BPH

Question 1

Pathophysiology of BPH

Answer 1

Inner (transitional layer of prostate affected
5α-reducatase converts testosterone to DHT
Increased DHT causes hyperplasia

Question 2

Presentation of BPH

Answer 2

Storage symptoms
Voiding symptoms
Bladder stones
UTI

Question 3

Storage symptoms

Answer 3

Nocturia
Frequency
Urgency
Overflow incontinence

Question 4

Voiding symptoms

Answer 4

Hesitancy
Poor stream
Terminal dribbling
Strangury - urinary tenesmus
Incomplete emptying - pis en deux

Question 5

PR findings for BPH

Answer 5

Smoothly enlarged prostate

Definable median sulcus

Question 6

Ix for BPH

Answer 6

U+Es, PSA
Urine dip and MCS
Transrectal US +/- biopsy
Urodynamics

Question 7

Conservative Mx of BPH

Answer 7

Reduce caffeine and EtOH
Double voiding
Bladder training

Question 8

Medical Mx of BPH

Answer 8

1st) Tamsulosin - α-blockers, relax smooth muscle

2nd) Finasteride - 5α-reducatase inhibitor

Question 9

Side effects of tamsulosin

Answer 9

Drowsiness
Hypotension
Depression
Weight gain

Question 10

Side effects of finasteride

Answer 10

Erectile Dysfunction

Excreted in semen (use condoms)

Question 11

Surgical Mx of BPH

Answer 11

TURP
TUIP - less risk to sexual function
Laser prostatectomy
Open retropubic prostatectomy

Question 12

TUIP

Answer 12

Transurethral Incision of Prostate

Question 13

Immediate TURP complications

Answer 13

Haemorrhage

TURP syndrome - large fluid absorption leading to hyponatraemia

Question 14

Early TURP complications

Answer 14

Haemorrhage
Infection
Clot retention

Question 15

Late TURP complications

Answer 15

Retrograde ejaculation
ED
Incontinence
Urethral stricture
Recurrence