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Benign Prostatic Hyperplasia (BPH)

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Two-panel drawing shows normal male reproductive and urinary anatomy and benign prostatic hyperplasia (BPH) - National Cancer Institute

Presentation

  • Frequency

  • Urgency

  • Hesitancy - difficulty starting stream

  • Straining

  • Nocturia

  • Weak/interrupted stream

  • Straining

  • Terminal dribbling

  • Incomplete emptying w/chronic retention


Investigations

  • Abdominal examination - assess for palpable bladder

  • DRE

  • PSA

  • Urine dip - assess infection and haematuria


N.B. PSA is unreliable with a high rate of false positives (75%) and false negatives (15%), therefore may lead to unnecessary further investigations or false reassurance.


Other causes of a raised PSA include:

  • Prostatitis, Prostate cancer

  • UTI, Vigorous exercise, Recent ejaculation


Management

Lifestyle changes:

  • Reduce caffeine + alcohol to help with symptoms of urgency/nocturia

  • Bladder training


Medical:

  • Tamsulosin (a-blocker)

    • Main SE of Postural hypotension

  • Finasteride (5-a reductase inhibitor)

    • Main SE of Sexual dysfunction (Low libido and ED)


Surgical:

  • Transurethral Resection of Prostate (TURP)

  • Open prostatectomy



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