Benign Prostatic Hyperplasia

Question 1

Define Benign Prostatic Hyperplasia?

Answer 1

Slowly progressive nodular hyperplasia of the periurethral (transitional) zone of the prostate gland
It is the most frequent cause of LUTS in adult males

Question 2

What is the aetiology of Benign Prostatic Hyperplasia?

Answer 2

Linked with hormonal changes (e.g. androgens)

Question 3

What are the risk factors for Benign Prostatic Hyperplasia?

Answer 3

Reduced risk with soya/vegetable based diets

Negative association with cirrhosis

Question 4

What is the epidemiology of Benign Prostatic Hyperplasia?

Answer 4

COMMON
70% of men > 70 yrs have histological Benign Prostatic Hyperplasia (50% of them will experience symptoms)
More common in the West than the East
More common in Afro-Carribeans

Question 5

How can the Obstructive and Irritative symptoms be remembered?

Answer 5

FUND HIPS 
Frequency 
Urgency 
Nocturia 
Dysuria 
Hesitancy
Incomplete Voiding 
Poor Stream
Smell/odour

Question 6

What are the Acute Retention Symptoms of Benign Prostatic Hyperplasia?

Answer 6

Sudden inability to pass urine

Associated with severe pain

Question 7

What are the Chronic Retention Symptoms of Benign Prostatic Hyperplasia?

Answer 7

Painless
Frequency - with passage of small volumes of urine
Nocturia is a major feature

Question 8

What do we see on a DRE for Benign Prostatic Hyperplasia?

Answer 8

The prostate is usually smoothly enlarged with a palpable midline groove

Question 9

What’s important to remember about the enlarged prostate in Benign Prostatic Hyperplasia?

Answer 9

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

Question 10

What are the signs of Acute Retention in Benign Prostatic Hyperplasia?

Answer 10

Suprapubic pain

Distended palpable bladder

Question 11

What are the Signs of Chronic Retention in Benign Prostatic Hyperplasia?

Answer 11

A large distended painless bladder (volume > 1 L)

Signs of renal failure

Question 12

What investigations do we do for Benign Prostatic Hyperplasia?

Answer 12

Urinalysis
Bloods
Midstream Urine
Imaging

Question 13

What do we look for on a Urinalysis for Benign Prostatic Hyperplasia?

Answer 13

Check for UTI signs and blood

Question 14

What bloods do we do for Benign Prostatic Hyperplasia?

Answer 14

U&Es - check for impaired renal function

PSA

Question 15

Why do we do a MSU for Benign Prostatic Hyperplasia?

Answer 15

MC&S

Question 16

What imaging do we do for Benign Prostatic Hyperplasia?

Answer 16

US of urinary tract (check for hydronephrosis)
Bladder scanning to measure pre- and postvoiding volumes
Transrectal US (TRUS)
Flexible Cystoscopy

Question 17

Why do we do a TRUS for Benign Prostatic Hyperplasia?

Answer 17

Allows assessment of bladder size and volume

Question 18

What is the Emergency Management plan for Benign Prostatic Hyperplasia?

Answer 18

Catheterisation

Question 19

What is the Conservative management plan for Benign Prostatic Hyperplasia?

Answer 19

Only if mild

Watchful waiting

Question 20

What is the medical management plan for Benign Prostatic Hyperplasia?

Answer 20

Selectiver a-blockers (e.g. tamsulosin) relax the smooth muscle of the internal urinary sphincter and prostate capsule
5a-reductase inhibitors (e.g. finasteride) will inhibit the conversion of testosterone to dihydrotestosterone, which can reduce prostate size by around 20%

Question 21

What is the surgical management plan for Benign Prostatic Hyperplasia?

Answer 21

TURP

Open Prostatectomy

Question 22

What are the possible complications of Benign Prostatic Hyperplasia?

Answer 22

Recurrent UTI
Acute or chronic urinary retention
Urinary stasis 
Bladder diverticula 
Stone development 
Obstructive renal failure 
Post-obstructive diuresis

Question 23

What are the complications of TURP?

Answer 23

Retrogade ejaculation
Haemorrhage 
Incontinence 
TURP syndrome
Urinary infection
Erectile dysfunction
Urethral stricture

Question 24

What is Retrogade Ejaculation?

Answer 24

You ejaculate up into your bladder because the internal urinary sphincter is relaxed

Question 25

What is TURP syndrome?

Answer 25

Seizures or cardiovascular collapse caused by hypervolaemia and hyponatraemia due to absorption of glycine irrigation fluid

Question 26

What is the prognosis for patients with Benign Prostatic Hyperplasia?

Answer 26

Mild symptoms are usually well controlled medically

Most patients get significant relief from surgery