224b BPH

Question 1

prostate anatomy

Answer 1

BPH - transition zone - surrounds urethra, grows with age

peripheral zone - most of prostate, acinar (glandular) tissue, majority of cancers arise here

Question 2

BPH

Answer 2

hyperplasia of stroma that compresses everything
some glandular growth, but not as much

(cancer is glandular growth)

anatomic enlargement is often present, but not required for BPH symptoms

Question 3

hormones that drive prostate

Answer 3

T/DHT drive process

T - stroma + glands

DHT - important hormone for stromal component

stroma overgrowth = BPH = DHT driven

Question 4

symptoms of BPH

Answer 4

obstruction – decreased force, straining, frequency, nocturia

one cause of LUTS

Question 5

untreated BPH

Answer 5

bladder dilation and thickened –> hydronephrosis –> compressive atrophy of renal parenchyma, infection, pyelonephritis

Question 6

BPH dx

Answer 6

clinical dx (no biopsy), rule out other causes

Question 7

BPH medical management + SE

Answer 7

1st - alpha-blocker (ends in _sin): relaxes smooth muscle, rapid improvement, good for long term

SE: hypotension, dizziness, congestion, retrograde ejactulation

2nd - androgen suppression (ends in _asteride) (5a reductase inhibitors) - reduces prostate size, gradual symptoms improvement

SE: might falsely lower PSA, decreased libido

Question 8

minimally invasive therapy

Answer 8

remove adenoma growth in center

TURP (transurethral resection of the prostate)
gold standard
requires anesthesia
leaves big hole that in which urethra regrows

Question 8

minimally invasive therapy

Answer 8

remove adenoma growth in center

indications: urinary retention, gross hematuria, bladder stones, UTI

TURP (transurethral resection of the prostate)
gold standard
requires anesthesia
leaves big hole that in which urethra regrows
low risk of ED and UI