Benign Prostatic Hyperplasia (BPH)

Question 1

BPH is caused by hyperplasia of the s____ and e___ cells of the prostate (inner transitional zone),which narrows urethra and presents with lower urinary tracts symptoms (LUTS)

Answer 1

stromal and epithelial

Question 2

What are stromal cells?

Answer 2

connective tissue cells

Question 3

What are some typical LUTS that occur with prostate pathology?

Answer 3

Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining
Terminal dribbling
Incomplete emptying
Nocturia

Question 4

What is used to assess the severity of LUTS?

Answer 4

International prostate symptom score (IPSS)

Question 5

What are risk factors for BPH?

Answer 5

Increased age
Family history
Heart disease
Beta-blocker use
Obesity
Diabetes
Erectile dysfunction

Question 6

What initial assessments are done for men presenting with LUTS?

Answer 6

Abdominal exam to assess palpable bladder

Digital rectal exam to assess size, shape and characteristics of prostate

Urine dipstick (infection, haematuria)

PSA test if patient wants

Urinary frequency-volume chart

Question 7

What imaging can be done for BPH?

Answer 7

USS
Cystoscopy

Question 8

What is PSA testing?

Answer 8

Prostate-specific antigen is raised in prostate cancer, BPH, prostatitis, UTIs, vigorous exercises and recent ejaculation or prostate stimulation.
High rate of false positive and some false negatives. may lead to more invasive prostate biopsies.
Needs to be informed decision.

Question 9

What medications can be given to patients with symptoms?

Answer 9

Alpha blockers eg Tamsulosin (relax smooth muscle ie bladder neck)

5-alpha reductase inhibitors eg finasteride (gradually reduce size of protate)

Question 10

How do 5-alpha reductase inhibitors work?

Answer 10

The enzyme 5-alpha reductase, converts testosterone to dihydrotestosterone (DHT) which is more potent. Inhibiting this conversion leads to reduction in prostate size.
Takes up to 6 months treatment for effects.

Question 11

What are surgical options for BPH?

Answer 11

TURP (transurethral resection of prostate)

TUVP (transurethral electro-vaporisation of prostate

HoLEP (holmium laser enucleation of prostate)

Open prostatectomy (via abdominal or perineal incision)

Question 12

What is a complication of TURP?

Answer 12

Retrograde ejaculation (semen goes wrong way, up into bladder rather than down urethra)

Question 13

What are complications of BPH?

Answer 13

Bladder hypertrophy
Urinary retention
UTIs (residual urine)
Hydronephrosis