Enhanced Verifiable CPD from the
University of Birmingham

Dentaljuce Shorts: 500 words, 10 MCQs, on general medicine and surgery.

Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BPH), also known as prostate enlargement, is a noncancerous increase in the size of the prostate gland. It is predominantly seen in males over the age of 40. The condition can lead to symptoms such as frequent urination, difficulty starting urination, weak urine stream, inability to urinate, and loss of bladder control. Complications may include urinary tract infections, bladder stones, and chronic kidney problems.

Diagram of a normal prostate (left) and benign prostatic hyperplasia (right)
Diagram of a normal prostate (left) and benign prostatic hyperplasia (right)

Signs and Symptoms

BPH is the most common cause of lower urinary tract symptoms (LUTS), categorised into storage, voiding, and post-urination symptoms. Storage symptoms include frequent urination, nocturia (waking at night to urinate), urgency, and urge incontinence. Voiding symptoms encompass urinary hesitancy, intermittency, weak stream, straining to void, and a sensation of incomplete emptying. Post-urination symptoms may involve bladder pain or dysuria.

Lower urinary tract symptoms of BPH
Lower urinary tract symptoms of BPH

Causes

The exact cause of BPH remains unclear, but it is thought to involve hormonal changes, particularly involving androgens such as testosterone and dihydrotestosterone (DHT). Androgens are essential for BPH development but do not directly cause it. Castrated males do not develop BPH, highlighting the role of androgens. DHT, a potent androgen, promotes prostate cell growth, and its inhibition through medications like finasteride can reduce prostate size.

Diet and lifestyle factors may also influence BPH development. Studies suggest a possible link between high animal protein intake and BPH, while other research indicates a correlation with metabolic syndrome.

Pathophysiology

BPH involves hyperplasia of both glandular epithelial and stromal cells, with stromal hyperplasia being more predominant. Anatomically, the median and lateral lobes of the prostate are usually enlarged. Growth primarily occurs in the transition zone of the prostate, with rare instances of exceptional enlargement termed giant prostatic hyperplasia.

Benign prostate hyperplasia
Benign prostate hyperplasia

Diagnosis

Diagnosis is based on a history of LUTS, digital rectal examination, and exclusion of other conditions with similar symptoms. Validated questionnaires like the International Prostate Symptom Score (I-PSS) aid in diagnosis. Laboratory investigations, including urinalysis and blood tests for kidney function and prostate-specific antigen (PSA), are commonly performed.

Imaging techniques such as abdominal ultrasound and transrectal ultrasonography (TRUS) help evaluate prostate size and rule out other conditions. Uroflowmetry measures urine flow rate and total volume, while post-void residual volume assessment can indicate significant obstruction.

Treatment

Lifestyle Modifications

Lifestyle changes include increasing physical activity, reducing fluid intake before bedtime, moderating alcohol and caffeine consumption, and following a timed voiding schedule. Avoiding medications with anticholinergic properties is also advised.

Medications

Alpha blockers, such as tamsulosin and terazosin, relax smooth muscle in the prostate and bladder neck, improving urine flow. 5α-reductase inhibitors like finasteride reduce DHT production, shrinking the prostate. Phosphodiesterase inhibitors (PDE) may also be used, particularly in combination with other medications.

Self-Catheterisation

Intermittent urinary catheterisation is an option for relieving bladder retention in BPH patients. Self-catheterisation can help manage urinary retention, though it carries a risk of urinary tract infections.

Surgery

If medical treatments are ineffective, surgery may be performed. Transurethral resection of the prostate (TURP) is the gold standard, while other options include holmium laser ablation (HoLAP), photoselective vaporisation (PVP), and aquablation therapy.

Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate (TURP)

Minimally Invasive Procedures

Minimally invasive procedures include prostatic artery embolisation, water vapour thermal therapy (Rezum), and prostatic urethral lift (UroLift). These outpatient procedures use local anaesthesia and aim to reduce prostate size and urinary symptoms with fewer risks.

Alternative Medicine

Herbal remedies like saw palmetto have been studied but found ineffective compared to placebos. Other studied herbs include beta-sitosterol, pygeum, pumpkin seeds, and stinging nettle root, but their efficacy varies.

Epidemiology

Globally, BPH affects about 210 million males. The risk of developing BPH increases with age, with a prevalence rate of 24% by the age of 80 years.

Global disability-adjusted life year for benign prostatic hyperplasia per 100,000 inhabitants in 2004
Global disability-adjusted life year for benign prostatic hyperplasia per 100,000 inhabitants in 2004

Self-assessment MCQs (single best answer)

What is Benign Prostatic Hyperplasia (BPH)?




Which of the following is NOT a symptom of BPH?




Which diagnostic method involves assessing the prostate gland through the rectal wall?




Which substance is primarily associated with the development of BPH?




Which class of medications for BPH works by relaxing smooth muscle in the prostate and bladder neck?




What is the gold standard surgical treatment for BPH?




Which minimally invasive procedure uses water vapour to reduce prostate size?




Which laboratory test is used to rule out infections or other conditions like diabetes in BPH patients?




What is the role of 5-alpha reductase inhibitors in the treatment of BPH?




Which zone of the prostate is predominantly affected by BPH?




Dentaljuce

Dentaljuce provides Enhanced Continuing Professional Development (CPD) with GDC-approved Certificates for dental professionals worldwide.

Founded in 2009 by the award-winning Masters team from the School of Dentistry at the University of Birmingham, Dentaljuce has established itself as the leading platform for online CPD.

With over 100 high-quality online courses available for a single annual membership fee, Dentaljuce offers comprehensive e-learning designed for busy dental professionals.

The courses cover a complete range of topics, from clinical skills to patient communication, and are suitable for dentists, nurses, hygienists, therapists, students, and practice managers.

Dentaljuce features Dr. Aiden, a dentally trained AI-powered personal tutor available 24/7 to assist with queries and provide guidance through complex topics, enhancing the learning experience.

Check out our range of courses, or sign up now!

Membership Options

Dentaljuce offers a range of membership options…

Regular Membership

With enhanced CPD Certificates. Dentaljuce is brought to you by the award winning Masters team from the School of Dentistry, University of Birmingham, UK. All have won awards for web based learning and teaching and are recognised as leaders and innovators in this field, as well as being highly experienced clinical teachers. Full access to over 100 courses, no extras to pay.

Buy Now

£89.00 per year

Student Membership

No Certificates. With universities cutting down on traditional lectures, many students are currently having to rely more on online resources. If you don't need CPD Certificates, we are offering an amazing discount on your Dentaljuce personal membership fee. Special student price just £29 for 12 months individual membership.

Buy Now

£29.00 per year

Very good material. Brilliant for CPD.
PC

© Dentaljuce 2024 | Terms & Conditions | Privacy Policy

Recording CPD time: recorded.