Benign Prostatic Hyperplasia (BPH) Flashcards
BPH
gradual periurethral enlargement
hyperplasia
inc in # of glandular cells –> enlargement
hypertrophy
inc in size of SM
etiology
unclear
- genes
- race
- diet
- AGING
- hormonal influences
what hormones involved in cause of BPH
- testosterone
- DHT
- estrogen
testosterone relationship with DHT & estrogen
- testosterone converted to DHT via 5a-reductase
- DHT supports growth & Fx of prostate gland
- estrogen sensitizse prostatic cells to DHT
testosterone and estrogen levels in BPH
- dec testosterone –> dec DHT
- same estrogen levels
dec testosterone levels causes what to estrogen effects
estrogen’s effects more pronounced, making prostatic cells more sensitive to DHT –> inc growth & secretion = enlargement of prostate gland
enlargement of prostate compresses what structure
prostatic urethra
bladder’s compensatory response to compressed prostatic urethra
bladder wall thickens
why does bladder wall thicken when prostatic urethra compressed
to compensate for retention of urine d/t inability to release urine through obstructed prostatic urethra (prevent bladder from bursting d/t inc vol of urine0
what structural changes occur to inc storage in bladder & prevent rupture
- trabeculations
- diverticula
complications
- calculi formation
- lower UTI
- hydroureter
- hydronephrosis
how does calculi formation occur
d/t urine stasis
how does lower UTI can occur
Urine may flow into urethra, but w/ compression from prostate gland, urine is squeezed back into bladder (bringing normal flora from urethra into bladder)
how does hydroureter occur
ureters fill w/ urine & distend
how does hydronephrosis occur
urine backs up in kidney
mnfts
- hesitancy
- weak urine stream
- frequency
- terminal dribbling
complete obstr of the urethra causes what to happen to urine flow
NO urine flow –> urine retention & cmplx
Dx
- Hx, Px
- DRE Screen (digital rectal exam)
- PSA (prostate-specific antigen)
- kidney Fx tests – BUN, creatine
- urinalysis
PSA Dx meaning
elevated levels of PSA = prostatic cells have inc in size or #
kidney Fx test Dx meaning
low levels of BUN & creatine = compromised kidney Fx (ex. hydronephrosis)
urinalysis Dx purpose
detect possible urine stasis which can cause kidney stones or infections and possible hematuria
Tx
- often NO Tx required
- behavioural approaches
- pharmacological therapy
- Sx
behavioural approaches Tx
Address frequency & hesitancy when urinating
- Avoid fluids few hours before bedtime
- Avoid alcohol & caffeine
pharmacological therapy Tx
- 5α-reductase inhibitor
- α adrenergic antagonists
5α-reductase inhibitor
Reduces prod of DHT (hormone that nurtures prostatic growth) –> inhibit growth of prostate (used long-term for benefit)
α adrenergic antagonists
Relaxes muscles in urethra –> dec obstr & improved urination (used for short-term benefit)
