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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
What are the three features of prostate cancer in a rectal exam?
Enlarged Smooth Palpable midline sulcus
26
How is a urine dipstick test used to diagnose benign prostatic hyperplasia?
It is used to rule out an urinary tract infection
27
What is a post-void residual urine test?
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
What post-void residual urine test result indicates benign prostatic hyperplasia?
Positive
29
What is a urinary flow test?
It involves the patient urinating into a receptacle attached to a machine that measures the strength and amount of urine flow
30
What three urinary flow test results indicate benign prostatic hyperplasia?
Qmax < 10ml/s Vv < 150mL Urine Flow Chart = Peaks & Troughs
31
What is Qmax in a urinary flow test?
The maximum urinary flow rate
32
What is Vv in a urinary flow test?
The voided volume
33
What three blood test results indicate benign prostatic hyperplasia?
Increased Prostate Specific Antigen (PSA) Levels Increased Urea Levels Increased Creatinine Levels
34
What is PSA?
A substance produced in the prostate
35
When is conservative management used to treat benign prostatic hyperplasia?
In mild disease, in which individuals have not developed any significant complications
36
What is the conservative management option of benign prostatic hyperplasia?
Active monitoring
37
What are the two pharmacological management options of benign prostatic hyperplasia?
Alpha Blockers 5-Alpha Reductase Inhibitors
38
When are alpha-1 antagonists to manage benign prostatic hyperplasia?
It is the first line pharmacological management option - recommended when there are moderate to severe voiding clincial features indicated by an IPSS > 8
39
Name four alpha-1 antagonists used to manage benign prostatic hyperplasia
'sin' Tamsulosin Alfuzosin Doxazosin Prazosin
40
What is the first line alpha-1 antagonist used to treat benign prostatic hyperplasia? Why?
Tamsulosin It has a high selectivity to the prostate
41
What is the mechanism of action of alpha-1 antagonists?
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
What are five side effects of alpha-1 antagonists?
Retrograde ejaculation Dizziness Postural hypotension Dry mouth Depression
43
What is a the most common side effect of alpha-1 antagonists?
Retrograde ejaculation
44
What is retrograde ejaculation?
It is when the semen enter back into the urinary bladder instead of out the penis tip
45
When are 5-alpha reductase inhibitors recommended to manage benign prostatic hyperplasia?
It is the second line pharmacological management option
46
What are the two disadvantages of using 5-alpha reductase inhibitors to treat benign prostatic hyperplasia instead of alpha blockers?
They can take up to six months to work They are less effective in relieving symptoms
47
Name two alpha-5 reductase inhibitors used to manage benign prostatic hyperplasia
Finasteride Dutasteride
48
What is the mechanism of action of 5-alpha reductase inhibitors?
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
What are four side effects of 5-alpha reductase inhibitors?
Erectile dysfunction Reduced libido Ejaculation problems Gynaecomastia
50
What is the most common side effect of 5-alpha reductase inhibitors?
Erectile dysfunction
51
When is combination therapy of alpha blockers and 5-alpha reductase inhibitors recommended?
When individuals have moderate-to-severe voiding symptoms and prostatic enlargement
52
In which three circumstances is surgical treatment of benign prostatic hyperplasia considered?
If the patient suffers from moderate to severe symptoms If pharmacological management hasn't relieved the patient's symptoms If complication development occurs
53
What is the surgical management option used to treat benign prostatic hyperplasia?
Trans-urethral resection of the prostate (TURP)
54
What is TURP?
It involves removal of all but the outer aspect of the prostate
55
What are the four complications of TURP?
TURP Turp syndrome Urethral stricture/urinary tract infection Retrograde ejaculation Perforation of the prostate
56
What is TURP syndrome?
It is a condition in which there is venous destruction and absorption of the irrigation fluid (glycine) used during surgery
57
What are the seven risk factors of TURP syndrome?
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
What are the two blood test results of TURP syndrome?
Hyponatraemia Hyperammonia
59
How do we treat patients who require surgery management of benign prostatic hyperplasia, however are deemed unfit?
Catheterisation
60
What are the five complications of benign prostatic hyperplasia?
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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