Benign Diseases of the Prostate

Question 1

What part of the prostate does benign prostatic hyperplasia usually affect?

Answer 1

Transition zone

Question 2

What can benign prostatic hyperplasia lead to?

Answer 2

Bladder outflow obstruction

Question 3

What might be experienced due to voiding?

Answer 3

Hesitancy
Poor stream
Terminal dribbling
Incomplete emptying

Question 4

What might be experienced due to storage?

Answer 4

Frequency
Nocturia
Urgency/ urge incontinence

Question 5

What should be involved in the physical examination of lower urinary tract symptoms?

Answer 5

Palpation of bladder
Penis (phimosis, external urethral, metal stenosis)
Digital rectal examination

Question 6

What investigations are used in the assessment of lower urinary tract symptoms?

Answer 6

MSSU 
Flow rate study 
Post-void bladder residual USS 
Bloods (PSA, urea, creatinine) 
Renal tract USS 
Flexible cystoscopy 
Urodynamic study

Question 7

What is the general treatment for uncomplicated benign prostatic obstruction (BPO)?

Answer 7

Medical therapy (alpha blockers, 5 alpha reductase inhibitors) 
Surgical intervention (TURP etc)

Question 8

Why are alpha blockers used to treat BPO?

Answer 8

Cause smooth muscle relaxation and antagonise the ‘dynamic’ element to prostate obstruction

Question 9

What are the different types of alpha blockers?

Answer 9

Non-selective (phenoxybenzamine) 
Selective short acting (prazosin, indoramin) 
Selective long acting (alfuzosin, doxazosin, terazosin)
Highly selective (tamsulosin)

Question 10

What is the role of 5 alpha reductase inhibitors in the treatment of BPO?

Answer 10

Reduces prostate size and reduces risks of progression of BPE
Reduced LUTS
Reduce prostatic vascularity, reduces haematuria

Question 11

How do 5 alpha reductase inhibitors work?

Answer 11

Convert testosterone to dihydrotestosterone

Question 12

What are the indications for surgery in the treatment of BPO?

Answer 12

Failure of medical therapy
Increase in symptoms
Complex urinary tract symptoms

Question 13

What are the complications of TURP?

Answer 13

Bleeding
Infection
Retrograde ejaculation
Stress urinary incontinence

Question 14

What are the complications of BPO?

Answer 14

Progression of LUTS 
Acute and chronic urinary retention 
Urinary incontinence 
UTI 
Bladder stone 
Renal failure

Question 15

What is the treatment for complicated BPO?

Answer 15

Most need surgery (cystolitholapaxy and TURP)
Alternative
Long term urethral or suprapubic catheterisation
Self-catherisation