BPH

Question 1

Background on BPH

Answer 1

• Benign Prostatic Hyperplasia
• Most common condition in men
• Three stages (BPH, BPE-enlargement, BPO-obstruction)
• Peak incidence for BPH is age 63-65

Question 2

Normal Pathophysiology

Answer 2

• Prostate located at the anterior of the rectum and below the urinary bladder
• Size is a chestnut
• Typically symmetric and mobile
• PE: Done via digital rectal exam, manually palpated

Question 3

Two functions of prostate

Answer 3

• Secrete fluids that make up a portion of the ejaculate

- Provide secretions with antibacterial effect

Question 4

Pathophysiology of BPH

Answer 4

• Prostate enlargement: DHT is responsible for prostate growth
• Prostate stromal tissue adrenergic alpha 1 receptor stimulation (NE stimulates this receptor)
• —contractions causes urethral compression

Question 5

Obstructive symptoms of BPH

Answer 5

reduce bladder emptying, diminished flow, incomplete bladder emptying. Symptoms can go as far causing urinary retention

Question 6

Irritative symptoms

Answer 6

Occur late in the disease process from long standing obstructive

• cholinergic receptors become sensitive to the smallest amount of urine in the bladder causing involuntary contractions which leads to symptoms such as urinary urgency and frequency
• Causes a person to wake frequently through the night to void

Question 7

BPH TX: Alpha 1 adrenergic antagonists

Answer 7

• provides relaxation for the smooth muscle in the prostate and bladder neck
• Does not have effect on the prostate volume or prostate specific antigen (PSA) levels

Question 8

Examples of alpha 1 adrenergic antagonists

Answer 8

• Prazosin (minipres)
• Alfuzosin (Uroxatral)
• Terazosin (Hytrin)
• Doxazosin (Cardura)
• –watch for syncope, orthostatic hotn, dizziness
• Tamsulosin (flomax)
• Silodosin (rapaflo)
• –s/e dizziness, nasal congestion, ejaculatory dysfunction, intraoperative floppy iris syndrome
• Tadalafil (Cialis)

Question 9

5a-reductase inhibitors

Answer 9

• Function to minimize the testosterone effect on the prostate
• slows disease progression and decreases risks of complications
• Can take up to 6 months to see maximum effect
• Decreases prostate volume and PSA levels by approximately 50%

Question 10

5a Reductase Inhibitors

Answer 10

• Finasteride (Proscar)
• Dutasteride (Avodart)
• Cautious with pregnancy

Question 11

PDE inhibitors

Answer 11

• Used w/ patients who have mild to moderate symptoms
• Consider for those with erectile dysfunction
• no effect on urinary flow rate or PVR
• Tadalafil is approved by the FDA (avoid in renal dysfunction, contraindicated in nitrates, caution w/ hotn with alpha 1 antagonist)

Question 12

Anticholinergic/Antimuscarinics

Answer 12

• Don’t use if individual has high PVR
• Can be used in conjunction with alpha 1 adrenergic antagonists if patient has irritative voiding symptoms
• If PVR of >150mL or higher-don’t use

Question 13

Herbal Supplements

Answer 13

• Not FDA approved
• Saw Palmetto
• Stinging Nettle
• African Plum