Benign Prostatic Disease

Question 1

two key pathophysiological factors of benign prostatic hyperplasia

Answer 1

increased prostatic tissue leading to narrowing of urethra and smooth muscle hyperplasia leading to increased tone

Question 2

what are the voiding LUTS

Answer 2

hesitance, slow stream, terminal dribbling, residual volume

Question 3

what are the storage LUTS

Answer 3

frequency, nocturia, urgency, urge incontinence

Question 4

what are the two types of LUTS

Answer 4

voiding and storage

Question 5

score sheet for assessing LUT symptoms

Answer 5

international prostate symptoms score sheet (IPSS)

Question 6

what is the scale of IPSS

Answer 6

0-7 mild
8-19 moderate
20-35 severe

Question 7

what would you examine the abdomen for in benign prostatic hyperplasia

Answer 7

a palpable bladder

Question 8

what is phimosis

Answer 8

foreskin not retract back over glans

Question 9

what would you do a digital rectal exam to check for in BPH

Answer 9

prostate enlargement (>2 fingers breadth)
nodules or firm prostate
reduced anal tone

Question 10

what would reduced anal tone suggest about the origin of LUTS

Answer 10

a neurological cause

Question 11

why might a UTI be caused by BPO

Answer 11

urinary retention

Question 12

what flow rate is abnormal

Answer 12

<20ml/s

Question 13

imaging in BPO

Answer 13

CT/ultrasound for a mass hydronephrosis or stones

cytoscopy (if haematuria)

post-voiding blasdder residual ultrasound

Question 14

bloods in BPO

Answer 14

PSA, urea and creatinine

Question 15

reasons for doing a prostate biopsy in BPO

Answer 15

a suspicious DRE or raised PSA

Question 16

what does a urodynamic study do

Answer 16

measures the bladder pressures and muscle activity

Question 17

what about the BPO will alter the treatment route

Answer 17

whether it’s complicated or uncomplicated

Question 18

treatment route in uncomplicated BPO

Answer 18

just let it be

alpha blockers to reduce muscle tone (tamsulosin and alfuzosin)

or 5 alpha reductase inhibitors to reduce testosterone and shrink the prostate

Question 19

how long do 5 alpha reductase inhibitors take to work

Answer 19

about 6 months

Question 20

how long do alpha blockers take to work

Answer 20

a few days

Question 21

side effect of alpha blockers

Answer 21

weak ejaculation

Question 22

side effects of 5 alpha reductase inhibitors

Answer 22

sexual dysfunction and breast growth

Question 23

what doe TURP stand for

Answer 23

Transurethral Resection of Prostate

Question 24

how long is TURP surgery effective for

Answer 24

10-15 years

Question 25

true/false medical therapy in the treatment of complicated BPO is effective

Answer 25

false - rarely effective

Question 26

treatment route in complicated BPO

Answer 26

medical therapy can be but is rarely effective

TURP surgery

catheterisation: either long term or intermittent self-administered

Question 27

what makes complicated BPO complicated

Answer 27

risk of causing kidney damage, severe symptoms on IPSS, just generally more severe

Question 28

7 complications of complicated BPO

Answer 28

1. progression of LUTS
2. acute urinary retention
3. chronic urinary retention
4. urinary incontinence
5. UTI
6. bladder stone
7. renal failure

Question 29

how could BPO cause renal failure

Answer 29

high pressure bladder that can’t fully void obstructs the ureters

Question 30

normal size of a 20 year old prostate in cubic cm

Answer 30

15cc

Question 31

what part of the prostate is most hyperplasia-ed in BPH

Answer 31

transistional