BPH

Question 1

Pathology

Answer 1

Anatomical vs dynamic

Anatomical: true hyperplasia of cells, 🔼 in epithelial content

Dynamic: 🔼 fibromuscular stroma, tone of smooth muscle fibers in prostate under adrenergic control changes

Prostate ca= peripheral zone
BPH= transitional zone

Question 2

LUTS name 11 constituents

Answer 2

Obstructive
Hesitancy, poor stream, intermittency,
post micturition dribbling, incomplete
voiding and straining

Irritative
Nocturia x3, frequency, urgency, urge
incontinence

Question 3

Other causes for LUTs other than BPH

Answer 3

Ca of prostate
Urethral stricture
Bladder neck contracture
Neurogenic bladder dysfunction 
Diabetes

Question 4

Treatment of BPH

Answer 4

Watchful waiting
Medical mx (for symptomatic BPH without complications)
Alpha adrenergic blockers tamusalin/flomax
decrease dynamic obstruction therefore relaxing
prostatic smooth muscle (best for small prostate)
Causes vasodilation, hypotension, dizzy and
syncope

5 alpha reductase inhib (causes shrinkage of
prostate by blocking testosterone into DHT)
Large prostates and decrease PSA= finesteride 

Surgery

Question 5

Indications for surgery

Answer 5

Complications of bladder outflow obstruction (recurrent UTI, hydroneohrosis)
Recurrent haematuria
Previous prostate surgery
Failed medical mx

Question 6

Complications of TURP

Answer 6

TUR syndrome
Secondary hemorrhage
Septicemia 
Retrograde ejaculation 
Incontinence 
Urethral stricture

Question 7

Etiology

Answer 7

Age >40 (70% of 70 year olds have BPH)
Hormones: androgens, oestrogen and prolactin, DHT
Racial/ dietary factors
Epithelial stromal interaction: