Benign Prostatic Hyperplasia

Question 1

Benign Prostatic Hyperplasia (BPH) is the non cancerous growth of the prostate that is typically diagnosed by histology. Which age group is BPH most common in?

1 - 41-50
2 - 50-60
3 - 61-70
4 - >80

Answer 1

4 - >80

• 8% men 41-50
• 70% aged 61-70
• > 80% aged >80

Question 2

Does BPH always need treating?

Answer 2

• no
• typically assessment will confirm if treatment is required
• if there is a complicated Bladder Outflow Obstruction who would benefit from treatment

Question 3

What is the name of the part of the urethra that has to pass through the prostate?

1 - membranous
2 - prostatic
3 - penile

Answer 3

2 - prostatic

Question 4

The prostate can be divided into sections. What is the name of the part of the prostate that is the largest part of the prostate and contains 70% of the prostates glandular tissue?

1 - transition zone
2 - verumontanum
3 - central zone
4 - peripheral zone

Answer 4

4 - peripheral zone

Question 5

The peripheral zone of the prostate is the largest and most outer layer of the prostate. What is the next layer moving inwards, which also contains the ejaculatory ducts that join with the prostatic urethra and contains 25% of the glandular tissue of the prostate?

1 - transition zone
2 - verumontanum
3 - central zone
4 - anterior fibromuscular zone

Answer 5

3 - central zone

Question 6

What is the inner most layer of the prostate that contains 5% of the prostates glandular tissue and a proportion of the prostatic urethra?

1 - transition zone
2 - verumontanum
3 - central zone
4 - anterior fibromuscular zone

Answer 6

1 - transition zone
- called this as it contains transitional cells which are also present in the bladder

Question 7

Which zone does BPH typically occur?

1 - transition zone
2 - verumontanum
3 - central zone
4 - peripheral zone

Answer 7

1 - transition zone

Question 8

In males testosterone is converted to dihydrotestosterone (DHT) by the enzyme 5 alpha reductase (5AR). DHT binds to cellular androgen receptors (AR), resulting in DNA transcription, producing growth factors that stimulate prostate growth.

Question 9

In patients with BPH, this can occlude the prostatic urethra and lead to urinary retention. This can cause which of the following complications?

1 - diverticulum
2 - thick walled bladder that is easily irritated
3 - bladder stones
4 - ureteric obstruction
5 - all of the above

Answer 9

5 - all of the above
- also reduces outflow which can be measured using Uroflowmetry, which measures the rate and total volume

Question 10

Which of the following medications can be given to relax the bladder and muscles around the prostate and help with urinary retention in BPH?

1 - Tamsulosin
2 - Solifenacin
3 - Atropine
4 - Dutasteride

Answer 10

1 - Tamsulosin

Question 11

Transurethral Resection of the Prostate (TURP).

• most common treatment
• removes part of the prostate from inside the urethra
• resectoscope inserted into the urethra, and prostate tissue is removed using a diathermy loop.

Answer 11

Question 12

Holmium Laser Enucleation of the Prostate (HoLEP).

• not as common as TURP
• removes part of the prostate from inside the urethra
• resectoscope inserted into the urethra, and prostate tissue is removed using a laser
• BEST relief from obstruction

Answer 12

Question 13

Urethral Strictures are scarring within the urethra. They rarely cause obstructive nephropathy, but can. Can be caused by:

• Congenital
• Post infection
• Instrumentation
• Unknown

Answer 13

Treated with:

• Urethral dilatation
• Optical Urethrotomy (strictures can be opened up)
• Urethroplasty (treating scar tissue in the urethra)