Renal & Urology / Benign Prostatic Hyperplasia

Question 1

What is benign prostatic hyperplasia (BPH)?

Answer 1

• It is prostate enlargement that can cause symptoms of urinary obstruction (hesitancy, retention)
• Its prevalence increases with age, and it is considered a normal part of aging in men over the age of 50 years.

Question 2

What area of the prostate does BPH most commonly occur?

Answer 2

Central zone

Question 3

Is BPH always detectable on exam?

Answer 3

No

Question 4

What are the obstructive symptoms of BPH?

Answer 4

• retention
• hesitancy
• decreased stream
• sensation of incomplete voiding
• straining
• postvoid dribbling

Question 5

What are the irritative symptoms of BPH?

Answer 5

• urgency
• frequency
• hematuria
• nocturia

Question 6

What digital DRE findings are characteristic of BPH?

Answer 6

• uniform enlargement
• rubbery texture

Question 7

In a patient with a history of BPH, what is the most likely cause of a palpable suprapubic mass and elevated creatinine?

Answer 7

• Obstruction from BPH causing distended bladder (palpable suprapubic mass) and renal insufficiency (elevated creatinine)

Question 8

According to the American Urological Association, is it necessary to measure PSA in BPH patients?

Answer 8

• No. PSA measurement is usually optional.
• Follow PSA if the patient has a ≥10-year life expectancy
• if knowledge of the presence of prostate cancer would change management or
• if PSA measurement changes management of the patient’s voiding symptoms.

Question 9

What is the medical treatment of BPH?

Answer 9

• Alpha-adrenergic blockers
  
  • prazosin
  • terazosin
• 5-alpha reductase inhibitors
  
  • finasteride

Question 10

What is the mechanism of action of alpha-1-adrenergic blockers?

Answer 10

• Relax the prostatic smooth muscle alleviating the dynamic component of the obstruction and relax the bladder’s internal sphincter

Question 11

What are the common side effects of alpha-1-adrenergic blockers?

Answer 11

• orthostatic hypotension
• retrograde ejaculation

Question 12

How long does it take these drugs to effect a change in symptoms?

Answer 12

1 week

Question 13

What is the mechanism of action of 5-alpha reductase inhibitors?

Answer 13

• Decrease the size of the prostate by inhibiting the conversion of testosterone to the more potent androgen dihydrotestosterone (DHT)

Question 14

What are the common side effects of 5-alpha reductase inhibitors?

Answer 14

• decreased libido
• decreased ejaculate volume
• impotence
• gynecomastia

Question 15

What effect do 5-alpha reductase inhibitors have on PSA?

Answer 15

Reduce the PSA by 50%

Question 16

How long does it take for 5-alpha reductase inhibitors to have their full effect?

Answer 16

6 months

Question 17

What is the surgical treatment of BPH?

Answer 17

Transurethral resection of the prostate (TURP) or open prostatectomy, if severe

Question 18

What are the indications for surgical intervention in BPH?

Answer 18

• refractory urinary retention
• recurrent UTI from BPH
• recurrent gross hematuria
• bladder stone formation
• renal failure
• large bladder diverticula