Benign Prostatic Hypertrophy Flashcards
(41 cards)
The functions of the prostate is to…
Contribute fluid to ejaculate
Constrict urethra during ejaculation to avoid contamination with urine
3 tissue types of the prostate are…
What are they responsive to?
- Epithelial tissue (glandular tissue) - responsive to testosterone
- Stromal tissue (smooth muscle) - lots of alpha1 receptors
- Capsule (outer shell)
The prostate is in close proximity of the bladder, which contains…
Muscarinic receptors
BPH occurs when…
Enlarged prostate starts to push against urethra, restricting flow of urine
BPH course overtime results in…
Bladder wall thickening, becoming irritable.
Bladder starts to contract even when containing small amount of urine
Overtime - bladder weakens + loses ability to empty itself completely, leaving urine behind
BPH has two main contributing factors, which include…
- Androgens - responsible for enlargement
- Age - decline in detrusor muscle strength
This androgen is particularly responsible for prostate enlargement:
Dihydrotestosterone (DHT)
Although androgens tend to decline with age, DHT…
Is likely increased, due to increased activity of intra-prostatic 5-alpha-reductase, converting testosterone to DHT
BPH symptoms may manifest as…
Storage issues - increased frequency, urgency, nocturia; terminal dribbling
Voiding issues - obstructive; weak/interrupted stream, difficulty initiating, straining, intermittency, pain while peeing
Post-micturition - post-void dribbling, sensation of incomplete bladder emptying
BPH symptoms usually appear ____ and…
Gradually - MAY worsen over time
BPH complications can include…
Overall decreased QoL
Overflow urinary incontinence/unstable bladder
Painful urinary retention - acute renal failure
Chronic renal failure - long-standing bladder outlet obstruction
Recurrent UTI’s
Bladder diverticula, stones
Persistent/intermittent gross hematuria
BPH assessment consists of…
International Prostate Symptom Score - questionnaire assessing severity
Urinalysis to rule out other causes
Digital rectal exam - smooth/nodular
Prostate specific antigen - baseline + progression
Prostate specific antigen is a predictor for…
Prostate size
Drugs that can exacerbate BPH include…
Androgens - encourage growth
Anticholinergics - cause further urinary retention
Stimulants - stimulate sphincter muscle
Non-pharm options to help with BPH may include…
Limting caffeine, alcohol, diuretic, anticholinergic use, and fluid intake in the evening
Bladder training - pelvic floor exercises
Physical activity
Avoiding/treating constipation
Anticholinergic use would be appropriate if there was urge incontinence
Pharmacological options to help with BPH include…
Alpha-1 blockers - 1st line
5-alpha-reductase inhibitors
PDE5 inhibitors
Potentially anticholinergics
Alpha1 blocker MOA to help with BPH is…
Blocking norepinephrine at alpha1 receptors in prostate gland, bladder neck, and urethra, causing vasodilation
Addresses dynamic component of obstruction, which can improve flow rates
These alpha1 blockers are uro-selective…
Alfuzosin, silodosin, tamsulosin - all equally effective at improving symptoms
Doxazosin, prazosin, terazosin are not
Do alpha1 blockers change the size of the prostate?
No - do NOT lower PSA
Time for benefit of alpha1 blockers is…
1-2 weeks
Improve, NOT eliminate
Effects of alpha1 blockers are…
Dose-related; including side effects
AE’s of alpha-1 blockers include…
Dizziness, fatigue, rhinitis, headaches
Decreased volume of ejaculate
Retrograde ejaculation
If someone has had cataract surgery and they are taking alpha1 blockers, there is a risk of…
Intraoperative floppy iris syndrome
Some potential CI’s/DI’s with alpha1 blockers include…
Anyone at risk of hypotension + falls
Caution in HF due to hypotension
3A4 inhibitors/inducers, or liver dysfunction
Dosage adjustment for renal impairment
