BPH

Question 1

How common is BPH?

Answer 1

50% over 50, 80% over 80

Question 2

Pathogenesis of BPH

Answer 2

Hyperplasia of transition zone under control of DHT (converted from testosterone by 5-a-reductase); may be other factors involved (e.g. impaired apoptosis, oestrogens, GFs)

Question 3

LUTS symptoms

Answer 3

Obstructive symptoms: SHED
Irritative symptoms: FUND
Others: pain (flank, loin or groin), cloudy or smelly urine, urethral discharge, polydipsia
Complications: overflow incontinence, stones, haematuria, distension due to retention, renal compromise due to hydronephrosis
May be relevant to ask sexual history

Question 4

BPH Ix

Answer 4

DRE
FBE: WCC, signs of anaemia
UEC: signs of renal compromise (creatinine, urea, electrolyte derangement)
Urinalysis: RBC, WBC, protein, glucosuria
MSU for MCS
PSA (perform before DRE)
Uroflowmetry
Biopsy if suspicion of malignancy

Question 5

BPH Mx

Answer 5

DEPENDENT ON SYMPTOMS AND IMPACT ON LIFE
Conservative: watchful waiting (half will improve spontaneously) and lifestyle changes (e.g. avoid caffeine and alcohol)
Pharmacological: a-blockers, 5-a-reductase inhibitors (combination is synergistic), PDE-5 inhibitors, NSAID
Surgical: TURP/TULIP, TUIP, retropubic radical prostatectomy (last line), minimally invasive options

Question 6

Advantages of TUIP

Answer 6

Less destruction than TURP
Less risk to sexual function
Best for those with small glands

Question 7

Mechanism of TURP syndrome

Answer 7

Fluids (other than normal saline e.g. glycine, free water) used to irrigate bladder during surgery absorbed into prostatic venous sinuses
Symptoms result from fluid overload

Question 8

Minimally invasive therapies (7)

Answer 8

Prostatic stents
Microwave therapy
Laser ablation
Thermotherapy
Cytotherapy
High intensity focussed US
Transurethral needle ablation (TUNA)

Question 9

Complications of TURP

Answer 9

Impotency (