Benign Prostatic Hyperplasia

Question 1

What are the risk factors for BPH?

Answer 1

• Age:
  
  • 50% of 50 year old men will have evidedence of BPH.
  • 80% of 80 year olds.
  • 30% will have symptoms.
• Ethnicity: Black>white>asian

Question 2

Describe some typical LUTS symptoms.

Answer 2

• voiding symptoms (obstructive): weak or intermittent urinary flow, straining, hesitancy, terminal dribbling and incomplete emptying
• storage symptoms (irritative) urgency, frequency, urgency incontinence and nocturia
• post-micturition: dribbling
• complications: urinary tract infection, retention, obstructive uropathy

Question 3

Describe some management options for BPH.

Answer 3

• watchful waiting
• Medication:
  
  • alpha-1 antagonists (Tamsulosin)
  • 5 alpha-reductase inhibitors.(Finasteride)
  • The use of combination therapy was supported by the Medical Therapy Of Prostatic Symptoms (MTOPS) trial
• Surgery: transurethral resection of prostate (TURP), HOLEP

Question 4

How do alpha-1 antagonists (Tamsulosin, alfusozin) work?

Answer 4

Decrease smooth muscle tone (prostate and bladder)

Question 5

What are some side effects of Alpha-1 Antagonists?

Answer 5

• Dizziness
• Postural hypotension
• Dry mouth
• Depression

Question 6

What is the mode of action for 5 alpha-reductase inhibitors (finasteride)?

What is their effect on PSA levels?

How long do they take to worK?

Answer 6

1. They block the conversion of testosterone to dihydrotestosterone (DHT).
   
   1. And thus can decrease PSA levels by up to 50%.
2. They slow disease progression but can take up to 6 months to work.

Question 7

What are some adverse effects of 5 alpha reductase inhibitors?

Answer 7

• Erectile dysfunction
• Reduced libido
• Ejaculation problems
• Gynecomastia

Question 8

Tamsulosin, first line for BPH, improves symptoms in a matter of a few weeks. In what percentage of men does it help?

Answer 8

70%