BPH

Question 1

What is BPH?

Answer 1

Benign prostatic hyperplasia - histological diagnosis

Question 2

What is BPE?

Answer 2

Benign prostatic enlargement - clinical diagnosis based on DRE

Question 3

What is bladder outflow obstruction?

Answer 3

Clinical diagnosis

Question 4

What are the risk factors for BPH?

Answer 4

Age
Hormonal (increased oestrogen/androgen ratio)
Obesity
Diabetes (& elevated fasting glucose)
Dyslipidaemia
Genetic
Afro-caribbean

Question 5

What makes up the assessment for BPH?

Answer 5

History
Examination
DRE
IPSS questionnaire to assess symptoms

Question 6

What investigations are done for BPH?

Answer 6

Urine dip
Freq/vol chart
PSA
Renal function
Flow rate & PVR (post void residual)
UDS/VUDS (video urodynamic studies)

Question 7

What is the medical management for BPH?

Answer 7

Alpha blockers (tamsulosin)
5 alpha reductase enzyme inhibitor (Finasteride)
Anticholinergics (Solifinacen)
Beta 3 agonist (Mirabegron)
BDE5 inhibitors

Question 8

What are the surgical management options for BPH?

Answer 8

TURP
HoLEP
Urolift - minimally invasive, inject steam into prostate to make it shrink
Rezum

Question 9

How can you assess for urinary retention?

Answer 9

Palpable blader

Bladder scan

Question 10

What is the management for urinary retention?

Answer 10

Clean intermittent self catheterisation e.g. post pelvic surgery

Question 11

What is the presentation of acute urinary retention?

Answer 11

Painful

RV <1.5L

Question 12

What is the management of acute urinary retention?

Answer 12

Catheterise - aseptic technique, size 14-16F
Record residual
Urinalysis
U&Es
DRE

Question 13

What is the presentation of chronic urinary retention?

Answer 13

Painless

RV >1.5L

Question 14

What is the management on chronic urinary retention?

Answer 14

Check U&Es
USS
Need follow up
Monitor residuals

Question 15

What can cause elevated PSA?

Answer 15

BPH
Urinary retention
Urine infection
Catheterisation/instrumentation of urethra
Prostate cancer