BPH & Proctatitis

Question 1

Where does they hyperplasia occur in BPH

Answer 1

Stroma and epithelium of peri-urethral area of prostate (transition zone)

Question 2

Findings on DRE for BPH

Answer 2

Symmetrically enlarged, smooth, rubbery prostate

Question 3

What does FUNWISE stand for

Answer 3

F = frequency
U = urgency
N = nocturia 
W = weak stream
I = intermittent stream
S = straining
E = sense of incomplete emptying

Question 4

Complications of BPH

Answer 4

1. Urinary retention, which may cause overflow incontinence
2. Obstruction –> hydronephrosis and renal failure
3. Increased risk of UTI
4. Increased risk of bladder stone
5. Gross hematuria

Question 5

What investigations would you do?

Answer 5

1. Urinalysis R&M and C&S to R/O UTI
2. Bloodwork: Cr and BUN for renal function, PSA to rule out prostate cancer
3. Renal U/S to assess for hydronephrosis
4. Consider uroflowmetry to measure flow rate
5. Consider bladder U/S with post-void residual for urinary retention

Question 6

What are the indications for BPH surgery

Answer 6

Absolute indication: renal failure due to obstructive uropathy
Relative indication: refractory urinary retention, recurrent UTI, recurrent hematuria, bladder stones

Question 7

What are the options for management?

Answer 7

1. Conservative (mild symptoms)
2. Medication
3. Surgical

Question 8

What are the conservative management options for BPH

Answer 8

• Watchful waiting - 50% of patients improve spontaneously

- Lifestyle changes (evening fluid restriction, planned voiding)

Question 9

What are the medication options for BPH

Answer 9

1. Alpha adrenergic antagonist (i.e. Tamsulosin (flomax), terazosin (hytrin), doxazosin (cardura): reduce stromal smooth muscle tone
2. 5-alpha reductase inhibitor (i.e. finasteride (proscar), dutasteride (avodart)): inhibit conversion of testosterone to DHT to reduce prostate size

Question 10

What are the surgery options for BPH

Answer 10

1. TURP - traunsurethral resection of prostate
2. Open prostatectomy
3. Minimally invasive therapy: prostatic stents, microwave therapoy, laser ablation, water induce thermotherapy, cryotherapy, high intensity focused ultrasound, truansurethral needle ablation (TUNA)

Question 11

What are indications you would refer to urology

Answer 11

1. hematuria
2. Urinary retention with hydronephrosis
3. Recurrent UTI
4. Abnormal DRE
5. Elevated PSA