Benign Prostate Hyperplasia

Question 1

Lifestyle treatment for BPH

Answer 1

Fluid intake - avoid drinking large amounts and caffeinated drinks

Question 2

Basic anatomy and function of prostate

Answer 2

Anatomy - circles urethra, usually 4cm in diameter
made up of: anterior lobe, median lobe, posterior lobe and prostatic capsule

Function - contributes fluid for approx 25% of ejaculate which maximises likelihood of fertilisation
fluid contains: citric acid, G-proteolytic enzymes and G-seminal plasmin

Question 3

What is prostate specific antigen (PSA) and its role

Answer 3

PSA = glycoprotein enzyme secreted by epithelial membranes of prostate cells

Role = liquefaction of semen and dissolving cervical mucus which both allow better penetration of sperm into female reproductive tract

PSA levels rise with age and size of prostate gland

Question 4

5 causes of enlarged prostate glands

Answer 4

Age
Tissue remodelling
Hormonal effects (increased estradiol and decreased testosterone)
Metabolic effects
Inflammation (triggers cytokine release => healing responses cause proliferative environment => growth in prostate may lead to hypoxia (low O2 levels) within tissue

Question 5

Symptoms of BPH

Answer 5

Lower urinary tract symptoms (LUTS) - primary effect

Voiding - hesitancy, incomplete emptying, poor urine flow, dribbling, increased time taken to urinate

Storage - polyuria (increased pee production) during day and night

Question 6

Diagnosis of BPH

Answer 6

International Prostate Symptom Score (IPSS)

• 0 to 7 = mild LUTS
• 8 to 19 = moderate LUTS
• 20 - 35 = severe LUTS

Additionally:

• urine dipstick test
• urine frequency chart
• med and drug history
• bladder and digital rectal exam (not preferable)

Question 7

Consequences of bladder outflow obstruction (BOO)

Answer 7

renal failure
hypertension
chronic UTI

Question 8

3 main focuses of treatment of BPH

Answer 8

1. control LUTS
2. reduce readmission to hospital as consequence of recurrent UTI
3. minimise impact on QoL

Question 9

2 aims of pharmacological treatment of BPH

Answer 9

1. reduce smooth muscle tone in bladder/prostate

2. alter size of prostate = reduces resistance to urinary flow

Question 10

Surgery options and consequences for BPH

Answer 10

Transurethral resection of the prostate (TURP)
Transurethral incision of the prostate (TUIP)
Laser prostatectomy

Side effects - urinary and faecal incontinence