Benign Prostatic Hyperplasia (BPH)

Question 1

Presentation of BPH

Answer 1

• Hesitancy
• Urgency
• Frequency
• Intermittency
• Straining to void
• Terminal dribbling
• Incomplete emptying

Question 2

Assessment of BPH

Answer 2

• Urine dipstick (exclude injection as a major differential)
• PSA done prior to rectal examination can help with assessing potential for prostate cancer
• Rectal exam to assess prostate size, shape and characteristics

Question 3

Management of BPH

Answer 3

• Reassurance and monitoring if manageable symptoms
• Medications
  
  • Alpha blockers to relax smooth muscle (i.e. tamsulosin)
  • 5-alpha reductase inhibitors to block testosterone and actually help reduce the size of the prostate (i.e. finasteride)
• Surgery
  
  • Transurethral resection of the prostate (TURP)
  • Transurethral electrovaporisation of the prostate (TUVP)
  • Holmium laser enucleation of the prostate (HoLEP)
  • Open prostatectomy via abdominal or perineal incision

Question 4

Complications of TURP

Answer 4

• Bleeding
• Infection
• Incontinence
• Retrograde ejaculation
• Urethral strictures
• Failure to resolve symptoms
• Erectile dysfunction