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S3 Case 3 - Sexual Health > Benign Prostate Hyperplasia (BPH) > Flashcards

Benign Prostate Hyperplasia (BPH) Flashcards

1
Q

What is the function of the prostate?

A

Contributes for about 25% of ejaculate

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2
Q

What does the prostate contribute to the ejaculate?

A

Citric acid
G proteolytic enzymes - eg. prostate specific antigen (PSA)
G seminal plasmin

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3
Q

What is citric acid used for?

A

Provides sperm with energy

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4
Q

What is PSA used for?

A

Help facilitate sperm motility via liquefaction of seminal fluid
Dissolving cervical mucus

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5
Q

What is G seminal plasmin used for?

A

Sperm motility
Potent antimicrobial activity

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6
Q

What is PSA?

A

Glycoprotein enzyme secreted by epithelial membranes of prostate cells

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7
Q

What happens to PSA with age?

A

Increases
Also increases with size of prostate

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8
Q

Why does the prostate tend to get bigger with age?

A

Age
Tissue remodelling
Hormonal effects
Metabolic effects
Inflammation

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9
Q

What happens with age?

A

Larger prostate + lower flow of rates of urine

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10
Q

How does tissue remodelling increase the prostate?

A

The balance between cell growth + apoptosis is disrupted

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11
Q

How does hormonal effects increase the prostate?

A

Androgen is the main regulator in stimulating proliferation + inhibiting apoptosis

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12
Q

How does inflammation increase the prostate?

A

Inflammation within prostate triggers cytokine release + resultant healing responses = proliferative environment dominant

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13
Q

What are the symptoms?

A

Lower tract urinary symptoms (LUTS)
Voiding symptoms
Storage symptoms
Acute/chronic urinary retention

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14
Q

What are voiding symptoms?

A

Hesitancy associated with resistance to urinary flow
Poor urinary flow = increased time to urinate
Incomplete bladder emptying = increased times at toilet

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15
Q

What are storage symptoms?

A

Urgency
Polyuria during day + night

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16
Q

What can cause an acute/chronic urinary retention to develop?

A

Bladder outflow obstruction
Very painful
= chronic UTI

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17
Q

How do you diagnose?

A

International prostate symptom score (IPSS)
Medical + drug history
Physical examination = bladder + rectal
Urine dipstick test
Complete urine frequency chart
Assessment of serum creatine if renal impairment suspected

18
Q

What are the scores for IPSS?

A

0-7 = mild
8-19 = moderate
20-35 = severe

19
Q

What is the focus of treatment?

A

Control LUTS
Minimise impact on QoL
Reduce other issues - eg. hospital admission + recurrent UTI

20
Q

What can be lifestyle issues?

A

Not adequate fluid intake
Drinking large amounts of fluids
Medication on symptoms
Food + drinks containing active substances

21
Q

What is the pharmacological management?

A

Reduce smooth muscle tone
Alter size of prostate

22
Q

What are the first drugs used?

A

Alpha blockers

23
Q

Where does alpha-1 + alpha-2 receptors exist?

A

Both in bladder
Alpha-2 in CVS

24
Q

What are examples of alpha blockers?

A

Tamsulosin
Doxazosin
Alfuzosin
Terazosin

25
Q

What does alpha blockers do?

A

Improve IPSS = improve urinary flow
BUT do NOT alter prostate size

26
Q

What is the problem with alpha blockers?

A

Older agents cause more cardiovascular problems = first dose hypotension = taken at night

27
Q

What are the adverse effects of alpha blockers?

A

Postural hypotension
Headache
Dizziness
Drowsiness
Sweating

28
Q

What are some adverse effects of alpha blockers caused by?

A

Initial doses
= first doses taken bedtime = patient lying down

29
Q

Who is Tamsulosin OTC licensed for?

A

Men aged 45-75 years

30
Q

What is the dose of Tamsulosin OTC?

A

400 microgram dosage units

31
Q

How long can Tamsulosin OTC be taken for?

A

6 weeks before clinical assessment by doctor

32
Q

When should a patient see a doctor when using Tamsulosin OTC?

A

After 14 days if symptoms have not improved

33
Q

What is the second drug?

A

5-alpha reductase inhibitors (5ARIs)

34
Q

What does 5ARIs do?

A

Stop the conversion of testosterone to dihydrotestosterone (DHT)

35
Q

How does 5ARIs benefit?

A

Improve IPSS
Reduce PSA
Reduce likelihood of requiring surgery
Reduce prostate volume

36
Q

What does Dutasteride inhibit?
5ARI

A

I + II

37
Q

What does Finasteride inhibit?

A

II

38
Q

What are the adverse effects of 5ARIs?

A

Loss of libido
Impotence
Ejaculatory dysfunction
Breast tenderness

39
Q

What is the problem with 5ARIs?

A

Drug is present in sperm + women of child bearing age should NOT be exposed to it
Either through intercourse or handling broken tablets

40
Q

Why combine the treatment?

A

Reduce progression
Improve symptom score
Improve LUTS
Improve prostate size

41
Q

Who is the combined treatment for?

A

Men with worsening LUTS + large prostates
Estimated over 30g

42
Q

What are the surgical interventions?

A

Transurethral resection of prostate (TURP)
Transurethral incision of prostate (TUIP)
Laser prostatectomy

S3 Case 3 - Sexual Health (11 decks)

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