Male repro health Flashcards
What is the pathophysiology of BPH?
Static factors:
Increased conversion of testosterone to 5-dihydrotestosterone (5-DHT) by 5 alpha reductase. DHT stimulates the growth of the prostate.
Dynamic factors:
Activation of alpha adrenergic receptors cause vasoconstriction of smooth muscles in the prostate –> narrowing the urethral passage for urine
In early stages, the detrusor muscle of the bladder contracts more forcefully to force urine through the narrowed lumen leading it to hypertrophy. When the muscle hypertrophies to the extreme state in later stages, the muscle becomes over sensitive, leading to LUTS symptoms
What are the risk factors of BPH
Age (>50y)
Describe the epidemiology of BPH.
Men >50y
What are the symptoms of BPH?
Obstructive symptoms:
Weak stream, intermittent stream, incomplete emptying, straining, dribbling, hesitancy
Storage/irritative symptoms:
Dysuria, frequency, urgency, nocturia, incontinence
How do we diagnose BPH?
Hx, clinical presentation
Digital rectal exam: abnormality of prostate, nodules (shld be performed annually in males >40y)
Ultrasonography: vol of prostate volume (borderline enlarged - 30g, enlarged >=40g)
Maximary urinary flor rate <10 mL/min
Post void residual >=100 mL
Prostate Specific Antigen (PSA): non-specific for BPH, specific to prostate growth
- Can predict the progression of BPH (>1.5 ng/mL)
- Higher risk for prostate cancer
International Prostate Symptom Score
What agents are available for the treatment of BPH?
Alpha-1 adrenergic rece antagonists
5 alpha reductase inhib (5-ARI)
Phosphodiesterase-5 inhib (PDE-5i)
Antimuscarinics
Describe the principles of management for BPH.
Treat with pharmacotherapy if symptomatic:
International Prostate Symptom Score QoL > 3
Treat surgically if: PVR >=100 mL OR uroflow <10 mL/min
Treat with surgical resection if:
resection of urine, bladder calculi, recurrent UTI, persistent macroscopic hematuria
Other considerations for BPH and the selection of pharm management
Medications:
- Anticholinergics
- Alpha-1 adrenergic agonists
- Opioid analgesics
- BP meds
- Testosterone
LUTS (IPSS)
Prostate size
Concurrent comorbidities
PSA value
Presence of irritative, storage symptoms
Describe the physiology of an erection?
Normal:
ACh stimulates
- Increased NO release –> activates guanylate cyclase, increased conversion of GMP –> cGMP (muscle relaxant)
- Increased prostaglandin E release –> activates adenylyl cyclase, increased conversion of AMP –> cAMP (vasodilation)
Increased blood flow into the corpora cavernosa.
Increased blood flow compresses on venules against tunica albuginea –> prevent blood outflow
Inflow > Outflow –> erection
Detumescence (subsiding of erection):
Phosphodiesterase-5 enzyme selectively xp in the penis (> peripheral, cardio) deactivates ACh
Decreased cGMP, decreased muscle relaxant
Induce smooth muscle contraction via alpha 2 adrenergic rece of arterioles –> reduction in blood flow
What are the risk factors of ED?
Age
Obesity
Smoking
Alcohol
Stress
Sleep disorders
Sedentary lifestyle
HTN
Hyperglycemia
Hyperlipidemia
Enlarged prostate
CNS problems
Drugs
Describe the epidemiology of ED.
Low in men <50y
50% of those >50y
What are the agents available for ED?
PDE-5i
Testosterone suppl
Alprostadil
How do we diagnose ED?
Hx, clinical presentation
Testosterone level (if low, suppl)
- Normal: 300-1000 ng/dL
Sexual Health Inventory for Men (SHIM)
- Lower score, more severe
- Mild to no EF: 17-21
- Mod to severe: <11
- Incl sexual Hx, performance, satisfaction
Describe the principles of management for ED.
Workup to ID underlying causes of ED
- Med Hx
- SH
- Surgical Hx
- Labs: BG, lipids, testosterone
- CV evaluation
ED might be an early symptom of unidentified CVD and sexual activity may increase BP, HR, risk of MI (sympathetic activation)
What are the criteria for CV evaluation in ED?
Low risk: proceed for both sexual activity and treatment of ED
Unstable or severe symptomatic CVD: Defer sexual activity and treatment of ED until stabilised condition
