BPH and sexual dysfunction pp Flashcards
function of prostate
secrete fluid that becomes part of the seminal fluid carrying sperm
prostate surronds
male urethra and base of the bladder
development, maintenance of size, and function I dependent on what
androgens- mainly testosterone
testosterone is metabolized by
dihydrotestosterone (DHT) by 5 alpha reductase
DHT is responsible for what
normal and hyperplasticity growth (increase in number of cells)
overgrowth of the stromal and epithelial cells of prostate cells results in what
BPH
BPH risk factors
> 45 y/o
obesity
local or systemic inflammation
family history
African America or latino
current or former smoker
heavy alcohol use
history of HTN or diabetes
evaluation labs and tests
rectal exam (DRE)
BUN
SCr
urinalysis
prostate specific antigen (PSA)
drugs that worsen BPH
androgens- testosterone (enlargement)
adrenergic agonists- PE (SM contraction –> obstruct urine flow)
anticholinergic- antihistamines, TCAs, antiparkinsonian (decrees ability of detrusor muscle to contract)
anticonvulsants- VPA (functional incontinence)
diuretics- thiazides and loop (frequency and volume)
antiderpressants- escitalopram (suppress ACh mediated contraction of detrusor muscle)
lower urinary tract symptoms (LUTS)
weak urine stream
intermittent urine flow
straining to urinate
incomplete emptying
frequency
urgency
nocturia
PVR >50ml at risk for what
UTI
predictors of disease progression
enlarged prostate of at least 40g (1.4oz)
PSA of 1.6 or higher
ED commonly develops
when is surgery indicated
renal insufficiency secondary to BPH
refractory urinary retention
recurrent UTIs
recurrent bladder stons
refractory gross hematuria
refractory LUTS
inadequate gonadal function, bc of deficiencies in gametogenesis and/or the secretion of gonadal hormones
hypogonadism
hypogonadism s/s
decreased libido
ED
breast discomfort/gynecomastia
low sperm count
low BMD
hot flashes/sweats
decreased energy/motivation
depressed mood
poor concentration
sleep disturbances
anemia
reduced muscle bulk/strength
increased body fat/BMI
treatment with testosterone increases risk of what
prostate cancer
testosterone replacement info
prevent secondary exposure
redness/irritation at site of admin
increased BP, acne, enlarged prostate, liver toxicity, cholesterol changes, edema, polycythemia
monitor therapy within 3 months and at least 6-12 month intervals
decreased sexual drive or desire
decreased libido
inappropriate and excessive sexual drive or desire
increased libido
failure to achieve a penile erection suitable for satisfactory sexual intercourse
ED (impotence)
dry sex; delayed or absent
delayed ejactulation
ejaculate passes retrograde into the bladder, instead of toward the anterior urethra and out of the penis
retrogade ejactulation
sperm are insufficient in number, have abnormal morphology or inadequate motility
infertility
results from reduced blood flow to penis and most common sexual disorder in men that leads to lower QOL and self esteem
incidences increase with age
ED
