BENIGN PROSTATIC HYPERTROPHY

Question 1

True or False

Benign prostatic hyperplasia (BPH) is a hyperplastic process, meaning there is an increased number of cells

Answer 1

True

Question 2

What is the most common benign tumor in men and its incidence is age related?

Answer 2

Benign Prostatic Hyperplasia (BPH)

Question 3

At age 55, what percentage of men report obstructive voiding symptoms?

Answer 3

25%

Question 4

At age 75, what percentage of men report a decrease in the force and caliber of the urinary steam?

Answer 4

50%

Question 5

True or False

Symptoms of BPH can be related either to obstructive component of the prostate or to the secondary response of the bladder to the outlet resistance (irritative)

Answer 5

True

Question 6

These are symptoms of what component of BPH?

1. hesitancy
2. decreased force and caliber of stream
3. sensation of incomplete bladder emptying
4. double voiding
5. straining to urinate
6. postvoid dribbling

Answer 6

Obstructive

Question 7

These are symptoms of what component of BPH?

1. Urgency
2. Frequency
3. Nocturia

Answer 7

Irritative symptoms

Question 8

What is the most important tool used in the evaluation of patients with BPH?

Answer 8

American Urological Association (AUA) symptom index

Should be calculated for all patients before starting therapy

Question 9

What are important physical exams to perform for a patient with possible BPH?

Answer 9

1. DRE
   a. smooth firm elastic enlargement of prostate
   b. induration should alert you to the possibility of cancer
2. Neuro exam
3. Abdominal exam
   a. assess for distended bladder

Question 10

Is imaging normally warranted for BPH?

Answer 10

not routinely ordered

Question 11

What is recommended only in the presence of concomitant urinary tract disease or complications of BPH (hematuria, UTI, Chronic kidney disease, history of stone disease)?

Answer 11

Upper tract imaging (CT or renal ultrasound)

Question 12

What is only recommended to assist in determining the surgical approach in patients with BPH needing invasive therapy?

Answer 12

Cystoscopy

Question 13

Patients with mild symptoms of BPH (AUA scores 0-7) should be managed with what?

Answer 13

watchful waiting only

Question 14

What are some medications that can be given in BPH?

Answer 14

1. Alpha-blockers
2. 5-alpha-reductase inhibitors
3. Phosphodiesterase-5 inhibitors

Question 15

These are all what kind of indicators in patients with BPH?

1. Refractory urinary retention (failing at least one attempt at catheter removal)
2. Large bladder diverticula
3. Sequelae of BPH; recurrent UTI, recurrent gross hematuria, bladder stones, or chronic kidney disease

Answer 15

Absolute surgical indicators

Question 16

Are these conventional or minimally invasive surgical procedures for BPH?

1. Transurethral resection of the prostate (TURP)
2. Transurethral incision of the prostate (TUIP)
3. Open simple prostatectomy

Answer 16

Conventional

Question 17

Are these conventional or minimally invasive surgical procedures for BPH?

1. Laser therapy
2. Transurethral need ablation of the prostate (TUNA)
3. Transurethral electovaporization of the prostate
4. Hyperthermia
5. Implant, to open prostatic urethra

Answer 17

Minimally invasive