SM_242: BPH Flashcards
____ zone of prostate is where BPH arises
Transitional zone of prostate is where BPH arises
This is a ____
This is a normal prostate acinus and surrounding stroma
Describe the 3 anatomic / physiologic zones of the lower urinary tract
3 anatomic / physiologic zones of the lower urinary tract
- Zone 1: supra-trigonal bladder
- Zone 2: bladder neck, prostate, and prostatic urethra
- Zone 3: membranous urethra surrounded by UGC
Prostate growth and differentiation is ___
Prostate growth and differentiation is a complex interaction between the epithelial / stromal components, hormones, and growth factors
___ may promote prostate cell proliferation
Estrogens may promote prostate cell proliferation
BPH has ___ with ___ and ___ on histology
BPH has nodular cell proliferation with glandular epithelial cells and stromal cells
BPH can compress the ____
BPH can compress the prostatic urethra
BPH results in ____
BPH results in bladder wall thickening / trabeculation reflecting increased detrusor collagen deposition
BPH usually begins at ___ histologically and increases with ___
BPH begins at age 30 histologically and increases with age
Describe phases of BPH
BPH phases
- Histologic
- Clinical
- Symptomatic
PSA is a surrogate marker of ___
PSA is a surrogate marker of prostate volume
- Specifically [-2]proPSA
Describe presentation of BPH
BPH presentation
- Obstructive: decreased force of stream, hesitancy, intermittency, straining, feeling of incomplete bladder emptying
- Irritative: frequency of urination, urgency
- Nocturia
BPH is a ___ diagnosis
BPH is a clinical diagnosis
- No biopsy required
- Diagnosed by a combination of subjective and objective paramters
Prostate volume ____ with age and ____ with PSA
Prostate volume increases with age and increases with PSA
Urinary flow rate ____ with age
Urinary flow rate decreases with age
Post void residual urine is ___
Post void residual urine is amount of urine not emptied during voiding
- Increases in elderly men due to blockage and weakening of the bladder muscle
BPH involves detrusor ____
BPH involves detrusor areflexia
Describe behavioral therapy for BPH
BPH behavioral therapy
- Double voiding
- Timed voiding
- Avoidance of caffeine, alcohol, and other diuretics
- Night-time fluid restriction
- Increasing level of physical activity: leads to decreased body size, decreased sympathetic nervous system, decreased levels of systemic inflammation, and improved sleep quality
There is ____ evidence for use of herbal therapies in BPH
There is NO objective evidence for use of herbal therapies in BPH
Describe medical treatment of BPH
Medical treatment of BPH
- Alpha antagonists
- 5-alpha reductase inhibitors
- Combination therapy
- Antimuscarinics
- Beta-3 adrenergic agonist
- Phosphodiesterase-5 inhibitors
____ is a potential complication associated with use of a1 blockers for BPH
Intraoperative Floppy Iris Syndrome is a potential complication associated with use of a1 blockers for BPH
5a-reductase inhibitors ___ in treatment of BPH
5a-reductase inhibitors decrease likelihood of surgery and acute urinary retention in treatment of BPH
Combination therapy with a1 blocker and 5-alpha reductase inhibitor is used for treatment of BPH in patients with ____, ____, ____, and ____
Combination therapy with a1 blocker and 5-alpha reductase inhibitor is used for treatment of BPH in patients with moderate-severe symptoms, prostates above 40 mL, higher PSA, and advanced age
Anticholinergics block ACh signal at ____, leading to ____
Anticholinergics block ACh signal at NMJ of detrusor muscle, leading to inhibition of detrusor contractions
- Target detrusor overactivity
Anticholingergic side effects are ____, ____, and ____
Anticholingergic side effects are dry mouth, constipation, and blurry vision
- Dementia
Mirabegron (B3 agonist) is used to treat BPH due to ____
Mirabegron (B3 agonist) is used to treat BPH due to B3 activation and possible a1 blockade leading to relaxation of urethral smooth muscle
- Same rate of adverse events as placebo
PDE-5 inhibitors function by ____, leading to ____
PDE-5 inhibitors function by blocking the breakdown of cGMP to GMP by phosphodiesterase, leading to vasodilation
- Sildenafil, tadalafil, vardenafil
- Useful for treating lower urinary tract symptoms and ED
____, ____, and ____ are adverse effects of PDE-5 inhibitors
Headache, dyspepsia, and flushing are adverse effects of PDE-5 inhibitors
Describe indications for surgery for BPH
BPH surgery indications
- Acute urinary retention
- Bladder calculi
- Azotemia
- Recurrent UTI
- Recurrent hematuria
- Worsening lower urinary tract symptoms refractory to medical therapy
Describe surgical options for BPH
BPH for surgical options
- Minimally invasive technologies
- Transurethral resection of the prostate
- Transurethral incision of the prostate
- Laser therapies
- Open simple prostatectomy
- Robotic-assisted laparoscopic simple prostatectomy
____ is better for larger prostates in BPH
Bipolar transurethral resection of prostate (bTURP) is better for larger prostates in BPH
Transurethral incision of the prostate is most suitable for ____ in BPH and ____ retrograde ejaculation
Transurethral incision of the prostate is most suitable for small prostates with an obstructing bladder neck in BPH and decreases retrograde ejaculation
HoLEP (Holmium laser for BPH) requires ____
HoLEP (Holmium laser) for BPH requires morcellation of the specimen
- Adds to complexity and length of operative time
Simple prostatectomy for BPH involves ___
Simple prostatectomy for BPH involves enucleation of the transitional zone within the capsule
- Generally reserved for prostates larger than 80 mL and/or in patients with large bladder diverticula or bladder stones requiring concomitant procedures
Robotic assisted simple prostatectomy is ___, ___, and ___
Robotic assisted simple prostatectomy is good for large glands, minimizes blood volume and hospital time, and leads to quicker recovery
BPH originates from ____ of prostate
BPH originates from transition zone of prostate
___ cells are primarily responsible for production of type 2 5a-reductase in the prostate
Stromal cells cells are primarily responsible for production of type 2 5a-reductase in the prostate
Describe stages of BPH
BPH stages
- Stage 1: abnormal transition zone histology, normal DRE, no LUTS
- Stage 2: abnormal transition zone, enlarged prostate, no LUTS
- Stage 3: abnormal transition zone, enlarged prostate, increased LUTS
____ of men ages 60-69 are affected by symptoms of BPH
70% of men ages 60-69 are affected by symptoms of BPH
Components of initial evaluation of a patient with presumed BPH are ___, ___, ___, and ___
Components of initial evaluation of a patient with presumed BPH are history, DRE and focused physical exam, urinalysis, and PSA in selected patients
____ adrenergic receptors are linked to smooth muscle contraction in the prostate
a-1A adrenergic receptors are linked to smooth muscle contraction in the prostate
Recurrent episodes of gross hematuria with clot retention in BPH are an absolute indication for ___
Recurrent episodes of gross hematuria with clot retention in BPH are an absolute indication for surgical management
