BPH

Question 1

Risk factors

Answer 1

age
ethnicity: black > white > Asian

Question 2

Give examples of BPH symptoms which indicate difficulty with VOIDING (i.e. obstructive)

Answer 2

• weak or intermittent urinary flow
• straining
• hesitancy
• terminal dribbling
• incomplete emptying

Question 3

Give examples of BPH symptoms which indicate difficulty with STORAGE (i.e. IRRATATIVE)

Answer 3

urgency
frequency
urge incontinence
nocturia

Question 4

Complications of BPH

Answer 4

UTI
retention
obstructive uropathy

Question 5

How to assess for BPH

Answer 5

• Urine dipstick
• Bloods: U&Es, PSA
• Urine frequency/volume chart for 3 days
• IPSS score to classify severity of LUTS + impact on QoL

Question 6

Management of BPH

Answer 6

• watchful waiting
• alpha-1 antagonists (e.g. tamsulosin)
• 5 alpha-reductase inhibitors e.g. finasteride

adverse effects: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
the use of combination therapy (alpha-1 antagonist + 5 alpha-reductase inhibitor) was supported by the Medical Therapy Of Prostatic Symptoms (MTOPS) trial and is also supported by NICE: ‘If the man has bothersome moderate-to-severe voiding symptoms and prostatic enlargement’
if there is a mixture of storage symptoms and voiding symptoms that persist after treatment with an alpha-blocker alone, then an antimuscarinic (anticholinergic) drug such as tolterodine or darifenacin may be tried
surgery
transurethral resection of prostate (TURP)

Question 7

How do alpha-1-antagonists work? (e.g. Tamsulosin, alfuzosin, doxazosin)

Answer 7

decrease smooth muscle tone of the prostate and bladder

Question 8

Adverse effects of alpha-1-antagonists? (e.g. Tamsulosin, alfuzosin, doxazosin)

Answer 8

dizziness
postural hypotension
dry mouth
depression

Question 9

Mechanism of action of 5-alpha-reductase inhibitors (e.g. finasteride)

Answer 9

• block conversion of testosterone to dihydrotestosterone (DHT)

(which is known to induce BPH)
=> reduces prostate volume
=> slows disease progression
=> reduces PSA

Question 10

Why may alpha-1-antagonists be used for symptomatic relief, whereas 5-alpha-reductase inhibitors are used to slow disease progression?

Answer 10

symptoms may not improve for 6 months with 5-alpha-reductase inhibitors alone

Question 11

What surgical intervention can be used to manage BPH?

Answer 11

Transurethral resection of prostate (TURP)