1: BPH

Question 1

What is BPH

Answer 1

Enlargement of the peripheral zone of the prostate

Question 2

What is benign prostatic syndrome

Answer 2

Symptoms due to enlargement of peripheral zone of the prostate

Question 3

Explain incidence of BPH

Answer 3

Increases with age

Question 4

What are the two groups of symptoms in BPH

Answer 4

Storage

Voiding

Question 5

What is a mnemonic to remember storage symptoms

Answer 5

FUNI

Question 6

What are the storage symptoms

Answer 6

Frequency
Urgency
Nocturia
Incontinence

Question 7

What is a mnemonic to remember voiding symptoms

Answer 7

UR-HITS

Question 8

What are the voiding symptoms

Answer 8

Urinary retention 
Hesitancy 
Intermittency 
Terminal dribbling 
Stream weak

Question 9

How will BPH present on DRE

Answer 9

Smooth enlarged prostate rubbery texture

Question 10

How is BPH investigated

Answer 10

All men with LUTS should be offered: abdominal exam, male genital exam, DRE.

And, urinalysis.

Question 11

What are 3 indications for PSA in men with suspected BPH

Answer 11

1. Abnormal DRE
2. Concerns about prostate cancer
3. BPH causing obstruction

Question 12

If men with BPH are troubled by LUTS what should they complete

Answer 12

Urinary frequency-volume chart

Question 13

What should all men with BPH be asked to complete

Answer 13

International prostate symptom score (IPSS) to assess severity of symptoms

Question 14

What is first-line for BPH

Answer 14

Finasteride (5a reductase inhibitor)

Question 15

What lifestyle advice should be offered for BPH

Answer 15

• Reduce caffeine and alcohol
• Void twice in a row
• Bladder training

Question 16

What is first-line medication for BPH

Answer 16

Finasteride

Question 17

What is finasteride

Answer 17

5a reductase inhibitor

Question 18

When is finasteride given

Answer 18

Prostate >30g

PSA >1.4

Question 19

What is an alternative to finasteride

Answer 19

Tamsulosin

Question 20

What is the MOA of tamsulosin

Answer 20

a-blocker

Question 21

When is tamsulosin indicated

Answer 21

Moderate-Severe BPH

Question 22

When is surgery for BPH indicated

Answer 22

If medical management has failed

Question 23

What surgery is used most commonly for BPH

Answer 23

Trans-urethral resection prostate (TURP)

Question 24

What surgery can be used for prostates under 30g

Answer 24

Trans-urethral incision prostate (TUIP)

Question 25

What is TUVP

Answer 25

Trans-urethral vaporisation of prostate

Question 26

What is HoLEP

Answer 26

Holmium laser enucleation of prostate

Question 27

What is used for a large prostate

Answer 27

Retropubic prostatectomy

Question 28

What can as a complication of TURP

Answer 28

Post TURP syndrome

Question 29

What causes post-TURP syndrome

Answer 29

Irrigation with large amounts of glycine (which is hypos molar) on operating it enters systemic circulation. Causes hyponatraemia. As glycine is metabolised by the liver it produces ammonia which can cause encephalopathy and visual disturbance.

Question 30

When does post-TURP syndrome become increased risk

Answer 30

• Prolonged surgery
• More fluid used
• Larger prostate

Question 31

What can BPH lead to

Answer 31

• Acute urinary retention
• Recurrent UTIs
• Bladder calculi
• Hydronephrosis

Question 32

Explain relationship between BPH and prostate cancer

Answer 32

BPH does NOT increase risk of bladder cancer

Question 33

what is a mnemonic to remember complications of TURP

Answer 33

TURP

Question 34

what are complications of TURP

Answer 34

Turp syndrome

Urethral stricture or UTI

Retrograde Ejaculation

Peforation prostate