Benign Prostatic Hyperplasia

Question 1

Define benign prostatic hyperplasia.

Answer 1

BPH is multifactorial and involves smooth muscle hyperplasia, prostatic enlargement, and bladder dysfunction, as well as input from the central nervous system.
Presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).

Question 2

Explain the aetiology/risk factors of benign prostatic hyperplasia.

Answer 2

Age over 50 years
Family history
Non-Asian race
Cigarette smoking

Question 3

Summarise the epidemiology of benign prostatic hyperplasia.

Answer 3

The prevalence of histological BPH increases with age, affecting approximately 42% of men between the ages of 51 and 60 years and 82% of men between the ages of 71 and 80 years.

Question 4

Recognise the presenting symptoms of benign prostatic hyperplasia. Recognise the signs of benign prostatic hyperplasia on physical examination.

Answer 4

Storage symptoms
Voiding symptoms
Fever with dysuria
Urinary retention

Question 5

Identify appropriate investigations for benign prostatic hyperplasia and interpret the results.

Answer 5

Urinalysis
PSA
International Prostate Symptom Score
Global bother score
Volume charting

Question 6

Generate a management plan for benign prostatic hyperplasia.

Answer 6

Alpha blockers e.g. tamsulosin
5-alpha-reductase inhibitor e.g. finasteride
Surgical intervention e.g. TURP, laser

Question 7

Identify the possible complications of benign prostatic hyperplasia and its management.

Answer 7

BPH progression
Urinary tract infection (UTI)
Renal insufficiency
Bladder stones
Haematuria
Sexual dysfunction
Acute urinary retention
Overactive bladder

Question 8

Summarise the prognosis for patients with benign prostatic hyperplasia.

Answer 8

The majority of patients with BPH can expect at least moderate improvement of their symptoms with a decreased bother score and improved quality of life.