Benign Prostatic Hyperplasia

Question 1

what is hyperplasia

Answer 1

the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells, often as an initial stage in the development of cancer

Question 2

what is benign prostatic hyperplasia

Answer 2

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

Question 3

epidemiology

Answer 3

BPH is the most common cause of LUTS (lower urinary tract symptoms) in male adults

Question 4

examples of LUTS

Answer 4

storage symptoms; frequency, urgency, incontinence and nocturia

voiding symptoms; weak stream, dribbling, dysuria, straining

Question 5

main presenting symptoms

Answer 5

storage symptoms, voiding symptoms, fever with dysuria and urinary retention

Question 6

aetiology of BPH

Answer 6

Hyperplasia of the epithelial and stromal compartments, particularly in the transitional zone, may be attributed to various factors including shifts in age-related hormonal changes creating androgen/oestrogen imbalances.

related to androgens

Question 7

risk factors

Answer 7

reduced risk with soya/vegetable based diets and negative association with cirrhosis

Question 8

how to remember obstructive and irritative symptoms

Answer 8

TIP: the obstructive and irritative symptoms can be remembered using the mnemonic FUND HIPS 
Frequency 
Urgency 
Nocturia 
Dysuria 
Hesitancy 
Incomplete voiding  
Poor stream 
Straining

Question 9

acute vs chronic retention

Answer 9

Acute Retention Symptoms; Sudden inability to pass urine and Associated with SEVERE PAIN (suprapubic region)

Chronic Retention Symptoms; Painless, Frequency - with passage of small volumes of urine and Nocturia is a major feature

Question 10

signs of BPH on physical examination (DRE- Digital rectal examination)

Answer 10

the prostate is usually smoothly enlarged with a palpable midline groove

Question 11

investigations

Answer 11

urinalysis, bloods, midstream urine (MSU) and imaging

Question 12

significance of urinalysis in BPH

Answer 12

check for UTI’s and haematuria

Question 13

significance of bloods in BPH

Answer 13

urea and electrolytes to provide info on renal function

PSA (prostate-specific antigen)

Question 14

significance of imaging in diagnosis of BPH

Answer 14

US of urinary tract (check for hydronephrosis)

Bladder scanning to measure pre- and postvoiding volumes

Transrectal Ultrasound Scan (TRUS) - allows assessment of bladder size and volume

Flexible Cystoscopy

Question 15

management plan for BPH

Answer 15

In Emergency (acute urinary retention): 
Catheterisation  

Conservative (if mild) :
Watchful waiting

Medical :
Selective a-blockers (e.g. tamsulosin) relax the smooth muscle of the internal urinary sphincter and prostate capsule
5a-reductase inhibitors (e.g. finasteride) will inhibit the conversion of testosterone to dihydrotestosterone, which can reduce prostate size by around 20%

Surgery :
TURP
Open prostatectomy

Question 16

possible complications of BPH

Answer 16

Recurrent UTI,

Acute or chronic urinary retention,

Urinary stasis,

Bladder diverticula,

Stone development,

Obstructive renal failure,

Post-obstructive diuresis

Question 17

complications of TURP

Answer 17

Transurethral resection of the prostate:

Retrograde ejaculation (you ejaculate up into your bladder because the internal urinary sphincter is relaxed)

Haemorrhage

Incontinence

TURP syndrome - DEFINITION: seizures or cardiovascular collapse caused by hypervolaemia and hyponatraemia due to absorption of glycine irrigation fluid

Urinary infection

Erectile dysfunction

Urethral stricture

Question 18

prognosis

Answer 18

mild patients get good results medically, most patients get relief from surgery