Benign prostatic hyperplasia

Question 1

What are the typical symptoms of BPH? How can these symptoms be classified?

Answer 1

Storage and voiding symptoms

Storage:

• Urgency
• Frequency
• Nocturia

Voiding:

• Hesitancy
• Intermittent flow
• Terminal dribbling

Question 2

What scoring system can be used to assess the severity of symptoms in BPH?

Answer 2

IPSS - International prostate symptom score

Question 3

Describe the initial assessment of a man presenting with LUTS (examination and initial investigations)

Answer 3

Examination:

• DRE
• Abdominal examination

Investigation:

• Urine dipstick
• PSA
• Bladder diary

Question 4

What are the common causes of a raised PSA?

Answer 4

• BPH
• Prostate cancer
• Prostatitis
• Vigorous exercise (especially cycling)
• Recent ejaculation

Question 5

What are the options for medical management of the symptoms of BPH? Briefly describe how these medications work

Answer 5

• Alpha blockers e.g. tamsulosin (relax smooth muscle)

- 5 alpha reductase inhibitors, e.g. finasteride (gradually reduce the size of the prostate)

Question 6

Give two examples of surgical options to treat BPH

Answer 6

• Transurethral resection of the prostate (TURP)

- Prostatectomy