Benign Prostatic Hypertrophy Flashcards

1
Q

Normal Prostate Physiology

A
  • Located under rectum, below the bladder
  • Surrounds proximal urethra
  • Round, soft, symmetric, and mobile on palpation
  • Typically weighs 4-20 g
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2
Q

Prostate Gland Tissues

A
  • Epithelial tissue - under androgenic control, produces prostatic secretions
  • Stromal tissue: alpha-adrenergic receptors, NE causes contraction which can cause reduced bladder emptying
  • Capsule/outer shell: fibrous connective tissue and smooth muscle that can also contract from NE around the urethra
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3
Q

BPH Static Factors

A
  • Anatomic enlargement of prostate
  • Physical block at bladder neck
  • Androgen stimulation of epithelial tissue
  • Estrogen stimulation of stromal tissue
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4
Q

BPH Dynamic Factors

A
  • Excessive alpha adrenergic tone
  • Occurs in prostate gland, bladder neck, posterior urethra
  • Contracts prostate gland around urethra
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5
Q

Medicated Related Symptoms

A
  • Testosterone replacement: metabolized to DHT
  • Alpha agonists: muscle contraction decreased in urethral lumen
  • Anticholinergic activity: decreased detrusor muscle contraction causing urinary retention
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6
Q

BPH Clinical Presentation

A
  • No acute distress
  • Urinary symptoms
  • Size of prostate
  • Lab tests
  • Obstructive symptoms
  • Irritative symptoms: occurs later in disease
  • Symptoms vary over time
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7
Q

BPH Complications

A
  • Chronic renal failure from outlet obstruction
  • Gross hematuria when tissue growth exceeds blood supply
  • Overflow urinary incontinence
  • Recurrent UTI
  • Bladder diverticula
  • Bladder stones
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8
Q

BPH Severity

A

Mild

  • AUASI =< 7
  • No symptoms
  • Peak urine flow <10 mL/s
  • Postvoid residual volume between 25-50 mL

Moderate

  • AUASI 8-19
  • All of the symptoms above and obstructive/irritative voiding symptoms

Severe

  • AUASI >= 20
  • All of the above, plus one or more complications of BPH
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9
Q

Monitoring/Watchful Waiting

A
  • Reassess every 6-12 month
  • Symptoms survery tool
  • Digital rectal exam
  • Urinary flow rate
  • Postvoid residual urine volume
  • BUN/SCr
  • Behavior modification
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10
Q

Alpha Antagonists

A
  • Tamsulosin: more selective in prostate than vasculature
  • Silodosin: selective alpha-1 antagonist
  • Faster acting and less sexual dysfunction
  • SE: syncope, dizzy, hypotension, ejaculatory dysfunction, tiredness
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11
Q

5alpha Reductase Inhibitors

A
  • Idea in those with prostate between 40-50 g
  • Takes longer to work
  • Reduces size by 25%
  • SE: ED, nausea, dizziness, gynecomastia
  • Dutasteride + Tamsulosin (Jalyn)
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12
Q

Alternatives

A
  • No herbals recommended
  • Surgery: prostatectomy, laser/ultrasound ablation, microwave thermotherapy (necessary for severe symptoms/complications)
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