Benign Prostatic Hypertrophy

Question 1

What is the definition?

Answer 1

An increase in the size of the prostate gland without malignancy

Question 2

What causes it?

Answer 2

It is thought to be caused by a failure of Apoptosis

Question 3

What are the histological results of this?

Answer 3

It causes Benign Nodular or Diffuse proliferation of Musculofibrous and glandular layers of the prostate

Question 4

Which area of the prostate enlarges?

Answer 4

The inner transitional zone

Question 5

What is necessary for BPH to occur?

Answer 5

The presence of Testosterone (so this pathology cannot occur in castrated males)

Question 6

Is it common?

Answer 6

Yes, it affects 40% of 50 year olds and 90% of 90 years olds

Question 7

Who is more at risk?

Answer 7

Elderly and Afro-American men

Question 8

Signs and Symptoms (11)

Answer 8

Nocturia, frequency, urgency, post micturition dribbling, poor stream, reduced flow, hesitancy, overflow incontinence, haemturia, bladder stones, UTI

Question 9

Differentials (8)

Answer 9

Prostate cancer, UTI, Bladder tumour, bladder stone, bladder trauma, chronic prostatitis, detrusor instability, interstitial cystitis,

Question 10

What investigations? (7)

Answer 10

PR exam, midstream urinalysis, PSA, U&E, Ultrasound, Transrectal Ultrasound and Biopsy

Question 11

What are the drug treatments?

Answer 11

Alpha Blockers e.g Doxazocin, 5 Alpha Reductase Inhibitors e.g Finasteride

Question 12

What are lifestyle treatments? (4)

Answer 12

Avoid caffeine and alcohol, relax when voiding, double voiding, bladder training

Question 13

What are surgical treatments? (4)

Answer 13

Transurethral resection of the prostate, Transurethral incision of the prostate (relieves tension but can recurr), Retropubic Prostatectomy, Transurethral Laser-induced prostatectomy

Question 14

Complications (5)

Answer 14

Urinary retention, recurrent UTI, CKD, Bladder Calculi, Haematuria