Prostate 1 (596-606)

Question 1

What are the risk factors for BPH?;

Answer 1

Age (primary risk factor), Family history, obesity, T2DM

Question 2

In which part of the prostate is BPH most common?;

Answer 2

Transitional zone.
Medial and lateral loble.

Question 3

What medications are available to treat BPH?;

Answer 3

Tamsulosin. Finasteride.

Question 4

What is the mechanism of action of Tamsulosin and Finasteride?;

Answer 4

Tamsulosin- alpha-adrenorecpetor anatagonist (act by relaxing prostatic smooth muscle via blockade of alpha-adrenorecptors).
Finasteride- 5a-reductase inhibitor (act to prevent the conversion of testosterone to DHT, resulting in decrease in prostatic volume)

Question 5

What medications should be avoided in patients with BPH?;

Answer 5

Anti-cholinergics (can cause urinary retetion)

Question 6

What are the interventional/surgical options to treat BPH?:

Answer 6

Lifetyle- weight loss, reduce fluid intake at night. Surgical- TransUrethral Resection of the Prostate (TURP - gold standard), Holmium Laser Enucleation of the Prostate (HoLEP)- procedure involves laser to head sections of prostate [limited due to being technically challenging], open prostatectomy, Prostate artery embolisation (usually for patient who surgery is not appropriate).

Question 7

What irrigating fluids are used for TURP?:

Answer 7

Glycine (most common). Normal saline (note monopolar can’t be used with saline). Distilled water can be used but increases TURP syndrome.

Question 8

What type of diathermy should be used with the commonly used irrigating fluid in TURP?;

Answer 8

Monopolar is using glycine can be used. Only bipolar is using normal saline (cant use monopolar)

Question 9

What is TURP syndrome? What are the signs and symptoms of TURP syndrome?;

Answer 9

Irrigation used during the procedure can result in significant overload and dilutional hyponatreamia as the the fluid enters circulation through the exposed venous beds. Pts present with- confusion, nausea, agitation, cerebral odema (visual changes), coma.

Question 10

How can TURP be avoided?;

Answer 10

Minimise duration of the operation (less than 1 hour ideally), achieve haemostasis, using saline reduces chance of TURP as isotonic (however can only use bipolar).

Question 11

Whar features would be concerning or make one suspicious of cancer on digital rectal examination?;

Answer 11

Firm or hard nodules, fixed irregular mass, craggy prostate, uneven lobe, loss of medial sulcus