Genitourinary Disorders: Benign Prostatic Hyperplasia Flashcards
What is Benign Prostatic Hyperplasia (BPH)?
gradual periurethral benign enlargement
BPH is the most common _________ disorder in older ____
reproductive
men
BPH increased with ____ but takes ______ to progress
Age
years
Do symptoms appear quick of gradually?
quick
What does hyperplasia mean?
increase in numbers of granular cells
Pressing manifestations occurs beyond _____ y/o
50
Prevalence above 40 y/o?Prevalence above 60 y/o?
Prevalence above 80 y/o?
~20% –>less common in this age range
~50%
~90%
T or F: Aging causes BPH
NO!
aging accompanies BPH
Etiology (5/6)
- unclear
- aging is a primary risk factor
- hormonal influence
- genetics
- race, diet
Etiology: What are the 3 hormones that influence BPH?
- testosterone
- DHT: dihydrotestosterone
- estrogen
What is androgens?
What are 2 the primary androgen? What do they support?
male sex hormones
- testosterone
- dihydrotestosterone
reproductive structures
What is DHT and its fxn?
How is it produced?
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
Men have ________ but requires less than woman. What is it’s fxn in regard to male reproductive sysrem?
Estrogen
sensitizes prostatic cells to DHT
No estrogen = cells in __________ will not respond to ________
prostate
DHT
Etiology: genetics ___________ BPH to men but the kind of _______ is not known
predisposes
gene
Etiology: What race is more prone to BPH? Who is less prone? Give one reason why regarding diet? Give example of diet?
Afrikan American
Japanese men
Japanese men diet has abundance of yellow veggies which is protective of BPH
eg seawood
Patho: What H decline as men age? How does it cause BPH?
testosterone
decr. in testosterone results in decr. of DHT
Patho: How does Testosterone and Estrogen Ratio cause BPH?
- 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
With age, there is a ________ increase in _________ and _______ decline in _________
relative increase in E
absolute decline in T
relative _______ in E —> _______ sensitize cells to _____ —> ______ _______ enlarges
increase
over
DHT
prostate gland
Prostatic _____-_____ ______ _______ plays a role but the mechanism is _____. What does this do?
insulin-like growth factor
unclear
stimulate the proliferation of prostatic cells –> enlargement
Enlargement is _________ which means the urethra is __________. What prob occurs?
periurethral
compressed
impedes voiding of urine
What are 2 structural changes?
- thickened bladder wall
2. trabeculations and diverticula
Why does the bladder wall thickens?
to compensate for retention of urine d/t inability to release urine thru obstructed prostatic urethra -
Is thickened bladder wall a comp mech? Explain
Yes
to prevent bladder wall from bursting d/t increase vol of urine
What are trabeculations and diverticula? Why does this occur?
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
What are the 3 adaptive changes/consequences of BPH?
- hydroureters
- ureter loops and fishhooks
- hydronephrosis
What is hydroureters?
ureters becomes distended by dilation because they get filled with urine to allow more capacity
What are ureters loop and fishhooks?
ureters gets filled with urine and begin to loop downward due to increase weight resembling a fishhooks
What is hydronephrosis?
distension of renal pelvis and calyces d/t urine backing up into the kidneys
What are 2 other changes in BPH? 2 complications?
- urine accum on kidneys
- urine stasis
- calculi = kidney stones
- UTI
Urine stasis can form ________.
calculi
Urine may flow into ________ but w/ compression from ________ _______ it is squeezed back into ___________. How does this cause UTI?
urethra
prostate gland
bladder
brings normal flora from urethra into bladder (urine is normally sterile)
Manifestations of BPH (5)
- frequency
- hesitancy
- weak urine stream
- terminal driblling
- obstruction and urine retention
Mnfst relate to the fact that _______ is __________
urethra is compressed
BPH mnfst occurs ________ over years and can lead to renal _______
gradual
failure
What is frequency? Hesitancy?
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
What is a weak urine stream?
trickling of urine
What is terminal dribbling?
droplets of urine continue to pass in end of urine stream
Complete obstruction of urethra would result in ___ urine _____.
NO
flow
Urine retention leads to ___________ of _______
complications
kidney
Diagnosis of BPH
- mnfsts
- px - DRE screen
- PSA
- BUN, creatinine
- Urinalysis
Diagnostic tests done only those whose ______ indicate ____
mnfst
BPH
What is the DRE?
digital rectal exam is a screening tool to detect abnormality of the prostate by palpating it
What is the PSA stand for? What is it? How does it detect BPH?
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
Why is it not routinely used?
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
What are additional markers for BPH?
PSA = total PSA PSAd = density of prostate (# of cells) PSAv = velocity (speed) @ which prostate is enlarging
PSA is proportional to the mass of ______. What does this mean?
prostate
increase PSA = increase in mass
PSA is used as ____
a screening tool
How does creatinine and BUN detect BPH?
both are excreted by kidneys and elevated levels could mean compromised kidney fxn eg hydronephrosis
What is BUN and creatinine?
BUN = measures urea nitrogen in blood
creatinine = waste product that is excreted by kidneys (produced by breakdown of muscles)
What are 2 markers for renal injury?
BUN
creatinine
What is urinalysis and how does it diagnosis BPH?
looks for evidence of stones and blood in urine (eg hematuria)
it is r/t the complications of BPH eg kidney stones and infections
Treatment of BPH (4)
- behavioural approach
- pharmaceuticals
- TURP
- Laser prostatectomy
What are the behavioural approach? (2)
- avoid fluids a few hours before so bladder doesn’t fill
2. avoid alcohol and caffeine
What are the 2 drugs used for BPH? What gives the greatest benefits
- 5 alpha reductase inhibitors (long term)
- alpha adrenergic antagonists (acts on muscles)
two drugs used in combination for long term
What does 5 alpha reductase inhibitors do? How does it treat BPH? Long or short term?
inhibits 5 alpha reductase, an enzyme that converts T to DHT
decreases prod of DHT to inhibit growth of prostate
must use long term
What does alpha adrenergic antagonists do? How does it treat BPH? Long or short term effects?
relax muscle in urethra resulting in decrease obstruction and improve urination
for short term effects
What is TURP? How does it treat BPH?
transurethral resection of the prostate
a section of the prostate is removed by inserting a resectoscope thru the urethra to the prostatic urethra
In TURP, bleeding is controlled with _______ and _______ and _____ is used to flush out ______ during recovery
cautery
Catheter and controlled bladder irrigation is used to flush out blood
How does laser prostatectomy treat BPH?
removal of prostate gland
