BPH

Question 1

Where does BPH happen in the prostate?

Answer 1

• Arises in the transitional zone

- inner portion of the prostate that surrounds the urethra

Question 2

Name 2 factors that causes obstruction to urinary flow in BPH:

Answer 2

1. Static Factor
   - due to the physical increase in tissue of enlarged prostate.
2. Dynamic Factor
   - Smooth muscle tone (alpha adrenergic)

Question 3

Pathogenesis of BPH:

Answer 3

-Due to enlarged prostate = increased outflow resistance.

• The outflow resistance causes changes in the detrusor muscle of the bladder
• Thickening
• Trabeculation
• Diverticulae

-Changes in detrusor muscle leads to bladder decompensation or failure.

Question 4

What happens as a result of poor emptying from the bladder in BPH?

Answer 4

1. UTIs
   (Post-micturition residual volume)
2. Bladder Calculi
3. Chronic retention =hydronephrosis, renal failure

Question 5

What do pts with BPH present with on history?

Answer 5

-Present with Lower Urinary Tract Symptoms (LUTS)

1. Obstructive/ Voiding Sx:
   - Incomplete emptying
   - Intermittency
   - Poor stream
   - Straining
2. Storage/Irritative Sx:
   - Urgency
   - Frequency
   - Nocturia

Other Sx- Post micturition dribbling

-Hx to exclude complications:

• UTIs (recurrent)
• including epididymytis
• Haematuria
• Overflow Incontinence (happens due to incomplete bladder emptying)
• Sx of renal failure
• Oedema
• Nausea and vomiting

Question 6

What is IPSS Score?

Answer 6

-International
Prostate
Symptom Score (To quantify the severity of symptoms and track progress.)

the higher the score the greater the severity

Question 7

What to look o/e in BPH pt:

Answer 7

1. General
   - Pyrexia (for UTI)
   - Tachycardia (sepsis, anaemia)
   - Pallor (CKD)
   - Oedema (CKD)
2. Abdominal
   - No palpbale or percussable bladder (urinary retention)
3. Genitalia
   - look for signs of epididymitis
4. Pelvi-rectal
   - Prostate size
   - Exclude Cancer

Question 8

What side room investigations are needed for BPH?

Answer 8

1. Urine Dipstix
   - to exclude UTI
   - to exclude haematuria
2. Flowrate
   Normal Shape= Bell shaped curve
   Normal Flowrate > 15ml/sec

-Low flowrate=, <10ml/sec

Question 9

What special investigations can you do for BPH?

Answer 9

1. Creatinine
2. PSA, only if indicated clinically

3.KUB U/S
-optional
If you suspecting chronic retention with high post-micturition residue with hydronephrosis

Question 10

What are the treatment options for BPH?

Answer 10

1. Expectant Mx
   For pt with mild Sx
2. Medical Mx
   - Alpha Blockers
   - 5-Alpha Reductase Inhibitors
3. Surgery
   - TURP
   - Open Surgery

Question 11

Explain the medical mx for BPH:

Answer 11

1. Alpha Blockers
   - They target alpha 1A receptors
   - they decrease the dynamic component and relaxes prostatic smooth muscles
   - best for small prostates

Question 12

Name examples of alpha blockers:

Answer 12

1. Prazosin (Minipress)
   - cheap
   - high s/e

2.Doxa-zosin
(Cardura)
-good for hypertensive pt

3.Alfu-zosin
(Xatral)

4. Tamsu-losin
   (Flomax)

Question 13

What are the s/e of alpha blockers?

Answer 13

1. Vasodilation
   - Decreases BP
   - dizziness

2.Retrograde Ejaculation

Question 14

What do you do if pt have large prostate (>50g ) to give medical mx?

Answer 14

• 5-alpha reductase inhibitors may be added with alpha blockers.
• Also can be given if pt has bleeding BPH

Question 15

Name examples of 5-alpha reductase inhibitors:

Answer 15

1. Finasteride

2. Dutasteride

Question 16

What are the side effects of 5-alpha reducatse inhibitors?

Answer 16

• Causes hypospadias in foeus

- Reduces PSA by 50%

Question 17

Explain the surgical mx for BPH:

Answer 17

1. TURP (Gold Standard)
   -Trans-urethral
   Resection
   of Prostate

• endoscopic resection of prostate
• only transitional zone resected

2. Open Prostatectomy
   - For big prostates that cannot be resected endoscopically