Condition- Benign Prostatic Hyperplasia

Question 1

What is benign prostatic hyperplasia?

Answer 1

Slowly progressive nodular or diffuse hyperplasia of the periurethral (transitional) zone of the prostate gland.

Question 2

Describe how you can differentiate between benign and malignant enlargement of the prostate…

Answer 2

In BPH the inner transitional zone enlarges rather than peripheral layer expansion seen in prostate carcinoma

Question 3

What is the cause of BPH?

Answer 3

UNKNOWN Age related changes in androgen/oestrogen balance

Question 4

What are the two main changes in BPH which cause LUTS and obstruction of urinary outlet?

Answer 4

Static: Narrowing of the urethral lumen by increased benign prostatic tissue Dynamic: Increase in stromal muscle tone mediated by a1 receptors

Question 5

List the presenting symptoms of BPH

Answer 5

LUTS:

1. Storage:

• Increased frequency
• Increased Urgency
• Nocturia

2. Voiding:

• Weak stream
• Hesitancy
• Intermittency
• Straining
• Incomplete emptying
• Post-void dribbling

Question 6

What are the syptoms of acute vs chronic retention syndrome…

Answer 6

ACUTE

• Sudden onset inability to urinate
• SEVERE PAIN

CHRONIC

• Painless
• Frequency
• Nocturia

Question 7

What are the signs of BPH on physical examination

Answer 7

• DRE: smoothly enlarged, palpable midline groove
• Signs of Acute retention: suprapubic pain, palpable distended bladder
• Signs of Chronic retention: painless, distended bladder

Question 8

List some of the appropriate investigations for BPH?

Answer 8

1. Urinalysis: to check for UTI
2. Bloods:
   
   • U&Es- check for impaired renal impairment
   • PSA- to rule out cancer
3. MSU:
   
   • MC&S
4. Imaging:
   
   • US of urinary tract
   • Transrectal US (TRUS)- to asses bladder size and volume +/- biopsy
   • Flexible cytoscopy

Question 9

How would you manage a patient with acute urinary retention?

Answer 9

Catheterisation

Question 10

What sort of advice would you give to a patient with mild BPH?

Answer 10

• Avoid caffeine
• Alcohol to reduce urgency
• Relax when voiding
• Control urgency by practising distracting exercises

Question 11

Which 2 classes of medications could you use to manage someone with BPH?

Answer 11

• Selective a1a blocker (TAMSULOSIN): relax SM of internal urinary sphicter + prostate capsule
• 5a-reductase inhibitor (FINASTERIDE): inhibits conversion of DHT to testosterone

Question 12

What advice should you give to a sexually active patient who is on FINASTERIDE for BPH management?

Answer 12

The Finasteride is excreted in the semen so a condom should be worn during intercourse

Question 13

List three types of surgery that could be performed on a patient with BPH

Answer 13

• TURP: transurethral resection of prostate
• TUIP: Transurethral incision of prostate
• Open Prostatectomy

Question 14

List some of the compliactions of BPH

Answer 14

• UTI
• Acute or chronic urinary retention
• Bladder diverticuli
• Stones
• Obstructive renal failure
• Complications of TURP