Benign Prostatic hyperplasia

Question 1

Define benign prostatic hyperplasia

Answer 1

Slowly progressive nodular or diffuse hyperplasia of the periurethral (transitional) zone of the prostate gland

Question 2

What are the risk factors for BPH?

Answer 2

1. Age over 50

Question 3

What is the epidemiology of BPH?

Answer 3

Very common = 70% of men over 70yrs have it

Question 4

What are the presenting symptoms of BPH?

Answer 4

LUTS:

1. Frequency
2. Urgency
3. Nocturia
4. Post-micturia dribbling
5. Poor stream/flow
6. Hesitancy
7. Overflow incontinence
8. Incomplete voiding

Question 5

what are some symptoms of acute retention?

Answer 5

1. Severe pain

2. sudden inability to pass urine

Question 6

What are some symptoms of chronic retention?

Answer 6

1. Painless
2. Frequency - with passage of small volumes of urine
3. Nocturia is a major feature

Question 7

What are the signs of BPH on physical examination?

Answer 7

1. DRE - the prostate is usually smoothly enlarged with a palpable mid-line groove
2. Signs of Acute Retention:
   - Suprapubic pain
   - Distended, palpable bladder
3. Signs of Chronic Retention:
   - A large distended painless bladder (volume > 1 L)
   - Signs of renal failure

Question 8

Does BPH increase the chances of prostate cancer?

Answer 8

No, it is considered a normal part of ageing.

Question 9

Does BPH increase the chances of prostate cancer?

Answer 9

No, it is considered a normal part of ageing.

Question 10

Does the size of the prostate correlate with the severity of the symptoms?

Answer 10

There is poor correlation between the size and the severity of the symptoms

Question 11

What are the investigations for BPH?

Answer 11

1. Urinanalysis (rule out UTI)
2. Bloods - U&E’s (impaired renal function), PSA
3. MCS
4. US of urinary tract
5. Flexi cystoscopy
6. Transrectal ultrasound scan (TRUS)

Question 12

What is the management for BPH?

Answer 12

1. in EMERGENCY = catheterisation
2. Conservative = watchful waiting, lifestyle changes (less caffeine and alcohol)
3. Medication:
   - 5-alpha-reductase inhibitors
   - A-1 receptor antagonists
4. Surgery - TURP (transurethral resection of prostate)

Question 13

What are the complications of BPH?

Answer 13

1. Recurrent UTI
2. Acute or chronic urinary retention
3. Stone development
4. Urinary stasis
5. Obstructive renal failure

Question 14

What is the prognosis for BPH?

Answer 14

Mild symptoms controlled medically.

Surgery provides significant relief.