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
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
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
4
Q
BPH Dynamic Factors
A
- Excessive alpha adrenergic tone
- Occurs in prostate gland, bladder neck, posterior urethra
- Contracts prostate gland around urethra
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
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
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
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
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
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
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)
12
Q
Alternatives
A
- No herbals recommended
- Surgery: prostatectomy, laser/ultrasound ablation, microwave thermotherapy (necessary for severe symptoms/complications)