BPH

Question 1

What is BPH?

Answer 1

Benign Prostatic Hyperplasia

Where there is profuse but benign proliferation of prostate layers causing enlargement

Question 2

What are the symptoms?

Answer 2

Post micturition dribbling
Hesitancy
Polyuria
Nocturia
Incomplete emptying
Urgent incontinence 
Poor stream
Retention (either acute or chronic with overflow incontinence)
UTI

Question 3

What investigations are needed?

Answer 3

Urine dip or culture for infection

Bloods

• PSA- rule out prostate cancer
• U&Es- if chronic retention

Urine flow and volume diary for 3 days

Urine flowmetry
-if <12ml/sec then sign of obstruction or weak bladder contractility

Bladder USS- retention
Transrectal USS and biopsy if cancer concerns

Question 4

What is acute management of BPH?

Answer 4

If there is acute retention
Insertion of 3 way catheter
Do suprapubic if cannot get catheter in

Question 5

What is the conservative management of BPH?

Answer 5

Drink less alcohol and caffeine
Relax when voiding- do not strain
Void twice to ensure emptying
Bladder retraining

Question 6

What is the medical management?

Answer 6

1) alpha blockers
- cause relaxation of bladder and prostate
- e.g. tamsulosin
- SE= dizziness, postural hypotension and drowsiness
- used in moderate BPH

2) 5 alpha reductase inhibitors
- stop conversion of testosterone to dihydrotestosterone which causes prostate enlargement
- used if very enlarged and high risk of progression
- SE= erectile dysfunction, decreased libido and gynaecomastia

Question 7

What is the surgical management?

Answer 7

Transurethral resection of the prostate