Benign Diseases of the Prostate

Question 1

What are the common diseases of the prostate?

Answer 1

Benign Prostatic Enlargement

Benign Prostatic Hyperplasia

Benign Prostatic Obstruction

Bladder outflow obstruction (BOO - the symptoms patients present with most commonly)

Lower Urinary Tract Symptoms

Question 2

What symptoms do prostatic diseases present with?

Answer 2

LUTS (Voiding):

• Terminal dribbling
• Incomplete voiding
• Problems initiating
• Weak stream

LUTS (Storage):

• Frequency
• Nocturia
• Urgency +- incontinence

Question 3

What investigations are carried out to assess for prostate disease?

Answer 3

• MSSU
• Flow rate study
• Post-void bladder residual USS
• Bloods to check for PSA and Urea and Creatinine (in chronic retention)

Question 4

How are prostate diseases treated?

Answer 4

Uncomplicated BPO:

• Watchful waiting

Medical Therapy:

• Alpha blockers (treatment for LUTS)
• 5 Alpha reductase inhibitors (reduce size of prostate)

Surical intervention:

• TURP (Trans urethral resection of prostate)

Complicated BPO:

• Most patients will require surgery
• Medical therapy
• Long term catheterisation in patients unfit for surgery

Question 5

What are the complications of BPO?

Answer 5

• Progression of LUTS
• Acute or Chronic urinary retention
• Overflow incontinence
• Bladder stones
• Renal failure due to back pressure build up from retention
• UTI’s

Question 6

How do patients with renal colic and ureteric colic present?

Answer 6

Symptoms:

• Pain
• Frank haematuria
• Symptoms of complications

Clinical signs:

• Palpable mass
• Microscopic haematuria
• Signs of complications

Question 7

How are patients with renal colic and ureteric colic managed?

Answer 7

Resuscitation:

• ABC’s
• IV access, bloods, ABG, urine and blood cultures
• IV fluids and antibiotics
• Analgesia

Investigations - e.g. imaging

Emergency treatment of obstruction:

• Percutaneous nephrostomy insertion
• Retrograde stent insertion

Definitive treatment of obstruction