Benign prostatic hyperplasia Flashcards
What is BPH
Non-cancerous enlargement of the prostate
Does it affect all ages
No, it’s age-dependent and affects 50% of 50 year old men- 95% affected by age 80
Glandular cell hyperplasia
Causes an increase in cell number
Theories on how BPH occurs
As men age, they decrease in serum testosterone (a major circulating androgen) levels. BPH is associated with an increase in oestrogen which may enlarge the prostate
OR
Dihydrotestosterone (DHT), the principle androgen in prostate tissue, increases as testosterone decreases causing the prostate to enlarge
Obstructive symptoms?
Weak urinary stream, prolonged voiding, incomplete emptying, post-urinary dribble and abdominal straining
Irritative symptoms?
Urgency, nocturia, bladder pain and incontinence
Ureter obstruction causes:
Bladder and/or kidney infection, acute urinary retention, haematuria and renal insufficiency
What are the diagnosis based on?
History, physical exam, clinical manifestations, tests
What constitutes the physical exams for diagnosis?
Digital rectal examination (DRE) examines the external surface and size of the prostate OR transrectal ultrasound can also determine the size of the prostate
What constitutes the tests for diagnosis?
Prostate-specific antigen blood test- measures a protein produced by both cancerous and non-cancerous tissue in the prostate OR a urinalysis can detect and rule out other pathogens by the presence of WBC or haematuria in the presence of infection/inflammation
Pharmacological treatment fo:
Relieving symptoms e.g. decrease urinary outflow resistance, reduce long-term complications
E.g. of Alpha1A-adrenoceptors antagonist
Prazosin, tamsulosin
Alpha1A-adrenoceptors antagonist mechanism of action:
Blocks alpha1A-adrenoceptors on the smooth muscle decreasing muscle contractility (greater selectivity for bladder and prostate alpha1 receptors)
Side effect of Alpha1A-adrenoceptors antagonist
Abnormal ejaculation
E.g. of 5alpha-reductase inhibitors
Dutasteride, finasteride
