4. Benign Prostatic Hyperplasia

Question 1

What is the Aetiology of Benign Prostatic Hyperplasia?

Answer 1

This is part of the aging process in men:
50% of men will have this by the age of 60
90%of men will have this by the age of 85

Question 2

What is the Pathology of Benign Prostatic Hyperplasia?

Answer 2

Benign Fibromuscular and Glandular Hyperplasia of the Prostate - Predominantly the Transitional Zones of the Prostate

Question 3

What can occur due to Benign Prostatic Hyperplasia?

Answer 3

Bladder Outflow Obstruction

Question 4

What are the Clinical Features of Benign Prostatic Hyperplasia?

Answer 4

1. Lower Urinary Tract Symptoms (LUTS)
2. Acute / Chronic Urinary Retention
3. Recurrent UTI’s and Frank Haematuria - Early Stage
4. Bladder Stone Formation and Renal Failure - Late Stage

Question 5

What are the Lower Urinary Tract Symptoms (LUTS)?

Answer 5

1. Incomplete Emptying of the Bladder
2. Increase in Frequency - urinating more often
3. Increase intermittency - stopping / starting several times
4. Increased Urgency - Need to urinate suddenly and severely
5. Weak Stream
6. Increased Straining - having to strain to begin urination
7. Nocturia - needing to urinate at night

Question 6

What investigations are necessary in Benign Prostatic Hyperplasia?

Answer 6

1. Physical (including Digital Rectal) Examination
2. Mid-Stream Urine Sample with Urinalysis
3. LUTS Scoring Sheet
4. Frequency / Volume Charts
5. Ultrasound
6. Flexible Cystoscopy
7. Blood Tests

Question 7

What is the purpose of a Physical (including Digital Rectal) Examination?

Answer 7

To feel for any structural abnormalities

Question 8

What is the purpose of the Mid-Stream Urine Sample with Urinalysis?

Answer 8

1. To look for blood in the Urine

2. To eliminate a UTI as the cause

Question 9

What is the LUTS Scoring sheet?

Answer 9

All of the LUTS symptoms are given ranked out of 5. The Scores are as follows:
Mild = 0 - 7
Moderate = 8 - 19
Severe = > 20

Question 10

What is a Frequency / Volume Chart?

Answer 10

A flow rate study

Question 11

What is the purpose of the Ultrasound?

Answer 11

To look for a Kidney stone / other obstruction

Question 12

When would a flexible Cystoscopy be done?

Answer 12

If Haematuria is present without a UTI / Signs of Renal Disease

Question 13

What Blood Tests would be done?

Answer 13

1. Urea and Electrolytes
2. Creatinine
3. Prostate Specific Antigen

Question 14

What are the Treatment Options for Benign Prostatic Hyperplasia?

Answer 14

1. Watchful Waiting
2. Alpha-Blockers
3. 5-Alpha-Reductase Inhibitors
4. Trans-Urethral Resection of the Prostate
5. Prostatectomy
6. Endoscopic Ablative Therapy

Question 15

What therapy is done in most cases of Benign Prostatic Hyperplasia?

Answer 15

Watchful waiting - most cases will resolve themselves

Question 16

How do Alpha Blockers work?

Answer 16

This is the main treatment.

These cause Smooth-Muscle Relaxation and antagonize the “Dynamic” element to the Obstruction

Question 17

What is the name of a type of Alpha-Blocker?

Answer 17

Phenoxybenzamine

Question 18

How do 5-Alpha-Reductase Inhibitors work?

Answer 18

This converts Testosterone into Dihydrotestosterone which causes a reduction in:

1. The Size (and progression)
2. The Vascularity (Haematuria)
3. The Symptoms (LUTS)

Question 19

Which surgical procedure is the “Goal-Standard”?

Answer 19

Trans-Urethral Resection of the Prostate (TURP)