Benign Prostatic Hyperplasia Flashcards
What are the functions of the prostate?
Contribute fluid to ejaculate and constricts urethra to avoid contamination with urine
What are the three types of tissues in the prostate?
Epithelial tissue (glandulat tissue, responsive to testosterone)
Stromal tissue (smooth muscle, rich with alpha-1 receptors)
Capsule (outer shell)
What is Benign Prostatic Hyperplasia (BPH)?
BPH is a histologic condition of proliferation of smooth muscle and epithelial cells in prostatic transition zone, which most commonly affects older adults (over 40)
What are some lower urinary symptoms experienced by patients with BPH?
Issues with urine voiding and storage
Postmicturition dribbling
What is the consequence of BPH on the bladder?
BPH causes prostatic tissue to push on the urethra, restricting the flow of urine.
The bladder responds to increased urethral resistance by increasing bladder wall thickness. The bladder contracts even when it contains small amounts of urine, causing it to gradually weaken and lose its ability to void itself completely
What is responsible for the enlargement of the prostate in BPH?
Testosterone and other androgens causes tissue proliferation
Increased activity of enzymes in prostate tissue convert precursors into testosterone is responsible for higher testosterone levels
What factors cause BPH to develop?
Increased androgens in the prostate and age-related weakening of the detrusor muscle
What are some examples of urine storage symptoms associated with BPH?
Frequency, nocturia, urgency, terminal dribbing
What are some examples of urine voiding symptoms associated with BPH?
Obstructive (weak or interrupted stream)
Difficulty initiating, straining, intermittency, and pain while urinating
What are some post-micturition symptoms associated with BPH?
Post-void dribbling
Sensation of incomplete bladder emptying
What are some complications associated with BPH?
Acute, painful urinary retention which can lead to acute renal failure
Gross hematuria when tissue growth exceeds blood supply
Overflow urinary incontinence
Recurrent UTIs
Bladder stones
Reduced QOL
How is BPH assessed by HCPs?
IPSS questionairre to differential diagnose BPH and assess severity
Urinalysis to rule out infectious causes
Digital rectal exam to determine prostate surface (smooth=benign, nodular=maybe malignant)
Prostate Specific Antigen (baseline and monitoring progression, best indicator for prostate size)
What drugs can exacerbate BPH?
- Androgens (encourage prostate growth)
- Anticholinergics (Beer’s list Rx, TCAs, antihistamines, FGAs, muscle relaxants, stimulants)
What are some non-pharmacological options for managing BPH?
- Limit evening fluid intake
- Limit alcohol and caffeine use
- Limit diuretic use
- Smoking cessation (due to nicotine stimulatory effects)
- Bladder training
- Pelvic floor exercises
What are the main drug classes used to treat BPH?
- alpha-1 blockers (ex. alfuzosin, silodosin, tamsulosin)
- 5-alpha-reductase inhibitors (ex. finasteride, dutasteride)
- PDE-5i
- Anticholinergics (questionable efficacy)
What is the MOA of alpha-1 blockers in treatment of BPH?
Block norepinephrine at alpha-1 receptors in the prostate gland, bladder neck, and urethra (addresses the dynamic component of obstruction, which can improve flow rates)
Alfuzosin, silodosin, and tamsulosin are the most uro-selective
These drugs do not modify disease progression, no impact on PSA
What are some adverse effects associated with alpha-1 blockers?
Symptoms of hypotension (less likely with uro-selective alpha-1 blockers)
ex. dizziness, fatigue, rhinitis, heachaches
Decreased ejaculate volume
Retrograde ejaculation
Relaxed dilator muscle in pupil (more common in pts on tamsulosin and cataract surgery)
What are some contraindications with alpha-1 blockers?
Pts at risk for hypotension or already on BP, BG lowering drugs
Caution in HF due to hypotension
3A4 inhibitors/inducers
What is the MOA of 5-alpha-reductase inhibitors in treatment of BPH?
Block conversion of intra-prostatic testosterone into a more potent form (DHT)
ex. dutasteride and finasteride
Reduces prostate colume by 20-30% and can reduce PSA by 50%
Can take a few months to work, up to 12 months for maximal effect
What adverse effects are associated with 5-alpha-reductase inhibitors?
Ejaculatory dysfunction
Loss of libido
Impotence
Gynecomastia
+ any effects on mental health
Pregnant/child-bearing age women should avoid contact with tablets
What is the MOA for PDE-5i in BPH?
Exact mechanism unknown, but smooth muscle relaxation in and around prostate my provide relief
Only Tadalafil is indicated for BPH
Younger patients see best improvement
What is used to treat BPH and urge incontinence?
Anticholinergics (fesoterodine, oxybutynin, solifenacin, tolterodine)
What two natural health products have decent efficacy in treating BPH?
Pygeum (may decrease nocturia and increase flow)
Beta-sitosterol (no impact on prostate size, but can improve urinary symptoms)
