Benign diseases of the prostate

Question 1

Prostate is divided into different zones, name these 3 zones

Answer 1

Transition zone (5% gland tissue)
Peripheral zone (70% gland tissue) 
Central zone (25% gland tissue)

Question 2

Most prostate cancers occur in what zone of the prostate

Answer 2

Peripheral

Question 3

Transition zone of the prostate is the area that…

Answer 3

surrounds the urethra as it enters the prostate gland

Question 4

List common benign diseases of the prostate (4)

Answer 4

Benign prostatic enlargement (BPE)

Benign prostatic hyperplasia (BPH)

Benign prostatic obstruction (BPO) - caused by the first 2

Bladder outflow obstruction (BOO) - caused by the first 2

Question 5

Lower urinary tract symptoms may manifest in prostatic diseases - list some of these symptoms (7)

Answer 5

Voiding symptoms

• Hesistancy
• Poor flow
• Terminal (post-void) dribbling
• Incomplete emptying

Storage symptoms

• Frequency
• Urgency/ incontinence
• Nocturia

Question 6

Benign prostatic hyperplasia predominantly affects what zone of the prostate

Answer 6

transition

Question 7

Benign prostatic hyperplasia presents as lower urinary tract symptoms (LUTS) due to bladder outflow obstruction (as prostate surrounds urethra)

So what are the symptoms (7) of BPH

Answer 7

Storage symptoms

• Frequency,
• urgency,
• and nocturia

Voiding symptoms

• Hesistancy
• Poor flow
• Terminal dribbling
• Incomplete emptying

Question 8

Assessment of lower urinary tract symptoms (LUTS) can be done by what methods by the patient themselves

Answer 8

Symptom scoring system, e.g. international prostate symptom score sheet

Frequency volume charts

Question 9

The international prostate symptom score sheet filled out by the patient is a way of assessing LUTS, total score is out of 35; what score indicates

• mild LUTS
• moderate LUTS
• severe LUTS

Answer 9

0-7

8-19

≥20

Question 10

Examination of BPH (2)

Answer 10

Rectal exam - enlarged smooth prostate

Abdo exam - +/- palpable bladder

Question 11

BPH high risk in what age males

Answer 11

> 50

Question 12

Investigations of benign prostatic hyperplasia (think urine, self tests (2), bloods (2), imaging (2))

Answer 12

Urinalysis - MSSU (any blood?)

International prostate symptom score (Self questionnaire)
Frequency volume charting (at home)

Bloods - prostate specific antigen, U+Es to check renal function

Imaging - renal tract USS (to see bladder/prostate size, any hydronephrosis), cystoscopy

Question 13

Treatment of UNCOMPLICATED benign prostatic obstruction (due to BPE/BPH)

• mild LUTS
• medical (2)
• surgical

Answer 13

Watchful waiting if mild symptoms (score 0-7)

Combination of

• Alpha blockers (Tamsulosin) - relax the muscle tone
• 5-alpha-reductase inhibitors (finasteride) - reduce prostate size

Surgical
-Transurethral resection of prostate (TURP)

Question 14

Over time, BPH results in

Answer 14

BPO/BOO

Question 15

5-alpha-reductase inhibitors reduce prostate size by

Answer 15

inhibiting formation of dihydrotestosterone (DHT) from testosterone

Question 16

The smooth muscle of the bladder neck and prostate is largely innervated by what nerves thus allowing the use of alpha blockers to relax muscle tone

Answer 16

Sympathetic alpha-adrenergic nerves releasing adrenaline/noradrenaline

Question 17

Name some commonly used alpha blockers

Answer 17

Tamsulosin

Terazosin

Question 18

Name 2 5-alpha-reductase inhibitors used in BPH (reduce prostate size)

Answer 18

finasteride

dutasteride

Question 19

Gold standard surgical treatment for BPH is transurethral resection of prostate (TURP) - when is this indicated

Answer 19

Bothersome LUTS due to BPH

Complications attributed to BPH - renal insufficiency, bladder stones, recurrent haematuria or UTIs, urinary retention

Question 20

Complications of bladder outflow obstruction

Answer 20

Renal insufficiency from obstructed outflow due high bladder pressure

bladder stones,

recurrent haematuria or UTIs,

urinary retention

Question 21

Treatment of complications of BPH leading to bladder outflow obstruction

• bladder stone
• urinary retention

Answer 21

Cystolitholapaxy (to dissolve bladder stones if present)

Catheterisation

Question 22

Complicated bladder outflow obstruction ultimately needs

Answer 22

surgical treatment