Benign Prostate Hyperplasia

Question 1

What is BPH?

Answer 1

slowly progressive nodular hyperplasia of the periurethral (transitional) zone of the prostate gland
Most common cause of LUTS in adult males

Question 2

Describe the aetiology of BPH

Answer 2

UNKNOWN

Link with hormonal changes (e.g. androgens)

Question 3

List 3 risk factors for BPH

Answer 3

Increasing age
FHx
Metabolic syndrome (Obesity, DM, CHD)

Question 4

Describe the epidemiology of BPH

Answer 4

COMMON

70% of men > 70 yrs have histological BPH (50% of them experience sx)

Question 5

How can symptoms of BPH be classified?

Answer 5

Obstructive + Irritative

Acute Retention vs Chronic Retention

Question 6

What is found on DRE in BPH?

Answer 6

Smooth enlargement with a palpable midline groove

poor correlation between size + severity of symptoms

Question 7

What are the acute and chronic retention symptoms in BPH?

Answer 7

Acute: 
Sudden inability to pass urine  
Associated with SEVERE PAIN 
Chronic:
Painless 
Frequency: with passage of small volumes of urine  
Nocturia is a major feature

Question 8

How may differentials differ in urinalysis of suspected BPH?

Answer 8

Uncomplicated BPH: NORMAL
UTI: PYURIA
Cancer: HAEMATURIA

Question 9

How is BPH treated in an emergency (acute urinary retention)?

Answer 9

Catheterisation

Question 10

What basic investigations should be performed in suspected BPH? What results are seen?

Answer 10

Urinalysis (normal)
Midstream urine MC+S
Bloods; 
U+Es (check renal function) 
PSA (elevated)
ALP (to exclude bone mets in Ca)

Question 11

What imaging investigations should be performed in suspected BPH? What results are seen?

Answer 11

US of urinary tract (check for hydronephrosis)
Bladder scanning to measure pre- + postvoiding volumes
Flexible Cystoscopy (mass, stone, stricture)
Transrectal Ultrasound Scan (TRUS) + biopsy

Question 12

What medical management may be used in BPH?

Answer 12

Selective a-blockers (e.g. tamsulosin) relax smooth muscle of internal urinary sphincter + prostate capsule

5a-reductase inhibitors (e.g. finasteride) inhibit conversion of testosterone to dihydrotestosterone, which can reduce prostate size

Question 13

List 7 complications of BPH

Answer 13

Recurrent UTI 
Acute or chronic urinary retention  
Urinary stasis  
Bladder diverticula  
Stone development  
Obstructive renal failure  
Post-obstructive diuresis

Question 14

List 7 complications of TURP in BPH

Answer 14

Retrograde ejaculation (ejaculate up into bladder because  internal urinary sphincter is relaxed) 
Haemorrhage  
Incontinence  
TURP syndrome  
UTI 
Erectile dysfunction  
Urethral stricture

Question 15

What is TURP syndrome?

Answer 15

seizures or cardiovascular collapse caused by hypervolaemia + hyponatraemia due to absorption of glycine irrigation fluid

Question 16

What is the prognosis of BPH?

Answer 16

Mild sx: well controlled medically

Most pts get significant relief from surgery