41. Benign Prostate Hyperplasia (BPH) Flashcards
(25 cards)
what is the definition of BPH (benign prostate hyperplasia)
what are the 3 parts to the defintion
BPH is 1) benign enlargement of the prostate gland over 20cc/cm3?// 11g 2)causing obstruction leading to LUTS and on 3) uroflowometry w/ a q max (max urination) is less than 15ml/sec // elevated urinary sx score
which tissues comprise the prostate gland
which tissue is more likely to undergo hyperplasia
what are the 3 histological types of cells in the prostate
stromal and epithelial tissues
stromal tissues undergo hyperplasia 80% of the time
epithelial tissues can also undergo hyperplasia
histological cell types of prostate
- Glandular- 92% causing adenocarcinoma
- myoepithelial cells
- subepithelial intenrstitial cells
what is the difference between Hyperplasia and Hypertrophy
Hyperplasia= increas in cell number that occurs in cancers
Hypertrophy= increase in cell size that occurs in muscle growth
2 pathological mechanisms of obstruction in BPH causing LUTS
-
60% d/2 Hyperplasia: cells grow in NUMBER caused by the increased level of dehydrotestosteroone catalyzed from testosterone by 5 alphareductase causing:
- Narrowing of prostatic urethra
- Elongation of prostatic urethra as enlarged PG raises trigone of UB
- Distortion of prostatic urethra from assymetrical enlarged PG tubules
- 40% d/2 SM constriction alpha 1 receptors stim of SM of the 1)prostate gland stroma, 2)periurethral sm and 3)bladder neck causing constrictions and obstruction & LUTS
Describe the Contemporary concept of Prostatic Growth
- roles of DHT
- role of 5alpha reductase
*
- Prostate gland is androgen dependant: needs testosterone for growth and function
- when androgens target prostate it converts testosterone into Dihydrotestosterone by action of 5alphareductase
- DHT is 2.5x more biologically active than testosterone
- when DHT eventually binds to prostate androgen recepters the DHT androgen receptor complex forms
- complex enters cells and modulates 1)gene expresh 2) protein synthesis
- This modulation by the more bioactive DHTcomplex causes an increased response in Stomal and Epithelial tissues of prostate gland
- stromal and epithelial hyperplasia occurs and as theses are the 2 components of the prostate gland it is known as BPH
what is the epidemiology of BPH
which wre the 2 rf
WHAT age has the highest incidence rate
- risk increases w/ AGE: highest risk over 50 y/o
- Th/4: pts over 45 req mandatory PSA check in uro
- Race: whites people most affected
- blacks more at risk for prostate cancer so it’s fair
what are the sx of BPH
what are the 3 groups of this general sx
Lower Urinary Tract Symptoms
- Storage- related to bladder. irritative sx
- Voiding- act of ruination and urethral flow. obs sx
- Post voiding- after urination
list the 3 examples of Storage sx
syndrome comprises all 3 sx
- increased freq: over 8x/24hrs
- Urgency w/ or w/o uncontinence
- Nocturia
- OAB= all 3 above
list the 7 V O I D I N G sx
S H O W, U P, T
H O W’S, U P, T
- Hesitancy
- Straining
- Weak urinary stream
- Terminal dribbling
- Prolonged urinatino
- Urinary retention
- Overflow incontinence
list the 2 Postvoiding sx
- dribbling after urination
- feeling imcomplete voiding
what is the anatomic location of the prostate gland
below the urinary bladder
how are LUTS catagorised into mild moderate and severe
IPSS = international prostate sx score. max score is 35
7 questions 0-5
0-7 mild = surveilance & WW
8-19 mod = Conservative rx. surgery in some cases
20-35 is severe = Surgery is reccomended
NB= expression og sx status of BPH is 0-35 + QoL of 0-6
how are the complications of BPH classified in urology
which is the 1st alarming sx for bph
what is predisposition for stones and uti’s in bph
what are the 2 complications of compression of the ureter by the prostate
at the level of the Lower Urinary Tract
- URINARY RETENTION
- acute: 1st alarming sx for bph
- chronic: freq and painless. predisposition for mx stones / UTI
- => struvite combo
- HAEMATURIA -> hyperplasia is associated with vascularisation
at the level of Upper Urinary Tract
- BILATERAL HYDRONEPHROSIS
- d/2 enlarged prostate compressing ureters
- predisposes to
- ACUTE/Chronic Renal Failure
- Ascending pyelonephritis
sx of acute KF
anuria
diagnostic steps for BPH
- history & IPSS
- Phys exam w/ DRE
- LAB: -bloods especially PSA -Urine analysis -Kidney func
- US: trans abdominal/ transrectal
What is the purpose od DRE in bph
what findings on DRE indicate abrnormal findings
- check suspicions for US.
- If suspicious transrectal US guided biopsy
- abnormal findings include
- hard prostate
- obliterated median sulcus
what is the purpose of US in BPH regarding the PG
what is the requirement of US for bph
what can US dg at both the Upper & Lower urinary tracts
full bladder required for exam?? not sure
- used to determine the size of the prostate- 20nm = normal
- used to determine type of prostatic growth=
- 1) subvesical or 2) endovesical
UUT level: dg urinary retention by residual urine under 30ml = normal
LUT level dg presence or abscence of stones
LAB inv for BPH
what is checked in the blood
what is checked in urine
which one d the 2 is useful for early detection of BPH
blood
- PSA= 0-4mg/dl is normal
- CBC & anemia
- Leukocytosis for infection
- renal func: creatinine etc
urine
Analysed for early detection
what are the 4 types of rx for BPH
- Watchful waiting for mild sx (IPSS0-7) and young pts every 6mo-year
-
Conservative rx: (IPSS:8-19)
- 1) alpha blockers with fast effect. Only symptomatic relaxation of sm in pg. periurethral tissue and bladder neck
- 2) 5alphareductase inhibitors
-
Combined therapy for pts at risk of disease progression
- alpha blockers + 5 reductase inhibitors
-
pt’s at risk:
- PSA over 1.5 nanograms
- Prostate over 40-cc/g.
- Q max below 10%
- SURGICAL rx.
- sever IPSS (20-35)
- Below 80cc = gold standard TURP
- Above 80cc is open prostatectomy
- C.I. for other methods or poor ECOG =
- balloon dilation
- stent
Side effects of alpha blockers
Hypotension so people with low BP are contraindicated for this drug
Retrograde ejaculation in young patients and can afffect fertility
- also occurs in R.P LN dissection of NGC TT
Side effects of 5 alphareductase inhibitors
Reduced libido and ED
Constipation
Dizziness
Malignancy -? cryptorchidism and testicular cancer.
when is PSA mandatory
every pt over 45 espicially if tey present w/ LUTS
Combined therapy for pts at risk of disease progression
alpha blockers + 5 reductase inhibitors are for which pts?
pt’s at risk:
PSA over 1.5 nanograms
Prostate over 40cc/g.
Q max below 10%
pts indicated for surgery
sever IPSS (20-35)
Below 80cc = gold standard TURP
Above 80cc is open prostatectomy
C.I. for other methods or poor ECOG =
