Benign prostatic hyperplasia (BPA)

Question 1

What is the commonest risk factor for BPA?

Answer 1

Older age

Question 2

What is the pathological change that occurs?

Answer 2

Hyperplasia of the stromal and epithelial cells of the prostate

Question 3

It presents with lower urinary tract symptoms. Name 3 of these and what they mean

Answer 3

• Hesitancy: difficult starting and maintaining the flow of urine
• Weak flow
• Urgency: sudden pressing urge to pass urine
• Frequency: needing to pass urine often,
• Intermittency: flow that starts, stops and varies in rate
• Straining to pass urine
• Terminal dribbling: dribbling after finishing urination
• Incomplete emptying: not being able to fully empty the bladder, with chronic retention
• Nocturia: having to wake to pass urine multiple times at night

Question 4

Name 2 aspects of the assessment of someone with lower urinary tract symptoms

Answer 4

• Digital rectal examination
• Abdominal examination
• Urinary frequency volume chart (3 days)
• Urine dipstick
• Prostate-specific antigen

Question 5

Name 2 ways a benign prostate would feel in a digital rectal examination

Answer 5

• Smooth
• Symmetrical
• Slightly soft
• Maintained central sulcus

Question 6

1) Alpha blockers are one of the options for the management of BPA - name one of these
2) How does it work?
3) 5-alpha reductase inhibitors is another option, name 1 of these
4) Which of these are used to treat immediate symptoms, and which are used to treat enlargement of the prostate?
5) How do 5-alpha reductase inhibitors work?
6) What is the commonest side effect for each of these drugs?

Answer 6

1) Tamsulosin
2) Relaxes smooth muscle
3) Finasteride
4) Treat immediate symptoms = alpha blockers, treat enlargement of the prostate = 5-alpha reductase inhibitors
5) They reduce DHT in the tissues leading to a reduction in prostate size as 5-alpha reductase doesn’t convert testosterone into DHT (a more potent androgen hormone).
6) Tamsulosin = postural hypotension (headaches + falls). Finasteride = sexual dysfunction

Question 7

1) What is the commonest surgical procedure for BPA?
2) How does it work?

Answer 7

1) Transurethral resection of the prostate
2) A resectoscope is inserted into the urethra, and prostate tissue is removed using a diathermy loop