Benign Prostatic Hyperplasia Flashcards
(42 cards)
What are the functions of the prostate?
to contribute fluid to ejaculate
to constrict urethra during ejaculation to avoid contamination with urine
What are the 3 tissue types of the prostate?
epithelial tissue (aka - glandular tissue)
-responsive to testosterone
stromal tissue (aka - smooth muscle)
-rich with a1 receptors
the capsule (outer shell)
How does BPH occur?
BPH occurs when the enlarged prostate starts to push against the urethra, restricting the flow of urine
-the bladder wall begins to thicken and become irritable
-the bladder starts to contract even when it contains only small amounts of urine
-over time, the bladder weakens and loses its ability to empty itself completely, leaving urine behind
What are the contributing factors to BPH?
androgens (DHT) + aging (detrusor muscle) –> BPH
What is responsible for the enlargement of the prostate?
androgens (particularly DHT)
-ratio of stromal : epithelial tissue
–>non-BPH stromal : epithelial is 2:1
–>BPH stromal : epithelial is 5:1
Why do androgens contribute to BPH even though androgens decline with age?
increased activity of intra-prostatic 5a-reductase despite overall declining androgens with age
-5a-reductase converts T to DHT
What are the symptoms of BPH?
storage:
-frequency, nocturia, urgency, terminal dribbling
voiding:
-obstructive: weak or interrupted stream, difficulty initiating, straining, intermittency, pain while peeing
post-micturition:
-post-void dribbling, sensation of incomplete bladder emptying
What are the complications of BPH?
acute, painful urinary retention, can lead to acute renal failure
persistent or intermittent gross hematuria when tissue growth exceeds its blood supply
overflow urinary incontinence or unstable bladder
recurrent UTI that results from urinary stasis
bladder diverticula
bladder stones
chronic renal failure
What is the main reason we treat BPH?
because it is associated with a decreased QoL
What is the use of PSA?
baseline and for monitoring progression
predictor for prostate size (in combo with age)
no evidence to link to cancer
What are some drugs that can exacerbate BPH?
androgens - encourage growth
anticholinergics - cause further urinary retention
-antidepressants
-antihistamines
-antipsychotics
-muscle relaxants
stimulants - stimulate sphincter muscle and worsen sx
What are some non-pharmacological options for BPH?
limit fluid intake in evening
limit caffeine and alcohol use
limit diuretic use
limit anticholinergic use
smoking cessation
bladder training
pelvic floor exercises
stay physically active
avoid/treat constipation
watchful waiting
What are the pharmacological options for BPH?
a1-blockers
5a-reductase inhibitors
PDE5 inhibitors
What are examples of a1-blockers?
alfusozin
doxasozin
prazosin
sildosin
tamsulosin
terazosin
Which a1-blockers are uro-selective?
alfusozin
sildosin
tamsulosin
What is the MOA of a1-blockers?
block NE at a1-receptors in the prostate gland, bladder neck and urethra (i.e. sphincter)
-addresses the dynamic component of obstruction, which can improve flow rates
Which a1-blocker is the most effective for BPH?
all equally effective at improving symptoms
What is the effect of a1-blockers on the size of the prostate?
do not change size of prostate –> do not lower PSA
What is the onset of a1-blockers?
works in 1-2 weeks
-improve, not eliminate symptoms
What is the effect of dose of a1-blockers?
effects are dose-related
-including side effects
True or false: all a1-blockers are once daily
false
all except prazosin
What are the adverse effects of a1-blockers?
dizziness
-first-dose syncope, orthostatic hypotension
fatigue
rhinitis
headache
decreased volume of ejaculate (sildosin)
retrograde ejaculation
IFIS
When is IFIS a concern with a1-blockers?
tamsulosin + cataract surgery
What are the contraindications/precautions for a1-blockers?
anyone at risk for hypotension (additive effects)
caution in heart failure due to hypotension
dose adjust in renal impairment (sildosin)
liver dysfunction
