BPH

Question 1

BPH

Answer 1

• common, benign nodular/diffuse proliferation of musculofibrous AND glandular layers of prostate
• the inner transitional zone enlarges

Question 2

features of BPH

Answer 2

LUTS

• nocturia
• frequency
• urgency
• post-micturition dribbling
• poor stream/flow
• overflow incontinence
• haematuria
• bladder stones
• UTI

Question 3

latent BPH

Answer 3

• Latent foci are increasingly seen with advancing age
• Are not clinically relevant but are histologically identical to overt cancers in other patients

Question 4

aetiology

Answer 4

• hormonal imbalance - alteration of androgen/oestrogen ratio

Question 5

investigations of BPH

Answer 5

• assess severity of symptoms and impact on life
• DRE
• MSU
• US
• rule out cancer: PSA, transrectal USS, biopsy

Question 6

how does BPH appear on DRE

Answer 6

smooth and rubbery, enlarged

Question 7

what does a raised PSA mean

Answer 7

not a reliable test - often raised by BPH

Question 8

histology

Answer 8

proliferation of glands AND stroma - looks like trees

Question 9

management

Answer 9

• lifestyle
• drugs
• surgery

Question 10

lifestyle management of BPH

Answer 10

• avoid caffeine and alcohol
• learn to control urgency eg by breathing methods
• train bladder to increase holding time on voiding

Question 11

drugs used in BPH

Answer 11

• a blocker eg tamsulosin, doxazosin
  
  • symptomatic relief
  • these relax the sphincter by decreasing muscle tone and allow for better urine flow
• finasteride
  
  • reduces androgen activity, reducing prostate volume

Question 12

finasteride mechanism of action

Answer 12

decrease testosterone converstion to DHT

Question 13

warning with finasteride

Answer 13

• excreted in the semen, so condoms must be worn
• females should avoid handling

Question 14

surgery avilable for BPH

Answer 14

TURP of HolEP (laser)

Question 15

what is there a risk of with TURP

Answer 15

impotency - ≤14%

Question 16

complications

Answer 16

• Prolonged bladder obstruction can lead to hypertrophy of the detrusor muscle - trabeculation, and eventually diverticulum
• If untreated can lead to hydroureter (dilatation of the ureter) and hydronephrosis. These can lead to infection.