Male genitourinary disorders and the prostate and BPH Flashcards
to have a genitourinary disorder a male ___to be sexually mature for disorders
does not have
can occur at any age
some common things about male genitourinary disorders
- various disorders
- all ages affected
- fairly common
what is the prostate?
-glandular and encapsulated, located inferior to urinary bladder and around neck of bladder
what is in contact with the prostate and how does this relate to physical exams
rectum is in contact with the prostate so you can palpate prostate through rectum, this becomes a routine procedure in physical for men over 50
passing through prostate gland is the________
urethra (this is called the prostatic urethra that passes through prostate)
the prostate can be a primary site of _________ in men
neoplasia
what is Benign prostatic hyperplasia (BPH)?
gradual periurethral enlargement (enlargement begins at central part of urethra)
BPH is very _____
common
BPH is ______ related
age related
- more than 60 years old approx 50% have BPH
- more than 80 years old approx 90% have BPH
what is the etiology of BPH
- unclear
- linked to genetics (genetic predisposition) diet (suggestion that diet may play role, Japanese may have a yellow seaweed that is protective), Race (prevalence very low in Japanese men & high in African american men)
- ageing is the primary risk factor
what is the primary risk factor for BPH
-ageing
what are male sex hormones called
androgens
what are the two main male sex hormones
- testosterone
- DHT (dihydrotestosterone)
what does 5a-reductase do?
testes produce testosterone some is converted to DHT by enzyme 5a-reductase (90-95% of testosterone that goes through testes converted to DHT)
how much testosterone that goes through testes is converted to DHT and by what
90-95 % converted by enzyme 5a-reductase
patho of BPH
- Testosterone converted by 5a-reductase to DHT
- DHT supports prostate growth & function
- est
what does estrogen do relating to prostate?
estrogen sensitizes prostate to DHT (essentially says here is DHT you need to bind to it)
what does DHT(dihydrotestosterone) do in relation to the prostate?
-DHT supports prostate growth & function
what is the theory of patho for BPH
- hormonal changes as men ages
- BPH d/t changes in testosterone, DHT & estrogen: as men ages testosterone declines, Testosterone converted to DHT, so DHT declines, if testosterone decreases impacts testosterone: estrogen ration, estrogen ratio higher sensitizes DHT more causing it to increase
- prostatic IGF-1 (insulin growth factor) also implicated
- hyperplasia of periurethral tissue-compresses urethra
- also hypertrophy of smooth muscle
- if stores urine may expand bladder & cause rupture (wall of urinary bladder thickens - which prevents rupture)
- structural changes to increase bladder capacity: trabeculations (folds) diverticula (pouches)
- urine stasis: complications could form kidney stones & calculi (infections)
- ureters distended with urine (hyrdoureter)
- ureters loop downward & “fish hook”: due to pressure of urine moving back up ureter & gravity
- urine backs up into kidney causing hydronephrosis
what are trabeculations
structural change to increase bladder capacity (FOLDS)
what are diverticula
structural changes to increase bladder capacity (pouches)
what is hydronephrosis?
distention of renal pelvis & calyces with urine, result of urine backing up into kidney
how can infections be caused with BPH
compression of urethra causes reflux-reflux allows normal flora to enter bladder and may cause infection
how do ureters loop downward and “fish hook” with BPH
-due to pressure of urine moving back up into ureter & gravity
