BPH

Question 1

What does BPH stand for?

Answer 1

benign prostatic hyperplasia

Question 2

What is BPH?

Answer 2

Diffuse hyperplasia of the periurethral (transitional) zone

Question 3

What is the epi of BPH?

Answer 3

1. Prevalence increases with age

2. More common in Afro-Caribbeans

Question 4

What are LUTS symptoms?

Answer 4

storage and voiding symptoms

Question 5

What are the storage symptoms?

Answer 5

1. Frequency
2. Urgency
3. Nocturia
4. Dysuria

Question 6

What are the voiding symptoms?

Answer 6

1. Hesitancy
2. Incomplete voiding
3. Poor stream

FUND HIPS

Question 7

What bedside tests are done for BPH?

Answer 7

1. Urinalysis: exclude UTI and check for bloods

2. DRE

Question 8

What does DRE show for BPH?

Answer 8

1. smoothly enlarge

2. palpable midline groove

Question 9

What bloods are done for BPH?

Answer 9

1. PSA: high >4

2. U+Es check impaired renal function

Question 10

What imaging is done for BPH?

Answer 10

Transrectal US-guided needle biopsy: gold standard

Question 11

How do you diagnose BPH?

Answer 11

o HISTOLOGICAL diagnosis that requires biopsy
o Benign prostatic enlargement – clinical finding
o To be classed as hyperplasia – histological finding needed

Question 12

Is PSA specific?

Answer 12

no

Question 13

What is the conservative management for BPH?

Answer 13

1. Monitor symptom progression
2. Lifestyle e.g. avoid caffeine
3. Medication review

Question 14

What is the medical treatment for BPH?

Answer 14

• 1st line : Selective a1-blockers e.g. tamsulosin

- 5a-reductase inhibitors e.g. finasteride

Question 15

What is an example of a Selective a1-blocker?

Answer 15

tamsulosin

Question 16

What is an example of a 5alpha reductase inhibitor?

Answer 16

finasteride

Question 17

When do you do surgical treatment for BPH?

Answer 17

if chosen, or refractory to medical Tx

Question 18

What is the surgical treatment for BPH?

Answer 18

Transurethral resection of the prostate (TURP)

Question 19

What is TURP?

Answer 19

visualise the prostate through the urethra – removing the tissue by electrocautery or sharp dissection

Question 20

Why is a medication review for BPH important?

Answer 20

anticholinergics lead to urinary retention; diuretics etc

Question 21

How do you manage BPH in emergency (acute urinary retention)?

Answer 21

catheterisation

Question 22

What other medications can be used?

Answer 22

1. Anticholinergics e.g solifinacen: reduce contraction
2. Beta 3 agonist: mirabegron
3. PDE5 inhibitors

Question 23

What other surgical methods are there?

Answer 23

4. HoLEP
5. Urolift
6. Rezum
7. PAE

Question 24

How can you find urinary retention?

Answer 24

• Palpable bladder
• Dull percussion
• Consider CISC

Question 25

What do you do if failed urinary catherterisation?

Answer 25

1. Catheter introducer (senior input) 2. Suprapubic 3. Flexi guided catheterisation

Question 26

How do you managed acute urinary retention?

Answer 26

1. Painful 2. Retained Volume <1-1.5L 3. Catheterize 4. Consider TWCO +/- alpha blockers

Question 27

How do you manage chronic urinary retention?

Answer 27

1. Painless 2. RV>1-1.5L 3. If no symptoms and tests normal can observe 4. Otherwise needs BOO surgery

Question 28

What are foley catheters?

Answer 28

1. Simplastic (ST) 2. PTFE coated (ST) 3. Hydrogel coated and silicone (LT)

Question 29

How are catheters measured in size?

Answer 29

French or Charriere

Question 30

What are special catheters?

Answer 30

1. 3 way | 2. Coudettip