Urology - BPH

Question 1

How does BPH present?

Answer 1

Hesitancy - difficulty starting to pass urine

Weak flow

Urgency - sudden urge to pass urine

Frequency

Intermittency - flow that starts, stops and varies in rate

Terminal dribbling

Incomplete emptying

Nocturia

Straining to pass urine

Question 2

What scoring system can be used to assess the severity of LUTS?

Answer 2

International prostate symptom score (IPSS)

Question 3

Questions to ask with urine symptoms?

Answer 3

Difficulty starting urination?

Sudden urge to pass urine?

Frequency of urine?

Pain when urinating? Straining to pass?

Feel like bladder not emptied fully?

Dribbling once finished passing urine? (terminal dribbling?

Nocturia?

Haematuria? Urine colour?

Question 4

Assessment of LUTS in men

Answer 4

DRE - to examine the prostate

Abdominal examination - to assess for palpable bladder

Urine output chart

Urine dipstick to assess for infection, haematuria (e.g., due to bladder cancer) and other pathology

PSA

Question 5

Common causes of raised PSA

Answer 5

PSA is non-specific for prostate cancer

Prostate cancer
Benign prostatic hyperplasia
Prostatitis
Urinary tract infections
Vigorous exercise (notably cycling)
Recent ejaculation or prostate stimulation

Question 6

How may a cancerous prostate feel on DRE?

Answer 6

A cancerous prostate may feel firm/hard, asymmetrical, craggy or irregular, with loss of the central sulcus

Question 7

Medical options for BPH

Answer 7

Alpha blockers e.g. tamsulosin

5-alpha reductase inhibitors e.g. finasteride

Question 8

How does tamsulosin help symptoms in BPH?

Answer 8

Relaxes smooth muscle, with rapid improvement in symptoms

Used for immediate symptoms

Question 9

How do 5-alpha reductase inhibitors help in BPH?

Answer 9

5-alpha reductase converts testosterone to dihydrotestosterone (DHT), which is a more potent androgen hormone.

Inhibitors of this reduce DHT and therefore lead to reduction in prostate size.

Can take up to 6 months for treatment to result in symptom improvement?

Question 10

What is an important side effect of tamsulosin?

Answer 10

Postural hypotension

Question 11

Surgical options for management of BPH?

Answer 11

Transurethral resection of the prostate (TURP)

Transurethral electrovaporisation of the prostate (TEVAP/TUVP)

(Holmium laser enucleation of the prostate (HoLEP))
(Open prostatectomy via an abdominal or perineal incision)