BPH

Question 1

How does the prostate gland change with age?

Answer 1

The male sex hormone testosterone makes the prostate grow in size. As men get older, the prostate grows larger.

The prostate doubles in size between 21 and 50 years, and almost doubles again in size between 50 and 80 years. The reasons for this ongoing growth are not fully understood.

. As the prostate surrounds the top part of the urethra, enlargement of the prostate makes the urethra narrower and puts pressure on the base of the bladder.

Reference: Andrology Australaia

Question 2

1/ Normal size of the prostate

2/ What residual volume of urine in the bladder needs further investigations?

Answer 2

1/ normal is <25 cc
2/ residual volume (>100 ml may require further investigation)

(Ref: Urology Check 2012)

Question 3

Complications of BPH

Answer 3

Hydronephrosis
Acute Urinary Retension 
Chronic Urinary Retention 
Recurrent UTI's 
Haematuria 
Bladder stones 
(Ref: Urology Check 2012)

Question 4

Causes of Lower Urinary Tract sx in men?

Answer 4

Lower Urinary Tract Obstruction e.g. BPH , Prostate Cancer, Urethral stricture

Bladder Irritation e.g. Bladder calculi, UTI

Medications e.g. frusemide, lithium, Anticholinergics

Polyuria e.g. increase intake, diabetes, congestive heart failure

Neurological e.g. MS, Parkinson’s, Dementia
(Ref: Urology Check 2012)

Question 5

Medical management

Answer 5

Alpha Blockers
- Tamsulosin - quick onset, improves sx, doesn’t
decrease size of prostate
- Prazocin - more side effects

Alpha-5-Reductase-Inhibitors
- Dutasteride - takes a few months, dec size of
prostate, sexual dysfunction

Combination is on the PBS
–> faster onset but sexual dysfunction

(Ref: Urology Check 2012)

Question 6

Complications of TURP

Answer 6

Infections
Post op urinary frequency, dysuria, haematuria for a few weeks 
Retrograde ejaculation 
Persitent LUTS in some patients 
(Ref: Urology Check 2012)

Question 7

Indications for surgery

Answer 7

refractory urinary retention
bladder stones
recurrent infections
persistent haematuria. Patients may also opt for surgical treatment over medical therapy.

(RACGP 2011: LUTS)