Benign prostatic hyperplastia (BPH)

Question 1

What is meant by BPH?

Answer 1

Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate.
Inner (transitional) zone layers enlarge in BPH, in contrast to peripheral layer expand in prostate carcinoma.

Question 2

What are the features of BPH?

Answer 2

Lower urinary tract symptoms:

• Nocturia
• Frequency
• Urgency
• Post-micturition dribbling
• Poor stream/flow
• Hesitancy
• Overflow incontinence
• Haematuria
• Bladder stones
• UTI

Question 3

How is BPH managed?

Answer 3

Assess severity of symptoms and impact on life.
PR exam

MSU
U&E
Ultrasound bladder

‘Rule out cancer’: PSA, transrectal USS +biopsy

Then consider :
LIFESTYLE
DRUGS
SURGERY

Question 4

What lifestyle advice is given to a patient with BPH?

Answer 4

Avoid caffeine and alcohol (to decrease urgency/nocturia)

Relax when voiding

Void twice in a row to aid emptying

Control urgency by practicing distraction methods e.g. breathing exercises

Train the bladder by ‘ holding on’ to increase time between voiding

Question 5

Which medication are given for BPH?

Answer 5

Alpha blockers - Decrease smooth muscle tone
–> Tamsulosin, Alfuzosin, Doxazosin
SE: drowsiness, depression, dizziness, hypotension, dry mouth, ejaculatory failure, nasal congestion, weight gain

5-Alpha reductase inihibitors
–> Finasteride
SE: impotence, decreased libido

Question 6

What surgery is available for BPH?

Answer 6

Transurethral resection of prostate (TURP)
Transurethral incision of the prostate (TUIP)
Retropubic prostatectomy
Transurethral laser-induced prostatectomy (TULIP)