Benign Prostatic Hyperplasia (BPH)

Question 1

BPH

Answer 1

gradual periurethral enlargement

Question 2

hyperplasia

Answer 2

inc in # of glandular cells –> enlargement

Question 3

hypertrophy

Answer 3

inc in size of SM

Question 4

etiology

Answer 4

unclear

• genes
• race
• diet
• AGING
• hormonal influences

Question 5

what hormones involved in cause of BPH

Answer 5

• testosterone
• DHT
• estrogen

Question 6

testosterone relationship with DHT & estrogen

Answer 6

• testosterone converted to DHT via 5a-reductase
• DHT supports growth & Fx of prostate gland
• estrogen sensitizse prostatic cells to DHT

Question 7

testosterone and estrogen levels in BPH

Answer 7

• dec testosterone –> dec DHT

- same estrogen levels

Question 8

dec testosterone levels causes what to estrogen effects

Answer 8

estrogen’s effects more pronounced, making prostatic cells more sensitive to DHT –> inc growth & secretion = enlargement of prostate gland

Question 9

enlargement of prostate compresses what structure

Answer 9

prostatic urethra

Question 10

bladder’s compensatory response to compressed prostatic urethra

Answer 10

bladder wall thickens

Question 11

why does bladder wall thicken when prostatic urethra compressed

Answer 11

to compensate for retention of urine d/t inability to release urine through obstructed prostatic urethra (prevent bladder from bursting d/t inc vol of urine0

Question 12

what structural changes occur to inc storage in bladder & prevent rupture

Answer 12

• trabeculations

- diverticula

Question 13

complications

Answer 13

• calculi formation
• lower UTI
• hydroureter
• hydronephrosis

Question 14

how does calculi formation occur

Answer 14

d/t urine stasis

Question 15

how does lower UTI can occur

Answer 15

Urine may flow into urethra, but w/ compression from prostate gland, urine is squeezed back into bladder (bringing normal flora from urethra into bladder)

Question 16

how does hydroureter occur

Answer 16

ureters fill w/ urine & distend

Question 17

how does hydronephrosis occur

Answer 17

urine backs up in kidney

Question 18

mnfts

Answer 18

• hesitancy
• weak urine stream
• frequency
• terminal dribbling

Question 19

complete obstr of the urethra causes what to happen to urine flow

Answer 19

NO urine flow –> urine retention & cmplx

Question 20

Dx

Answer 20

• Hx, Px
• DRE Screen (digital rectal exam)
• PSA (prostate-specific antigen)
• kidney Fx tests – BUN, creatine
• urinalysis

Question 21

PSA Dx meaning

Answer 21

elevated levels of PSA = prostatic cells have inc in size or #

Question 22

kidney Fx test Dx meaning

Answer 22

low levels of BUN & creatine = compromised kidney Fx (ex. hydronephrosis)

Question 23

urinalysis Dx purpose

Answer 23

detect possible urine stasis which can cause kidney stones or infections and possible hematuria

Question 24

Tx

Answer 24

• often NO Tx required
• behavioural approaches
• pharmacological therapy
• Sx

Question 25

behavioural approaches Tx

Answer 25

Address frequency & hesitancy when urinating

• Avoid fluids few hours before bedtime
• Avoid alcohol & caffeine

Question 26

pharmacological therapy Tx

Answer 26

• 5α-reductase inhibitor

- α adrenergic antagonists

Question 27

5α-reductase inhibitor

Answer 27

Reduces prod of DHT (hormone that nurtures prostatic growth) –> inhibit growth of prostate (used long-term for benefit)

Question 28

α adrenergic antagonists

Answer 28

Relaxes muscles in urethra –> dec obstr & improved urination (used for short-term benefit)