Benign prostatic hyperplasia

Question 1

Which ethnicity is BPH more common in

Answer 1

afro-caribbeans
prevalence increases with age

Question 2

What are some diagnostic factors for BPH

Answer 2

LUTS- storage and voiding symptoms

• frequency
  -urgency
  -nocturia
  -dysuria
  -hesitancy
  -incomplete voiding
  -poor stream

FUND HIPS

Question 3

What are some risk factors for BPH

Answer 3

age > 50 years
family history
afro-carribean

Question 4

What investigations are required for BPH

Answer 4

Urinalysis
DRE - smooth enlarged prostate with palpable midline groove

U and Es

PSA- if worried about prostate cancer

urinary frequency -volume chart

Transrectal ultrasound guided needle biopsy

Question 5

What is the international prostate symptom score

Answer 5

IPSS

Score 0-7 - mildly symptomatic
Score 8-19 - moderately symptomatic
Score 20-35 - severely symptomatic

Question 6

What management is required for BPH

Answer 6

catheterisation if acute urinary retention
monitory symptoms
lifestyle changes - avoid caffeine
medication review

Question 7

What medications can be used for management of BPH

Answer 7

Selective alpha 1 blocker - TAMSULOSIN - if IPSS >8
first line drug choice

• decreases smooth muscle tone of prostate

5 alpha reductase inhibitors - FINASTERIDE - if significantly enlarged prostate

blocks conversion of testosterone to DHT

Question 8

What are side effects of alpha 1 blockers

Answer 8

dizziness, postural hypotension, dry mouth , depression

Question 9

What are side effects of 5 alpha reductase inhibitors

Answer 9

ED, reduced libido , ejaculation problems , gynaecomastia

Question 10

What surgical interventions can be carried out

Answer 10

Transurethral resection of prostate