Urology

Question 1

Benign Prostatic Hypertrophy: Management Options

What are the management options for BPH (assuming they are not in renal failure)

Note: decision based upon level of “bothersome” symptoms

Answer 1

1. Lifestyle: modifications and watchful waiting
2. Medical:
   
   1. ​α-antagonist: tamsulosin
   2. 5-α reductase inhibitor: finasteride
   3. Muscarinic antagonism: oxybutinin
3. Surgical:
   
   1. ​TURP
   2. Laser ablation / enucleation
   3. Open retropubic enucleation

Question 2

Benign Prostatic Hypertrophy: Lifestyle Measures

What lifestyle measures are recommended for reducing symptoms in BPH?

Answer 2

1. Limit evening fluids → reduce nocturia
2. Limit caffiene and alcohol → diuretic effect
3. Limit diuretics if possible; should be taken in the morning
4. Limit decongestants and anti-histamines: may worsen obstructive symptoms
5. Take exercise
6. Keep warm: irritative symptoms worse with cold

Question 3

Benign Prostatic Hypertrophy: Alpha Antagonists

What is the mechanism, efficacy, adverse effects and cautions of alpha antagonists (e.g. tamsulosin)

Answer 3

1. Mechanism: relaxation of prostatic smooth muscle, ↓ urinary outflow resistance
2. **Efficacy: **(suitable for mod / severe LUTS)
   
   1. Rapid action (48h), immediate symptomatic relief. Usually first line
   2. Improve symptom score by 30-40%, and maximum flow by 15-30%.
3. Adverse effects: affect CV, GU and CNS:
   
   1. CV: postural ↓BP and syncope, headaches, oedema
   2. GU: Failure of ejaculation (4-11%) - due to effect on vas and seminal vesicles, rather than relaxation of bladder neck
   3. CNS: dizziness, drowsiness
4. **Cautions: **patients on anti-hypertensives at ↑risk of fluit retention and postural hypotension.