Benign Diseases of the Prostate

Question 1

Name the different area’s of the prostate from centre outwards

Answer 1

Known as Mcneal’s Zones

Transition zone - wraps around the urethra
Central zone
Peripheral zone - where more cancers occur
Anterior fibromuscular stroma

Question 2

What do the following stand for - BPE, BPH, BPO, BOO, LUTS

Answer 2

BPE - Benign prostatic enlargement 
BPH - ""    "" hyperplasia
BPO - ""    "" obstruction
BOO - bladder outflow obstruction
LUTS - Lower urinary tract symptoms

Question 3

What is BPH characterised by?

Answer 3

Fibromuscular and glandular hyperplasia

Presents with LUTS

Question 4

What zone does BPH affect?

Answer 4

Transition zone

Question 5

Prevalence of BPH?

Answer 5

Part of ageing process in men - 50% of men will have it by 60 and 90% by 85

Question 6

What are the LUTS?

Answer 6

Voiding:

• Hesitancy
• Poor Stream
• Terminal dribbling
• Incomplete Emptying

Storage:

• Frequency
• Nocturia
• Urgency/urge incontinence

Other:

• Intermittency
• Straining

Question 7

Signs on examination of a BOO?

Answer 7

Palpable bladder
External urethral meatus stricture
Phimosis
Mass on Digital Rectal Exam (mostly BPH)

Question 8

What is phimosis?

Answer 8

Inability to retract foreskin

Question 9

Investigations for a UTO?

Answer 9

Midstream urine sample
Flow Rate Study
Post-void bladder ultrasound (looking for residual)
Bloods:
- PSA
- U&C (only if in chronic retention)
Renal tract ultrasound
Cystoscopy - Good for BPE, cancer & strictures

Question 10

Medical treatment of BPH?

Answer 10

Alpha blockers to relax smooth muscle

5-alpha-reductase inhibitors which reduces prostate size by metabolizing testosterone

Question 11

Surgical treatment for BPH?

Answer 11

Trans-Urethral-Resection of prostate - TURP
Open prostatectomy
Endoscopic ablative procedures

Question 12

What makes a BPH complicated?

Answer 12

Acute or chronic urinary retention 
Urinary Incontinence 
UTI 
Bladder Stone 
Renal Failure (due to hydronephrosis)

Question 13

How can we treat a complicated BPH if they’re not fit for TURP?

Answer 13

• Long term urethral catheter

- CISC (clean intermittent self Catheterisation)

Question 14

Acute vs chronic urinary retention?

Answer 14

Acute: Painful inability to void bladder

Chronic - painless incomplete voiding, may have LUTS, UTIs or overflow incontinence (bed wetting)

Both have a palpable bladder

Question 15

Causes of acute urinary retention?

Answer 15

Usually BPH

Question 16

Triggers of BPH?

Answer 16

Natural ageing process

constipation or a urological procedure.

Question 17

AUR treatment?

Answer 17

Catheterise and start treatment for BPH

Question 18

Causes of chronic urinary retention?

Answer 18

Detrusor underactivity

Largely due to primary bladder failure or a longstanding BOO

Question 19

Chronic urinary retention treatment?

Answer 19

Catheterisation followed by clean intermittent self Catheterisation

TURP can be considered

Question 20

Chronic urinary retention varies from very dangerous to less dangerous - how can you tell what state patient is in?

Answer 20

High pressure retention - incontinent, raised creatinine and causes bilateral hydronephrosis

Low pressure retention is less dangerous. Its usually dry, Cr is normal and the kidneys are ok.

Both are painless

Question 21

Is TURP better for high or low pressure CUR?

Answer 21

TURP in CUR has a less successful outcome than for AUR but better in low pressure than high

Question 22

What are the major complications when you treat urinary retention?

Answer 22

Post-obstructive diuresis

Decompression haematuria

Question 23

What is post-obstructive diuresis, what does it cause5 and how do you manage it?

Answer 23

Massive UO >200ml/hr which can lead to life-threatening hypotension, weight loss and Electrolyte abnormalities

IV fluids resus and then a long term catheter, CISC or TURP.

Question 24

What is decompression haematuria?

Answer 24

Shearing of the small vessles during decompression because of different compliance between different tissue layers.
Usually self-limiting