BPH

Question 1

Age as cause of BPH

Answer 1

Not much in those less than 40 About 70% in 70 year olds

Question 2

Hormones as cause of BPH

Answer 2

Oestrogen and prolactin-facilitators

Androgen needed for BPH development (dihydrotestostrone)

Question 3

Racial and dietary fx. in BPH

Answer 3

Low incidence in Far East

Question 4

Epithelial stromal interaction in BPH

Answer 4

Increase in fibroblast or epithelial growth factors

Suppresion of apoptosis-normal process of cell death> accumulation of cells

Question 5

Pathology of BPH

Answer 5

Increase in epithelial component (prostatic acini and ducts) and fibroblast stroma( smooth muscle and CT)

Question 6

pathogenesis of BPH

Answer 6

Normally affects the transitional zone

Obstruction to urine flow caused by two components

• Anatomic component-physical enlargement of prostate
• Dynamic component- due to tone of smooth muscle in fibres under sympathetic fibres

Two lateral lobes bulgung into urethra develop

Question 7

Effects of enlarged prostate in BPH

Answer 7

Increased resistance to urine flow detrusor hypertrophy decompensation increased residual urine post-micturition chronic urinary retention

Bilateral hydronephrosis

Chronic renal failure

Question 8

LUTS consists of which two components

Answer 8

Obstructive (voiding sx

Storage (irritative sx)

Question 9

Causes of LUTS

Answer 9

BPH

Prostate CA

Bladder neck contracture

Neurogenic bladder

DM

Question 10

causes of neurogenic bladder

Answer 10

MS

CVA

Parkinsons

Alzheimers

Collapsed intervetebral disc

Question 11

Types of BPH symptom scoring questionnaires

Answer 11

American Urology Association Symptom Index

International prostate symptom score

Question 12

Minimum requirements for patients with LUTS to decide on tx.

Answer 12

Sx. score

Urinary flow rate

rectal exam

urinalysis

Creat serum

Serum PSA

U/S KUB

Question 13

Indications for and medical treatment options for BPH

Answer 13

For mild symptomatic BPH uncomplicated

Alpha adrenergic blockers

5 alpha reductase inhibitors

Question 14

Alpha adrenergic blocker MOA

Answer 14

Act on dynamic component by blocking alpha -1 adrenorecpetors causes relaxation of smooth muscle

Alpha 1 A recptor more selective newer subtype

Question 15

Types of alpha blockers to treat BPH

Answer 15

Prazosin (Minipress)

Doxazosin (Cardura)

Tamsulosin (Flowmax)

Terazosin (Hytrin)

Alfuzosin (Xatral)

Question 16

Alpha blocker side effects

Answer 16

Vasodilatation

Hypotension

Dizziness and syncope

Retrograde ejaculation (alpha 1A blockers)

Question 17

Indication of 5 alpha reductase inhibitors

Answer 17

Large prostates >50g (large epithelial component )

PSA >2.5 ng/ml

Macrospopic haematuria dt BPH

Question 18

Effect of 5- ARI s

Answer 18

Decrease prostate by 25% in 3-6 months

Decrease PSA by 50%

Question 19

5-ARIs Side effects

Answer 19

Secreted in semen caasing hypospadias in semen

Dec. libido, ED, dec ejaculation

Question 20

Types of 5-ARIs

Answer 20

Finasteride (Proscar)

Dutasteride (Avodart)

Question 21

indications for BPH surgery

Answer 21

Failed medical tx

Complications of bladder outflow obstruction

Recurrent haematuria

Previous prostatic surgery

Question 22

Types of prostatic surgery and indications

Answer 22

TURP or Prostatectomy (open)

Open surgery if >60g

Both remove adenoma transitional zone

Question 23

Complications of TURP

Answer 23

TUR syndrome

Septicaemia

Secondary haemorrhage

Stricture

Retrograde ejaculation

Incontinence