Benign Prostatic Hyperplasia

Question 1

In what age group is benign prostatic hypertrophy most common?

Answer 1

60+

Question 2

Which tissues are affected by benign prostatic hypertrophy?

Answer 2

glandular and connective tissue elements of the prostate

Question 3

Give 9 symptoms of benign prostatic hypertrophy:

Answer 3

1) post-void dribbling
2) difficulty or delay in urination
3) intermittency
4) frequency
5) incontinence
6) hesitancy
7) retention
8) nocturia
9) haematuria (rupture of prostatic vein)

Question 4

Give two physical exams required to investigate for benign prostatic hypertrophy:

Answer 4

1) digital rectal exam
2) abdominal examination for bladder enlargement (retention)

Question 5

How does a hypertrophic prostate feel upon digital rectal examination?

Answer 5

enlarged and smooth

Question 6

Give 5 investigations used to aid the diagnosis of benign prostatic hypertrophy:

Answer 6

1) urine culture
2) measurement of serum prostate-specific antigen (PSA)
3) renal function tests (e.g. GFR)
4) ultrasound
5) measurement of the urinary flow rate

Question 7

What does PSA stand for?

Answer 7

prostate-specific antigen

Question 8

Name two drug groups used to treat benign prostatic hypertrophy:

Answer 8

1) alpha blockers
2) 5-alpha reductase inhibitors

Question 9

Give an example of an alpha-blocker drug:

Answer 9

tamsulosin

Question 10

Give an example of a 5-alpha-reductase inhibitor drug:

Answer 10

finasteride

Question 11

How do alpha blocker drugs treat benign prostatic hypertrophy?

Answer 11

they relax the prostate, reducing the obstruction for urine

Question 12

How do 5-alpha-reductase inhibitors treat benign prostatic hypertrophy?

Answer 12

they block the conversion of testosterone to dihydrotestosterone, the androgen primarily responsible for prostatic growth and enlargement

Question 13

Give 2 examples of surgical treatment used to treat severe benign prostatic hypertrophy:

Answer 13

1) transurethral resection of the prostate
2) laser therapy (vaporisation of the prostate)

Question 14

what is benign prostatic hyperplasia?

Answer 14

benign enlargement of the prostate gland, specifically the transition zone causing compression of the urethra

Question 15

what is the epidemiology of benign prostatic hyperplasia?

Answer 15

• VERY COMMON in ELDERLY MEN
• 80% of 80yrs have evidence of benign prostatic hyperplasia

Question 16

what is the aetiology of benign prostatic hyperplasia?

Answer 16

UNKNOWN

• age, hormones and lifestyle factors

Question 17

what is the pathophysiology of benign prostatic hyperplasia?

Answer 17

• overgrowth of the nodular prostatic tissue, specifically in the transition zone
• overgrown compresses the prostatic urethra > obstruction and lower UTI symptoms

Question 18

what are the clinical features of benign prostatic hyperplasia?

Answer 18

LOWER UTI SYMPTOMS

Question 19

what are the investigations for benign prostatic hyperplasia?

Answer 19

• urine dipstick
• bloods = U+Es, PSA
• urinary frequency-volume chart for at least 3 days
• digital rectal exam to asses prostate size and nodules
• 2 week wait if suspected prostate cancer

Question 20

what scoring system is used to assess severity of benign prostatic hyperplasia?

Answer 20

international prostate symptom score (IPSS)

• 20-35 = severe
• 8-19 = moderate
• 0-7 = mild

Question 21

what is the management of benign prostatic hyperplasia?

Answer 21

• watchful waiting if mild
• lifestyle modifications eg fluid restriction, avoid caffein and alcohol
• medical therapy
• surgery = transurethral resection of the prostate or laser prostatectomy for moderate-severe

Question 22

what are the side effects of alpha 1 blockers?

Answer 22

• dizziness
• postural hypotension
• dry mouth
• depression

Question 23

how long do 5 alpha reductase inhibitors take to work?

Answer 23

6 months

Question 24

what are the side effects of 5 alpha reductase inhibitors?

Answer 24

• erectile dysfunction
• reduced libido
• ejaculation problems
• gynaecomastia
• DECREASES PSA LEVELS

Question 25

what are the differential diagnosis for benign prostatic hyperplasia?

Answer 25

• prostate cancer
• UTI
• neurogenic bladder dysfunction
• urethral strictures