BPH

Benign prostate hyperplasia

Prostate function:
1.secrete alkaline 2.PSA

**PSA increased ddx:
 x6:tumor, BPH,prostatitis, infection, trauma, urine routine

Risk:
  1.Age
  2.Testosterone-->DHT(via 5 alpha-reductase)

--->造成muscle, gland 的比例增加
-->造成BPH

Location:
transitional zone(around urethra),median lobe,lateral lobe
S/S:
  1.hematuria 初段尿和末段尿
  2.LUTS syndrome

  -obstruction(voiding):
     Weak voiding strain
     Intermittemt
     Strain to voiding
     Empty incomplete

  -Storage(irritation):
    Frequency
    Urgency
    Nocturia

Evaluation score:"IPSS"

Treatment:

-medication:
     1.alpha-1 blocker
     2.5alpha-reductase inhibitor: side effect:libido
     3.anticholinergic: for urgency (if PVR>100ml才用)

-surgery :TURP
*surgical indication:
     1.aurea episode>3 times
     2.urosepsis
     3.Stone formation
     4.VUR

*TURP complication:
1.TURP syndrome:

S/S:
 hypertension first->then hypotension shock
 hyponatremia->IICP
 pulmonary edema
Treatment:
 IV fluid
2.Bleeding
3.Urine retention due to blood clot
4.incontinence
5.retrograde ejaculation
6.urethra stricture

*TURP拔 foley:
兩個月內會urgency,漏尿,dysuria,hematuria.不可以騎腳踏車or 機車