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Year Two - Urinary System > Benign Prostatic Hyperplasia > Flashcards

Benign Prostatic Hyperplasia Flashcards

1
Q

What is benign prostatic hyperplasia?

A

A benign enlargement of the prostate gland

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2
Q

What McNeal prostatic zone of the prostate is most commonly affected by BPH?

A

Transitional zone

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3
Q

Which two prostatic lobes tend to be affected by benign prostatic hyperplasia?

A

Median lobe

Lateral lobe

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4
Q

What is the pathophysiological cause of benign prostatic hyperplasia?

A

Androgen dihydrotestosterone

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5
Q

Where is the prostate gland located?

A

It is a gland located between the bladder and the penis

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6
Q

Where is the prostate gland located in relation to the rectum?

A

Anterior

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7
Q

What urinary structure runs through the centre of the prostate gland?

A

Urethra - connecting the bladder to the penis

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8
Q

What is the function of the prostate?

A

It secretes proteolytic enzymes into the semen, which act to break down clotting factors in the ejaculate

This allows the semen to remain in a fluid state, moving through the female reproductive tract for potential fertilisation

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9
Q

How is the prostate histologically classified?

A

McNeal prostatic zones

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10
Q

What are the four McNeal prostatic zones?

A

Transition Zone

Centre Zone

Peripheral Zone

Anterior Fibromuscular Zone

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11
Q

What scoring system is used to classify benign prostatic hyperplasia?

A

International prostate symptom score (IPSS)

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12
Q

What is the international prostate symptom score (IPSS)?

A

This involves patients answering questions relating to the different symptoms they might be experiencing and their overall quality of life

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13
Q

What IPSS score defines mild benign prostatic hyperplasia?

A

0-7

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14
Q

What IPSS score defines moderate benign prostatic hyperplasia?

A

8-19

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15
Q

What IPSS score defines severe benign prostatic hyperplasia?

A

> 20

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16
Q

What six risk factors are associated with benign prostatic hyperplasia?

A

Older Age > 60 Years Old

Black Ethnicity

Family History

Obesity

Diabetes Mellitus

Cardiovascular Disease

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17
Q

What are the six clinical features of benign prostatic hyperplasia?

A

Polyuria

Nocturia

Dysuria

Urinary Incontinence

Urinary Urgency

Urinary Tract Infections

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18
Q

What is polyuria?

A

It is defined as an increased urine output > 3L/day

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19
Q

What is nocturia?

A

It is defined as waking up at night on more than one occasion to micturate

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20
Q

What is dysuria?

A

It is defined as painful or difficulty in urinating

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21
Q

What are the three clinical features of bladder outlet obstruction - a common complication of benign prostatic hyperplasia?

A

Urinary Hesitancy

Intermittent Flow

Incomplete Bladder Emptying

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22
Q

What is urinary hesitancy?

A

It is defined as a difficulty in starting urination

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23
Q

What is intermittent flow?

A

It is defined as a urine stream that starts and stops, with dribbling occurring at the end of urination

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24
Q

What are the five investigations used to diagnose benign prostatic hyperplasia?

A

Rectum Examination

Urine Dipstick Test

Post-Void Bladder Residual Test

Urinary Flow Test

Blood Tests

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25
Q

What are the three features of prostate cancer in a rectal exam?

A

Enlarged

Smooth

Palpable midline sulcus

26
Q

How is a urine dipstick test used to diagnose benign prostatic hyperplasia?

A

It is used to rule out an urinary tract infection

27
Q

What is a post-void residual urine test?

A

It measures the amount of urine left in the bladder after urination

The test can be done using an ultrasound or by inserting a catheter into the bladder.

28
Q

What post-void residual urine test result indicates benign prostatic hyperplasia?

A

Positive

29
Q

What is a urinary flow test?

A

It involves the patient urinating into a receptacle attached to a machine that measures the strength and amount of urine flow

30
Q

What three urinary flow test results indicate benign prostatic hyperplasia?

A

Qmax < 10ml/s

Vv < 150mL

Urine Flow Chart = Peaks & Troughs

31
Q

What is Qmax in a urinary flow test?

A

The maximum urinary flow rate

32
Q

What is Vv in a urinary flow test?

A

The voided volume

33
Q

What three blood test results indicate benign prostatic hyperplasia?

A

Increased Prostate Specific Antigen (PSA) Levels

Increased Urea Levels

Increased Creatinine Levels

34
Q

What is PSA?

A

A substance produced in the prostate

35
Q

When is conservative management used to treat benign prostatic hyperplasia?

A

In mild disease, in which individuals have not developed any significant complications

36
Q

What is the conservative management option of benign prostatic hyperplasia?

A

Active monitoring

37
Q

What are the two pharmacological management options of benign prostatic hyperplasia?

A

Alpha Blockers

5-Alpha Reductase Inhibitors

38
Q

When are alpha-1 antagonists to manage benign prostatic hyperplasia?

A

It is the first line pharmacological management option - recommended when there are moderate to severe voiding clincial features indicated by an IPSS > 8

39
Q

Name four alpha-1 antagonists used to manage benign prostatic hyperplasia

A

‘sin’

Tamsulosin

Alfuzosin

Doxazosin

Prazosin

40
Q

What is the first line alpha-1 antagonist used to treat benign prostatic hyperplasia? Why?

A

Tamsulosin

It has a high selectivity to the prostate

41
Q

What is the mechanism of action of alpha-1 antagonists?

A

They work by relaxing the smooth muscles of the bladder neck (intrinsic urethral sphincter) and muscle fibres in the prostate, which are innervated by the sympathetic alpha-one adrenergic nerves

This therefore makes urination easier

42
Q

What are five side effects of alpha-1 antagonists?

A

Retrograde ejaculation

Dizziness

Postural hypotension

Dry mouth

Depression

43
Q

What is a the most common side effect of alpha-1 antagonists?

A

Retrograde ejaculation

44
Q

What is retrograde ejaculation?

A

It is when the semen enter back into the urinary bladder instead of out the penis tip

45
Q

When are 5-alpha reductase inhibitors recommended to manage benign prostatic hyperplasia?

A

It is the second line pharmacological management option

46
Q

What are the two disadvantages of using 5-alpha reductase inhibitors to treat benign prostatic hyperplasia instead of alpha blockers?

A

They can take up to six months to work

They are less effective in relieving symptoms

47
Q

Name two alpha-5 reductase inhibitors used to manage benign prostatic hyperplasia

A

Finasteride

Dutasteride

48
Q

What is the mechanism of action of 5-alpha reductase inhibitors?

A

5-alpha reductase is an enzyme involved in the conversion of testosterone to dihydrotestosterone, which is a hormone that promotes prostate growth

5-alpha reductase inhibitors inhibit this enzyme

49
Q

What are four side effects of 5-alpha reductase inhibitors?

A

Erectile dysfunction

Reduced libido

Ejaculation problems

Gynaecomastia

50
Q

What is the most common side effect of 5-alpha reductase inhibitors?

A

Erectile dysfunction

51
Q

When is combination therapy of alpha blockers and 5-alpha reductase inhibitors recommended?

A

When individuals have moderate-to-severe voiding symptoms and prostatic enlargement

52
Q

In which three circumstances is surgical treatment of benign prostatic hyperplasia considered?

A

If the patient suffers from moderate to severe symptoms

If pharmacological management hasn’t relieved the patient’s symptoms

If complication development occurs

53
Q

What is the surgical management option used to treat benign prostatic hyperplasia?

A

Trans-urethral resection of the prostate (TURP)

54
Q

What is TURP?

A

It involves removal of all but the outer aspect of the prostate

55
Q

What are the four complications of TURP?

A

TURP

Turp syndrome

Urethral stricture/urinary tract infection

Retrograde ejaculation

Perforation of the prostate

56
Q

What is TURP syndrome?

A

It is a condition in which there is venous destruction and absorption of the irrigation fluid (glycine) used during surgery

57
Q

What are the seven risk factors of TURP syndrome?

A

Surgical time > 1 hr

Height of bag > 70cm

Resected > 60g

Large blood loss

Perforation

Large amount of fluid used

Poorly controlled congestive heart failure

58
Q

What are the two blood test results of TURP syndrome?

A

Hyponatraemia

Hyperammonia

59
Q

How do we treat patients who require surgery management of benign prostatic hyperplasia, however are deemed unfit?

A

Catheterisation

60
Q

What are the five complications of benign prostatic hyperplasia?

A

Acute Urinary Retention

Chronic Urinary Retention

Acute Kidney Injury

Recurrent Urinary Tract Infections

Renal Calculi

Year Two - Urinary System (15 decks)

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