By

Melisa Sukarno Putri

122.0118

Hyperplasia of epithelial and stromal

components of prostate
Progressive obstruction of urinary outflow
Increased activity of detrusor muscle
Causes
Frequency, nocturia
Poor flow , intermittent stream
Hesitation, terminal dribbling

Men > 50 = 41% have

symptoms of LUTS
Only 18% have a diagnosis
Only 10% aware of drugs or
surgery that will help it

Age
? obesity

 Poorly controlled diabetes

Neurological disorders
Urinary tract infections
Abacterial prostatitis
Overactive bladder
Drugs diuretics, anticholinergics,

antidepressants
Lifestyle factors caffeine, alcohol, xs fluids

The presence of the following symptoms

indicates referral to urologist for futher

assessment
Urinary incontinence
Retention
Dysuria
Haematuria
Acute change in symptoms

Palpation of abdomen for

enlarged bladder
enlarged kidneys
constipation
Rectal examination for
Size and consistency of prostate
gland

 Blood tests
Fbc esr
U&es
Fasting blood sugar
? PSA level rises with increasing volume of

prostate gland
Urinalysis
Infection
haematuria

Additional tests as

appropriate by GP
Ultrasound for residual urine

volume
Urinary diaries

Reasons for doing them

Patient reassurance
Patient explanation
Objective assessment of symptoms
Diagnostic precision
Ranking of treatment options
Prediction of treatment outcome

Uroflowmetry
max flow rate and volume of residual urine

after voiding low flow rate indicates need for

TURP
Bladder pressure studies
pressure measurement during filling and

emptying (cystometry) gives information on

over/under activity of detrusor muscle and
obstruction of bladder outlet. Predicts response
to treatment. Use antimuscarinics for over
activity and turp for bladder outlet obstruction

Urinary tract imaging

Ultrasound to estimate residual urine

Urethroscopy
Visual inspection of bladder and uerethra is

used in dysuria or haematuria

 A validated questionnaire using international

prostate symptom scale.

Completion gives total score of 35
17
8 19
20 35

mild
moderate
severe

Response to the quality of life questionnaire

strong predictor or whether intervention is

necessary

 Ask 7 questions. Answers on scale 0 5

depending on severity of symptoms

For first 6 questions scores are
Not at all
=0
< 1 in 5
=1
< half the time
=2
About half the time
> half the time
Almost always

=3

=4
=5

Q7
Never = 0, once = 1, 2x = 2, 3x = 3, 4x = 4, 5x = 5

In last month how often have you

1.
2.
3.
4.
5.
6.
7.

Had sensation of not emptying bladder

completely
Had urge to urinated < 2 hours after previously
finished
Found you stopped and started again several
times
Found it difficult to postpone urination
Had a weak stream (compared to when aged 30)
Had to push or strain to begin urination
How many times did you get out of bed per night
to urinate

 If you were to spend the rest of your life with

your urinary condition the way it is now, how

would you feel about that?
Delighted
Pleased

1
Mostly satisfied
2
Mixed feelings
3
Mostly dissatisfied 4
Terrible
5

Lifestyle modification
Reduce fluid intake
Stop diuretics if poss
Avoid xs night time fluid
intake/caffeine /alcohol
Empty bladder before long
trips/meetings

Treat co morbid contributing

conditions
Diabetes
uti

Drug therapy
Alpha blockers
Improve bladder and prostate smooth

muscle tone
More effective than 5 alpha reductase
inhibitors
All work equally well
Tamsulosin and alfuzosin require no
dose titration

 Drug therapy
5 alpha reductase inhibitors
Reduce prostate volume
Reduces risk of prostate cancer, increases risk of
high grade disease
Combined therapy
Men with large prostate > 40g or PSA >4 or
moderate to severe symptoms combined therapy
will prevent 2 episodes of clinical progression per
100men over 4yrs. Much less effective for men with
smaller prostates

 Drug therapy
Storage problems
Men with symptoms of urinary urgency, frequency,
small, urine volumes and nocturia in the absence of
serious obstructive symptoms are categorised as
over active bladder
Bladder training
Biofeedback
Antimuscarinic drugs ( oxybutinin, tolteridine) alone
or in combination with treatment for obstructive
symptoms

Surgery
TURP
Greatest improvement in symptoms
5% severe haemorrhage risk
Requires GA

Alternative energy sources for TURP

Ultrasound
Laser
microwave

Surgery
Adverse effects of surgery
Loss of ejaculation
Erectile dysfunction
Retrograde ejaculation
Incontinence
Stricture formation
Urinary retention