Benign Prostatic Hyperplasia (BPH) Flashcards
Benign Prostatic Hyperplasia (BPH)?
Gradual periurethral enlargement
What is the most common reproductive disorder in men?
Benign Prostatic Hyperplasia (BPH)
When do symptoms typically appear with BPH?
quickly
Who does BPH mainly occur in?
Very common in older males
BPH is age-related. List the age groups and prevalence of this disorder.
- 40-60 yrs ~20% have BPH
- 60-80 yrs ~50% have BPH
- 80 yrs + ~ 90% have BPH
Explain hyperplasia in terms of BPH.
increase in the number of glandular cells (accounts for most of the enlargement)
Explain hypertrophy in terms of BPH.
Increase in the size of smooth muscles (less significant)
What primarily occurs in BPH, hyperplasia or hypertrophy?
Hyperplasia
Primary risk factor of BPH?
Aging
Which ethnicity does BPH occur in more? And which ethnicity does BPH occur in less? Why is this the cause?
More common in African American, least common in Japanese men. Unclear why but could be d/t lifestyle, genetics and diet.
Etiology of BPH?
- unclear
- aging
- genetics
- race
- diet
- hormonal influence
In a pt with BPH, which 3 horTmone levels change as men age?
- testosterone
- dihydrotestosterone (DHT)
- Estrogen
What does DHT stand for?
Dihydrotestosterone
Dihydrotestosterone?
A metabolite of testosterone
Do men have the same amount of estrogen as women?
No, they require a decreased amount compared to women.
What is testosterone normally converted to and how?
Testosterone is converted into dihydrotestosterone (DHT) with 5-alpha reductase
What does DHT support?
It supports the growth and function of the prostate gland (it allows the prostate to continue to produce secretions)
What does estrogen normally do?
It sensitizes prostatic cells to DHT
What occurs if there is no estrogen?
Cells in the prostate will not respond to DHT
What are 2 mechanisms that cause BPH?
Decreased testosterone and prostatic IGF-1
Explain how decreased tester one plays a role with BPH?
You continue to produce testosterone but there is a decline as men age) -> this results in decreased DHT which is a normal part of aging. Testosterone:Estrogen ratio changes. This ratio decreases as testosterone production decreases and estrogen production remains the same. “Relative increase” in estrogen; “absolute decline” in testosterone. With the decreased ratio, estrogens effects are more pronounced, -> meaning that estrogen will make prostatic cells more sensitized to DHT. Increased responsiveness to DHT = Increased growth and secretion = enlargement.
What is prostatic IGF-1?
Prostatic Insulin Growth Factor-1
Explain how prostatic IGF-1 plays a role with BPH?
Mechanism is unclear (stimulates the proliferation of prostate cells -> enlargement)
What will a DRE reveal?
It will reveal peripheral nodules on the prostate if cancer is present
What is the histology of the bladder wall?
Transitional
What occurs to the bladder wall in BPH?
The bladder wall thickens to compensate for the retention of urine d/t the inability to release urine through the obstructed prostatic urethra.
Why does the bladder wall thicken in BPH?
this is compensatory to prevent the bladder from bursting d/t increased volume of urine
What structural changes occur in BPH and why?
Trabeculations and diverticula to increase storage in the bladder and prevent rupture
Why do trabeculations occur in BPH?
D/t the thickened muscle wall and loss of elasticity and muscle tone
What is a complication that can occur in BPH?
urine stasis can form calculi (kidney stones)
What occurs with urine when a pt has BPH?
Urine may flow into the urethra, but with compression from the prostate gland is squeezed back into bladder. (It brings normal flora from the urethra into the bladder)
What occurs with the ureters in BPH?
Urine backs up in the kidneys causing hydroureter
Hydroureter?
Kink in the bottom of the ureter leading into the bladder d/t the build up of urine in the vertical portion of the ureter and resulting weight causing a bend in the ureter (ureters loops)
What can urine backing up in kidneys cause?
Hydronephrosis
Hydronephosis?
Distention of renal pelvis and calyces
Manifestations of BPH?
- problems with voiding (r/t the fact that the urethra is compressed)
- Hesitancy
- Weak urine stream (the bladder will not empty fully)
- Frequency
- Terminal dribbling
- complete obstruction of the urethra would result in NO urine flow (usually this does not result because the individual would seek help sooner)
What complications can occur with a complete obstruction of the urethra?
Urine retention and renal failure
Diagnostics of BPH?
- based off manifestations
- usually part of standard physical (if the pt is over 50, part of the GU assessments should be asking them if they have issues with voiding)
- Digital rectal exam
- Dx tests done only on individuals whose manifestations indicate BPH:
- Prostate Specific Antigen (PSA)
- BUN, Creatinine (kidney function tests),
- Urinalysis
Treatment for BPH?
- based on the severity and complications
- often no tx is required (if S+S are not severe)
- Behavioural approach (bc of frequency and hesitancy the pt may have to get up 5-6 x in a night, so you address this problem by instructing the pt to: Avoid fluids a few hrs before bedtime so the bladder does not fill; avoid alcohol and caffiene)
- Pharmacological (5 alpha reductase inhibitor; alpha adrenergic antagonist; combining the two gives the greatest benefit)
- Transurethral Resection of the prostate
- Laser Prostatectomy
Why are 5-alpha-reductase inhibitors taken for treatment?
Reduces the production of DHT (which is the hormone that natures prostatic growth) so decreased DHT will inhibit the growth of the prostate (must be used long-term for benefit)
What are alpha adrenergic antagonists taken for treatment?
Acts on muscles (causes relaxation of the muscles in the urethra, resulting in decreased obstruction and improved urination.
