Benign Prostatic Hyperplasia

Question 1

What is BPH

Answer 1

Benign hyperplasia of the inner transitional layer of the prostate, this is the fibrous glandular tissues.

Question 2

Clinical features of BPH

Answer 2

Lower Urinary Tract Obstruction = Nocturia, frequency, urgency, post void dribbling, poor flow/stream, hesitency, incomplete voiding, overflow incontinence.
Acute retention
UTI
O/E = smooth enlarged prostate and palpable bladder.

Question 3

Investigations into BPH

Answer 3

Bloods - FBC, U+Es (Renal dysfunction), PSA,

MSSU and urine dip for UTI, Blood etc

Question 4

Imaging for BPH

Answer 4

Renal USS for hydronephrosis. 
TRUSS needed (transrectal ultrasound) + biopsy

Question 5

Treatment for BPH

Answer 5

Avoid caffeine, alcohol (urinary symptoms)
Relaxation techniques for voiding.

Drugs= Tamsulosin (alpha blocker helps increase SM tone) 
or Finasteride (5 alpha reductase inhibitor reducing testosterone content) 

TURP used to removed prostatic tissue -
TUIP used also, has less complications
Reteropubic prostectomy - more difficult

Question 6

Complications of TURP

Answer 6

Impotency.
TURP syndrome - need wash out can cause a hyponatraemia due to absorbance of wash.

Bleeding, clot retention, urethral stricture. Urinary retention post TURP.