Benign Prostate Hypertrophy

Question 1

What causes BPH

Answer 1

Hyperplasia of stromoal and epithelial cells of the prostate

Question 2

presentation of BPH

Answer 2

Lower UTI symptoms
Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining
Terminal dribbling
Incomplete emptying
Nocturia

Question 3

What scoring system is used for BPH

Answer 3

International prostate symptoms score

Question 3

What scoring system is used for BPH

Answer 3

International prostate symptoms score

Question 4

Assessment for BPH

Answer 4

Digital rectal examination
Abdominal examination
Urinary frequency volume cahrt
Prostate specific antigen - PSA for cancer

Question 5

What find abnormal on abdo exma in BPH

Answer 5

Palpable bladder

Question 6

How long record urine output for chart

Answer 6

3 days

Question 7

Is PSA reliable?

Answer 7

No - not specific at all, a bit sensitive
75% false positives
15% false negatives

Question 8

Causes of raised PSA

Answer 8

Prostate cancer
BPH
prostatitis
UTIs
Vigorosu exercise - cycling
Recent ejaculation or prostate stimulation

Question 9

What does a BPH feel like

Answer 9

Smooth, symmetrical, slightly soft, maintained central sulcus

Question 10

Whast does a cancerous prostate feel like

Answer 10

Firm/hard, asymmetrical, craggy or irregular, loss of central sulcus

Question 11

Medical options for BPH

Answer 11

Alpha blockers eg tamulosin
5-alpha reducatse inhibitors eg finasteride

Question 12

What des tamulosin do>

Answer 12

Alpha blocker - smooth muscle relaxation 0> rapid symptom improvement

Question 13

What does finasteride do

Answer 13

5-alpha reductase inhibitor
Gradually reduces size of prostate

Question 14

How do 5-alpha reductase inhibitors work

Answer 14

Stops 5AR enzyme converting testosterone to DHT = more potent androgen
Reduce DHT levels - reduce prostate size
Works over 6 months

Question 15

Surgical options BPH

Answer 15

Transurethral resection of prostate (TURP )
Transurethral electroaporisation of teh prostate (TEVAP/TUVP)
Holmium laser enucleation of the prostate (HoLEP)
Open prostatectomy via abdo or perineal incision

Question 16

What is the notable side effect of tamsulosina nd other alpha blockers

Answer 16

Postural hypotension

Question 17

Most common side effect of finasteride

Answer 17

Sexual dysfunction due to reduced DTH

Question 18

What is TURP

Answer 18

Most common surgical treatment of BPH ‘
Removes part of prostate from inside urethra
Resectoscope inseted, prostate tissue removed with diathermy loop - more space for urin

Question 19

Major complications of TURP

Answer 19

Bleeding
infection
Urinary incontinecne
Erectile dysfunctuion
Retrograde ejaculation
Urethral strictures
Failure to resolve symptoms

Question 20

How do other surgical options for BPH work

Answer 20

Transurethral electrovaporisation of the prostate (TEVAP / TUVP) involves inserting a resectoscope into the urethra. A rollerball electrode is then rolled across the prostate, vaporising prostate tissue and creating a more expansive space for urine flow.
Holmium laser enucleation of the prostate (HoLEP) also involves inserting a resectoscope into the urethra. A laser is then used to remove prostate tissue, creating a more expansive space for urine flow.
Open prostatectomy involves an open procedure to remove the prostate. An abdominal or perineal incision can be used to access the prostate. Open surgery is less commonly used as it carries an increased risk of complications, a more extended hospital stay and longer recovery than other surgical procedures.