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Benign Prostatic Hyperplasia

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UTI/Urolithiasis/history of urosurgery/tumors ... Post void residuals (if not done earlier) ... Expectant (Watchful waiting) Low IPPS, adequate flow, low PVR ... – PowerPoint PPT presentation

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Title: Benign Prostatic Hyperplasia


1
Benign Prostatic Hyperplasia
  • Rajan Narula
  • Senior Staff Specialist
  • The Townsville Hospital

2
Assessment LUTS
  • IPPS
  • Voiding Diary
  • DRE
  • Urinalysis
  • Serum creatinine
  • PSA

3
  • Upper tract Imaging
  • UTI/Urolithiasis/history of urosurgery/tumors/rete
    ntion/hematuria
  • USS generally adequate in uncomplicated LUTS
  • CT and MRI no role in elderly uncomplicated LUTS

4
Assessment by Urologist
  • Uroflowmetry
  • Post void residuals (if not done earlier)
  • Prostate size-TRUS or Suprapubic Ultrasound (if
    not done earlier)

5
Management options
  • Expectant (Watchful waiting)
  • Low IPPS, adequate flow, low PVR
  • 85 stable at 1 year 65 at 5 years
  • Education May not progress
  • Reassurance Ca Prostate
  • Monitoring IPPS, PVR, Uroflowmetry
  • Lifestyle advice Fluid intake, Constipation,
    Medications

6
Medical management 1
  • Medications Alpha Blockers
  • Tamsulosin, Alfuzosin, Terazosin,Prazosin
  • 20-50 reduction in IPSS
  • 20-30 improvement in flow
  • Ideally in patients with small prostates and no
    complicating factors,but can be used in larger
  • Rapid action 24-48 hours
  • Can be used for TOV after acute retention
  • 4-8 week before giving up
  • Efficacy similar
  • Side effects(10) and price are decisive

7
Medical management 2
  • 5 alpha reductase inhibitors
  • Finasteride, Dutasteride
  • Reduce size IPSS and Flow improvement
  • Mean time
  • for max. effect 6 months
  • Prostate size should be gt 40 gm
  • Costs
  • PSA real value is 2x of measured
  • Side effects Minimal

8
AnticholinergicAntimuscaranicSelective M1-M3
receptor inhibitors
  • Not essentially for BPH but when overactive
    bladder symptoms predominate
  • Ditropan(Oxybutinin)
  • Detrusitol(Tolterodine)
  • Vesicare(Solifenacin)
  • Enablex(Darifenacin)
  • Often required post TURP for shorter /longer
    periods.

9
Surgical management
  • Failure of medical management
  • Very high IPPS, poor flow, large PVR
  • Complicating factors
  • Bladder Stones
  • Hematuria
  • ARF
  • Recurrent UTIs
  • Retention/IDC
  • Operations TURP TUIP Millins HOLEP
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