Urology: BPH - Benign Prostatic Hypertrophy

Question 1

Outline the pathophysiology of BPH

Answer 1

Hyperplasia of the transitional zone (surrounds the urethra) = enlargement

Static component = increase in benign prostatic tissue narrowing the urethral lumen

Dynamic component = increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors

Question 2

What are the risk factors of BPH

Answer 2

Aging

FH

DM and heart disease

Lifestyle

Question 3

What are the signs and symptoms of BPH

Answer 3

Urinary frequency

Urinary urgency

Nocturia = needing to get up frequently at night to urinate

Hesitancy = difficulty initiating the urinary stream; interrupted, weak stream

Incomplete bladder emptying = feeling of persistent residual urine, regardless of the frequency of urination

Straining = need to push (Valsalva manoeuvre) to initiate/maintain urination, to empty the bladder

Decreased force of stream = subjective loss of force of the urinary stream over time

Dribbling = loss of small amounts of urine due to a poor urinary stream as well as weak urinary stream

Question 4

What investigations are undertaken for BPH

Answer 4

DRE = assess prostate size and contour, evaluate for nodules, and detect areas suggestive of malignancy

Urinalysis = assess for the presence of blood, leukocytes, bacteria, protein, or glucose

Urine culture = exclude infectious cause

International Prostate Symptom Score (IPSS)

PSA = men at risk of BPH are also at risk of prostate cancer

US = abdo, renal, transrectal, determine prostate size

Endoscopy of LUT = when a foreign body or malignancy is suspected

Question 5

How is BPH managed?

Answer 5

Pharmacological

• Alpha-adrenergic receptor blockers
• 5-alpha reductase inhibitors = FINASTERIDE
• Phosphodiesterase-5 enzyme inhibitors
• Anticholinergic agents

Surgical

• Transurethral resection of the prostate (TURP)
• Open prostatectomy = pts with very large prostates (>75g)

Question 6

Outline complications of BPH

Answer 6

Chronic bladder obstruction = retention, renal insufficiency, recurrent urinary tract infections, gross haematuria, and bladder calculi, kidney damage

TURP syndrome = excessive absorption of the irrigation solutions used, hyponatraemia, fluid overload