BPH (module 3)

Question 1

in BPH the prostate size increases due to

Answer 1

increased cell numbers
NOT increased cell size

Question 2

which cells undergo hyperplasia in BPH

Answer 2

hyperplasia of prostatic stromal and epithelial cells results in nodular growth in the prostatic urethra

Question 3

symptoms of BPH

Answer 3

continued enlargement can block the urethra
this causes LUTS:
frequency
incomplete emptying
hesitancy
intermittency
urgency
weak stream
staining
nocturia

Question 4

symptoms of BPH are classified into

Answer 4

storage and voiding symptoms

Question 5

which symptoms are storage symptoms

Answer 5

urinary frequency
urgency
nocturne
incontinence

Question 6

which symptoms ate voiding symptoms

Answer 6

weak urinary stream
hesitancy
intermittency
straining
incomplete emptying

Question 7

complications of BPH

Answer 7

poor bladder emptying leads to:
recurrent UTIs
urinary bladder stones
urinary retention
obstructive uropathy and renal failure

Question 8

diagnosis of BPH

Answer 8

history of LUTS
rectal examination (smooth enlarged prostate)
prostate specific antigen (PSA)
trans-rectal US and biopsy (a negative prostate cancer biopsy helps confirm BPH)

Question 9

prostate specific antigen

Answer 9

is a serine protease produced by the prostate involved in the liquefaction of sperm
is prostate specific but not cancer specific

Question 10

what causes PSA to be increased

Answer 10

serum PSA increases with age, increasing size of prostate and in prostate cancer
can be elevated in urinary infections or after surgical instrumentation

Question 11

what is IPSS

Answer 11

International prostate symptom score
based on 7 questions to score severity of LUTS
does not establish diagnosis

Question 12

LUTS stands for

Answer 12

lower urinary tract symptoms

Question 13

scoring of the IPSS

Answer 13

0-7: misty symptomatic
8-19: moderately symptomatic
20-35: severely symptomatic

Question 14

what would an IPSS of 22 be?

Answer 14

severely symptomatic

Question 15

what wound an IPSS of 9 be?

Answer 15

moderately symptomatic

Question 16

3 classes of drugs used for the treatment of BPH

Answer 16

alpha blockers
5a-reductase inhibitors
anti-cholinergics

Question 17

commonly used alpha blockers for BPH

Answer 17

prazocin, tamsulosin

Question 18

which alpha blocker is more uro-selective

Answer 18

tamsulosin (alpha 1a adrenergic antagonist)

Question 19

what do alpha blockers do to help BPH

Answer 19

relaxes smooth muscle in the prostate gland and bladder neck improving urinary flow

Question 20

common side effect of alpha blockers

Answer 20

postural hypotension

Question 21

5 alpha reductase inhibitors

Answer 21

5a-reductase is responsible for the conversion of testosterone to DHT in the prostate
DHT is known to be responsible for the enlargement of the prostate gland

Question 22

commonly used 5a-reductase inhibitor

Answer 22

finasteride
dutasteride

Question 23

5a-reductase inhibitor may also be used to treat

Answer 23

male pattern baldness

Question 24

side effects of 5a-reductase inhibitors

Answer 24

erectile dysfunction
loss of libido
breast tenderness

Question 25

how do anticholinergics help

Answer 25

treat symptoms of overactive bladder (storage symptoms)

Question 26

side effects of anticholinergics

Answer 26

dry mouth and contipation
rarely blurred vision and confusion
may precipitate urinary retention (avoid in bladder outflow obstruction)

Question 27

contraindications of anticholinergics

Answer 27

contraindicated in glaucoma, avoid in the elderly

Question 28

combination treatment

Answer 28

a combination of an Alpha blocker and a 5a-reductase inhibitor is sometimes required in the medical management of patient with severe LUTS

Question 29

indications for surgery

Answer 29

severe symptoms
failed medical treatment
complications of bladder outflow obstruction eg. urinary retention, bladder stones, UTI, upper tract obstruction/renal impairment

Question 30

types of surgery for BPH

Answer 30

transurethral resection of the prostate (TURP)
laser ablation/resection
open prostatectomy

Question 31

most commonly used surgical treatment of BPH

Answer 31

TURP

Question 32

which type of patient should get TURP

Answer 32

patient with mainly storage symptoms rather than voiding symptoms

Question 33

TURP is performed under

Answer 33

spinal or general anaesthetic

Question 34

TURP involves

Answer 34

inserting a cystoscope and an electrical loop that cuts and diathermies bleeding vessels in the prostate gland.
irrigation fluid is also passed through the cystoscope.
prostate chips that have been removed will be sent off for histopathology
IDC is inserted at the end and remains in situ for 24 hours post op

Question 35

recovery time for TURP

Answer 35

patients are expected to stay in hospital for approximately 1-2 days post operatively
recovery for most patients in about 2 weeks

Question 36

how long must the patient have an IDC in after TURP

Answer 36

24 hours post op

Question 37

possible risks of TURP

Answer 37

bleeding
infection
retrograde ejaculation
erectile problems
urinary incontinence
bladder neck stricture

Question 38

what is TURP syndrome

Answer 38

dilution hyponatraemia after absorption of hypotonic irrigation solution used during the procedure

Question 39

what irrigation fluid is usually used during TURP

Answer 39

glycine - this used to be used when monopolar electrical loops were used because it would not conduct electricity, now they have bipolar loops so they can use normal saline

Question 40

when to do a TURP

Answer 40

• severe symptoms
• failed medical treatment
• complications of

Question 40

when to reconsider whether TURP is appropriate

Answer 40

over 80s and under 50s
consider possible neurogenic cause for symptoms eg. CVA, diabetic
previous TURP

Question 41

is increased PSA level diagnostic of BPH

Answer 41

it is not diagnostic of BPH or prostate cancer

Question 42

how do you quantify symptoms of BPH

Answer 42

IPSS scale