Benign prostatic hypertrophy

Question 1

Define Benign prostatic hypertrophy

Answer 1

Benign prostatic hypertrophy (BPH) is the increase in size of the prostate without malignancy present. It is normal with increasing age.

40% of 50yr old M and 90% of 90yr old M will develop it.

More common in African american than white.

Question 2

BPH presentation

Answer 2

HIFU

Hesitancy - stand in toilet before initiating, with poor stream, dribbling, and stop during the act

Frequency - commonest presentation

Incomplete emptying - always temptation no matter how many times try to void

Urgency - fear and quickly fearing incontinence or accident

Question 3

What to ask about frequency when taking history

Answer 3

How many times void a day?

And how many times rise at night?

Small or large volumes?

Question 4

Signs of BPH

Answer 4

• Palpable bladder – causes could be obstruction or neuro caused.

• PR:
o Poor anal tone (neuro related palpable bladder)
o Size of prostate
o Texture: firm but not hard, smooth without nodules

Question 5

Investigations

Answer 5

PR

Symptom scoring systems

Urine flow meter readings

Prostate volume assessment (PR and trasrectal USS)

Renal function tests and USS

Urine dipstick

U&E - kidney function

FBC

LFTs - isolated elevation of alkaline phosphate indicates malignancy of prostate to bone. Or pagets of bone undiagnosed

PSA - elevated with a large benign prostate.

Question 6

Management of BPH

Answer 6

Watchful waiting

Alpha blockers (Doxazocin)

5-alpha reductase inhibitor (Finasteride)

Surgery

Question 7

What surgical options for BPH are there

Answer 7

Transurethral resection of the prostate (TURP) is first line.

Holmium laser enucleation of the prostate (HoLEP) equally effective.

Transurethral incision of the prostate (TUIP)

Open prostatectomy - rarely needed unless very large

Question 8

Differential diagnosis

Answer 8

Bladder tumours, stones, trauma, neurogenic

Prostate cancer

Urethral strictures

UTI