Benign Prostatic Hyperplasia (BPH)

Question 1

Benign Prostatic Hyperplasia (BPH)?

Answer 1

Gradual periurethral enlargement

Question 2

What is the most common reproductive disorder in men?

Answer 2

Benign Prostatic Hyperplasia (BPH)

Question 3

When do symptoms typically appear with BPH?

Answer 3

quickly

Question 4

Who does BPH mainly occur in?

Answer 4

Very common in older males

Question 5

BPH is age-related. List the age groups and prevalence of this disorder.

Answer 5

• 40-60 yrs ~20% have BPH
• 60-80 yrs ~50% have BPH
• 80 yrs + ~ 90% have BPH

Question 6

Explain hyperplasia in terms of BPH.

Answer 6

increase in the number of glandular cells (accounts for most of the enlargement)

Question 7

Explain hypertrophy in terms of BPH.

Answer 7

Increase in the size of smooth muscles (less significant)

Question 8

What primarily occurs in BPH, hyperplasia or hypertrophy?

Answer 8

Hyperplasia

Question 9

Primary risk factor of BPH?

Answer 9

Aging

Question 10

Which ethnicity does BPH occur in more? And which ethnicity does BPH occur in less? Why is this the cause?

Answer 10

More common in African American, least common in Japanese men. Unclear why but could be d/t lifestyle, genetics and diet.

Question 11

Etiology of BPH?

Answer 11

• unclear
• aging
• genetics
• race
• diet
• hormonal influence

Question 12

In a pt with BPH, which 3 horTmone levels change as men age?

Answer 12

• testosterone
• dihydrotestosterone (DHT)
• Estrogen

Question 13

What does DHT stand for?

Answer 13

Dihydrotestosterone

Question 14

Dihydrotestosterone?

Answer 14

A metabolite of testosterone

Question 15

Do men have the same amount of estrogen as women?

Answer 15

No, they require a decreased amount compared to women.

Question 16

What is testosterone normally converted to and how?

Answer 16

Testosterone is converted into dihydrotestosterone (DHT) with 5-alpha reductase

Question 17

What does DHT support?

Answer 17

It supports the growth and function of the prostate gland (it allows the prostate to continue to produce secretions)

Question 18

What does estrogen normally do?

Answer 18

It sensitizes prostatic cells to DHT

Question 19

What occurs if there is no estrogen?

Answer 19

Cells in the prostate will not respond to DHT

Question 20

What are 2 mechanisms that cause BPH?

Answer 20

Decreased testosterone and prostatic IGF-1

Question 21

Explain how decreased tester one plays a role with BPH?

Answer 21

You continue to produce testosterone but there is a decline as men age) -> this results in decreased DHT which is a normal part of aging. Testosterone:Estrogen ratio changes. This ratio decreases as testosterone production decreases and estrogen production remains the same. “Relative increase” in estrogen; “absolute decline” in testosterone. With the decreased ratio, estrogens effects are more pronounced, -> meaning that estrogen will make prostatic cells more sensitized to DHT. Increased responsiveness to DHT = Increased growth and secretion = enlargement.

Question 22

What is prostatic IGF-1?

Answer 22

Prostatic Insulin Growth Factor-1

Question 23

Explain how prostatic IGF-1 plays a role with BPH?

Answer 23

Mechanism is unclear (stimulates the proliferation of prostate cells -> enlargement)

Question 24

What will a DRE reveal?

Answer 24

It will reveal peripheral nodules on the prostate if cancer is present

Question 25

What is the histology of the bladder wall?

Answer 25

Transitional

Question 26

What occurs to the bladder wall in BPH?

Answer 26

The bladder wall thickens to compensate for the retention of urine d/t the inability to release urine through the obstructed prostatic urethra.

Question 27

Why does the bladder wall thicken in BPH?

Answer 27

this is compensatory to prevent the bladder from bursting d/t increased volume of urine

Question 28

What structural changes occur in BPH and why?

Answer 28

Trabeculations and diverticula to increase storage in the bladder and prevent rupture

Question 29

Why do trabeculations occur in BPH?

Answer 29

D/t the thickened muscle wall and loss of elasticity and muscle tone

Question 30

What is a complication that can occur in BPH?

Answer 30

urine stasis can form calculi (kidney stones)

Question 31

What occurs with urine when a pt has BPH?

Answer 31

Urine may flow into the urethra, but with compression from the prostate gland is squeezed back into bladder. (It brings normal flora from the urethra into the bladder)

Question 32

What occurs with the ureters in BPH?

Answer 32

Urine backs up in the kidneys causing hydroureter

Question 33

Hydroureter?

Answer 33

Kink in the bottom of the ureter leading into the bladder d/t the build up of urine in the vertical portion of the ureter and resulting weight causing a bend in the ureter (ureters loops)

Question 34

What can urine backing up in kidneys cause?

Answer 34

Hydronephrosis

Question 35

Hydronephosis?

Answer 35

Distention of renal pelvis and calyces

Question 36

Manifestations of BPH?

Answer 36

- problems with voiding (r/t the fact that the urethra is compressed) - Hesitancy - Weak urine stream (the bladder will not empty fully) - Frequency - Terminal dribbling - complete obstruction of the urethra would result in NO urine flow (usually this does not result because the individual would seek help sooner)

Question 37

What complications can occur with a complete obstruction of the urethra?

Answer 37

Urine retention and renal failure

Question 38

Diagnostics of BPH?

Answer 38

- based off manifestations - usually part of standard physical (if the pt is over 50, part of the GU assessments should be asking them if they have issues with voiding) - Digital rectal exam - Dx tests done only on individuals whose manifestations indicate BPH: - Prostate Specific Antigen (PSA) - BUN, Creatinine (kidney function tests), - Urinalysis

Question 39

Treatment for BPH?

Answer 39

- based on the severity and complications - often no tx is required (if S+S are not severe) - Behavioural approach (bc of frequency and hesitancy the pt may have to get up 5-6 x in a night, so you address this problem by instructing the pt to: Avoid fluids a few hrs before bedtime so the bladder does not fill; avoid alcohol and caffiene) - Pharmacological (5 alpha reductase inhibitor; alpha adrenergic antagonist; combining the two gives the greatest benefit) - Transurethral Resection of the prostate - Laser Prostatectomy

Question 40

Why are 5-alpha-reductase inhibitors taken for treatment?

Answer 40

Reduces the production of DHT (which is the hormone that natures prostatic growth) so decreased DHT will inhibit the growth of the prostate (must be used long-term for benefit)

Question 41

What are alpha adrenergic antagonists taken for treatment?

Answer 41

Acts on muscles (causes relaxation of the muscles in the urethra, resulting in decreased obstruction and improved urination.