BPH

Question 1

Typically presents with LUTS, which may be categorised into…

Answer 1

Voiding (obstructive): weak/ intermittent flow, straining, hesitancy, terminal dribbling, incomplete emptying
Storage (irritative): urgency, frequency, urge incontinence, nocturia
Post-micturition: dribbling

Question 2

Treatment of BPH?

Answer 2

Watchful waiting
Medical: alpha-1 antagonists e.g. tamsulosin and 5 alpha-reductase inhibitors e.g. finasteride (can use combo therapy)
Surgical: TURP

Question 3

how do alpha-1 antagonists e.g. tamsulosin help?

Answer 3

decrease smooth muscle tone (prostate, bladder)

Question 4

adverse effects of alpha-1 antagonists e.g. tamsulosin

Answer 4

dizziness, postural hypotension, dry mouth, depression

Question 5

5 alpha-reductase inhibitors

1) example
2) MOA
3) benefit over alpha-1 antagonists?
4) downside?
5) they may decrease ____ concentrations by up to 50%

Answer 5

1) finasteride
2) block conversion of testosterone > dihydrotestosterone (DHT), which is known to induce BPH
3) cause a reduction in prostate volume and may therefore slow disease progression
4) take about 6 months to work
5) PSA

Question 6

adverse effects of 5 alpha-reductase inhibitors e.g. finasteride

Answer 6

ED
reduced libido
ejaculation problems
gynaecomastia

Question 7

complications of BPH?

Answer 7

UTI, retention, obstructive uropathy

Question 8

which medication is considered 1st line in BPH?

Answer 8

alpha-1 antagonists e.g. tamsulosin, alfuzosin

improve symptoms in around 70%