Benign Prostatic Hypertrophy

Question 1

How does it present?

Answer 1

It usually presents with lower urinary tract symptoms in older men.
•Hesitancy
•Urgency
•Frequency
•Intermittency
•Straining to void
•Terminal dribbling
•Incomplete emptying

Question 2

Assessing BPH

Answer 2

• Urine dipstick (exclude injection as a major differential)
• PSA done prior to rectal examination can help with assessing potential for prostate cancer
• Rectal exam to assess prostate size, shape and characteristics

Question 3

Managing BPH

Answer 3

• Reassurance and monitoring if manageable symptoms
• Medications

◦Alpha blockers (relax smooth muscle; e.g. tamsulosin 400 mcg once daily)
◦5-alpha reductase inhibitors (block testosterone and actually help reduce the size of the prostate; e.g. finasteride)

•Surgery

◦Transurethral resection of the prostate (TURP)
◦Transurethral electrovaporisation of the prostate (TUVP)
◦Holmium laser enucleation of the prostate (HoLEP)
◦Open prostatectomy via abdominal or perineal incision

Question 4

What is Transurethral Resection of the Prostate (TURP)?

Answer 4

• Involves accessing the prostate through the urethra and “shaving” off prostate tissue from inside using diathermy
• Aim is to create a wider space for urine to flow through, thereby improving symptoms

Question 5

What are complications of TURP?

Answer 5

◦Bleeding
◦Infection
◦Incontinence
◦Retrograde ejaculation (semen goes backwards and is not produced from the urethra during ejaculation)
◦Urethral strictures
◦Failure to resolve symptoms
◦Erectile dysfunction