Benign prostatic hyperplasia (BPH)

Question 1

What is BPH

Answer 1

Very common condition affecting older men. Hyperplasia of the stromal and epithelial cells of the prostate.

Question 2

What zone does BPH usually affect

Answer 2

Transitional and Central zones

Question 3

BPH presentation

Answer 3

Older male
Difficulty starting or maintaining flow
Weak flow
Sudden urge to pass urine
Increased frequency and decreased volume of urination
Flow that starts, stops and varies in rate
Straining to pass urine
Terminal dribbling
Incomplete emptying - may have chronic retention
Nocturia

Question 4

BPH assessment

Answer 4

International prostate symptom score (IPSS) to assess severity of LUTS
DRE - smooth symmetrical and slightly soft with a maintained central sulcus
Abdo exam to assess for palpable bladder
Urine frequency volume chart - record fluid intake and output for 3 days
Urine dipstick - infection, haematuria
PSA (Prostate specific antigen) for prostate cancer testing

Question 5

Problems with PSA testing

Answer 5

Unreliable - false positives and false negatives
Causes of raised PSA:
Prostate cancer
BPH
Prostatitis 
UTI
Vigorous exercise (esp. cycling)
Recent ejaculation or prostate stimulation

Question 6

BPH management

Answer 6

Medications:
Alpha-blockers (e.g. Tamsulosin) to relax smooth muscle - rapid improvement in symptoms
5-alpha reductase inhibitors (e.g. Finasteride) to gradually reduce size of prostate (takes up to 6 months) - reduces conversion of testosterone to dihydrotestosterone (DHT), which is a more potent androgen hormone.
Both meds can be used together
Surgical options:
Transurethral resection of prostate (TURP) - most common. Remove part of prostate from inside urethra.
Transurethral electrovaporisation of the prostate (TUVP/TEVAP)
Holmium laser enucleation of prostate (HoLEP)
Open prostatectomy