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Biology 253 > Genitourinary Disorders: Benign Prostatic Hyperplasia > Flashcards

Genitourinary Disorders: Benign Prostatic Hyperplasia Flashcards

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1
Q

What is Benign Prostatic Hyperplasia (BPH)?

A

gradual periurethral benign enlargement

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2
Q

BPH is the most common _________ disorder in older ____

A

reproductive

men

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3
Q

BPH increased with ____ but takes ______ to progress

A

Age

years

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4
Q

Do symptoms appear quick of gradually?

A

quick

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5
Q

What does hyperplasia mean?

A

increase in numbers of granular cells

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6
Q

Pressing manifestations occurs beyond _____ y/o

A

50

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7
Q

Prevalence above 40 y/o?Prevalence above 60 y/o?

Prevalence above 80 y/o?

A

~20% –>less common in this age range

~50%

~90%

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8
Q

T or F: Aging causes BPH

A

NO!

aging accompanies BPH

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9
Q

Etiology (5/6)

A
  1. unclear
  2. aging is a primary risk factor
  3. hormonal influence
  4. genetics
  5. race, diet
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10
Q

Etiology: What are the 3 hormones that influence BPH?

A
  1. testosterone
  2. DHT: dihydrotestosterone
  3. estrogen
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11
Q

What is androgens?

What are 2 the primary androgen? What do they support?

A

male sex hormones

  1. testosterone
  2. dihydrotestosterone

reproductive structures

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12
Q

What is DHT and its fxn?

How is it produced?

A

a metabolite of testosterone

supports growth and fxn of the prostate gland by allowing prostate to continue to produce secretion

testosterone convert to DHT with 5 alpha-reductase

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13
Q

Men have ________ but requires less than woman. What is it’s fxn in regard to male reproductive sysrem?

A

Estrogen

sensitizes prostatic cells to DHT

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14
Q

No estrogen = cells in __________ will not respond to ________

A

prostate

DHT

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15
Q

Etiology: genetics ___________ BPH to men but the kind of _______ is not known

A

predisposes

gene

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16
Q

Etiology: What race is more prone to BPH? Who is less prone? Give one reason why regarding diet? Give example of diet?

A

Afrikan American

Japanese men

Japanese men diet has abundance of yellow veggies which is protective of BPH

eg seawood

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17
Q

Patho: What H decline as men age? How does it cause BPH?

A

testosterone

decr. in testosterone results in decr. of DHT

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18
Q

Patho: How does Testosterone and Estrogen Ratio cause BPH?

A
  • this ratio decr. as T prod decr. and E prod. remains about the same
  • w/ decr. in ratio, E’s effect are more pronounced meaning E will make prostatic cells more sensitized to DHT
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19
Q

With age, there is a ________ increase in _________ and _______ decline in _________

A

relative increase in E

absolute decline in T

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20
Q

relative _______ in E —> _______ sensitize cells to _____ —> ______ _______ enlarges

A

increase

over

DHT

prostate gland

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21
Q

Prostatic _____-_____ ______ _______ plays a role but the mechanism is _____. What does this do?

A

insulin-like growth factor

unclear

stimulate the proliferation of prostatic cells –> enlargement

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22
Q

Enlargement is _________ which means the urethra is __________. What prob occurs?

A

periurethral

compressed

impedes voiding of urine

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23
Q

What are 2 structural changes?

A
  1. thickened bladder wall

2. trabeculations and diverticula

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24
Q

Why does the bladder wall thickens?

A

to compensate for retention of urine d/t inability to release urine thru obstructed prostatic urethra -

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25
Q

Is thickened bladder wall a comp mech? Explain

A

Yes

to prevent bladder wall from bursting d/t increase vol of urine

26
Q

What are trabeculations and diverticula? Why does this occur?

A

trabeculations = thickened bladder muscle wall and l/o elasticity and muscle tone

diverticulas = foldings in wall of bladder

to increase storage in bladder and prevent rupture

27
Q

What are the 3 adaptive changes/consequences of BPH?

A
  1. hydroureters
  2. ureter loops and fishhooks
  3. hydronephrosis
28
Q

What is hydroureters?

A

ureters becomes distended by dilation because they get filled with urine to allow more capacity

29
Q

What are ureters loop and fishhooks?

A

ureters gets filled with urine and begin to loop downward due to increase weight resembling a fishhooks

30
Q

What is hydronephrosis?

A

distension of renal pelvis and calyces d/t urine backing up into the kidneys

31
Q

What are 2 other changes in BPH? 2 complications?

A
  1. urine accum on kidneys
  2. urine stasis
  3. calculi = kidney stones
  4. UTI
32
Q

Urine stasis can form ________.

A

calculi

33
Q

Urine may flow into ________ but w/ compression from ________ _______ it is squeezed back into ___________. How does this cause UTI?

A

urethra
prostate gland
bladder

brings normal flora from urethra into bladder (urine is normally sterile)

34
Q

Manifestations of BPH (5)

A
  1. frequency
  2. hesitancy
  3. weak urine stream
  4. terminal driblling
  5. obstruction and urine retention
35
Q

Mnfst relate to the fact that _______ is __________

A

urethra is compressed

36
Q

BPH mnfst occurs ________ over years and can lead to renal _______

A

gradual

failure

37
Q

What is frequency? Hesitancy?

A

Frequency = not complete voiding b/c there’s not enough pressure in urethra to force urine so residual vol causes an urge to void shortly after

Hesitancy = urge to empty bladder b/c with BPH there is a difficulty to start a urine stream

38
Q

What is a weak urine stream?

A

trickling of urine

39
Q

What is terminal dribbling?

A

droplets of urine continue to pass in end of urine stream

40
Q

Complete obstruction of urethra would result in ___ urine _____.

A

NO

flow

41
Q

Urine retention leads to ___________ of _______

A

complications

kidney

42
Q

Diagnosis of BPH

A
  1. mnfsts
  2. px - DRE screen
  3. PSA
  4. BUN, creatinine
  5. Urinalysis
43
Q

Diagnostic tests done only those whose ______ indicate ____

A

mnfst

BPH

44
Q

What is the DRE?

A

digital rectal exam is a screening tool to detect abnormality of the prostate by palpating it

45
Q

What is the PSA stand for? What is it? How does it detect BPH?

A

prostate specific antigen

a protein produced by prostate and is secreted and entered in circulation and is measured using a blood test

elevated levels tells you prostatic cells have increase in size and numbers

46
Q

Why is it not routinely used?

A

elevated PSA could mean BPH or prostate CA

some pt w/ prostate CA or BPH do NOT have elevated levels and some w/ elevated levels do not have CA/BPH

47
Q

What are additional markers for BPH?

A 
PSA = total PSA
PSAd = density of prostate (# of cells)
PSAv = velocity (speed) @ which prostate is enlarging
48
Q

PSA is proportional to the mass of ______. What does this mean?

A

prostate

increase PSA = increase in mass

49
Q

PSA is used as ____

A

a screening tool

50
Q

How does creatinine and BUN detect BPH?

A

both are excreted by kidneys and elevated levels could mean compromised kidney fxn eg hydronephrosis

51
Q

What is BUN and creatinine?

A

BUN = measures urea nitrogen in blood

creatinine = waste product that is excreted by kidneys (produced by breakdown of muscles)

52
Q

What are 2 markers for renal injury?

A

BUN

creatinine

53
Q

What is urinalysis and how does it diagnosis BPH?

A

looks for evidence of stones and blood in urine (eg hematuria)

it is r/t the complications of BPH eg kidney stones and infections

54
Q

Treatment of BPH (4)

A
  1. behavioural approach
  2. pharmaceuticals
  3. TURP
  4. Laser prostatectomy
55
Q

What are the behavioural approach? (2)

A
  1. avoid fluids a few hours before so bladder doesn’t fill

2. avoid alcohol and caffeine

56
Q

What are the 2 drugs used for BPH? What gives the greatest benefits

A
  1. 5 alpha reductase inhibitors (long term)
  2. alpha adrenergic antagonists (acts on muscles)

two drugs used in combination for long term

57
Q

What does 5 alpha reductase inhibitors do? How does it treat BPH? Long or short term?

A

inhibits 5 alpha reductase, an enzyme that converts T to DHT

decreases prod of DHT to inhibit growth of prostate

must use long term

58
Q

What does alpha adrenergic antagonists do? How does it treat BPH? Long or short term effects?

A

relax muscle in urethra resulting in decrease obstruction and improve urination

for short term effects

59
Q

What is TURP? How does it treat BPH?

A

transurethral resection of the prostate

a section of the prostate is removed by inserting a resectoscope thru the urethra to the prostatic urethra

60
Q

In TURP, bleeding is controlled with _______ and _______ and _____ is used to flush out ______ during recovery

A

cautery

Catheter and controlled bladder irrigation is used to flush out blood

61
Q

How does laser prostatectomy treat BPH?

A

removal of prostate gland

Biology 253 (39 decks)

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