Benign Prostatic Hyperplasia

Question 1

What is BPH?

Answer 1

Benign growth of the prostate gland commonly seen in older men.

Question 2

What are the risk factors for BPH?

Answer 2

Age: around 50% men >50 will have evidence and 30% symptoms, 80% men aged >80.
Ethnicity: black> white> asian

Question 3

What are the symptoms of BPH?

Answer 3

Voiding symptoms (obstructive): weak or intermittent urinary flow, straining, hesitancy, terminal dribbling and incomplete emptying

Storage symptoms (irritative): urgency, frequency, urgency incontinence and nocturia.

Post-micturition: dribbling

Complications: urinary tract infection, retention, obstructive uropathy

Question 4

What are the voiding symptoms seen in BPH?

Answer 4

Weak or intermittent urinary flow, 
Straining, 
Hesitancy, 
Terminal dribbling
Incomplete emptying

Question 5

What are the management options of BPH?

Answer 5

Watchful waiting
Medication: alpha-1- antagonists and 5 alpha-reductase inhibitors.
Surgery: transurethral resection of the prostate (TURP) (Transurethral prostatectomy)

Question 6

What medications can be used in the management of BPH?

Answer 6

Alpha-1 antagonists e.g tamsulosin, alfuzosin

5 alpha-reductase inhibitors e.g. Finasteride

Question 7

What are the adverse effects of A-1 antagonistis?

Answer 7

Dizziness
Postural hypotension
Dry mouth
Depression

Question 8

How do A-1 antagonists work in BPH?

Answer 8

Decrease smooth muscle tone (prostate and bladder)

Considered first-line, improve symptoms in around 70% of men

Question 9

What are the adverse effects of 5-a-r inhibitors?

Answer 9

Erectile dysfunction
Reduced libido
Ejaculation problems
Gynaecomastia

Question 10

How do 5-a-r inhibitors work?

Answer 10

Block the conversion of testosterone to dihydrotestosterone (DHT) which is known to induce BPH
May slow disease progression, over 6 months.

Question 11

What are the two key causes of lower urinary tract symptoms in men?

Answer 11

Benign prostatic hyperplasia
Prostate cancer
UTI

Question 12

What are the investigations for a man with lower urinary tract symptoms?

Answer 12

Urinalysis: exclude infection, check for haematuria
DRE: size and consistency of prostate
PSA test: appropriate counselling

Question 13

What are some complications of TURP?

Answer 13

Haemorrhage
Urosepsis
Retrograde ejaculation
Electrolyte disturbances from the irrigation fluids used during surgery