Benign Prostatic Hypertrophy (BPH)

Question 1

How common is it?

Answer 1

Common - 24% of 40-65 y/os, 40% if older.

Question 2

Who does it affect?

Answer 2

Blokes

Question 3

What causes it?

Answer 3

• Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate. Inner (transitional) zone enlarges in contrast to peripheral expansion seen in prostate carcinoma.

Question 4

How does it present?

Answer 4

• Lower urinary tract symptoms (LUTS) = nocturia, frequency, urgency, post-micturation dribbling, poor stream/flow, hesistancy, overflow incontinence, haematuria, bladder stones, UTI.

Question 5

Investigations?

Answer 5

• MSU, U&E, ultrasound (large residual volume, hydronephrosis).
• ‘Rule out’ cancer: PSA, transrectal USS ± biopsy.

Question 6

Treatments?

Answer 6

Lifestyle
- Avoid caffeine, alcohol (to ↓nocturia and urgency). Relax when voiding. Void twice in a row to avoid emptying. Control urgency by practising distraction methods. Train bladder by ‘holding on’ to ↑time between voiding.

Drugs

• Useful in mild disease and when awaiting surgery.
• 1st line = α-blockers – (eg tamsulosin). ↓SM tone. SE = drowsiness, depression, dizziness, ↓BP, dry mouth, ejaculatory failure, extra-pyramidal signs, nasal congestion, weight gain.
• 2nd line = 5α-reductase inhibitors – (eg finasteride). Excreted in semen, so warn to use condoms, females should avoid handling. SE: impotence, ↓libido. Effects on prostate size limited and slow.

Surgery

• Transurethral resection of prostate (TURP)
• Transurethral incision of prostate (TUIP) – less risk to sexual function.
• Retropubic prostatectomy (open operation).
• Transurethral laser-induced prostatectomy (TULIP)