Benign prostatic hyperplasia (Complete)

Question 1

What are the main risk factors for BPH?

Answer 1

Age (50% at age 50 and 80% at age 80)

Ethnicity: Blacks > White > Asian

Question 2

What are the main signs/symptoms of BPH?

Answer 2

Voiding (obstructive) symptoms:

Hesitancy (difficulty starting or maintaing urinary flow)

Weak or intermittent urinary flow

Straining

Terminal dribbling

Incomplete emptying

Storage (irritation) symptoms:

Urgency

Urgency incontinence

Nocturia

Increased urinary frequency

Post-micturation:

Dribbling

Signs:

Symmetrically enlarged prostate

Question 3

Give examples of voiding symptoms in patients with BPH (5)

Answer 3

Hesitancy (difficulty starting or maintaing urinary flow)

Weak or intermittent urinary flow

Straining

Terminal dribbling

Incomplete emptying

Question 4

Give examples of storage symptoms in patients with BPH. (4)

Answer 4

Urgency

Urgency incontience

Nocturia

Increased urinary frequency

Question 5

What are the main complicatons that can arise as a result of BPH?

Answer 5

Urinary retention

UTI

Obstructive uropathy (leads to hydronephrosis)

Question 6

What are the main investigations performed for patients suspected of BPH?

Answer 6

Bedside:

Urine dipstick: Rule out UTI

Bloods:

U&Es: Check especially if chronic retention is suspected which can cause renal impariement.

PSA: Check if patient worried for prostate cancer or obstructive symptoms.

Other:

Urinary frequency-volume chart: For at least 3 days [helps distingush obstructive or irritative pathology]

International prostate symptom score (IPSS): Define severity of symptoms

Question 7

What scoring system is used to determine severity of BPH?

Answer 7

International prostate symptom score (IPSS)

Question 8

For IPSS, what is the score range for the following:

Mildly symptomatic

Moderatley symptomatic

Severely symptomatic

Answer 8

Mild: 0-7

Moderate: 8-19

Severe: 20-35

Question 9

Urinary frequency chart must be done for at least how many days?

Answer 9

At least 3 days

Question 10

What is the management plan for a patient with BPH who is mildly symptomatic?

Answer 10

Watchful waiting

Question 11

What is the management plan for a patient with BPH who is moderately/severely symptomatic?

Answer 11

Medicine:

First line: Alpha-1-antagonists: e.g. tamsolusin, alfusozin.

5 alpha-reductase: For significantly enlarged prostate at high risk of progression. (e.g. finasteride)

Anticholinergics: If a mixture of voiding and storage symptoms that have not been managed by alpha-1-antagonist alone.

Surgery:

Transurethral resection of prostate (TURP): If previous management innefective.

Question 12

Name examples of alpha-1-antagonists in management of BPH.

Answer 12

Tamsulosin

Alfuzosin

Question 13

What are complications of alpha-1-antagonists?

Answer 13

Dizziness

Postural hypotension

Dry mouth

Deppresion

Question 14

How does alpha-1-antagonists work?

Answer 14

Relaxes smooth muscle of bladder and prostate

Question 15

Give an example of a 5 alpha-reductase inhibitor

Answer 15

Finasteride

Question 16

When would a 5 alpha reductase inhibitor be considered in a patient with BPH?

Answer 16

If patient has significantly enlarged prostate and high risk of progression

Question 17

What is the effect of 5 alpha reductase inhibitors?

Answer 17

Reduces prostate size and slows down disease progression.

This however takes time (up to 6 months) to start showing effects

Question 18

What are some adverse effects of alpha 5 reductase inhibitor?

Answer 18

Erectile dysfunction

Loss of libido

Gynaecomastia

Ejaculation problems

Question 19

When would a patient be considered for combination therapy with alpha-1-antagonist and 5 alpha-reductase inhibitor?

Answer 19

If moderate-severe voiding symptoms and enlarged prostate

Question 20

What surgical option can be considered in patients with BPH?

Answer 20

Transurethral resection of the prostate (TURP)

Question 21

What are the main complications of TURP?

Answer 21

Turp syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of the prostate

Question 22

What is the most common complication of TURP?

Answer 22

Anteretrograde ejaculaton

Question 23

What is a serious complication of TURP?

Answer 23

TURP syndrome which presents as:

Fluid overload

Hyponatraemia

Glyceine toxicity

Question 24

How does TURP syndrome occur?

Answer 24

Occurs when too much of the fluid used to wash the area around the prostate during the procedure is absorbed into the bloodstream.

This tends to cause hyponatraemia