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urology final boss > 41. Benign Prostate Hyperplasia (BPH) > Flashcards

41. Benign Prostate Hyperplasia (BPH) Flashcards

1
Q

what is the definition of BPH (benign prostate hyperplasia)

what are the 3 parts to the defintion

A

BPH is 1) benign enlargement of the prostate gland over 20cc/cm3?// 11g 2)causing obstruction leading to LUTS and on 3) uroflowometry w/ a q max (max urination) is less than 15ml/sec // elevated urinary sx score

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2
Q

which tissues comprise the prostate gland

which tissue is more likely to undergo hyperplasia

what are the 3 histological types of cells in the prostate

A

stromal and epithelial tissues

stromal tissues undergo hyperplasia 80% of the time

epithelial tissues can also undergo hyperplasia

histological cell types of prostate

  1. Glandular- 92% causing adenocarcinoma
  2. myoepithelial cells
  3. subepithelial intenrstitial cells
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3
Q

what is the difference between Hyperplasia and Hypertrophy

A

Hyperplasia= increas in cell number that occurs in cancers

Hypertrophy= increase in cell size that occurs in muscle growth

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4
Q

2 pathological mechanisms of obstruction in BPH causing LUTS

A
  1. 60% d/2 Hyperplasia: cells grow in NUMBER caused by the increased level of dehydrotestosteroone catalyzed from testosterone by 5 alphareductase causing:
    • Narrowing of prostatic urethra
    • Elongation of prostatic urethra as enlarged PG raises trigone of UB
    • Distortion of prostatic urethra from assymetrical enlarged PG tubules
  2. 40% d/2 SM constriction alpha 1 receptors stim of SM of the 1)prostate gland stroma, 2)periurethral sm and 3)bladder neck causing constrictions and obstruction & LUTS
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5
Q

Describe the Contemporary concept of Prostatic Growth

  • roles of DHT
  • role of 5alpha reductase
    *
A
  1. Prostate gland is androgen dependant: needs testosterone for growth and function
  2. when androgens target prostate it converts testosterone into Dihydrotestosterone by action of 5alphareductase
  3. DHT is 2.5x more biologically active than testosterone
  4. when DHT eventually binds to prostate androgen recepters the DHT androgen receptor complex forms
  5. complex enters cells and modulates 1)gene expresh 2) protein synthesis
  6. This modulation by the more bioactive DHTcomplex causes an increased response in Stomal and Epithelial tissues of prostate gland
  7. stromal and epithelial hyperplasia occurs and as theses are the 2 components of the prostate gland it is known as BPH
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6
Q

what is the epidemiology of BPH

which wre the 2 rf

WHAT age has the highest incidence rate

A
  1. risk increases w/ AGE: highest risk over 50 y/o
    • Th/4: pts over 45 req mandatory PSA check in uro
  2. Race: whites people most affected
    • blacks more at risk for prostate cancer so it’s fair
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7
Q

what are the sx of BPH

what are the 3 groups of this general sx

A

Lower Urinary Tract Symptoms

  1. Storage- related to bladder. irritative sx
  2. Voiding- act of ruination and urethral flow. obs sx
  3. Post voiding- after urination
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8
Q

list the 3 examples of Storage sx

syndrome comprises all 3 sx

​

A
  1. increased freq: over 8x/24hrs
  2. Urgency w/ or w/o uncontinence
  3. Nocturia
  • OAB= all 3 above
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9
Q

list the 7 V O I D I N G sx

S H O W, U P, T

H O W’S, U P, T

A
  • Hesitancy
  • Straining
  • Weak urinary stream
  • Terminal dribbling
  • Prolonged urinatino
  • Urinary retention
  • Overflow incontinence
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10
Q

list the 2 Postvoiding sx

A
  • dribbling after urination
  • feeling imcomplete voiding
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11
Q

what is the anatomic location of the prostate gland

A

below the urinary bladder

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12
Q

how are LUTS catagorised into mild moderate and severe

A

IPSS = international prostate sx score. max score is 35

7 questions 0-5

0-7 mild = surveilance & WW

8-19 mod = Conservative rx. surgery in some cases

20-35 is severe = Surgery is reccomended

NB= expression og sx status of BPH is 0-35 + QoL of 0-6

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13
Q

5 compications of BPH

A
  1. Urinary retention most common
  2. Rpx infection from retention
  3. Urolithiasis = stasis
  4. Acute/ chronic renal failure d/2 stasis from retention
  5. Hematuria = growth of prostate tissue is assoc with vascularisation
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14
Q

how are the complications of BPH classified in urology

which is the 1st alarming sx for bph

what is predisposition for stones and uti’s in bph

what are the 2 complications of compression of the ureter by the prostate

A

at the level of the Lower Urinary Tract

  • URINARY RETENTION
    • acute: 1st alarming sx for bph
    • chronic: freq and painless. predisposition for mx stones / UTI
      • ​=> struvite combo

at the level of Upper Urinary Tract

  • BILATERAL HYDRONEPHROSIS
    • d/2 enlarged prostate compressing ureters
    • predisposes to
    1. ACUTE/Chronic Renal Failure
    2. Ascending pyelonephritis
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15
Q

sx of acute KF

A

anuria

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16
Q

diagnostic steps for BPH

A
  • history & IPSS
  • Phys exam w/ DRE
  • LAB: -bloods especially PSA -Urine analysis -Kidney func
  • US: trans abdominal/ transrectal
17
Q

What is the purpose od DRE in bph

what findings on DRE indicate abrnormal findings

A
  • check suspicions for US.
  • If suspicious transrectal US guided biopsy
  • abnormal findings include
    1. hard prostate
    2. obliterated median sulcus
18
Q

what is the purpose of US in BPH regarding the PG

what is the requirement of US for bph

what can US dg at both the Upper & Lower urinary tracts

A

full bladder required for exam?? not sure

  • used to determine the size of the prostate- 20nm = normal
  • used to determine type of prostatic growth=
    • 1) subvesical or 2) endovesical

UUT level: dg urinary retention by residual urine under 30ml = normal

LUT level dg presence or abscence of stones

19
Q

LAB inv for BPH

what is checked in the blood

what is checked in urine

which one d the 2 is useful for early detection of BPH

A

blood

  • PSA= 0-4mg/dl is normal
  • CBC & anemia
  • Leukocytosis for infection
  • renal func: creatinine etc

urine

Analysed for early detection

20
Q

what are the 4 types of rx for BPH

A
  1. Watchful waiting for mild sx (IPSS0-7) and young pts every 6mo-year
  2. Conservative rx: (IPSS:8-19)
    • 1) alpha blockers with fast effect. Only symptomatic relaxation of sm in pg. periurethral tissue and bladder neck
    • 2) 5alphareductase inhibitors
  3. Combined therapy for pts at risk of disease progression
    • ​​alpha blockers + 5 reductase inhibitors
    • pt’s at risk:
      • ​PSA over 1.5 nanograms
      • Prostate over 40-cc/g.
      • Q max below 10%
  4. SURGICAL rx.
    • sever IPSS (20-35)
    • Below 80cc = gold standard TURP
    • Above 80cc is open prostatectomy
    • C.I. for other methods or poor ECOG =
      • balloon dilation
      • stent
21
Q

Side effects of alpha blockers

A

Hypotension so people with low BP are contraindicated for this drug

Retrograde ejaculation in young patients and can afffect fertility

  • also occurs in R.P LN dissection of NGC TT
22
Q

Side effects of 5 alphareductase inhibitors

A

Reduced libido and ED

Constipation

Dizziness

Malignancy

23
Q

when is PSA mandatory

A

every pt over 45 espicially if tey present w/ LUTS

24
Q

Combined therapy for pts at risk of disease progression

​​alpha blockers + 5 reductase inhibitors are for which pts?

A

pt’s at risk:

​PSA over 1.5 nanograms

Prostate over 40cc/g.

Q max below 10%

25
Q

pts indicated for surgery

A

sever IPSS (20-35)

Below 80cc = gold standard TURP

Above 80cc is open prostatectomy

C.I. for other methods or poor ECOG =

urology final boss (22 decks)

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