MBBS OSCE · General Surgery
OSCE — Benign Prostatic Hyperplasia
Eight-minute OSCE station on Benign Prostatic Hyperplasia: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Benign Prostatic Hyperplasia.[1][2] You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[1][2]
Clinical context
Benign prostatic hyperplasia (BPH) is age-related nodular hyperplasia of the periurethral transition zone causing bladder outlet obstruction. Affects 50% of men over 50, up to 90% over 80. Presents with LUTS: voiding (hesitancy, weak stream, straining, incomplete emptying) and storage (frequency, urgency, nocturia) symptoms. DRE: smooth, symmetrically enlarged, rubbery prostate (vs hard, irregular in cancer). PSA over 4 ng/mL warrants cancer investigation. IPSS scores severity: mild 0 to 7, moderate 8 to 19, severe 20 to 35. Treat: alpha-1-blocker (tamsulosin 0.4 mg OD — rapid relief) plus 5-alpha-reductase inhibitor (finasteride 5 mg OD — shrinks gland over 6 months) for moderate symptoms.[1][2]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.[1][2]
- State focused examination priorities.
- List first-line investigations and any named score/criteria.[1][2]
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.[1][2]
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).[1][2]
- Mention one special-population modifier (pregnancy, child, elderly, CKD).[1][2]
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Acute urinary retention (sudden inability to void with severe suprapubic pain) - |
| Safety | Hard, irregular, asymmetrical prostate on DRE - prostate cancer until proven oth |
| Safety | Bilateral hydronephrosis with elevated creatinine from chronic bladder outlet ob |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[1][2]
References3ShowHide
- [1]Lerner LB, McVary KT, Barry MJ, et al. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline J Urol, 2021.PMID 34384237
- [2]McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia N Engl J Med, 2003.PMID 14681504
- [3]McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia N Engl J Med, 1998.PMID 9475762