Benign Prostatic Hyperplasia Flashcards
benign prostatic hyperplasia
gradual periurethral enlargement that is space occupying; most common in older males
prevalence
closely r/t to age; gradual increase with age
> 40 yr = 20% have BPH
60 yr = 50% have BPH
80 yr = 90% have BPH
etiology
- unclear
- ageing is the primary risk factor and most important
- genetics, race and diet (african-american vs japanese men)
- hormonal influence
what are the hormones that have an influence on the prostate?
- testosterone
- DHT
- estrogen
DHT
dihydrotestosterone, a metabolite of testosterone
supports growth and fx of the prostate gland (allows the prostate to continue to produce secretions)
manifestations
- gradual over years
- r/t fact that urethra is compressed -> problems with voiding
- hesitancy (urge to empty bladder but difficulty starting stream)
- weak urine stream
- frequency (not completely emptying bladder, residual vol causes urge to void)
- terminal dribbling
- complete obstruction -> no urine flow -> urine retention -> renal failure
diagnosis
- based on manifestations
- usually part of the Px
- DRE screen (done on men >50 yrs)
- PSA
- BUN, creatinine (increased levels = compromised kidney)
- urinalysis (urine stasis -> kidney stones or infection)
PSA
- prostate specific antigen
- nothing to do with the IR
- protein produced by the prostate and is secreted normally, some enters circulation so there are physiologic levels, but elevated levels indicates increase in size or # of prostatic cells
- not specific
- volume of prostate is obtained through an US and is required for PSAv and PSAd
PSAd and PSAv
PSAd = density of prostate (# of cells) PSAv = velocity (speed) at which prostate is enlarging
what do you look for in a urinalysis?
evidence of stones or hematuria
treatment
- based on severity and complx
- often none is required if s&s not severe
- least invasive -> most invasive
- behavioural approach (avoid fluids before bedtime, avoid alcohol + caffeine)
- drugs
- TURP
- laser prostatectomy
drugs used for treatment?
- 5 alpha reductase
decreases prod of DHT so decreased DHT will
inhibit growth of prostate; used long-term - alpha adrenergic receptors
causes relaxation of muscles in the urethra,
resulting in decreased obstr and improved
urination (short-term effects)
what must you be careful of with 5 alpha reductase?
don’t want to completely stop the prod of DHT b/c other organs depend on the hormone, but decreased levels so there’s not excessive prostatic growth
TURP
- transurethral resection of the prostate
- spinal or general anesthetic, resectoscope passed through urethra and removes prostate core causing the obstruction in smaller pieces
when would you combine the use of both drugs?
if BPH manifestations are severe
