BPH

Question 1

3 drugs used in BPH

Answer 1

• drugs that relax the internal urethral sphincter → a-adrenergic blocking agents
• drugs to decrease the volume of the prostate → 5a-reductase inhibitor
• antimuscarinics → inhibit PSNS receptors on the detrusor muscle → this decreases the muscle tone (SNS relaxes and PSNS contracts the detrusor muscle)

Question 2

Describe surgical treatment of BPH

Answer 2

Surgical:

• transurethral resection of the prostate → TURP
  
  • risk of complications including infection, sexual dysfunction
• prostatectomy if prostate is particularly large (>60g)
  
  • retrograde ejaculation is a complication of prostate surgery.

Question 3

Describe lifestyle management of BPH

Answer 3

Lifestyle management:

• not drinking too much fluid at night before bed → helps to avoid the nocturia
• review medications that might be contributing to urinary symptoms such as antidepressants
• pelvic floor exercises
• bladder retraining
• techniques to assist with urination → e.g. listening to running water, tapping the bladder

Question 4

Differential diagnosis of BPH

Answer 4

• UTI
• prostate cancer
• neurogenic bladder
• urethral stricture
• detruser underactivity