benign prostatic hyperplasia

Question 1

what is the normal size of the prostates ?

Answer 1

20-25 ml

Question 2

what is the role of alpha reductase enzyme in the prostate ?

Answer 2

it catalyzes the reaction between testosterone and DHT

DHT is then used to grow the prostates

Question 3

how can we define benign prostatic hyperplasia histologically ?

Answer 3

by glandular, stromal and muscular hypertrophy

Question 4

how can we define BPH clinically ?

Answer 4

by using the IPSS score , international prostate symptom score

Question 5

what IPSS score would mild LUTS take ?

Answer 5

0-7

Question 6

what IPSS score would moderate LUTS take ?

Answer 6

8-19

Question 7

what IPSS score would severe LUTS take ?

Answer 7

20-35

Question 8

what do male LUTS consist of ?

Answer 8

these are associated with voiding
storage
or post micturition

Question 9

what are the LUTS associated with voiding ?

Answer 9

inconsistent stream 
terminal dribbling 
straining 
hesitancy 
incomplete emptying

Question 10

what are the LUTS associated with storage ?

Answer 10

urgency
frequency
incontinence
nocturia

Question 11

what are the LUTS associated with post-micturition ?

Answer 11

dribbling

Question 12

what is the relationship between the symptom severity and the size of the prostate ?

Answer 12

no direct correlation

Question 13

what are the consequences of BPH ?

Answer 13

increased risk of acute urinary retention
increased risk of surgery
deterioration in symptoms

Question 14

what are the factors that may increase the onset of acute urinary retention ?

Answer 14

sexual excitement 
alcohol 
cold weather 
wetness 
withholding of micturition

Question 15

what should be done at initial assessment for a man complaining of LUTS ?

Answer 15

digital rectal examination
urine dip stick test
ask patient to complete urinary frequency chart

Question 16

when should PSA testing be offered ?

Answer 16

1- LUTS suggestive of bladder outlet obstruction secondary to BPE
2- Prostate feels abnormal on DRE
3- concern is about prostatic cancer

Question 17

what are frequency volume charts mainly used for ?

Answer 17

these charts give an indication of voiding patterns as well as the severity of symptoms

Question 18

what drug treatments should be offered for patients complaining of moderate to severe LUTS ?

Answer 18

alpha blockers

Question 19

what drug treatments should be offered for patients complaining of moderate to severe LUTS along with a prostate heavier than 30g accompanied with a risk of progression of the disease ?

Answer 19

5 alpha reductase inhibitor

Question 20

if the patient is complaining of severe symptoms of LUTS along with a PSA level higher than 1.4 mg/dl what is the best drug treatment ?

Answer 20

combination of alpha blockers and 5 alpha reductase inhibitor

Question 21

if the patient is complaining of storage symptoms and symptoms that fall under OAB syndrome which drug treatment is the most appropriate ?

Answer 21

Mirabegron (antimuscarinic)

Question 22

how often should the patient be reviewed after prescribing ann alpha blocker ?

Answer 22

review at 4-6 weeks then every 6-12 months

Question 23

how often should the patient be reviewed after prescribing an 5ARI ?

Answer 23

review at 3-6 months then every 6-12 months

Question 24

how often should a patient on anticholinergics be reviewed ?

Answer 24

review at 4-6 weeks then every 6-12 months

Question 25

besides pharmaceutical management what must also be done with a patient complaining of LUTS/BPH ?

Answer 25

education
reassurance
life style advice

Question 26

what additional pharmaceutical drugs can be used for BPH ?

Answer 26

phosphodiesterase 5 inhibitors

Question 27

what role for phosphodiesterase inhibitors play ?

Answer 27

regulates smooth muscle tone in prostates

Question 28

what is the gold standard inn surgical therapy for BPH ?

Answer 28

TURP , Transurethral resection of the prostate

Question 29

what is the future gold standard in surgical therapy of BPH ?

Answer 29

HoLEP (Holmium laser ablation )

Question 30

what are the risk factors for progressive disease ?

Answer 30

1- age over 70 with LUTS
2- moderate to severe symptoms i.e IPSS >7
3- PSA >1.4 ng/ml
4- prostate volume over 30 ccs
5- flow rate <12 ml/sec