine dipstick (exclude infection as a major differential)
  • PSA done prior to rectal examination can help with assessing potential for prostate cancer
  • Rectal exam to assess prostate size, shape and characteristics

 

Management

  • Reassurance and monitoring if manageable symptoms
  • Medications
    • Alpha-blockers (relax smooth muscle; e.g. tamsulosin 400 mcg once daily)
    • 5-alpha reductase inhibitors (block testosterone and actually help reduce the size of the prostate; e.g. finasteride)
  • Surgery
    • Transurethral resection of the prostate (TURP)
    • Transurethral electrovaporisation of the prostate (TUVP)
    • Holmium laser enucleation of the prostate (HoLEP)
    • Open prostatectomy via abdominal or perineal incision

 

Transurethral Resection of the Prostate (TURP)

  • Involves accessing the prostate through the urethra and “shaving” off prostate tissue from inside using diathermy
  • The aim is to create a wider space for urine to flow through, thereby improving symptoms
  • Major complications
    • Bleeding
    • Infection
    • Incontinence
    • Retrograde ejaculation (semen goes backwards and is not produced from the urethra during ejaculation)
    • Urethral strictures
    • Failure to resolve symptoms
    • Erectile dysfunction
  • Alternatives (similar to TURP but different methods for removing prostate tissue)
    • TUVP – prostate tissue is removed using a laser
    • HoLEP – prostate tissue is removed using an electrical current

 

You can remember the complications of a TURP with the mnemonic FIRES:

  • F – Failure to resolve symptoms
  • I – Incontinence
  • R – Retrograde ejaculation (semen goes backwards and is not produced from the urethra during ejaculation)
  • E – Erectile dysfunction
  • S – Strictures
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