BPH

Question 1

Define BPH

Answer 1

BPH is a histological diagnosis and is characterised by non-cancerous hyperplasia of the glandular-epithelial and stromal tissue of the prostate leading to an increase in its size.

Question 2

BPH risk factors

Answer 2

1. Males
2. Age > 50 years
3. Black African or Caribbean ethnicity
4. Obesity

Question 3

what is BPH the most common cause of

Answer 3

Bladder Outlet Obstruction in men –> LUTs

Question 4

BPH clinical prsentations

Answer 4

1. LUTs
2. Haematuria
3. Haematospermia

Question 5

What is LUTs

Answer 5

Voiding Sx (hesitancy, weak stream, terminal dribbling, or incomplete emptying)

Question 6

What examination is essential in the case of BPH

Answer 6

1. DRE: ?prostate maglignancy, enlargement, texture
2. Abdo: urinary retention

Question 7

normal DRE features of the prostate

Answer 7

• Firm
• Size: walnut
• smooth
• symmetrical prostate

Question 8

What score is used to assess / quantify LUTS

Answer 8

International Prostate Symptom Score (IPSS)

Question 9

when is PSA indicated

Answer 9

1. Men >50 pesenting
2. Black Afro/Caribbean >40
   presented w/ LUTS for the 1st time

Question 10

BPH initial Ix

Answer 10

1. Urinary frequency and volume chart (bladder diary)
2. Urinalysis: to exclude UTI

Question 11

At what volume, the prostate is deemed enlarged

Answer 11

Any prostate >30ml

Question 12

What Ix is used to determine the volume of the prostate

Answer 12

USS KUB

Question 13

BPH Asymptomatic Mx

Answer 13

1. Sx diary
2. Med review
3. lifestyle advice (moderate caffeine / alcohol intake)

Question 14

BPH symptomatic pharmacological Mx

Answer 14

1. α-adrenoreceptor antagonist (α-blockers): Tamsulosin
2. 5α-reductase inhibitors: Finasteride

Question 15

α-blockers: Tamsulosin SEs

Answer 15

• Postural hypotension
• Retrograde ejaculation (semen enters bladder instead of existing through the urethra)

Question 16

How long does it take for α-blockers: Tamsulosin to be effective

Answer 16

few days

Question 17

α-blockers: Tamsulosin response rate

Answer 17

Around 30-40%

Question 18

5α-reductase inhibitors - Finasteride MoA

Answer 18

Prevent the conversion of testosterone to DHT, resulting in a decrease in prostatic volume

Question 19

BPH pathophysiology

Answer 19

the prostate converts testosterone to dihydrotestosterone (DHT) using the enzyme 5α-reductase. DHT is more potent and accounts for 90% of androgen in the tissue. Also, unlike other tissues, the prostate retains the ability to respond to testosterone and thus levels of DHT also remain high though life.

Question 20

Function of the prostate

Answer 20

Produce prostatic fluid that helps nourish and protect sperm

Question 21

Concering features of the prostate on DRE

Answer 21

• Lumps / bumps
• Asymmetry
• nodules
• enlarged

Question 22

How long does it take for 5α-reductase inhibitors - Finasteride to be symptomatic benefit

Answer 22

up to 6/12

Question 23

BPH surgical Mx

Answer 23

1. TransUrethral Resection of the Prostate (TURP)
2. Holmium Laser Enucleation of the Prostate (HoLEP)

Question 24

what is TURP

Answer 24

involving endoscopic removal of obstructive prostate tissue using a diathermy loop to increase the urethral lumen size

Question 25

what is HoLEP

Answer 25

involves using a Holmium:YAG laser used to heat and dissect sections of prostate into the bladder

Question 26

BPH complications

Answer 26

1. high-pressure retention (where chronic or acute-on-chronic urinary retention results in a post-renal kidney injury)
2. Recurrent UTIs
3. Haematuria