Benign Prostatic Hypertrophy

Question 1

ESSENCE

Answer 1

Common condition affecting men in older age (>50)

Caused by hyperplasia of stromal and epithelial cells in prostate

Question 2

CLINICAL FEATURES

Presentation

Answer 2

• Lower urinary tract symptoms (LUTS)
  
  • Hesitancy
  • Weak flow
  • Urgency
  • Frequency
  • Intermittency
  • Straining
  • Terminal dribbling
  • Incomplete emptying
  • Nocturia

Question 3

What is used to assess severity of lower urinary tract symptoms

Answer 3

International prostate symptom score (IPSS)

Question 4

INVESTIGATIONS

First choice

Answer 4

• Digital rectal examination
• Abdominal examination
• Urinary frequency volume chart - recording 3 days fluid intake and output
• Urine dipstick - assess infection, haematuria
• Prostate specific antigen - prostate cancer

Question 5

MANAGEMENT

General principles

Answer 5

• If mild symptoms may not require intervention
• Medical options
• Surgical options

Question 6

MANAGEMENT

Medical options

Answer 6

• Alpha blockers (eg tamsulosin)
  
  • Improve symptoms
• 5-alpha reductase inhibitors (eg finasteride)
  
  • Reduce size of prostate

Question 7

What does 5-alpha reductase do

Answer 7

Converts testosterone into dihydrotestosterone (DHT), which is a more potent androgen hormone

Question 8

MANAGEMENT

Surgical options

Answer 8

• Transurethral resection of prostate (TURP)
• Transurethral electrovaporisation of prostate (TEVAP/TUVP)
• Holmium laser enucleation of prostate (HoLEP)
• Open prostatectomy

Question 9

Notable SE of alpha blockers

Answer 9

Postural hypotension (consider if man presents with lightheadedness of standing or falls)

Question 10

Most common SE of finasteride

Answer 10

Sexual dysfunction due to reduced testosterone

Question 11

Major complications of TURP

Answer 11

• Bleeding
• Infection
• Urinary incontenence
• Erectile dysfunction
• Restrograde ejaculation (semen goes backwards)
• Urethral strictures
• Failure to resolve symptoms