BPH

Question 1

What is BPH

Answer 1

BPH is a histological diagnosis and is characterised by non-cancerous hyperplasia of the glandular-epithelial and stromal tissue of the prostate leading to an increase in its size

Question 2

What are risk factors for BPH

Answer 2

Male > 50

FH

Question 3

What are Sx of BPH

Answer 3

Storage: frequency, urgency, nocturia

Voiding: weak stream, hesitancy, intermittency, incomplete emptying, post-void dribbling

Question 4

What are DDx for BPH

Answer 4

Prostate cancer
UTI
overactive bladder
bladder cancer

Question 5

What Ix in BPH?

Answer 5

DRE: cancer or BPH

Urinalysis: rule out infection

PSA: raised in cancer and BPH

Frequency/volume chart

US: if chronic retention, calculate prostate volume

Can do urodynamic studies

Question 6

What are Rx of BPH

Answer 6

If asymptomatic, watchful waiting : limit fluids and caffeine, bladder training

If symptoms:

alpha blocker e.g tamsulosin

5-alpha reductase blocker e.g. Finasteride

PDE-5 inhibitors e.g.
sildenafil

Anticholinergic e.g. oxybutynin

Surgery if no response to meds, stones, UTI, retention

Question 7

What surgical options for BPH?

Answer 7

If prostate < 30mg, TUIP

If 30-80mg: TURP or others e.g. photoselective vaporisation of the prostate (PVP), prostatic urethral lift (PUL), transurethral microwave therapy (TUMT

If prostate >80mg, open prostatectomy, hoLEP

Question 8

What are complications of BPH?

Answer 8

• High pressure urinary retention 
	• Disease progression 
	• Recurrent UTI
	• Haematuria 
Sexual dysfunction

Question 9

What is TURP syndrome?

Answer 9

Complication of TURP.

Use of hypo-osmolar irrigation can cause fluid overload and hyponatraemia. Patients with TURP syndrome present with confusion, nausea, agitation, or visual changes and needs urgent management by addressing the fluid overload and carefully reducing the level of hyponatremia