Benign Prostatic Hyperplasia

Question 1

Benign prostatic hyperplasia

Answer 1

Condition involving proliferation of different prostate layers, particularly the inner layers.
Effects men histologically from ~40 years, but sometimes may not show until decades later.

Question 2

Aetiology of benign prostatic hyperplasia

Answer 2

1. decreased testosterone, increased dihydrotestosterone
2. inflammation - i.e. chronic infections, autoimmune conditions

Question 3

statistics of men with BPH at 1) 31-40 years, 2) 51-80 years, 3) >80 years

Answer 3

• 8%
• 40-50%
• > 80%

Question 4

Clinical features of BPH

Stoarge symptoms

Answer 4

• frequency
• nocturia
• urge incontinence

Question 5

Clinical features of BPH

Voiding symptoms

Answer 5

• hesitancy
• poor stream
• dribbling

Question 6

Acute complication of BPH

Answer 6

acute urinary retention
requires immediate catheterisation

Question 7

Prostate findings on rectal exam in BPH

Answer 7

enlarged, smooth, firm, non-tender

Question 8

Investigations in suspected BPH

Answer 8

• urinalysis, culture, MSU, & PSA
• frequency-volume charts
• post-void residual urine measurement (bladder scan)
• IPSS score
• USS urinary tract
• uroflowmetry
• cystoscopy
• urodynamics

Question 9

BPH differentials

Answer 9

• prostate cancer
• prostatitis

Question 10

Managing BPH

Answer 10

1. Lifestyle alterations
2. Medications
3. Referral
4. Surgery

Question 11

Lifestyle alterations to help with BPH

Answer 11

• avoiding fluids before bed
• reducing alcohol and caffeine consumption
• ‘double voiding’

Question 12

Medications used for BPH

Answer 12

• tamsulosin (alpha blocker - reduce smooth muscle tone, immediate effect)
• finasteride (5-alpha-reductase-inhibitor, reduce conversion testosterone to DHT, 6-12 months, reduce PSA)

Question 13

Common side effects of tamsulosin

Answer 13

• dizziness
• postural hypotension
• dry mouth
• depression
• drowsiness

Question 14

Side effects of 5-alpha-reductase inhibitors

Answer 14

• impotence
• reduced libido

Question 15

Surgical procedure for BPH

Answer 15

Transurethral resection of the prostate (TURP)

Question 16

Side effect of TURP surgery

Answer 16

impotence

Question 17

Complications of poorly managed BPH

Answer 17

• UTIs
• acute urinary retention
• bladder stones & damage
• kidney stones & hydronephrosis