240: Benign Prostatic Hyperplasia Flashcards

1
Q

Which medications are proven to decrease prostate volume by ~20%?

A

Finasteride, dutasteride

(5-alpha-reductase inhibitors)

Also decreases PSA by 50%

But takes up to 6 months

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2
Q

List the 3 stages of BPH

What size and symptoms occur at each stage?

A
  • Stage 1 = Histologic
  • Stage 2 = Clinical (can discover on exam)
  • Stage 3 = Symptomatic (pt has sx)

LUTS= lower urinary track symptoms

DRE= digital rectal exam

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3
Q

Which structures make up the 1st, 2nd, and 3rd anatomic/physiologic zones of the lower urinary tract?

Which receptors predominate in each zone?

A
  • Zone 1
    • Bladder (above the trigone)
    • M3 (pelvic nerve), Beta-3 (hypogastic nerve)
  • Zone 2
    • Trigone to prostate
    • Bladder neck, prostate, prostatic urethra
    • Alpha-1 (pudendal nerve)
  • Zone 3
    • Membranous urethra
    • Nicotinic ACh receptors (pudendal nerve)
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4
Q

When would surgical managment be preferred over medical for BPH?

A
  • High AUR score (lots of symptoms)
  • Bladder caliculi
  • Large bladder diverticulum w/narrow neck + stasis
  • Recurrent UTI
  • Recurrent gross hematuria
  • Overflow incontinence (bilateral hydronephrosis, azotemia)
  • Lower urinary tract sx refractory to medical mangement
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5
Q

What is the half life of PSA?

A

2-3 days

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6
Q

What form of sexual dysfunction is associated with tamsulosin?

A

Retrograde ejaculation

Tamuslosin = Selective alpha-1A blocker, relaxes bladder neck

Semen can get into the bladder during ejaculation

Usually it is just peed out, no complaints

I guess only a problem if trying to conceive?

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7
Q

List the behavioral modifications that might be useful for mildy symptomatic pts with BPH (5)

A
  • Double voiding
  • Timed voiding (based on diary)
  • Avoid caffein, EtOH, diruetics
  • Night time fluid restriction
  • Exercise
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8
Q

What ophthalmologic problem is associated with alpha-blockers?

A

Intra-operative floppy iris syndrome

Not a contra-indication, but ophthalmologist needs to know before catarct surgery

Higher rates of iris trauma, posterior capsule rupture during cataract surgery

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9
Q

What are the standard components of a BPH workup? (6)

A
  • History
  • Focused physical exam
  • Digital rectal exam
  • Urinalysis
  • Creatinine
  • PSA (in select pts)

DO NOT need urodynamics in most people

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10
Q

Which type of enzyme is PSA?

What is its function?

A

Serine protease

Liquifies semen

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11
Q

What is the major advantage of laser prostatectomy over conventional TURP?

A

Less bleeding

-> better hemostasis in an anticoagulated pt

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12
Q

Which herbal treatments work to treat BPH?

A

NONE of them

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13
Q

For which patients would combined pharmacologic therapy for BPH be most helpful?

(alpha-blocker + 5-alpha reductase inhibitor)

A

Moderate-severe sx

Prostate volume >40mL

Higher PSA

Advanced age

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14
Q

Which two types of drugs will work best for irratiative symptoms of BPH?

What needs to be monitored when patients take these medications?

A

M2/M3 blocker or beta-3 agonist

Goal is to prevent detrusor contraction or promote relaxation

Monitor post-void residual volume to avoid urinary retention

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15
Q

What does phosphodiesterase 5 do?

A

Breaks cyclic-GMP into GMP

Block this process with PDE-5 inhibitors→ promote vasodilation

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16
Q

Which phosphodiesterase enzymes are located in the prostae? (3)

A

4

5

11

PDE-5 inhibitors can help with ED and BPH

17
Q

Which cells of the prostate produce PSA?

A

Adlumina/secretory cells

18
Q

Which zone expand in BPH?

A

Transitional zone

On either side of the urethra

19
Q

Which drug class would be best to treat a patient with BPH and erectile dysfunction?

A

PDE-5 inhibitors

(Sildinafil)

Age increases risk of both ED and BPH

20
Q

Which embryonic structure is the prostate derived from?

A

Pelvic part of the UG sinus

21
Q

How does chronic BPH affect the bladder?

A

Hypertrophy of the detrusor muscles.

Bladder has to generate lots of force to push urine out through enlarged prostate

22
Q

Which enzyme converts testosterone to DHT?

A

5 alpha reductase

23
Q

Which kind of cell is primarily responsible for the production of 5 alpha reductase (Type 2) in the prostate?

A

Stromal cells

24
Q

What percent of men between the ages of 60-69 are affected by symptoms of BPH?

A

70%

25
Q

How does exercise improve BPH-related lower urinary tract symptoms?

A
  • decreased sympathetic NS activity
  • improved sleep quality
  • decreased systemic inflammation
26
Q

What a-adrenergic receptor subtype is linked to smoth muscle contraction in the prostate?

A

Alpha 1a

27
Q

What is an absolute indication for surgical management of BPH?

A

Recurrent episodes of gross hematuria with clot retention