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RGU Exam 3 > BPH > Flashcards

BPH Flashcards

1
Q

BPH

A
  • Increase in the # of prostatic stromal and epithelial cells that commonly contribute to lower urinary tract symptoms (LUTS) in aging men
  • Larger prostate does not mean more LUTS
  • BPH is a physiologic hyperplasia

*there is not an increased risk of prostate cancer in the pt.

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2
Q

LUTS

A
  • Lower Urinary Tract Symptoms
  • A constellation of symptoms that include poor stream, intermittent stream or hesitancy, terminal dribbling, straining, urgency, nocturia, and sensation of incomplete bladder emptying
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3
Q

BPH epidemiology

A
  • Generally ~70% of men ages 60-69 and 80% of men >70 are affected by BPH
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4
Q

Blood supply to the prostate

A
  • Inferior vesicle artery
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5
Q

Autonomic innervation of the prostate

A
  • Cavernous nerve; facilitates seminal emission
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6
Q

Zone of prostate where cancer usually starts

A
  • Peripheral zone
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7
Q

Function of prostate

A
  • Male sex accessory gland
  • It is roughly 20-30 gms in the adult male (~size of walnut)
  • Its function is to secrete certain enzymes into the semen to facilitate sperm survival in the female reproductive tract

*prostatic secretions have a large conc. of Zinc compared to blood’s

  • Also aids in emission of semen during ejaculation

*contracts around the urethra which assists in the propulsion of semen out of the body

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8
Q

Prostatic growth

A
  • The growth of the prostate is mainly regulated by androgens, most specifically thru DHT
  • As the prostate grows, there is an increase in the amount of prostatic stroma and an increase in the # of alpha-1 receptors in the stroma as well
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9
Q

Prostate alpha-1 receptors

A
  • Mediate the contractions of smooth muscle
  • Primarily located in the prostatic stroma and bladder neck and the main subtype found are alpha-1A receptors
  • Their contraction leads to a restriction of urine flow
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10
Q

Differentials for BPH symptoms

A
  • BPH symptoms are related to urination
  • UTI
  • Bladder stones
  • Neurogenic bladder
  • Urethral stricture
  • Bladder cancer
  • Urethritis
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11
Q

Medications that can exacerbate symptoms of bladder outlet obstruction

A
  • Anticholinergics

*atropine, oxybutynin, dicycloamine, glycopyrrolate, etc

  • Antihistamines

*diphenhydramine, hydroxyzine, chlorpheniramine, etc.

  • Antidepressants

*TCA’s

  • Sympathomimetics (alpha-adrenergic agonists)

*ephedrine, phenylephrine`

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12
Q

Medications for urination problems

A
  • Alpha-blockers
  • 5alpha-reductase inhibitors
  • Cialis
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13
Q

Alpha blockers MOA

A
  • Blocks alpha receptors causing relaxation of the smooth muscle
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14
Q

Non-selective alpha-1 blockers for BPH

A
  • Terazosin, doxazosin, alfuzosin
  • May take up to 2-4wks for improvement of urination
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15
Q

Selective alpha-1A blockers for BPH

A
  • Tamsulosin, Silodosin
  • Take up to 8hrs for improvement of urination
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16
Q

Alpha blockers adverse effects

A
  • Orthostatic hypotension, retrograde ejaculation, dizziness, asthenia, nasal congestion, syncope
17
Q

Intraoperative floppy iris syndrome (IFIS)

A
  • A complication that could occur during cataract surgery that is assoc. w/ the use of alpha-blockers, but is most strongly assoc. w/ the use of Tamsulosin
  • Opthalmologists should be aware of any pt. that has been treated w/ tamsulosin may be susceptible to this complication
  • Discontinuing the medication prior to surgery will not reduce the risk of it occurring however. It is a permanent change
18
Q

5alpha-reductase inhibitors MOA

A
  • Inhibits 5alpha-reductase thereby lowering the conc. of DHT
19
Q

5alpha-reductase inhibitors for BPH

A
  • Finasteride; inhibits type 2
  • Dutasteride; inhibits type 1 and 2
20
Q

5alpha-reductase inhibitors clincal effects

A
  • Indicated in men w/ larger prostates
  • Reduces prostate volume by up to 25-50%
  • Increases max urinary flow rate
  • May take up to 3-6 months for maximal effect
  • Decreases total PSA by ~50% after 3-6 months of use
21
Q

5alpha-reductase inhibitors adverse effects

A
  • Impotence
  • Decreased libido
  • Decreased volume of ejaculate
  • Gynecomastia
22
Q

BPH combination therapy

A
  • CombAT trial and MTOPS trial showed…
  • Combination therapy b/w an alpha blocker and 5alpha-reductase inhibitor have been shown to decrease AUA symptom score and decrease risk of clinical progression of BPH
23
Q

Cialis

A
  • Type 5 Phosphodiesterase (PDE5) inhibitor
  • Blocks the breakdown of cGMP and thereby enhances the effect of NO on vasodilation of the blood vessels in the prostate (as well as the corpus cavernosum)
  • Originally marketed to treat men w/ erectile dysfunction, recently received additonal indication to treat BPH as well
24
Q

Cialis adverse effects

A
  • Headache, flushing, nasal congestion, blurry vision, priapism
  • Contraindicated in pts who are also taking nitrates or nitric oxides
  • Hypotension may also occur in men taking an alpha blocker
25
Q

Anticholinergics MOA

A
  • Non-selectively inhibits the cholinergic muscarinic receptors in the bladder to allow for detrusor and therefore bladder relaxation
26
Q

Anticholinergic drugs for BPH

A
  • Oxybutynin, darifenacin, solifenacin, tolterdrine, fesoterodrine, trospium
  • Indicated in men w/ irritative voiding symptoms w/ BPH who have adequate PVRs
  • Has been shown to improve BPH symptom scores, however, has mixed results on objective data such as PVR and Qmax
27
Q

Receptor responsible for detrusor function?

A
  • M3 cholinergic receptor
28
Q

Most common receptor in the bladder?

A
  • M2 cholinergic receptor
29
Q

Indications for bladder surgery

A
  • Urinary retention
  • UTIs
  • Gross hematuria
  • Bladder or renal calculi stones
  • Renal insufficiency or hydronephrosis
  • Failed medical management`
30
Q

TURP

A
  • Transurethral resection of the prostate
  • Gold standard of endoscopic management of BPH
  • Go in w/ a resectoscope and resect the adenomatous issue in the transition zone
31
Q

Laser TURP

A
  • When compared to monopolar/bipolar TURP, reduced risk of intraoperative fluid absorption, bleeding, retrograde ejaculation, ED, and incontinence
  • 2 types used primarily in clincal practice currently

*Holmium:Yttrium Aluminum Garnet

*Potassium Titanyl Phosphate (KTP) laser aka Greenlight Laser

32
Q

Monopolar and Bipolar TURP

A

Monopolar

  • Irrigate w/ glycine during procedure

*increased risk of TUR (transurethral resection) syndrome

*dilution HYPOnatremia

*AMS/seizures

Bipolar

  • Irrigate w/ normal saline during procedure

*no increased risk of TUR syndrome

33
Q

TUIP

A
  • Incision from UO to verumontanum down to capsule
  • Less risk of retrograde ejaculation compared to TURP
  • Less risk post op complications
  • Good for smaller prostates (<30gms)
34
Q

Simple prostatectomy

A
  • Retropubic, suprapubic, perineal approaches
  • Typically for large prostates >80gm
  • Contraindicated in pts w/ known prostate cancer

RGU Exam 3 (19 decks)

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