Benign Prostatic Hyperplasia

Question 1

Clinical Features

Answer 1

Lower Urinary Tract Symptoms:

1) Storage:
- Frequency
- Urgency
- Nocturia

2) Voiding:
- Hesitancy
- Poor stream
- Dribbling
- Incomplete emptying

Question 2

Investigation

Answer 2

Urine dipstick (exclude injection as a major differential)

Digital rectal exam to assess prostate size, shape and characteristics

PSA done prior to rectal examination can help with assessing potential for prostate cancer

Urodynamics: flow rate, residual volume

Question 3

Management

Answer 3

Reassurance and monitoring if manageable symptoms

MEDICAL

• Alpha blockers (relax smooth muscle; e.g. tamsulosin 400 mcg once daily)
• 5-alpha reductase inhibitors (block testosterone and actually help reduce the size of the prostate; e.g. finasteride)

SURGERY

• Transurethral resection of the prostate (TURP)
• Transurethral electrovaporisation of the prostate (TUVP)
• Holmium laser enucleation of the prostate (HoLEP)
• Open prostatectomy via abdominal or perineal incision

Question 4

What is TURP?

Answer 4

Involves accessing the prostate through the urethra and “shaving” off prostate tissue from inside using diathermy

Aim is to create a wider space for urine to flow through, thereby improving symptoms

Question 5

TURP Complications

Answer 5

Bleeding

Infection

Incontinence

Retrograde ejaculation (semen goes backwards and is not produced from the urethra during ejaculation)

Urethral strictures

Failure to resolve symptoms

Erectile dysfunction

TUR syndrome: hyponatraemia due to irrigation with glycine during the procedure