BPH

Question 1

Clinical presentation of BPH?

Answer 1

Voiding: hesitancy, intermittency, weak stream, incomplete emptying, post-void dribbling.

Storage: urinary frequency, noctuira, urgency.

Common in men >50

Question 2

Investigations for BPH/ how to assess?

Answer 2

Examination: PR (prostate will feel smooth symmetrical and soft) and abdo exam

Urinalysis: normal. haematuria may indicate cancer, rule out infection

Urodynamics

Prostate-specific antigen (PSA)- unreliable

Internation PRostate Symtpom Score

Volume Charting (urinary frequency chart, record 3 days of fluid input and output)

Imaging with USS or CT not recommended unless pt has chronic retention or recurrent UTIs etc.

Question 3

Management for BPH?

Answer 3

Mild sx: watch & wait (self monitor sx progression and annual follow ups + advise on reduced fluids, bladder training, tx constipation.

START WITH ALPHA BLOCKER (ALFUZOSIN
) BEFORE TWOC
If bothersome sx:
Terazosin or doxazosin or alfuzosin. (alpha blockers relax smooth muscle of prostate and bladder neck.

OR

finasteride / dutasteride: these reduce the prostate volume but take months to improve sx

OR PDE-5 inhibitos like sildenafil

Can start using combos of these

Question 4

Indications for surgical management of BPH?

Answer 4

If prostate volume <30 grams:

TUIP (transurethral microwave therapy), prostatic uretheral lift, photoselective vaporisation of prostate, open prostectomy