BENIGN PROSTATIC HYPERPLASIA

 

IPPS score in BPH

IFFUNSSI (for the last 30 day)

✓ Incomplete voiding

✓ Frequency

✓ Urgency

✓ Nocturia - asleep, wake up to PU (more than 2)

✓ Strain

✓ Stain

✓ Intermitency

0-5 each point

Assess the most troublesome to the patient everytime TCA?

 

Medication 2 type

- 1) Relieve symptom - alpha blocker

- 2) Reduce prostate volume - 5 alpha reductase inhibitor

 

1) 1st line - Alpha blocker

(Receptor byk di smooth ms)

Relax smooth ms

Alfuzocin, terazocin, tamsulosin

Urethra akan open up

How long it take to give effect?

- 3-7 days baru effect, so pt need use CBD

 

2) 2nd line

💊5 alpha reductase inhibitor

Reduce size volume postate

 

5 alpha reductase enzyme inhibitor-

( fenasteride, dutasteride are better kalau baru nak start)

MOA : This enzyme convert testosterone to dihydrotestosterone (this enzyme can make prostate hyperplasia- more DHT, more bigger prostate ) - so medication will inhibit this enzyme

Give if prostate volume more than 30

To take psa before give it.

 

Selama setahun ia akan bagi effect

Membuatkan level PSA jd half

Kalau lepas ambil setahun ,repeat psa incase PSA 2.5, = as if PSA pt adalah 5 (so, if pt on detasteride 1 year, PSA level more than 2 can consider as high, if pt not on medication must more than 4 then only high.

 

Nota Kaki:

o Testosterone

- produce by testis (95%) and adrenal gland (5%)

o Adverse Effect

- alpha blocker - orthostatic hypotension ( thats why kita bagi sebelum tidur)

- 5- a- reductase inhibitor - erectile dysfunction (so maybe kena bg sildenafil to counter side effect), must counsel patient before give.

 

 

~ Uroflow

- Kena ada 150cc urine utk valid test ni.

- Need to do Prevoiding and post voiding bladder scan

- Post voiding residual urine volume must not more than 30 cc(if more that, already abnormal)

 

✓ Indication TRUS biopsy

- PSA >4, DRE : nodular prostate

 

✓ TRUS Biopsy HPE

Sample Apex PZ, Middle PZ, Base PZ

Hantar different peripheral Zone