Benign Prostatic Hyperplasia

Question 1

How common is this condition?

Answer 1

Affects 50% of 50 yo men

Almost all men over 80

Question 2

What symptoms will the patient present with?

Answer 2

lower urinary tract symptoms

Voiding (obstructive)

• hesitancy
• poor stream
• straining
• terminal dribbling

Storage

• frequency
• urgency
• nocturia
• incontinence

Question 3

In what zone does hyperplasia take place?

Answer 3

Transitional

Question 4

What dietary step can patients take to improve symptoms?

Answer 4

Avoid dairy

Reduce caffeine and fluid intake at night

Question 5

If patient is suffering from the following symptoms what could it suggest:

a. haematuria
b. dysuria

Answer 5

Haematuria - invx for urinary tract cancer

Dysuria - infection

Question 6

What is the gold standard test for rate and pattern of urine flow?

Answer 6

Uroflowmetry

Question 7

If suspected symptoms are due to neurlogical disease e.g. diabetic neuropathy, what invx should be done instead?

Answer 7

Formal urodynamic studies

Question 8

What is the first line drug in management?
What is the MoA?

What is the main side effect to warn patients of?

Answer 8

A-blockers
- alfuzosin
- tamsulosin
Relaxes the smooth muscle of the bladder making urination easier - immediate response

Retrograde ejaculation - no/little cum

This usually resolves/significantly improves symptoms

Question 9

If a patient does not have adequate symptom relief with drug/lifestyle change what can be offered?

Answer 9

TURP - transurethral resection of the prostate

Question 10

What drug can be used which over time helps to reduce the size of the prostate?

Answer 10

5-alpha reductase inhibitors