Disorders of the prostate

Question 1

Anatomy of the Prostate

Answer 1

• 3 cm long and 3 cm in diameter and weighs 10–15g
• situated immediately below the bladder neck, first 3 cm of the urethra lies within the gland
• Prostatic hyperplasia or carcinoma may cause local urethral obstruction, carcinoma may invade/disrupt the sphincter mechanism.
• a median groove can usually be identified.
• This groove is described as dividing the gland into two lateral lobes, tends to be obliterated in advanced prostatic cancer but is usually exaggerated in benign hypertrophy

Question 2

Pathophysiology of benign prostatic hyperplasia

Answer 2

• the para-urethral transition zone glands undergo nodular hyperplasia
• progressive symmetrical enlargement of the gland up to several times its normal size (up to 150 g;assessed by ultrasound)

Question 3

Clinical features of benign prostatic hyperplasia

Answer 3

Symptoms of bladder outlet obstruction

• Symptoms assessed using the International Prostate Symptom Score (I-PSS)
• incomplete bladder emptying after urination
• Frequency—need for urination again after less than 2 hours
• Intermittent flow—stopping and starting during urination
• Urgency—difficult to postpone urination
• Weak stream—often made worse by a full bladder or by straining
• Straining to begin urination
• Nocturia—number of times needing to urinate per night

Other symptoms (not scored)

• Hesitancy, worse with a full bladder or at night
• Post-micturition dribbling
• Double micturition (‘pis-à-deux’)

Question 4

Management of benign prostatic hyperplasia

Answer 4

• Assess the symptoms
• Estimate the severity of bladder outlet obstruction
• Investigate any disturbance of upper tract function
• Exclude urinary tract infection
• Exclude prostatic carcinoma clinically
• Treat renal failure and other systemic problems
• Consider catheter drainage
• Cystoscope the patient to rule out other pathology
• Discuss with the patient what can be offered
• Implement appropriate non-surgical treatments
• Resect benign prostatic hyperplasia, divide bladder neck hypertrophy transurethrally, or obtain biopsy material by TURP if carcinoma seems likely and prior confirmation has been negative