Review Question - QID 103034

The patient in this vignette is most likely suffering from benign prostatic hyperplasia (BPH). The TURP procedure, as treatment for BPH, commonly causes retrograde ejaculation.

BPH results from hyperplasia of the periurethral/transitional prostate causing bladder outlet obstruction. This condition is common after age 45, with increasing frequency with advancing age. The hyperplastic process is mediated by dihydrotestosterone. Importantly, BPH does not predispose to prostate cancer.

Keister et al. describe indications for surgical therapy for BPH. They state that medical therapy (alpha blockers, 5-alpha reductase inhibitors) should be first line, but to recall that these medications are not without side effects. TURP is the most effective technique for reducing urinary symptoms, but patients should be counseled that there are several irreversible side effects of this procedure including erectile dysfunction (10-20%) and retrograde ejaculation (50-60%).

Zong et al. report a metaanalysis of TURP compared to watchful waiting as well as two other invasive modalities (transurethral electrovaporization - TUEVP and holmium laser treatment - HLT). TURP was associated with a higher occurrence of retrograde ejaculation compared to watchful waiting but not to TUEVP or HLT.

Illustration A demonstrates the pathophysiology of BPH. Illustration B demonstrates the TURP procedure.

Incorrect Answers:
Answer 1: Prazosin results in a reduction in blood pressure, not an increase.
Answer 2: Finasteride results in hair growth in male pattern baldness, not hair loss.
Answer 3: TUEVP can result in urinary incontinence, but retrograde ejaculation is much more common complication in TUEVP.
Answer 4: HLT can result in retrograde ejaculation and, less frequently, infection.