Lecture 8 BPH Flashcards
BPH is characterized by hyperplasia, aka an increase in what?
number of glands and stroma
also increase in size, of the prostate in general
what part of the prostate is typically involved in BPH
periurethral glands and surrounding stroma
most important risk factor for development of BPH
age (also male gender)
it is thought that ____ binds to androgen receptors, causing hyperplasia
DHT
DHT is made from ____. what enzyme is responsible for this?
testosterone; 5 alpha reductase
____ enhances DHT action
estradiol
is BPH associated with cancer?
no (ie not premalignant)
clinical manifestations are termed ____ or “___”
prostatism, LUTS (Lower urinary tract symptoms)
symptoms include increased ____ of urination, ___turia, difficulty ___ and _____, ___uria
frequency, noc;
stopping and starting;
dys
increased urinary ____ can cause ___ and renal insufficiency
retention, UTI
what is more important, symptoms or pathology, when determining significance of BPH?
symptoms
ie LUTS
the _____ score looks at obstructive and irritative symptoms, and the “bother score”
international prostatic symptom
on digital rectal exam, the prostate will feel _____, elastic, and with a ____ ____ enlargement
smooth, firm nodular
3 general options for treatment of BPH
watchful waiting, medication, surgery
BPH complications:
distention and ____ of bladder, leading to increased risk of ____. ____, UTI
hypertrophy, diverticuli;
hydronephrosis
2 general categories of medical therapy:
alpha blockers, 5 alpha reductase inhibitors
combo is best
5alpha reductase inhibitors cause significant shrinkage of ____ hyperplasisa, but minimal shrinkage of _____.
glandular, stromal
alpha blockers cause significant shrinkage of ____ hyperplasia, but minimal shrinkage of ____
stromal, glandular
finasteride and dutasteride mechanism of action:
2 most common side effects:
5 alpha reductase inhibtors;
impotence, decreased ejaculate
which work faster, alpha blockers or 5 alpha reductase inhibitors?
which affects progression of disease?
alpha blockers (days to weeks vs months); 5 alpha reductase inhibitors
2 alpha blockers mentioned in FA
terazosin, tamsulosin
alpha blockers cause ____ relaxation without impairing bladder ____
smooth muscle (outlet), contraction
tamsulosin (flomax) can cause this weird-ass side effect:
retrograde ejaculation
What is the gold standard of surgical treatment?
Transurethral resection of the prostate (TURP)
most common complication of TURP?
post op UTI
what works best for small prostates?
transurethral incision of prostate (TUIP)
what should be done for very large prostates?
open prostatectomy
what laser treatment has shown to be most effective?
HoLEP
laser enucleation of prostate
