Urology - BPH

Question 1

Sx BPH?

Answer 1

lower Sx

• nocturia, freq, urgency, post-micturition dribbling, poor stream, hesitancy, overflow incontinence
• haematuria
• bladder stones
• UTI

Question 2

Ex BPH?

Answer 2

PR exam

Question 3

Ix PBH?

Answer 3

MSU
U+E
US (large residual volume, hydronephrosis)
PSA, transrectal USS +/- biopsy

Question 4

Tx BPH?

Answer 4

Lifestyle
- avoid caffeine, alcohol, (↓ urgency, nocturia)
- voiding techniques/bladder training
Drugs (if mild, awaiting surgery)
- α-blockers (tamsulosin, doxazosin)
- 5α-reductase inhibitors (finasteride)
Surgery
- Transurethral resection prostate (TURP)
- Transurethral incision of prostate (TUIP)
- Retropubic prostatectomy (if v large)
- Transurethral laser-induced prostatectomy (TULIP)

Question 5

α-blockers mechanism?

S/E?

Answer 5

↓ smooth muscle tone in prostate + bladder

S/E
drowsiness
depression
dizziness
↓ BP
dry mouth
ejaculatory failure
extra-pyramidal sugns
nasal congestion
↑ weight

Question 6

5α-reductase inhibitors (finasteride) mechanism?

S/E?

Answer 6

↓ T conversion to dihyroT

S/E
impotence
↓ libido
also excreted in semen, so use condoms

Question 7

Transurethral resection prostate (TURP)

• S/E?
• =( ?

Answer 7

• impotency 14%
• bleeding, clots, incontinence
• TUR syndrome (↓ Na+ and fits)

Question 8

Transurethral incision of prostate (TUIP)

- how does it work?

Answer 8

relieves pressure on urethra

- less destruction and less loss of sexual function