BPH

Question 1

What is benign prostatic hyperplasia (BPH)?

Answer 1

Benign enlargement of the prostate causing mechanical obstruction to urine flow

Question 2

What part of the prostate enlarges in BPH?

Answer 2

Inner (transitional) zone

Question 3

What are the risk factors for BPH? (3)

Answer 3

Ageing
Family Hx
High levels of testosterone

Question 4

What are the clinical presentations for BPH (voiding)?

Answer 4

SHED:
Stream changes
Hesitancy
Emptying incomplete
Dribbling

Question 5

What are the clinical presentations for BPH (storage)?

Answer 5

FUND:
Frequency
Urgency
Nocturia
Dysuria (painful urination)

Question 6

What additional things should you ask a pt suspected of having BPH? (4)

Answer 6

Weight loss, bone pain
Hematuria
Sexual dysfunction

Question 7

Prostate cancer metastases most commonly to where?

Answer 7

Bone

Question 8

How would you diagnose BPH? (4)

Answer 8

• Raised PSA
• DRE w chaperone
• Urine dipstick (rule out infection)
• Transrectal US + biopsy

Question 9

How would you treat BPH non-pharmacologically? (2)

Answer 9

Watchful waiting

Limit coffee/ alcohol

Question 10

What is the first-line treatment for BPH?

Answer 10

Alpha-blocker: tamsulosin

Question 11

What are the side effects of alpha-blockers? (2)

Answer 11

Orthostatic hypotension

Ejaculatory dysfunction

Question 12

If first-line treatment for BPH doesn’t work, what do you give?

Answer 12

Add 5 alpha-reductase inhibitor: finasteride

Question 13

What are the side effects of 5 alpha-reductase inhibitor? (3)

Answer 13

Gynaecomastia
Sexual dysfunction
Low mood

Question 14

What are the surgical options for BPH? (3)

Answer 14

Transurethral resection of prostate (TURP)
Transurethral incision of prostate (TUIP)
Transurethral laser-induced prostatectomy (TULIP)

Question 15

Why are PSA levels not reliable? (3)

Answer 15

• Increase w age
• Men w prostate cancer have normal PSA: low sensitivity
• Generally used to monitor BPH