BPH

Question 1

What is BPH?

Answer 1

Histological diagnosis with features of BPO and LUTS

Fibromuscular and glandular hyperplasia

Question 2

Where does BPH normally affect?

Answer 2

Transition zone in centre of prostate

Question 3

What are the risk factors for BPH?

Answer 3

Increasing age

Afro-Caribbean

Question 4

What is the presentation of BPH?

Answer 4

Obstructive- hesitancy, poor stream, terminal dribbling, incomplete emptying
Irritative- frequency, nocturne, urgency
COmplications- UTI, retention

Question 5

What investigations are done for BPH?

Answer 5

urinalysis
PSA
Volume charting
Flow rate study
Post void bladder US

Question 6

What is the management of BPH if not bothersome?

Answer 6

Watchful waiting

Question 7

What is the medical management of BPH?

Answer 7

Alpha1 antagonist e.g. tamsulosin

5 alpha reductase e.g. finasteride

Question 8

What is the mechanism of action of tamsulosin?

Answer 8

Causes smooth muscle relaxation of internal urethral sphincter and prostate

Question 9

What is the mechanism of action of finasteride?

Answer 9

Reduce prostate size by converting testosterone to dihydrotestosterone

Question 10

What are the surgical management options for BPH?

Answer 10

TURP if prostate <100cc

Open resection if >100cc- retropubic or transvesical

Question 11

What are the complications of BPH?

Answer 11

Urinary retention
Incontinence
UTI
Surgery- erectile dysfunction