Benign prostate hyperplasia

Question 1

Define benign prostate hyperplasia

Answer 1

Slowly progressive nodular hyperplasia of the periurethral (transitional) zone of the prostate gland

Most frequent cause of LUTS in adult males

Question 2

Aetiology of benign prostate hyperplasia

1 + link

Answer 2

UNKOWN

Linked w/ hormonal changed (e.g. androgens)

Question 3

Protective factors for benign prostate hyperplasia

2

Answer 3

Reduced risk w/ soya/vegetable based diets

Negative association w/ cirrhosis

Question 4

Epidemiology of benign prostate hyperplasia

prevalence, age, ethnicity

Answer 4

COMMON
70% men >70 yrs have histological BPH
More common in West & in Afro-Caribbeans

Question 5

Categories of presenting symptoms of benign prostate hyperplasia
(4)

Answer 5

Obstructive
Irritative/storage
Acute retention
Chronic retention

Question 6

Presenting symptoms of benign prostate hyperplasia - obstructive symptoms
(4)

Answer 6

Hesitancy
Poor or intermittent stream
Terminal dribbling
Incomplete voiding

Question 7

Presenting symptoms of benign prostate hyperplasia - irritative/storage symptoms
(4)

Answer 7

Frequency
Urgency
Urge incontinence
Nocturia

Question 8

Pneumonic for obstructive & irritative symptoms

Answer 8

FUND HIPS
Frequency
Urgency
Nocturia
Dysuria
Hesitancy
Incomplete voiding
Poor stream
Smell/odour

Question 9

Presenting symptoms of benign prostate hyperplasia - acute retention symptoms
(2)

Answer 9

Sudden inability to pass urine

Associated w/ SEVERE PAIN

Question 10

Presenting symptoms of benign prostate hyperplasia - chronic retention symptoms

Answer 10

Painless
Frequency - w/ small volumes
Nocturia is a major feature

Question 11

Signs of benign prostate hyperplasia on physical examination

1 + 2 + 2

Answer 11

DRE
Prostate is usually smoothly enlarged w/ palpable midline groove

Acute retention
Suprapubic pain
Distended, palpable bladder

Chronic retention
Large distended painless bladder (volume >1L)
Signs of renal failure

Question 12

Investigations for benign prostate hyperplasia

4

Answer 12

Urinalysis
Bloods
MSU
Imaging

Question 13

Investigations for benign prostate hyperplasia - urinalysis

Answer 13

Check for UTI signs & bloods

Question 14

Investigations for benign prostate hyperplasia - bloods

2

Answer 14

U&Es - check for impaired renal function

PSA

Question 15

Investigations for benign prostate hyperplasia - MSU

Answer 15

MC&S

Question 16

Investigations for benign prostate hyperplasia - imaging

4

Answer 16

US of urinary tract (check for hydronephrosis)
Bladder scanning to measure pre & post voiding volumes
Transrectal US (TRUS) - allows assessment of bladder size & volume
Flexible cystoscopy

Question 17

Management of benign prostate hyperplasia

4

Answer 17

Emergency
Conservative
Medical
Surgery

Question 18

Management of benign prostate hyperplasia - emergency

Answer 18

Catheterisation

Question 19

Management of benign prostate hyperplasia - conservative

Answer 19

Watchful waiting

Question 20

Management of benign prostate hyperplasia - medical

2

Answer 20

Selective α-blockers

5α-reductase inhibitors

Question 21

Management of benign prostate hyperplasia - surgery

2

Answer 21

TURP

Open prostatectomy

Question 22

Complications of benign prostate hyperplasia

7

Answer 22

Recurrent UTI
Acute or chronic urinary retention
Urinary stasis
Bladder diverticula
Stone development
Obstructive renal failure 
Post-obstructive diuresis

Question 23

Complications of TURP

7

Answer 23

Retrograde ejaculation
Haemorrhage
Incontinence
TURP syndrome
Urinary infection 
Erectile dysfunction
Urethral stricture

Question 24

Prognosis of benign prostate hyperplasia

2

Answer 24

Mild symptoms usually well controlled medically

Most patients get significant relief from surgery