Benign diseases of the prostate

Question 1

What are the different zones of the prostate called

Answer 1

central peripheral anterior transitional

Question 2

What is BPH

Answer 2

Benign prostatic hyperplasia -big under microscope (histological)

Question 3

What is BPE

Answer 3

Benign prostatic enlargement (BPE) – big prostate gland

Question 4

What is BPO

Answer 4

Benign prostatic obstruction (BPO) – symptoms associated with a big prostate

Question 5

What is BOO

Answer 5

Bladder outflow obstruction (BOO) – bladder neck and prostate causing obstruction and symptoms

Question 6

What characterises BPH

Answer 6

Characterised by fibromuscular and glandular hyperplasia

Question 7

What zone of the prostate does BPH usually affect

Answer 7

Transition zone

Question 8

What % of men will have BPH by the age of 60

Answer 8

50%

Question 9

What are the two main categories of lower urinary tract symptoms

Answer 9

Voiding Storage

Question 10

What are voiding symptoms

Answer 10

Obstructive - Hesitancy - Poor stream - Terminal dribbling - Incomplete emptying

Question 11

What are storage symtpoms

Answer 11

Irritative - Frequency - Nocturia - Urgency +/- urge incontinence

Question 12

How do assess LUTS from prostate disease

Answer 12

International prostate symptom score sheet

Question 13

What is the International prostate symptom score sheet scored out of

Answer 13

Total score is out of 35

Question 14

What are the ranges on the International prostate symptom score sheet

Answer 14

Mild: 0-7 Moderate: 8-19 Severe: ≥ 20

Question 15

What areas do you examine if if patient has LUTS

Answer 15

Abdomen Penis Urinalysis

Question 16

What do you examine in the abdomen in patient with LUTS symptoms

Answer 16

palpable bladder

Question 17

What do you examine on the penis in patient with LUTS symptoms

Answer 17

External urethral meatal stricture Phimosis Digital rectal examination (DRE) to assess prostate size Suspicious nodules or firmness

Question 18

What investigations should you do for LUTS

Answer 18

MSSU Bloods Renal tract USS (if renal failure or bladder stone suspected) Flexible cystoscopy if haematuria Urodynamic studies in selected cases TRUS-guided prostate biopsy if PSA raised or abnormal DRE

Question 19

What do you inves in the urinalysis for patient with LUTS symptoms

Answer 19

Blood - PSA - Urine and creatinine (if chronic urinary retention) Signs of UTI

Question 20

What is treatment for uncomplicated LUTS from prostate disease

Answer 20

Watchful waiting Medical therapy Surgical intervention

Question 21

What medicines are used for treatment for uncomplicated LUTS from prostate disease

Answer 21

Alpha blockers 5 alpha reductase inhibitors (Finasteride or Dutasteride) Combination of both ^^

Question 22

What can be done surgically for treatment for uncomplicated LUTS from prostate disease

Answer 22

TURP (prostate size <100cc) (transurethral resection of prostate) Open retropubic or transvesical prostatectomy (prostate size >100cc) Endoscopic ablative procedures

Question 23

What is treatment for complicated LUTS from prostate disease

Answer 23

No role for Medical therapy (except for acute urinary retention) Most patients will require surgery eg. cystolitholapaxy and TURP for patients with BPO and bladder stones Some patients do not need any treatment (especially if residuals are relatively low, asymptomatic and no complications)

Question 24

What is the main treatment for Lower Urinary Tract Symptoms due to Benign Prostate Obstruction

Answer 24

Alpha blockers

Question 25

What do alpha blockers do

Answer 25

Alpha blockers cause smooth muscle relaxation and antagonise the ‘dynamic’ element to prostatic obstruction

Question 26

How do alpha blockers work

Answer 26

Smooth muscle of bladder neck (i.e. intrinsic urethral sphincter) and prostate innervated by sympathetic alpha-adrenergic nerves (mostly alpha-1a subtype

Question 27

What are the different categories of alpha blocker

Answer 27

Non-selective Selective short Selective long Highly selective

Question 28

What are the non selective alpha blockers

Answer 28

phenoxybenzamine

Question 29

What are the selective short acting alpha blockers

Answer 29

prazosin, indoramin

Question 30

What are the selective long acting alpha blockers

Answer 30

alfuzosin, doxazosin, terazosin

Question 31

What are the highly selective alpha blockers

Answer 31

tamulosin

Question 32

What is the prefferred alpha blocker and why

Answer 32

Tamsulosin (best as stops older people falling over when they stand up)

Question 33

What is a possible side effect of alpha blockers

Answer 33

Can give retrograde ejaculation

Question 34

What do 5a-reductase inhibitors do to the prostate

Answer 34

Reduces prostate size and reduces risks of progression of BPE (but only if \>25cc prostate)

Question 35

What does 5a-reductase do in the body

Answer 35

5a-reductase converts testosterone to dihydrotestosterone

Question 36

What drugs is best for treating the LUTS symptoms

Answer 36

Combination therapy of 5ARIs + alpha blockers most effective in reducing risk of progression of BPE and can also reduce prostatic vascularity and hence reduces haematuria due to prostatic bleeding

Question 37

What is a possible side effect of 5a-reductase inhibitors

Answer 37

Can give erectile dysfuction

Question 38

When can you start 5a-reductase inhibitors

Answer 38

Need to determine size before starting and only really start if its beyond a certain size

Question 39

What are possible complications of Benign outlet obstruction (x7)

Answer 39

Progression of LUTS (worsening) Acute urinary retention (painful) Chronic urinary retention (painless) Urinary incontinence (overflow) UTI Bladder stone formation Renal failure from obstructed ureteric outflow due to high bladder pressure

Question 40

What is TURP

Answer 40

Transurethral resection of prostate (TURP) - GOLD STANDARD