Benign Prostatic Hyperplasia

Question 1

Define BPH

Answer 1

Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BPH) is characterised by enlargement of the prostate gland. BPH is a pathological diagnosis, these symptoms should be considered bladder outflow obstruction until the diagnosis is made. It is defined symptomatically with the International Prostate Symptom Score (IPSS)

Question 2

Epidemiology of BPH

Answer 2

BPH is present in over 50% of men aged over 60 years and 80% over the age of 80. Heavily related to age.

Question 3

Pathogenesis of BPH

Answer 3

There is a benign hyperplasia, usually in the inner transitional zone, and increases in stromal smooth muscle in BPH. The predominant receptor in stromal tissue is a alpha-1A receptor.

Question 4

BPH Clinical Presentation

Answer 4

• LUTS (Lower Urinary Tract Symptoms)
  * Obstructive (voiding)
  * Weak stream
  * Hesitancy
  * Terminal dribbling
  * Intermittency
  * Irritative (storage)
  * Dysuria
  * Frequency
  * Nocturia
  * Haematuria
  • Acute urinary retention
  • Chronic renal failure
  • Recurrent UTIs

Question 5

BPH Investigations

Answer 5

• DRE - enlarged smooth prostate
  
  • MSU (urinalysis) & culture
  • Transrectal/abdominal ultrasound
  • Voiding chart

Question 6

BPH Management

Answer 6

• Active surveillance
  * The rational is that BPH does not progress to LUTS in most men
  • Pharmacology
    
    • alpha-adrenergic blockers (doxazosin)
      
      • 1st line to reduce smooth muscle tone.
      • Symptomatic relief, but does not prevent disease progression
    • 5 alpha-reductase inhibitors (finesteride)
      
      • Inhibits T (testosterone) to DHT (dihydrotestosterone)
      • Slows progression
  • Surgery
    
    • TURP (Transurethral Resection of the Prostate) or TUIP (Incision)
      
      • Complications include
        
        • Post-operative bleeding
        • UTI infection
        • Retrograde ejaculatory dysfunction
        • Urge incontinence