Benign Prostatic Hypertrophy

Question 1

How common is BPH?

Answer 1

80% of 80 yr men

Question 2

Who is affected by BPH?

Answer 2

Men over 60 yrs

Question 3

What are the presenting symptoms of BPH?

Answer 3

• increased frequency
• nocturia
• difficulty starting flow (hesitancy)
• poor flow
• terminal dribbling
• stream starts and stops
• incomplete bladder emptying
• acute urinary retention
• incontinence
• occasional haematuria

Question 4

What are the examination signs in BPH?

Answer 4

• palpate bladder - enlargement due to retention.

- rectal exam - Prostate feels smooth without nodules, firm but not hard, enlarged with an identifiable median sulcus.

Question 5

What are the investigations done for BPH?

Answer 5

• MSU ( look for signs of infection - prostatitis)
• U + E (blood? infection?)
• USS + biopsy ( rule out cancer)
• PSA (raised)

Question 6

What are the lifestyle treatment options for BPH?

Answer 6

Reduce urgency/ nocturia by:

• avoid caffeine
• avoid alcohol

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Question 7

What medications are used to treat BPH?

Answer 7

• alpha blockers are 1st line e.g. tamsulosin, doxazosin. They decrease the smooth muscle tone of prostate and bladder.
• 5a reductase inhibitors can be used alone or added to a blockers. e.g. finasteride 5mg - decreases testosterone conversion to dihydrotestosterone so reduced growth of prostate.

Question 8

What are the surgical options for BPH treatment?

Answer 8

• TURP (transurethral resection of the prostate) –> risk of impotence, may need redoing.
• TUIP (transurethal incision of prostate)
• Retropubic prostatectomy
• Laser induced prostatectomy

***surgery helps to relieve pressure on urethra.