Benign Prostatic Hypertrophy

Question 1

BPH

Answer 1

benign enlargement of the prostate which impacts flow of urine through the prostatic urethra

usually age related

Question 2

Presentation

Answer 2

difficulty voiding:
poor stream, hesitancy, incomplete voiding, intermittency

storage:
nocturia, freq, dribbling, overflow incontinencem haematuria, bladder stones, UTI

Question 3

Investigations

Answer 3

Blood: PSA, Cr, UEC 
MSU
international prostate symptom score IPSS 
Imaging: Abdo USS, Trans rectal USS
Flow studies 
Biopsy: TR or TP

Question 4

Management

Answer 4

Education

Lifestyle:

• avoiding caffeine/alcohol
• physio to work on relaxation, distraction to decrease frequency, bladder diary + retaining

Medication: (IPSS 8-10) 
a-blockers (doxazosin, tamsulosin) 
  - Smooth muscle relaxation 
  - SE: drowsy, postural drop, dry mouth, ED
5 a reductase (finasteride)
  - blocks conversion of T to DHT 
  - takes 6 months to work 

Surgery 
TURP or HOLEP
 - bleeding 
 - clot retention 
 - retrograde ejaculation 
 - secondary incontinence