Benign Diseases Of The Prostate

Question 1

What processes cause benign prostatic hyperplasia?

Answer 1

Fibromuscular and glandular hyperplasia

Question 2

What proportion of men with benign prostatic hyperplasia have lower urinary tract symptoms?

Answer 2

50%

Question 3

What are the obstructive lower urinary tract symptoms?

Answer 3

Hesitancy
Poor stream
Terminal dribbling
Incomplete emptying

Question 4

What are the irritative lower urinary tract symptoms?

Answer 4

Frequency
Nocturia
Urgency +/- urge incontinence

Question 5

What physical examination findings may be present with lower urinary tract symptoms?

Answer 5

Palpable bladder
External urethral meatus stricture 
Phimosis 
Abnormal prostate 
Blood and signs of UTI on urinalysis

Question 6

What investigations can be useful when lower urinary tract symptoms are present?

Answer 6

MSSU
Flow rate study
Post-void bladder residual USS
Bloods- PSA, urea and creatinine(if chronic retention)
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 rectal exam

Question 7

How is uncomplicated benign prostatic obstruction treated?

Answer 7

Watchful waiting
Medical therapy- alpha blockers, 5 alpha reductase inhibitors or a combination of both
Surgical intervention- TURP if prostate <100cc, open retropubic or transvesical prostatectomy if prostate >100cc, endoscopic ablative procedures

Question 8

What are the possible complications of bladder outflow obstruction?

Answer 8

Progression of LUTS
Acute urinary retention 
Chronic urinary retention 
Urinary incontinence 
UTI
Bladder stone 
Renal failure from obstructed ureteric outflow due to high bladder pressures

Question 9

How is complicated bladder outlfow obstruction treated?

Answer 9

Medical therapy
Most patients will need surgery- TURP, cystiolitholapaxy
Long term catheterisation
Self catheterisation

Question 10

What are the characteristics of acute urinary retention?

Answer 10

Painful inability to void with a palpable and percussible bladder

Question 11

What are the causes of acute urinary retention?

Answer 11

Benign prostatic obstruction 
UTI
Urethral stricture 
Alcohol excess
Post-operative 
Acute problems

Question 12

How is acute urinary retention managed?

Answer 12

Catheterise immediately
If no renal failure, start alpha blocker immediately and remove catheter two days later
Organise TURP/treat underlying cause

Question 13

What are the complications of acute urinary retention?

Answer 13

UTI
Post-decompression haematuria 
Pathological diuresis 
Renal failure
Electrolyte abnormalities

Question 14

What are the characteristics of chronic urinary retention?

Answer 14

Painless

Palpable and percussible bladder after voiding

Question 15

What are the complications of chronic urinary retention?

Answer 15

UTI
Bladder stones
Overflow incontinence
Post-renal or obstructive renal failure

Question 16

How is chronic urinary retention managed?

Answer 16

Catheterisation
IV fluids
Long term catheterisation, CISC, TURP

Question 17

What are the complications of catheterisation?

Answer 17

UTI
Post-decompression haematuria 
Pathological diuresis 
Electrolyte imbalance 
Persistent renal dysfunction due to acute tubular necrosis