Benign Prostatic Hyperplasia

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Benign Prostatic Hyperplasia

• Rajan Narula
• Senior Staff Specialist
• The Townsville Hospital

2
Assessment LUTS

• IPPS
• Voiding Diary
• DRE
• Urinalysis
• Serum creatinine
• PSA

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• 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)

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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

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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

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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

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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.

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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