Benign Prostatic Hyperplasia

Question 1

Define BPH

Answer 1

Lower urinary tract symptoms caused by bladder outflow obstruction (BOO) due to benign
prostatic enlargement (BPE)

Question 2

What are the causes/risk factors of BPH?

Answer 2

Benign hyperplasia of the epithelial and stromal compartments -> prostate enlargement
• Increasing age (>50 years)
• Hormonal changes (androgen:oestrogen imbalances)
• Family history
• Afro-Caribbean

Question 3

What are the symptoms of BPH?

Answer 3

Storage symptoms
• Frequency
• Urgency
• Nocturia
• Dysuria

Voiding symptoms
• Hesitancy
• Intermittency/Incomplete emptying
• Post-micturition dribbling
• Weak Stream/Straining

*May develop urinary retention

Question 4

What are the signs of BPH

Answer 4

Smooth prostitic enlargement of DRE

Question 5

What investigations are carried out for BPH?

Answer 5

• IPSS (International Prostate Symptom Score)
• DRE – smooth prostatic enlargement
• PSA – elevated (may also be elevated due to prostatitis, trauma – DRE, cycling, sex)
• Urinalysis – exclude pyuria
• Uroflowmetry <20ml/s
• USS/CT abdomen pelvis – exclude mass, hydronephrosis, calculi

Question 6

What is the management for BPH?

Answer 6

• Reduce fluid intake in the evening
• Alpha-blocker e.g. tamsulosin
• 5-alpha reductase inhibitor e.g. finasteride
• TURP (transurethral resection of the prostate)

Question 7

What are the complications of BPH?

Answer 7

• Recurrent urinary infections
• Acute or chronic urinary retention
• Urinary stasis
• Bladder diverticulae or stone development
• Obstructive renal failure
• Postobstructive diuresis

From TURP:
• Retrograde ejaculation (common)
• haemorrhage (primary, reactionary or secondary 2–10%)
• Clot retention

Rare: 
• Incontinence 
• TUR syndrome (seizures or cardiovascular collapse caused by hypervolaemia and hyponatraemia due to absorption of glycine irrigation fluid) 
• Urinary infection 
• Erectile dysfunction 
• Urethral stricture (Late complication)