BPH

Question 1

How common is BPH?

Answer 1

-24% of 40-64 y/o’s
-40% of >65s

Question 2

What causes BPH?

Answer 2

-Nodular / diffuse proliferation of musculofibrous and glandular layers of the prostate
-Transitional (inner) zone enlarges in contrast to the peripheral layers as seen in malignancy

Question 3

How does BPH present?

Answer 3

-LUTS ie nocturne, frequency, urgency, post-micturition dribbling, poor flow, hesitancy, haematuria
-UTIs
-Bladder stones

Question 4

How would you investigate a patient with BPH?

Answer 4

-MSU
-U+Es
-US (hydronephrosis may be present)
-PR
-PSA
-Transrectal US + biopsy

Question 5

What lifestyle advice could you give to someone with BPH?

Answer 5

SYMPTOM CONTROL
-Avoid caffeine and alcohol
-Relax when voiding, void twice in a row to aid emptying
-Train bladder by ‘holding in’

Question 6

What pharmacological management options are there for BPH?

Answer 6

Useful in MILD disease and while awaiting SURGERY
-Alpha-blockers eg tamsulosin (decrease muscle tone)
–SEs include drowsiness, depression, dizziness, low BP, dry mouth, ejaculatory failure
-5a-reductase inhibitors eg finasteride can be added
–SEs include impotence and reduced libido

Question 7

What surgical options are there for BPH?

Answer 7

-TURP (14% become impotent, incontinence, haematuria, infection)
-TUIP = transurethral incision of the prostate (lower risks, better for those with smaller prostates)
-Retropubic prostatectomy (for very large prostates)
-TULIP = transurethral laser-induced prostatectomy
-Robotic prostatectomy